Review of Acupuncturefor Schizophrenia

Nicholas Beecroft and Hagen Rampes

SummaryThere is a paLtcitl, of scientiiic data on th-' use ofacupunc tu re o r l ow-power l ase r t t ea tme t l l t nschiz,ophrenia. The authors have conducled al i terature search, identi lyi t l1 eiEht paperc an thcsubject: all \a,ere significantly llawed, most seriouslyso, The papers suSgest thal acupunctLtre an(l lar\lpower l ase r t rea tmen t may be as e i f ec t i ve aschlorpromazine in schizophrenia. However nosci-^nti f ical ly sound con.lusions can be dravtn.Bettet designed research is required beforeacuputicture can be caDsideted a suitable treatmentfor schizophrenia.

Key wordsAcupunc!ure, Clt lorytromazine, Law po\\,er laser,Menta I i I I ness, Sc h i zaphren i a.

lntroductionSince Lhe resufgence of tradit ional Chinese medicine( T C M ) u n d e r C h a i r m a n M a o , s o m e C h i n e s ehosp i ta l s use acupunc t l r re and he rbs a ongs ide' . i p - ) , h o i , m e o i , d . i o ' r ' o t , t t e a m c n t o lpsychotic disorders. However, the extent oi usa8eand effectiveness of such practice is unc ear.

MethodWe conducted a l i terature search on the e ectonicda tabases Med l i ne and Psych l i l us ing the sea rchterms: acupLrnctur€, electfoacupLlncture, tradit ionalChinese medicine, schizophrenia, r.ental i l ness andpsych ia t r y . I n add i t i on , t he Research Counc i l f o rComplementafy Medicine pro!, ided a similar searchirom their database, CISCOM.

T C M c I ass if i c ati on of s c h i zop h ten i aSch izophren ia i s a Wes te rn te rm o l recen t o r iS inwhose mean ing has evo l ved and con t i nues to becon t rove rs ia l . The re i s no d i rec t t rans la t i on i n toTCM te rm ino logy . Dur inB th i s cen tu r t t r ad i t i onaChinese doctors have come to use the term in theiro w n p r a c t i c e a n d r e l a t e i t t o t h e l o l l o w i n gtradit ional classif icatlon. The majority of cases arecovered by the TCM lerm Matla in which "Double

yang results in mania-schizophrenia characterisedby excitation". Depression-insanity in TCM is closeto "Schizophrenia characterised by melancholy ancltension caused by double Yitl ... [includinE] ... heartconfuserl by phlegm ... [and] ... depression of liver

Aepunctute h Mcdicine

energy." h "Patanoia insanity .. . $/onl, harms thespleen as spleenasthesia leading lo schizophreniacharaaterised by terror and worry." ( I ).

TCM treatment of schizophreniaA c u p u n c t u r e i n T C M i s o n e o f a n L t r n b c r o lapproaches to inrprove a patient 's condit ion. Thethe rapy wou ld a l so i nc lude he rbs f2 l , p roduc t i vel a b o u r , s e l f - t e l i a n c e , c o m m L r n i t y e t h o s a n d aspir i tua dimension, whether Taolst, Confucian orMaoist l3). Modern deve opments in acupunctureinvolvj11g electf ical and aser st irnulation ol pointshave nou, been incorporated nto treatments forschizophfenia l2J.

Putative mechanism of actionChronic schizophrenjcs show a heighLened level ofa rousa l . The re a re Ch inese s tud ies show ing tha tacupu fc lu fe can i n f l uence co r t i ca l ac t i va ion and| * H . f i , r r . i \ . ' . r . o , 5 , r , l i L . , r " . l \ . r r q \ \ - l r ^

to st lmuli l4). l t is poss b e that acLrpufcture coulclreduce levels oi arousal and therefore resLrlt in athcrapeutic etlecl.

N e u r o p h y s i o l o g i c a l s t u d i e s i n v e 5 t i E a t i n g t h eana iges i c e f l ec t o f acupunc tu re have shown tha tacupuncture sl irnulatcs A6 sensory f ibres [, i th hjghin tens i t y , l ow f requency shocks wh ich may bemechanical or eleclr ical. The analgesic eflect mayo . r e d ' , . d L 1 m n d u l a r o o i - u o r ' . r " , ri n c l u d i n g 5 - H y d r o x y i r y p t a m i n e ( 5 - H T ) a n c ldopamine cen l ra l l y (5J . The re a fe a nL lmber o ls tud ies show inB changes i n 5 HT p rodL rc t i on andexcretion as a resull of acupuncture, but th-.re is rotyel a clear consensus oi lhe pattefn or rnechanlsm( 6 1 . H a n s h o \ ' ! , e d i n a n i m a l e x p e r i r n e n t s t h a tacupuncture is capable of accelerating the synlhesisand release of 5-l lT and noradrenaline (NA) in thccentral nervous system |71.Z h a n g a n d S h e n 1 8 ) s h o w e d t h a t e e c l r i c

stimulation of acupuncture points y/Di.rn8 (Extra l),in the mid ine bet\" 'een the eyebrows, and Balhui(CV.20 ) , on the c rown o f t hc sca p , p roduce asiBnif icantly ncreased level oi bfain 5 HT and NAin rats- In a iol low'up srudy Zhang et a/. /9) showedthat e eclroacupuncture increases urinary excretiono f 3 -me thoxy 4 hyd roxypheny lg l yco l su lpha te i nu n m e d i c a t e d s c h i z o p h r e n i c s . T h i s i s t h e m a i frnetaboli te oi NA.

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Research findingsOne of the better studies was by Liu et ai. f /O whop e r f o r m e d a r a n d o m i s e d , c o n t r o l l e d t r i a l .Sch izophren ics w i th aud i to ry ha l l uc ina t i ons werea l i o c a t e d t o t h r e e g r o u p s : h e J i e r m - n e o n l a s e rirradiation of point Frmen (TE.21)just anterior to theear, mock-irradiation at that point together withchlorpromazine, and irradiation of a non-standarda c u p u n c t L r r e p o i n t . T h € y f o u n d m a r k e dimprovement in the Fmen laser group, sl ightly lessimprover.ent in Ihe chlorpromazine group, and noimprovement in those Jaser st ir.uiated at the nonstandard pornt.) ia et al. (11)used heJium neon laser irfadiation of

the yame, (CV.15) acupoint, at the f irst cervicalinterspace, compared with a control group usingch lo rp ramaz ine . They d id no t randomise thea l l oca l i on o f cases . They used case de f i n i t i onaccording to cri teria stated in the Diagnostic anclS ta t i s t i ca l Manua l o f t he Amer i can Psych ia t f i cAssociation (12). Ihe Wief Psychiatr ic Rating Scale(/Jl, which is val id and rel iable, was used as themeasured outcome, scored by bl inded, independentd o c t o r s . T h e r e s u l t s s h o w e d a s i g n i f i c a n timprovement in both groups, with no statist ical lysignil icant difference between the two, suggestingacupuncture was as efrective as chlorpromazine,Thang (14) used scalp acupuncture in 296 patients

with hallucinations due to n ult iple causes, rnostlyschizophrenia. He used points HoudinS lCV.19) andBa;hui (.CV.20) with auxil iary points ZhengyinBlCB.17), Muchang (C8.16), luxi l IE.l9), YifenglIE.17), Touqiayin lCB.11), Tienzhu (81.10) andC h e n B s u a n g ( 8 1 . 6 ) w i t h p o i n t - t h f o u g h p o i n tneedling. This was an uncontrol led study in which70 .6o lo were cons ide red cu red , " comp le tedisappearance without relapse", after 10 to 20sessions,Kane and Di Scipio f i5) reported 3 patients who

were used as their own controls with a pseudo-I acupuncture technique. Stimulation oi Hegu (L|.4),I Taichong (1R.3) and Rerzhorg (CV.26) alternatedI weekly \N)th TaiyanB (K|.1), Neiguan (PC.6) andI Sdn \ ;n ; i do l<P .o ,omp" ed to | ( o l t ro rpd rmcn lI - . i ns ron r r : d i t rona l a , upLn , ru rp po r r t . . B l ndcdI a..e..ors u -ed u "l l .de. Bned uutt ome mpdqLrre\. bLlI h.* r"ro'p no Bpreral i .ablF rF.ulr. be( aL.e or the| . n r l r nLmhp o f od l iF r l . . r ro , ,ed . \ o re .he 1 " . - . a l lI r l - r . e shon .d d , l ed r impro \eme1r uh . l e e (e i \ i , r g

I r " d . . o r a l d , L p L r , u r e $ r i r l - \ a . l o . l o u i n SI control treJtmenl.I S h . " n d l a n / l u o l e d d r q O n ( a \ e \ o .| .chizophr" r ia I 'adlcd ,"\ i lh d.Jpun, tLre. lho.e \^:.hI n a n i a r a d p d u , i n 8 m d n i o L l d r i o n o D d / h u iI C\. | 4 ,. Q,drj i ,r ,(r\ | 8 Rpn2hone tLV 26' "1d| / r . r r a e r , ( V . | 5 . l h o s F \ 4 r t l ^ d e o F i . \ c t \ p eI c , h i T o o h r e ' l r a h " d r e i r r o r , I n B - a ' r i p u " t i o n o la l uq , t - ,CV . r , . d1d l . , n ' / honB, l \ . 17 . l l - ose u i t l -I pa ' "no ,a l vpe h rd F n fo ' i r g r ran .pu la r i on o fI l honsven 'C \ . . 2 . T "nBzhan ; tCV . l t . Shcn t i nBI CV-4'. <h.�nmpn'Hf .7 ' 5.rnr inl ldo r\Pb'. NerFL/d,

I P C b d r d u o 4 g ' u n 5 P 4 . a L r - \ ^ d - r e p o r t c d . rIII No,e. be, t9 t7 \o l t 5 ̂ a .2 92

a

55ak ("al l symptoms disappeated"), 16.6% were"remarkably improved" and 11.6ok showed noirnprovement. This study was f lawed: with unclearselection of cases, no controls, and non bl ind ratersusing unrel iable rneasures. ln part icular there wasan unchecked use of chloryromazine.Thang e t a l . ( 16 , 17 ) pe t (o tmed a s tudy o {

treatment of schizophrenia which compared: herbsa lone , e lec t roacupunc tu re w i th he rbs , e lec t ro -acupuncture alone, and chlorpromazine. He usedG7401 electroacupuncture apparatus at a frequencyo f 120H2 w i th a 500 m ic romete r pu l se w id th topoints: yileng (fE.17), Tingqong (51.19), ChenglinglCB.1B), Toulinqi lCB.ls), Balhui (CV20). The herbused was Dinai Cui Cheng Qi lang 50ml twicedaily. The dose of chlorpromazine was 300 600mgper day. The results were: "marked improvement" in61.6%, 64.0%, 30.4% and 36.0% respectively. Thes tudy showed tha t TCM i s " l ess e f fec t i ve fo rindifference or apathy." lt seems to demonstrate agood eff icacy of the herb used, with l i f t le addit ionalbene f i t a t t r i bu tab le to acupunc tuTe . Th i s s tudysuffers from selection bias, poor outcome measuresa n d a s h o f t s t u d y p e r i o d i n w h i c h n e i t h e racupuncture nor chlorpromazine werc given time tobe effective before excludinB subjects.Shi f7B) compared the treatment of hal lucination

w i th au r i cu la r acupunc tu re a lone , au r i cu la r andbody acupuncture, and auricular acupuncture withch lo rp romaz ine . The au f i cu la r po in t was e i t he rNaod ian (ex te rna l au r i c l e ) o r Shenmen , andyanSwei ( internal auricle). The body points wereTinggong 61.19), Tin]hui lCB.2), Yifeng \IE.17),YanSgu (51.5), Taiyuan (LU.9), Yangri (11.5) andl i nbd i rSP . I r . T l ^e do .c o t ch la rp@maz ine wd .<200rng per day. ln al l cases, the more frequent theattacks and the more long standing the disease, theless effective the treatrnent. Out of 120 cases, 58.3%c la imed tha t t he i r ha l l uc ina t i ons d i sappeared ,22.5% showed al leviation of symptoms and 19.2%showed no improvement. There were no differencesbetween treatment groups. This study is of l i t t levalue since there is no randomisation, no controlSroup ano no creaf oulcome measures.

Esser er a/- P) aimed to investigate the idea thatacupuncture works by restoring homoeostasis; forexample that i t wouJd decrease over,aTousat anoi n c r e a s e u n d e r a r o u s a l . T h e y m e a s u r e dphysiological variables such as blood pressure andpupil dianTeter of a group of psychiatr ic outpatients,mostly schizophrenic, in China. Their method wasinadequate, with no controls, no psychological orsocial measures, non bl ind observers and only 17subjects, with vague inclusion criteria. The onlyconclusion of note is that the acupuncture produceda heightened sense of welJ being in al l but one ofthe subjects which lasted for approximately a weekafler treatment.

Methodological issuesDefinition of casesMost of the studies reviewed have had an unclear

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definit ion of lhe disease. _l_he problem has nol been

thit there is a clash bet\a, 'cen Western and Easielnc lass i f i ca t i on , bu l s imp ly tha t t he de f i n i t i ons havebeen L rns la ted . The rc a re i n te rna t i ona l l y ag reed ,ope ra t i ona l , va l i d and re l ab ie d iaBnos t i c c r i l e r i a ,such as ICD- l0 , t he Wor ld Hea l th Organ isa t i on ' sinternational classi i ical ion of diseases (/9), u,hichshou ld i o rn r t he bas i s l o r case de f i n i t i on . Somes tud ies havc tes ted acupunc tL r re t rea tn len l f o Isymploms rathcr than by broad diagnosis l /8)- Thisi s accep tab le , p rov ided the symptoms a re \ ! e ldefined and measured.

Se/ection arl crse5Horv applicable the resLrlLs of a c inical tr ia are tothe group beinB studied dcpends upon the randof.selection of cases lrom a representatjve population,with clear inclusion and exclusion criteria to avoidblas. This has been very poorly done in the studieswe have rev iewed . Fo r examp le , t he re a re fewattempts at exclLrding co morbidity l l) . Zhanp, et al.incorporated a selectiolr bias because cases wereinc luded on y i t "The ) , expc r ienced na rkedi n ) p o \ , m r 1 ' o , , d t F , j t t l t - p o d o t t h e p ' L ' a u .

caurse at' treatment." 117).

()ulconcI n g e n e r a t h e s t u d i e s u s e d i f f u s e c l i n i c a loL t t come measures such as "h . J / /ua i l ) a l i o r ,

pseudoha l l uc ina t i on o r t a l k ing to se l t " (18 ) o l" lLtcial i ty was part ial ly recovaed", which are notw,el l del ined, val id or re iable and afe very operr too b s e r v e r b i a s .

- l h e c o m m o n l y u s e d C h i n c s e

c l e f i n i t i o l r s o f o u t c o m e a t e : . u r e d , n r a t k e d l yimprovetl, imltrovecl or no /mproverrent, This wouldnot be a rel iable or repealable mcasure in a Westernsett ing, especial ly where the observers are not bl indto the treatmenl al locatiof. However, differencesbe tween these ca lego r i cs a re a rge enough andsuff icient 1, iarni l iar lo the Chinese practi t ioners inthF , r , n ' no r l r n h " r ' . o r r l p r ,b ' . r ' 9 .

thus these results should not be dismisseo.

According to Western interprelal ion ol tradit ionalC h i n e s e t h c o r y , a c u p u n c t u r e s h o u l d o n l v b eeilective when perforr.ed at part icu ar points. l-hus,shitm aclrpuncture f20), [ ,here needles are i fscrledat non standard points, has been lholrght to providea S o o d c o n t r o l f o r a l l t h e t h e r a p i s l a n d o t h e fc o m p o n e n t s o f t h e p l a c e b o e l f e c l d u e t od ' . p 1 ' L r ( . . I o r l r r " - l r | . r . r r . l na ' ' ' , r j l \s o . L e w i l h a n d V i n c e n t 1 2 7 ) n o t e d t h a l s h a r nacupunclure appeared to have an analEesic efiect in40-50% oi palients in comparison with 60% forc assica acupLrncturc. This rneans either lhat mosto f t he acupunc tu re e f i ec t i s p acebo o r t ha t i t j s" , i \ e . | , l u r - , l r * . r r p ^ n t . . l o t I t - p . r u o - e . rtesting schizophrenia trealment, sharn acupuncturemay thus not be the best placebo.Mjnimal acupuncture attempts to move on ironr

Acupun.Ltrc it Medi.ine

this by inscrt ing the needles only 1-2mm nnd withno stimulatjon. l ts cl inical effect is l ikely to be lesst h a n t h a t o f c a s s i c a a c u p u n c t L r f e , w h i l emaintaif ing most of the benefits of a placebo, unlesst h e s u b j e c t i s w e l l a c q u a i r ] t e d w i t h c l a s s i c a lacupunc tu re o r un less the the rap i s t chanEes anyo the r f ac to r i nadve r ten t y . Bo th these me thodsp robab ly have a phys io log i ca l e l f ec l , a lbe i t ar e d u c e d o n e . P o s s i b l e t r u e p l a c e b o s i n c l u c l edeac t i va ted / rock TENS, r r )ock l ase r andacupunc tu fe need le gu ide tubes l apped \ ' v i t hou tnccdle inseft ion; however these nray not a ways bcconsidered truly eqLrivalent to icupLrnclLrre by lhcpatie| l ts.

13lindingBecaLrse acupLrnc tu rc reqL r i res some t rd in inS , i t i sdif iculr lor the Lherapist to be bl ind to the treatfreJrthe is Bivin8. Onc can only str ive to ensLrre thal ing i v i n g p l a c c b o a c u p L | l r c t u r e c o n s i s l e f c y r smairtained in al l the othef factors to avoid a terint it he p lacebo o r t he rap i s t e f i ec t on the pa l i en l s .Flowevef, i t js pcrfectly possible for the selection,randonr a l l oca t i on , and p re and pos t t rea tmen tTneasuremef l ! l o be ca r r i ed oL r t by i ndepenc len tassesrors rr i th no cl inical involvement.

AcLlputlcture nethaclA c c o r d i n g t o t r a d i t i o n a C h i r ) e s e l h e o r \ r ,acupuncture treatment ls necessari y incl iviclual ised,p , e r t l ' ' F i . ! - r r ' ' p a l - r , l ' r 6 - 8 c . lvariety in the points avai able, nnd in the deplh andperiod of st inrul.rt ion. The modern deve oprnenL oie l e a l r o a c u p u n c t u f e a n d t h e u s e o i a 5 e f s a lacupunclufe points have added to the complexity oltfeatment variatron- However, most of the studiesreviewed here have iested a set frethod of treatmenlror a gLVef group.

Protocol violations_l-hcre are many examples of bias ir) l ioduced into the

rcviewed stLrdies due to chanSing l lealment or €iroupa l l oca t i on c lu r i ng a s tudy , o r no t accou r ] t i n€ j f o rcases rvho dropped olr l dLrrinEi a coursc of treatmefto r w e r e o s t t o f o l l o w - u p . F o I e x a r r p l e , " F o r

acupunc tu re shy pa t i eD ts , sn ta l l doses o f suchredalives as chlorpromazine were givetl ..." (l): lheamounts weTe not recorcled. N)d, "Adjustn)ent ofthc treatment depencls on t l le condit ion ai thep " l r n t . l l . , ' F t t J 4 . t \ ' t i c i - . ' n , . ' p r t n t h cpa t i cD ts were , , r , i t hd rawn [ ] a t l he s tudy andI t -.atr)1etrt ch a n Eed.

" I I 7 ).

Statistical pawetThe main statist ical l inri lat ions have been due to thepoor methodo ar8y oLrt l ined abovc afd due to smalltr ial nunrbers. Where slatisl ics have been used, i t isoftcn on demographic detai ls sLrch as the sex oi thep a t i c n t s f a t h e r t h , r n c o m p a r i n g t h e m o d c s o ilrealncnt.

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ConclusionThere was rarely any mention of adverse reactrons1 ( ) t he acupunc tu re o f Ch inese he rbs usec tn i nestudies, and thefe h,as no rnention of compliance$/ith the treatments us€d. Both adverse reactions andc o m p l i a n c e a f e s i g n i f i c a n t p r o b l e m s t h a t i a c epsychiatr ists in the use of neuroleptic medication- Anumber o f se r i ous adve rse e f fec ts have beenIn r i bu roL l l n . r , Jpu t \ t . t r , 2 ) .Al l ei€tht papers identif ied in our l i tefature search

on the use o f acupunc tu re o r l ow power l ase rt rea t rnen t f o r sch i zophren ia we fe s ign j f i can t l yl Ja \ \ / ed . A l though no re l i ab le conc lus ions can bed rawn i rom them, the i r ev idence sugges ts tha tacupunctLrre or low power laser may be effective inthe treatment of schizophrenia. However, bcfterd e s i g n e d , r a n d o m i s e d c o n t r o l l e d s t u d i e s a r enecessary before acupuncture could be advocatedas a treatnrent fof schizophrenia.

Nicholas Beecroft BSc MBBSRe]istraf in PsychiaLry

The Maudsley Hospital, Denmark HillLandon SEs 842 (UK)

Hagen Rampes BSc MBBS MRCPsychSenior reBistrar

Soulh KensingtoD & Chelsea Mental Health LlnitChelsea and Westninster Hospital

I Ni]ht ingale Place, London SWla 9NC (LiK)

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2 . W ! F ( 1 9 9 5 ) l l e a L m e n t o f s c h i z o p h r e n i a w i t h a c !moxib!nion and Chiiese nredicife. lodr"rl af Ttaditional(hinese Mc.lici ne. t 512 ) : 1 A6-9

l . E s s e . A H , B o t c k 5 T , C i l b e l C ( 1 9 7 { t t A . u p u n c t ! r eton l i .ar lon, adlunct in psychia l f i . rehi rb i l i ta t ion ADer ic ,l.ntnal af Chinese Medici nc. 41 1 ) : 7 :r9

,1. Rubic B ( r9951 Cai Wenern sc ien.e prov ide a roundarronioi ac!p!ncture? A/le.rrtive Ihctapies. 1 (1) : 41 -7

5 Thonrpson lW Ne!rofharmacoloSy of ac!p! ic ture andelectroacupunct!fe. trttacLable Pain Sa.iety Ptoceedin$.5 l t ) : | ) -3

a. Starr M (r99,1) 5HT: th. s tory so (d. AcupunctLtrc inMcdicine. t212):1AA-2

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8. Zh.rn8 WH, Shcn YC (1981) ChanSe in ievels o in iono.rmlneneurorr .nsnr t ters 01 rat bra ins a l te.e lect r ic acup!nct ! restimu arior. /rte.r.rlor!/ /ounlal oi Ne]rotcienccs. t j:117 -9

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1.r Zh.rg Ml {1988) Trear ent o i 296 cases oI hr l !cnat ionwi th scr lp ac!punct ! f - " . Journal of Ttadi t ional ChinescM.di.h-" 8(3):193 4

l 5 . l ( a n c J , D i S c i p o U / J ( 1 9 7 9 ) A c ! p u n c t ! r e r e a r m e n lschizophr€nia; repol on thrce.ases. Amet ican loLnnalPtrchi atty. I 361 t ) : 297'3O2

16. Zha.g L, Xu 5, TanS I Zh! W (1990) A .omp. i rat ive studyot the l fealnrent o i sch zophrenia wi th e lect r c ac!p! ic ture,hclbai de.ocrlor drd chlorpromazlne. American JoLnnal aiAcupun. tute. ln l l ) :11 5

r7.Zhan8 LD, Tang YH, Zhr WB, X! SH 119871 Comparat iv-"s l ldy o i schizophr-"n ia t rer tment wirh e lect rorcupuncture,h€'bs.ind chlopronrazin€. Chliiese Medical loutnal. 1 a00:1 5 2 7

18.5h ZX (r988) Observato i on lhe therapel t ic e i re.L o i t20cases of hal luc i ia t ion t reatcd wi th a! r ic ! lar ac!p!n. rure.Joun.l of Itad itionai Chinese MedicinE. 8t1):253 4

l9.WHO (1 l992) ln tenat ian. l Stat in ica i Classi i icat ion ofDlseases, lAth Kevi r ior . Wor ld l lca rh Orgi rn isat ion,

2 0 . L c w t h C l , M . r c h j n D ( 1 9 8 1 ) O i t h eacuplncture. Pi i , /6 j l l l 27

2 L Le$, i th CT, Vl fcenr C ( l995) [va l !at io . oI the c l in ica le l i e c t s o f a c u p ! i . t u r e : d p r o b l c m r e a s s e 5 s e d a n d airam-.wofk Ior fut!re lcsear.h. l\in fotum,l(l): )9-J9

22.Rrmpes H, ldmes R (1995) Compl icat ions o i acupufct ! re.AcupunctDrc in Mediche 1l(l):25-33

THE ASSOCIATION OFB RITISH VETE RI NARY ACU P U NCTU RE

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rhe President, Mr lohn Ni.ol orfhe Se.retary, Mrs lill Eercon

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The A$o.iai on lor Mod .al Acupunciure and RelatedTe(hnique5 olrheRepub c of L.rv a requenstho pleaiurc ofyour(ompany d a congrestod(u$the n tegra t iono lmedkta . lpun. ru re n tod inka tmed.neanothe a(e eraiion olthe mode.n (ientitk and te.hno ogi.a a(hievemonrrwirh n a(upunduro inlo dediel pradi.e

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M o d " e . o o . i o l o g d . t . d - , o - ' q a 1 p . a iPhys o ogy and morpho oqy oflhe acupun.iure 5y5temExperimenb a(upundureRe ated te.hn ques {Lsea Magnetm, Sioreso^an(e, Nti.rowave).Traditiona a$e.ir olmed c a.upundure., " q o o t , , o , o a " d . a r a . . p r f " d o , c t d ? d F t i q . - .

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