The Treatment of Cardiovascular Disease with Acupuncture by Lisa C. Nelson, L.Ac Capstone Advisor: Lawrence J. Ryan, Ph.D. A Capstone Project submitted in partial fulfillment of the requirements for the conferral of the degree, Doctor of Acupuncture and Oriental Medicine Yo San University Los Angeles, California April 2014 2 Approval Signatures Page This Capstone Project has been reviewed and approved by: 4/30/14 _________________________________________________________________ Lawrence J. Ryan, Ph.D. Capstone Project Advisor Date 4/30/14 ____________________________________________________________ Don Lee, L.Ac., Specialty Chair Date 4/30/14 _________________________________________________________________ Andrea Murchison, DAOM, L. Ac., Program Director Date 3 Abstract The purpose of this project is to identify factors that are present in scientific studies related to the use of acupuncture as a treatment for cardiovascular disease, with specific focus on the pericardium needling point (PC6). One in every four deaths in the United States is from heart disease. Coronary heart disease alone in the (US) costs $108.9 billion each year including both direct and indirect costs. Utilizing acupuncture as a preventative measure and treatment of heart disease, Western and Eastern practitioners can collaborate to achieve more efficient and effective care of patients experiencing cardiovascular dysfunction. This movement toward the expanded use of Traditional Chinese Medicine can save lives, money, and medical resources. Such a shift would be beneficial to both Western and Eastern medical practitioners. An educational tool is needed to link Traditional Chinese Medicine practitioners with cardiovascular patients. This study draws from the research of acupuncture treatment and Western treatments to identify the most salient factors under consideration in the development of an education tool that will detail how acupuncture can prevent and treat cardiovascular disease. 4 Acknowledgements My Family Dr. Larry Ryan Dr. Robert Mercadante Dr. Sheng-Xing Ma 5 Table of Contents Signature Approval Page…………………………………………………….2 Abstract………………………………………………………………………...3 Acknowledgements…………………………………………………………...4 Chapter One: Introduction…………………………………………………....6 Chapter Two: Review of Literature………………………..………………..13 Overview……………………………………………………………….13 Cardiovascular Disease—The Heart and Its Structures………….14 Chapter Three: Method…………………………………………….………..44 Chapter Four: Results………………………………………………………..48 Chapter Five: Discussion…………………..………………………………. 54 References…………………………………………………………………….60 Appendix A:……………………………………………………………………71 Appendix B:……………………………………………………………………73 Appendix C:……………………………………………………………………75 Appendix D:……………………………………………………………………79 6 List of Figures and Tables Table 1: Open coded themes and study numbers pertaining to each theme………………………………………….49 Table 2: Axial coded themes and study numbers pertaining to each theme …………………………………………50 Chapter One: Introduction One in every four deaths in the United States is from heart disease (Kocharek, XU, Murphy & Kung, 2011). Coronary heart disease alone in the US costs $108.9 billion each year, including both direct and indirect costs (Heidenreich, Trogdon & Khavjou, 2011). There is a need, therefore, to explore alternatives for the treatment of heart disease that are effective and perhaps less-expensive to the patient. This project will outline the significance of Traditional Chinese Medicine (TCM) as related to lifestyles, diet, and treatments of heart disease and related areas of human health. It will also outline a bit of the history of some present-day cardiovascular pharmaceutical products and suggest an alternative treatment option for cardiovascular disease. Utilizing acupuncture as prevention and treatment of heart disease with the collaboration of Western and Eastern modalities including TCM, physicians can be more efficient and effective in treating patients. This movement toward the expanded use of TCM can save money and medical resources. Such a shift would be beneficial to both Western and Eastern medical practitioners. The American lifestyle, in contrast to the Chinese, has been proven to play a contributory role on the prevalence of heart disease. Of the many elements of the Chinese lifestyle that have been investigated, 7 one particular point of interest has been the similarity of the Chinese diet with that of the typical American diet, such as meats, seafood, fruits, vegetables, and starches. The striking contrast, however, is that the Chinese population has a lower percentage of heart disease than the American counterpart. The exploration of findings and lessons learned from Chinese culture, daily practices, and diet have become essential for researchers committed to understanding the biological mechanisms involved in the ultimate prevention of heart disease. The "China Study" revealed that, even in a culture with similar amounts of the same food groups (proteins, starches, and fats) as the American diet, there is a stark contrast in the ratio of heart-disease-afflicted individuals to the general population (Campbell, & Campbell, 2005). Researchers have concluded that specific elements within the Chinese diet help regulate blood plasma levels of cholesterol, especially low-density cholesterol, which has been implicated in high blood pressure, atherosclerosis, and heart disease (Campbell & Campbell, 2005). Findings from this study opened up curiosity for further investigation into the mystery of the Chinese diet and lifestyles, for the purpose of uncovering the reasons of the lower rate of heart disease in the Chinese Culture. One of the components in the Chinese diet and lifestyle that sparked interest for further evaluation is the consumption of red yeast rice (RYR). This type of rice comes from the strain of yeast known as Monascus Purpureus that grows on the rice, and is considered a dietary staple in several Asian countries. RYR is traditionally used to color foods that are common in the Asian culture such as Peking duck, pickled tofu, and rice vinegar. RYR dates back as far as the Chinese Tang Dynasty in the 800 A.D., and its 8 medicinal value is used in TCM today for improving blood circulation and digestive disorders (Heber, Yip, Ashley, Elashoff, Elashoff, & Go, 1999). Research into this ancient Chinese secret revealed that the components of this type of rice disclosed a fungal metabolite named mevinolin, which interrupts the "mevinolate pathway," which is part of the cholesterol production pathway (Ma, Gil, Südhof , Bilheimer, Goldstein, & Brown, 1986). This research led to the creation of the pharmaceutical companies’ so- called statin drugs from the first one “ Simvastatin” (Tobert, 2003). Further research discovered that there are various biomarkers, such as angiotensin, involved in “tensing” the arterial walls, causing overall vasoconstriction and a subsequent increase in blood pressure, thereby putting strain and pain on the heart. The pharmaceutical response has been “angiotensin blockers.” (Venes,Thomas, & Taber, 2001). Continued studies led to the discovery of Angiotensin-Converting Enzyme (ACE), a component of the blood pressure-regulating renin-angiotensin system that catalyses the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, and degrades bradykinin, a potent vasodilator. This discovery led to the synthesis and marketing of the pharmaceutical “ACE inhibitor,” which inhibits ACE, thereby decreasing the tension of blood vessels and blood volume, thereby lowering blood pressure, thereby easing burden on the heart (Venes, Thomas, & Taber, 2001). With greater understanding of the mechanisms of ion channels on cell receptor sites, the pharmaceutical response has been, thus, “calcium channel blockers” and “sodium channel blockers.” It is the intent of this research, therefore, to strive to eliminate the routine response by our society of relying on drugs as the prescription for 9 our ailments, by analyzing and developing further the Chinese practices of health and well-being and determine what more can be done to lower the incidence of cardiovascular disease in the American population. Nonetheless, part of the Chinese regimen is not only diet and exercise but also the administration of acupuncture, which extends to the treatment of ailments that produce not only pain but also long-term dysfunctions, such as cardiovascular disease and heart disease. Research found that acupuncture on specific points such as Pericardium 6 (PC6) is effective for eliminating pain on the heart. Studies show that administration of acupuncture stimulation at PC6 increases the production of various biochemical agents, for example nitric oxide (NO), a small molecule that exhibits dilation of the arterial walls. It is this understanding that latter-day Western treatments of cardiovascular disease through pharmaceuticals were developed, in particular nitroglycerin tablets. Although nitroglycerin tablets have been used to treat angina pectoris (chest pain produced by obstruction of a coronary artery) for over a century, recent studies of nitroglycerin have shown that it is, in actuality, the NO molecule - liberated from the nitroglycerin molecule by the liver enzyme aldehyde dehydrogenase - that performs the vasodilation, thereby lessening burden on the heart (Marsh, & Marsh, 2000). The critical state of the American culture and the prevalence of heart disease is also enhanced because of the inadequacies and even harmful consequences of pharmaceuticals aimed at treating or averting heart disease. This project will assist the development, growing awareness, and acceptance of the American population to alternative methods for treating vasculature and coronary dysfunction. Its aim is also to 10 assist medical professionals in embracing various practices and techniques of Eastern medicine in treating ailments, such as acupuncture. Significance of problem Since it has been observed that one in four deaths in the United States results from heart disease, the issue of addressing cardiovascular problems is a major factor in our culture (Kocharek, Xu, Murphy & Kung, 2011). Acupuncture has been in existence for nearly 3,000 years. However, acupuncture was introduced to Western medicine only in the early 1970s, and specific attention to the use of acupuncture in the treatment of cardiovascular disease has been minimal. At the present time, acupuncture is utilized for research studies and clinical trials involving humans and animals. Because these studies and their results have attracted much attention, deeper explorations regarding how acupuncture facilitates the process of healing have been demanded (Ahn & Kaptchuk, 2005). It can be seen, then, that the combination of Western and TCM has the potential to create more options for the treatment and prevention of cardiovascular disease. Research Objective The objective of this research is to identify factors that are present in scientific studies related to the use of acupuncture as a treatment and preventative for cardiovascular disease, to be specific the use of pericardium PC6 stimulation. An educational tool will be developed as an outline based on studies and data collected. Data will be compiled to validate the uses of acupuncture for cardiovascular-related prevention and treatments. This is an important step to continuing growth in both Western and Eastern medical practices for the purpose of developing more options for