In the West, hundreds of randomized controlled trials (RCTs) have been performed testing acupuncture. They include two types: those that compare acupuncture to other therapies, usual care or no treatment (pragmatic trials), and those that have placebo controls (efficacy trials). Acupuncture has generally performed well against other therapies or no treatment, but until recently, the evidence from placebo controlled trials has been considered equivocal or contradictory. A recent series of large RCTs, mostly performed in Germany and also in the US have included both pragmatic and placebo comparisons. The evidence poises a conundrum for the profession of acupuncture. This essay first describes the two types of RCTs used to examine acupuncture and examine the results of two recent large RCTs for chronic low back pain as representative examples of recent large studies. The essay then presents the most common Euro-American acupuncture professions' interpretation of these results. Western responses have included: (1) methodological weaknesses; (2) inappropriateness of placebo controls; (3) questions as to whether acupuncture placebo controls are "inert"; (4) rejection of evidence-based medicine epistemology; (5) discrepancy between acupuncture performed in RCTs with real world acupuncture; (6) enhanced placebo effects of acupuncture; and (7) needs to re-evaluate acupuncture theory. The authors do not necessarily agree with all of these responses; they are presented in an attempt to foster critical discussion. The paper also looks at recent neuroimaging experiments on acupuncture that may point to some worthwhile new avenues of investigation. Finally, the Euro-American health care policy consequences of these recent RCTs are discussed.
Acupuncture Therapy ; Chronic Disease ; Evidence-Based Medicine ; General Practitioners ; Germany ; Health Policy ; Humans ; Low Back Pain ; therapy ; Placebos ; Randomized Controlled Trials as Topic ; United States

OBJECTIVETo observe the effect of Xuefu Zhuyu Decoction ()-containing serum (XFZYD-CS) on endothelial progenitor cell (EPC) tube formation in vitro.

METHODSMononuclear cells from rat bone marrow were prepared in a Ficoll density gradient centrifuge. EPCs were separated by the differential attachment method, and observed with inverted microscope for the effect of XFZYD-CS on EPC tube formation.

RESULTSAfter one day, EPCs exposed to the serum containing 5%, 10% and 15% XFZYD-CS formed typical tubes or vessel networks. The tube formation time was two days ahead of the control group and the size of most tubes in the serum groups was smaller than in the control group.

CONCLUSIONXFZYD-CS could induce EPC angiogenesis and hasten tube formation, especially in capillary vessels. The study provides experimental evidence for the plausibility of Xuefu Zhuyu Decoction in the treatment of ischemic diseases.

Angiogenesis Inducing Agents ; pharmacology ; Animals ; Cell Differentiation ; drug effects ; Cell Shape ; drug effects ; physiology ; Cells, Cultured ; Drug Evaluation, Preclinical ; Drugs, Chinese Herbal ; pharmacology ; Endothelial Cells ; cytology ; drug effects ; physiology ; Neovascularization, Physiologic ; drug effects ; Rats ; Rats, Sprague-Dawley ; Stem Cells ; cytology ; drug effects ; physiology

OBJECTIVETo study the angiogenesis modulation mechanism of Xuefu Zhuyu Decoction () on the endothelial cell line ECV304.

METHODSECV304 cells were treated with 2.5% Xuefu Zhuyu Decoction-containing serum (XFZYD-CS) for 24 h, 48 h or 72 h. Thiazolyl blue tetrazolium bromide (MTT), fluorescence activating cell sorter (FACS), migration, adhesion and in vitro tube formation assays were conducted to confirm an angiogenesis effect of XFZYD at 3 time points. An analysis of angiogenesis regulator profiles was performed at 3 times with real-time polymerase chain reaction (RT-PCR) superarray.

RESULTSAt 48 h, XFZYD-CS induced ECV304 significantly improved cell viability, number in S phase, migration, adhesion and tube formation. At 24 h and 72 h, only cell migration was elevated. Microarray results showed that the expression of 27 angiogenesis-related genes was changed.

CONCLUSIONXFZYD-CS treatment induced angiogenesis on ECV304 cells with significant cellcular changes occurring at 48 h and genetic changes as early as 24 h.

Angiogenesis Inducing Agents ; pharmacology ; Cell Adhesion ; drug effects ; genetics ; Cell Line ; Cell Movement ; drug effects ; genetics ; Cell Proliferation ; drug effects ; Cell Survival ; drug effects ; genetics ; Drugs, Chinese Herbal ; pharmacology ; Endothelial Cells ; drug effects ; metabolism ; Gene Expression Regulation ; Humans ; Neovascularization, Physiologic ; drug effects ; genetics ; Oligonucleotide Array Sequence Analysis ; methods

OBJECTIVETo evaluate the effect of Xuefu Zhuyu Capsule ()-containing serum (XFZY-CS) on EphB4/ephrinB2 and its reverse signal in human microvascular endothelial cell-1 (HMEC-1).

METHODSXFZY-CS and the blank control serum were collected. HMEC-1 cells were randomly assigned to 6 groups including the concentration 1.25%, 2.5%, and 5% XFZY-CS groups and their blank serum control ones. The angiogenesis effect of XFZY-CS was tested with an in vitro tube formation assay and the best condition of pro-angiogenesis was determined. The effect of XFZY-CS on EphB4/ephrinB2 and the reverse signal were determined by Western blot and real-time quantitative polymerase chain reaction, respectively; we also confifirmed the results through activating and inhibiting the reverse signal by EphB4/fc and pyrophosphatase/ phosphodiesterase2 (PP2).

RESULTSXFZY-CS promoted angiogenesis at the concentration of 2.5% corresponding serum after being cultured for 48 h, while inhibited angiogenesis at the concentration of 5% after culturing for 48 and 72 h. Under the 2.5% serum concentration, XFZY up-regulated the expression of EphB4-mRNA at 12 h (P<0.05), and down-regulates its expression at 24 h (P<0.01). Protein expression of EphB4 was apparently up-regulated at 12 h and down-regulated at 24 h. The phosphorylation of ephrinB2 increased at 9 h (P<0.05). In addition, 2.5% XFZY-CS played a similar role as the reverse signaling activator EphB4/Fc ranging from 0.5 to 5 μg/mL (P>0.05). XFZY-CS also reduced the inhibitive effect of PP2 in limited periods.

CONCLUSIONSEphB4/ephrinB2 was the upstream signal in the process of angiogenesis and its reverse signaling was responsible for XFZY's effect on promoting angiogenesis.

Adult ; Capsules ; Drugs, Chinese Herbal ; pharmacology ; Endothelial Cells ; drug effects ; metabolism ; Ephrin-B2 ; metabolism ; Gene Expression Regulation ; drug effects ; Humans ; Male ; Microvessels ; pathology ; Middle Aged ; Neovascularization, Physiologic ; drug effects ; genetics ; Phosphoric Diester Hydrolases ; metabolism ; RNA, Messenger ; genetics ; metabolism ; Receptor, EphB4 ; genetics ; metabolism ; Serum ; metabolism ; Time Factors ; Young Adult