Researchers find acupuncture and herbs effective for improving acute appendicitis patient outcomes. An emergency medical condition often requiring an appendectomy, acute appendicitis may alternately be treated with drug therapy under controlled conditions in a hospital setting. Fujian University hospital researchers combined acupuncture and herbs with standard drug therapy. The addition of acupuncture and herbs to the drug therapy treatment protocol increased the total effective rate by 23.69%. In addition, adverse affects due to medical intervention dropped to 7.89% from 28.95% with the addition of acupuncture and herbs to the treatment protocol. Based on the data, the researchers conclude that the addition of acupuncture and herbs to drug therapy is safe, effective, and reduces iatrogenic complications for patients with acute appendicitis.

Patients receiving only drug therapy had a 71.05% total treatment effective rate. However, that number improves to a 94.74% total treatment effective rate when acupuncture and herbs are added to the treatment protocol. Drug therapy produced 17 patients that were completely cured and 10 patients improved significantly. The study group receiving drug therapy plus acupuncture and herbs had a total of 29 patients that were completely cured and 7 patients significantly improved.

NOTA (Non Operative Treatment for Acute Appendicitis) is a procedure supported by research that may be applicable in many clinical scenarios. Fujian University hospital researchers tested patient outcomes when combining NOTA with acupuncture and herbs. A total of 76 patients with acute appendicitis were treated and evaluated in this study. The patients were diagnosed with acute appendicitis between January 2014 and January 2016. They were randomly divided into a treatment group and a control group, with 38 patients in each group. The treatment group received standard drug therapy plus acupuncture and herbal medicine. The control group received only standard drug therapy.

There were 22 male patients and 16 female patients in the treatment group. The average age was 35.4 (± 7.9) years. The average course of disease was 4.1 (± 2.5) days. For the control group, 21 male patients and 17 female patients were included in the group. The average age was 34.9 (± 8.1) years. The average course of the disease was 3.9 (± 2.7) days. There were no significant statistical differences in terms of gender, age, and disease duration relevant to patient outcome measures.The control group and the acupuncture plus herbs treatment group received identical medications. Intravenous injections were administered for 7 consecutive days of the following medications:

500 ml, 0.9% sodium chloride injection (once daily)
240, 000 IU, gentamicin (once daily)
100 ml, metronidazole (twice daily)

In addition, the treatment group received acupuncture, moxibustion, and herbs. The primary acupoints for acupuncture therapy were as follows:
ST36 (Zusanli)
EX-LE7 (Lanweixue)
LI11 (Quchi)
ST37 (Shangjuxu)
LI4 (Hegu)

ST36 and ST36 are stomach foot-yangming acupuncture points often used for spleen, stomach, and large intestine disorders. LI11 is traditionally used for the reduction of inflammation and LI4, also located on the large intestine hand-yangming channel, is indicated for the treatment of acute conditions. Of special note is the selection of Lanweixue as a primary acupoint.

Lanweixue is approximately 2 cun (units) distal to ST36, located on the right lower leg. It is commonly combined with the other acupoints for the treatment of acute appendicitis (across multiple TCM references). The exact location of the acupoint is determined by palpation for tenderness. In many clinical scenarios, this acupoint becomes tender when there is inflammation of the appendix. Diagnostically, tenderness upon palpation of Lanweixue and rebound pain at McBurney’s point indicates a potential appendicitis. This acupoint moves qi and blood and clears fire poisons from the large intestine. It is traditionally indicated for the treatment of acute and chronic appendicitis. Other indications include the treatment of lower limb paralysis and motor impairment, drop foot, and general digestion disturbances.

One acupuncture session was conducted per day. A needle retention time of 30 minutes per acupuncture session was observed. Immediately after acupuncture, moxibustion was applied on acupoints selected based on individual symptoms. For stomachache, the following acupoints received moxibustion stimulation:
CV4 (Guanyuan)
SP6 (Sanyinjiao)
SP1 (Yinbai)

For profuse sweating, the following acupoints received moxibustion stimulation:
KI7 (Fuliu)

For irritability, the following acupoints received moxibustion stimulation:
LV3 (Taichong)

The treatment group also received herbal medicine. Ingredients for the herbal medicine decoction were the following:
Da Huang 20 g
Chao Mu Dan Pi 10 g
Chi Shao 10 g
Dong Gua Ren 30 g
Mu Xiang 10 g
Hong Teng 20 g
Jin Yin Hua 20 g
Bai Jiang Cao 20 g
Pu Gong Ying 20 g
Sheng Mi Ren 30 g
Dang Gui 15 g

Following completion of treatments, the efficacy for each patient was categorized into one of three tiers:

Recovery: Normal blood test results. Absence of accompanying symptoms.
Effective: Improvement in blood test results. Significant improvement of accompanying symptoms.
Not effective: No improvement in acute appendicitis severity.

The addition of acupuncture and herbs to the drug therapy protocol increased the total effective rate by 23.69% and decreased the rate of iatrogenic complications by 21.06%. The results indicate that acupuncture and herbs enhance hospital protocols for the non-operational treatment of acute appendicitis. Given the 94.74% total treatment effective rate of acupuncture and herbs combined with drug therapy, the treatment protocol is indicated for implementation in emergency room treatment protocols. The findings are confirmed by Xing et al. in their research entitled TCM Combined with Acupuncture Treat Acute Pure Appendicitis 80 Cases.

The findings are consistent with Traditional Chinese Medicine (TCM) historical data, including both acupuncture continuing education courses and herbal medicine classics. In TCM, both acupuncture and herbal medicine share a system of theoretical principles for both diagnosis and treatment. Acute appendicitis is categorized in the Chang Yong class of disorders. It is caused by poor qi circulation and blood stasis, which can transform into heat (a TCM term for inflammation) that leads to abscesses. The concept of poor qi circulation, in this circumstance, refers to the inhibition of peristalsis and disruptions in the movement of solids through the appendix, thereby leading to inflammation.

Historical data informs us that successful treatments for an appendicitis have been documented since the Han Dynasty or earlier. The Jin Gui Yao Lue (Essential Prescriptions of the Golden Cabinet) was written by the Han Dynasty physician Zhang Zhong Jing and details treatment of Chang Yong (appendicitis), "In Chang Yong, there is a swollen and tender lower abdomen, painful urination, frequent fever, spontaneous sweating, and recurrent aversion to cold…. if the pulse is surging and rapid, which means an abscess has formed... Da Huang Mu Dan Decoction should be used." The herbal formula Da Huang Mu Dan Decoction remains in use by licensed acupuncturists throughout the world.

Da Huang Mu Dan Decoction is comprised of Da Huang, Mu Dan Pi, Tao Ren, Dong Gua Ren, and Mang Xiao. It is used for alleviating inflammation by removing excess heat and stasis. In the aforementioned research, a modification of this formula was employed. Historically, Da Huang Mu Dan Decoction has been used for the treatment of abdominal pain and swelling that worsens with pressure. It is indicated for the treatment of appendicitis, abdominal masses, leukorrhea with blood, lochia retention, and febrile diseases. In a modern setting, use of this formula for the treatment of appendicitis is appropriate in a TCM hospital setting where emergency surgical procedures and intravenous medications are available.

At the Healthcare Medicine Institute (HealthCMi), the course entitled Colitis, Crohn’s Disease, Chronic Appendicitis includes both TCM and modern research concerning the treatment of digestion disorders, including appendicitis.
 

References
1. Xing GH. Herbs TCM Combined with Acupuncture Treat Acute Pure Appendicitis in Conservation [J]. Journal of North Pharmacy, 2016, 13(7):46-46.

2. Salomone Di Saverio, M. D., Andrea Sibilio, Eleonora Giorgini, Andrea Biscardi, Silvia Villani, Federico Coccolini, Nazareno Smerieri et al. "The NOTA Study (Non Operative Treatment for Acute Appendicitis)." (2014).
3. Xing T. TCM Combined with Acupuncture Treat Acute Pure Appendicitis 80 Cases in Conservation [J]. Journal of Zhejiang Chinese Medical University, 2012, 36(3):315-316.

4. Xing GH. Herbs TCM Combined with Acupuncture Treat Acute Pure Appendicitis in Conservation [J]. Journal of North Pharmacy, 2016, 13(7):46-46.