Journal of Integrative and Complementary Medicine

Hippotherapy literally means “therapy with the help of a horse” and is derived from the Greek word hippos, meaning “horse.” Hippocrates was the first to describe the benefits of hippotherapy for rehabilitation purposes. Although this therapy has many years of history, few scholars have defined the theoretical bases of hippotherapy and less about how psychologic, physical, social, and educational benefits can be achieved through hippotherapy in children with special needs.

This article is designed from a chronological perspective to provide mental health professionals, educators, and others with current information on how horses can be used as a main tool in an effective and holistic therapy for children with special needs. This is supported by current literature review through a conceptual framework of hippotherapy explained by dynamic system theory along with the theory of neuronal group selection and sensory integration theory.

Hippotherapy, by affecting multiple systems such as the sensory, muscular, skeletal, limbic, vestibular, and ocular systems simultaneously, leads to psychologic, social, and educational benefits that will be evidenced in behavioral patterns used in other environments.

The objective of this review is to investigate the existing scientific information on the safe needling depth of acupuncture points.

The PubMed, EMBASE, Cochrane, AMED (Allied and Complementary Medicine), NCCAM (The National Center for Complementary and Alternative Medicine), and CNKI (China National Knowledge Infrastructure) databases were searched to identify relevant monographs from 1991 to 2009. Additional articles were also identified from the reference list of identified articles. Chinese journals that we thought might be relevant to our study were hand searched.

Thirty-three (33) studies were recruited into the review. Each research study was analyzed for study design, investigated acupuncture points, definition of safe depth, measuring methods, subject number, and for discussion of de qi. Factors that would affect the measured depth such as gender, age, body sizes, right or left side of limb, if using Ton Shen Cun for comparison, and needling angles were also reviewed. Needling depth of each point was revealed as well.

There is great inconsistency in terms of safe needling depths measured from different subject groups and measuring methods. There is suitable justification for a well-designed clinical trial to investigate the real needling depth for each acupuncture points to avoid adverse effects or complications.

The objective of this study was to study the effects of meditation on stress-induced changes in cognitive functions.

The study was conducted on 32 healthy adult male student volunteers who had never practiced meditation before the study. The study consisted of practicing 20 minutes of guided meditation and administration of psychologic stress to the subjects. The psychologic stress was administered to the subjects by asking them to play a (preselected) stressful computer game. The subjects were asked to meditate either before or after the administration of psychologic stress. For the control group measurements, the subjects were asked to wait quietly for an equivalent period of meditation time.

The outcome measures were galvanic skin response (GSR), heart rate (HR), electromyography (EMG), sympathetic reactivity (QTc/QS2 ratio), cortisol, and acute psychologic stress scores. The central nervous system functions were assessed using Wechsler memory scale and visual-choice reaction time (VCRT). These parameters were measured both at the beginning and at the end of the intervention, using a pre–post experimental test design.

Computer game stress was associated with a significant increase in physiologic (GSR, EMG, HR, QTc/QS2) and psychologic (acute stress questionnaire scores) markers of stress. Meditation was associated with relaxation (significant decrease in GSR, EMG, QTc/QS2, and acute stress questionnaire scores). Meditation, if practiced before the stressful event, reduced the adverse effects of stress. Memory quotient significantly increased, whereas cortisol level decreased after both stress and meditation. VCRT showed no significant change.

Practice of meditation produced a relaxation response even in the young adult subjects who had never practiced meditation before. The practice of meditation reduced the physiologic stress responses without taking away the beneficial effect of stress, namely, improved memory scores.

The objectives of this study were to assess the general acceptability and to assess domains of potential effect of a mindfulness-based stress reduction (MBSR) program for human immunodeficiency virus (HIV)–infected and at-risk urban youth.

Thirteen-to twenty-one-year-old youth were recruited from the pediatric primary care clinic of an urban tertiary care hospital to participate in 4 MBSR groups. Each MBSR group consisted of nine weekly sessions of MBSR instruction. This mixed-methods evaluation consisted of quantitative data—attendance, psychologic symptoms (Symptom Checklist 90-Revised), and quality of life (Child Health and Illness Profile–Adolescent Edition)—and qualitative data—in-depth individual interviews conducted in a convenience sample of participants until interview themes were saturated. Analysis involved comparison of pre- and postintervention surveys and content analysis of interviews.

Thirty-three (33) youth attended at least one MBSR session. Of the 33 who attended any sessions, 26 youth (79%) attended the majority of the MBSR sessions and were considered “program completers.” Among program completers, 11 were HIV-infected, 77% were female, all were African American, and the average age was 16.8 years. Quantitative data show that following the MBSR program, participants had a significant reduction in hostility (p = 0.02), general discomfort (p = 0.01), and emotional discomfort (p = 0.02). Qualitative data (n = 10) show perceived improvements in interpersonal relationships (including less conflict), school achievement, physical health, and reduced stress.

The data suggest that MBSR instruction for urban youth may have a positive effect in domains related to hostility, interpersonal relationships, school achievement, and physical health. However, because of the small sample size and lack of control group, it cannot be distinguished whether the changes observed are due to MBSR or to nonspecific group effects. Further controlled trials should include assessment of the MBSR program's efficacy in these domains.

Acupuncture has been gaining popularity among practitioners of modern medicine as an alternative and complementary treatment. However, the mechanism of its therapeutic effect still remains uncertain. The present study chose the GV20 acupoint to evaluate acupoint effectiveness, hypothesizing that its stimulation induces cerebrovascular responses.

The effects of GV20 acupuncture treatment on middle cerebral artery (MCA) and anterior cerebral artery (ACA) blood flow velocities, and CO₂ reactivity during hypocapnia were evaluated in 10 healthy male subjects (mean age 25.6 ± 0.8 years). Measurements were done at rest and during hypocapnia, and were repeated four times each at different cerebral artery territories with an interval of 1 week. MCA and ACA blood flow velocities were measured with a transcranial Doppler flowmeter. Blood flow velocity was corrected to 40 mm Hg of end-tidal CO₂ partial pressure (P_ETCO2), and was expressed as CV40. CO₂ reactivity was measured as percent change in mean blood flow velocity/mm Hg P_ETCO2.

Mean MCA and ACA blood flow velocities at rest, CV40, and CO₂ reactivity during hypocapnia increased significantly after GV20 acupuncture treatment, whereas mean arterial blood pressure and pulse rate at rest did not change significantly. The increases in MCA and ACA blood flow velocity were associated with improved CO₂ reactivity after GV20 acupuncture treatment.

The data suggest that GV20 acupuncture treatment increases cerebral blood flow. The results of this small-scale study provide preliminary evidence for acupuncture effectiveness.

Migraine is one of the most prevalent neurological disorders in Europe, severely affecting ability to work and quality of life. Medical therapies are considered to be the “gold standard” of treatment. This study addresses osteopathic treatment for acute therapy or prophylactic therapy as an alternative to traditional therapies.

Forty-two (42) female patients with migraine were randomized into an intervention group (n = 21) and a control group (n = 21). Outcomes were evaluated with three questionnaires before the treatment (t1) and 6 months later (t2).

The intervention group received five 50-minute osteopathic manipulative treatments (OMT) over a 10-week period. The control group did not receive OMT, sham treatment, or physical therapy. Patients of this group only filled the questionnaires. Both groups continued with previously prescribed medication.

The Migraine Disability Assessment (MIDAS) and Short Form–36 (SF-36) questionnaires as well as a German “pain questionnaire” were used to assess pain intensity, the impact of migraine on daily life and health-related quality of life (HRQoL), and the number of days subjects suffered from migraine.

Three (3) of the eight HRQoL domains of the SF-36 form in the intervention group showed significant improvement (from t1 to t2), with a general betterment exhibited in the other domains. The total MIDAS score, pain intensity, and disturbance in occupation due to migraine as well as number of days of disablements were also significantly reduced. The control group showed insignificant differences in these areas.

This study affirms the effects of OMT on migraine headache in regard to decreased pain intensity and the reduction of number of days with migraine as well as working disability, and partly on improvement of HRQoL. Future studies with a larger sample size should reproduce the results with a control group receiving placebo treatment in a long-term follow-up.

The study objectives were to observe the clinical efficacy of primary massage of twining manipulation with one finger (PMTMOF) versus conventional tuina manipulation for treating muscular torticollis.

A randomized, controlled, single-blind method was employed. Patients received either PMTMOF (experimental group, n = 265) or conventional tuina manipulation (control group, n = 235), once a day, 20 minutes each, for 15 days of treatment. After four treatment courses, sternocleidomastoid muscle morphology and size were detected using two-dimensional ultrasonography; sternocleidomastoid muscle blood flow was monitored by color Doppler ultrasonography; and head–neck deflection and range of motion were used to determine total curative effects.

In the treatment group, 55 patients were cured, 120 patients remarkably responded to the treatment, 75 patients effectively responded, and 15 patients were found to have no response. The total effective response rate to the treatment is 94.34%. In the control group, 15 patients were cured, along with very effective results in 60 patients, effective results in 125 patients, and ineffective results in 35 patients, and the total effective rate is 85.11%. A significant difference in total effective rate was found between experimental and control groups (p < 0.05).

PMTMOF produced more obvious curative treatment effects in infantile muscular torticollis than conventional tuina manipulation and could effectively shorten treatment time and avoid sequelae due to delayed healing.

The purpose of this pilot study was to evaluate the efficacy of acupuncture in relieving perineal pain after mediolateral episiotomy during childbirth.

Women with mediolateral episiotomy during delivery were enrolled in this study and were assigned to be treated or not with acupuncture.

Perineal pain relieving effect of acupuncture was evaluated considering oral analgesics request during post-partum period and was the main outcome of this trial.

A total of 42 women were enrolled in this trial. Twenty-one (21) women were treated with “wrist–ankle” acupuncture, inserting one needle in their right ankle. A second group of 21 women was not treated with acupuncture. Women in the acupuncture group were significantly less likely to experience pain; only 8 of them (38.1%) asked for analgesics. All women in the second group assumed oral analgesics because of perineal pain (p < 0.01).

Wrist–ankle acupuncture during the postpartum period is effective for perineal pain relief after mediolateral episiotomy.

The initial gain from a Pulmonary Rehabilitation Program (PRP) among patients with chronic obstructive pulmonary disease (COPD) begins to fade away 6 months after the completion of a rehabilitation program. One possible reason may be due to the poor compliance of the patients to the existing forms of home exercise program (e.g., walking, weight training activities, etc.).

This study tested the efficacy of health qigong (HQG), a traditional Chinese exercise, as an adjunct home exercise program in optimizing the gains obtained from PRP until 6 months after discharge.

This was a randomized controlled trial (RCT) on a mind–body exercise intervention.

Eighty (80) patients with COPD receiving conventional PRP pulmonary rehabilitation program were randomized to the HQG intervention group (n = 40) and control group (n = 40).

Assessments were undertaken by blinded assessors at baseline, discharge from training, and follow-up (FU) at 3 and 6 months. Primary outcomes involved functional capacity scales and secondary outcomes involved quality-of-life scales.

Intention-to-treat analysis identified trends of improvement in all outcome measures in the HQG group, whereas lesser improvement and trends of deteriorations were identified in the control group. Ancillary analysis using a per-protocol method, however, identified significantly better improvements in functional capacity measures among the HQG at the 6-month FU.

This RCT provided some evidence to support the positive effect of HQG as an adjunct home exercise for rehabilitation among people with COPD and to support further related research.

The objective was to study the effect of the add-on yogic prana energization technique (YPET) on healing of fresh fractures.

Thirty (30) patients (22 men and 8 women) between 18 and 55 years with simple extra-articular fractures of long and short bones were selected from the outpatient department of Ebnezar Orthopaedic Centre and Parimala Speciality Hospital, Bengaluru. They were randomized into yoga (n = 15) and control (n = 15) groups. Compound, complicated, pathologic fractures, old fractures, and those associated with dislocations were excluded. Both groups received the conventional plaster of paris immobilization of the fracture site as the primary treatment. The yoga group, in addition, practiced YPET twice a day (30 minutes/session) for 2 weeks using taped audio instructions after learning under supervision for 1 week. YPET is an advanced yoga relaxation practice that involves breath regulation, chanting, and visualization, which according to yogic science revitalizes the tissues by activating the subtle energies (prana) within the body. Both the groups were assessed on the 1st and 21st day by the Numerical Pain Rating Scale for pain (NRS), tenderness (0–4), swelling (0–4), fracture line density (1–4), and the bridging of cortices (1–4).

Two (2) groups were matched on all variables. The Wilcoxon test showed significant improvement in both groups on all variables. Pain reduction (NRS) was better (p = 0.001 Mann–Whitney test) in the YPET group (94.5%) than in the control group (58.6%); Tenderness reduced (p = 0.001) better in the YPET group (94.4 %) than in the control group (69.12%); Swelling reduced by 93% in the YPET group and by 69.4% in controls (between-groups p = 0.093, i.e., nonsignificant); increase in fracture line density was better (p = 0.001) in the YPET group (48%) than in the control group (18.25%). The number of cortices united was significantly better (p = 0.001) in the YPET group (81.4%) than in controls (39.7 %).

Add-on yoga-based YPET accelerates fracture healing.

Medical ozone is more bactericidal, fungicidal, and virucidal than any other natural substance. Some studies proved that ozone infused into donated blood samples can kill viruses 100% of the time. Ozone, because of its special biologic properties, has theoretical and practical attributes to make it a potent hepatitis C virus (HCV) inactivator, which suggests an important role in the therapy for hepatitis C.

The study aim is to evaluate the role of ozone therapy in decreasing HCV ribonucleic acid (HCV RNA) load and its effect on the liver enzymes among patients with chronic hepatitis C.

This study included 52 patients with chronic hepatitis C (positive polymerase chain reaction [PCR] for HCV RNA and raised serum alanine transaminase [ALT] for more than 6 months). All patients were subjected to meticulous history taking and clinical examination. Complete blood count, liver function tests, and abdominal ultrasonography were requested for all patients. The ozone group included 40 patients who received major autohemotherapy, minor autohemotherapy, and rectal ozone insufflation. The other 12 patients (conventional group) received silymarin and/or multivitamins.

There were significant improvements of most of the presenting symptoms of the patients in the ozone group in comparison to the conventional group. ALT and aspartate transaminase (AST) levels normalized in 57.5% and 60% in the ozone group, respectively, in comparison to 16.7% and 8% in the conventional group, respectively. Polymerase chain reaction (PCR) for HCV RNA was negative among 25% and 44.4% after 30 and 60 sessions of ozone therapy, respectively, in comparison to 8% among the conventional group.

Ozone therapy significantly improves the clinical symptoms associated with chronic hepatitis C and is associated with normalized ALT and AST levels among a significant number of patients. Ozone therapy is associated with disappearance of HCV RNA from the serum (-ve PCR for HCV RNA) in 25%–45% of patients with chronic hepatitis C.

The objective of this study was to identify the factors that make a good doctor, both from a patient and a physician perspective. Is there a connection between practicing homeopathy and being a good doctor?

This was a qualitative study of homeopathically trained physicians and their patients, using observation of patient–physician interactions (n = 29) and interviews with patients (n = 20) and with physicians (n = 4).

Patients identified the availability of time, both in itself and as a prerequisite for other physician characteristics, as the single most important factor. Other factors include scope of diagnosis/holistic approach, patient-centeredness/empathy, and perceived competence/therapeutic success. Patients did not link these factors to the homeopathic orientation of their physician, while physicians clearly made this connection.

The findings confirm other studies of patient satisfaction and physician characteristics. The availability of time, a holistic approach, and high physician empathy lead to high patient satisfaction. Homeopathic physicians probably are more likely to exhibit these characteristics.

Health care policy should create conditions that enable individual physicians to be “good doctors.” For medical education, a stronger emphasis on interpersonal skills and practitioner empathy could lead to higher patient satisfaction and potentially better treatment outcomes. Homeopathy might provide a good role model for this type of education.

This report presents a case of a 9-year-old boy with autism that responded positively to nutritional supplements.

The supplements were dimethylglycine and a combination of a large dose of vitamin B6 (pyridoxal HCl) and magnesium. The Autism Treatment Evaluation Checklist (ATEC) was used for outcome assessment and administered by 2 of his family members both before the nutritional supplements and 5 months into the supplements, thereby referred to as pretest and post-test, respectively. Two (2) assessors independently performed evaluations. The ATEC evaluates four areas: communication, sociability, sensory/cognitive awareness, and behavior. The lower the scores are, the less severe the symptoms are.

The ATEC evaluations by 2 independent assessors showed that the changes in total ATEC were from 63 at pretest to 33 at post-test, and from 64 at pretest to 30 at post-test, respectively. These changes represented reductions of 47.6% and 53.1%. A strong inter-rater reliability was demonstrated, with an intraclass correlation coefficient of 0.988. The school teachers also noticed improvements in various areas consistent with the ATEC evaluations.

Although the reported findings cannot be generalized, this case report provides useful preliminary evidence to an accumulating body of literature supporting the theory and efficacies of nutritional supplements in autism-spectrum disorders.

Appendicitis is an acute condition of the abdomen that is treated with surgical intervention. Conservative treatment of appendicitis currently involves intravenous antibiotics. While conservative care is a useful tool in apprehensive patients, in conditions such as appendicitis, delays in proper treatment can be life threatening. In spite of this, some patients will still refuse surgical and pharmacologic intervention, which can significantly limit the physician's therapeutic options.

Sonographic evidence is presented of appendicitis in a patient who strongly desired to avoid pharmacologic or surgical intervention.

The patient underwent a medically supervised water-only fast followed by a plant-based, low-fat, low-sodium diet and achieved a significant reduction and eventual elimination of symptoms.

This case demonstrates the need for further research on the effects of medically supervised water-only fasting and careful refeeding in cases of uncomplicated appendicitis.