Acupuncture for pleural effusion in lung cancer

Updated: Mar 14


According to American Cancer Society estimates, lung cancer remained the deadliest malignancy in the United States in 2018. It is the second most prevalent cancer in men and women and the commonest cause of a malignant pleural effusion (MPE), accounting for approximately 30% of such effusions. The course of about 15% of patients with non-small cell lung cancer (NSCLC) is complicated by a documented MPE. The presence of an MPE in the setting of lung cancer indicates stage IV disease and is an independent determinant of shorter survival. Despite overall progress in the survival of stage IV lung cancer patients in recent times, the occurrence of an MPE as a complication of lung cancer still portends a very poor prognosis in most cases. the median survival of lung cancer patients with pleural and/or pericardial effusion is approximately, 11 months. Individual center experience suggests that specific institutions are observing far worse survival closer to 5 months. Apparently, we need to find new approaches for this critical condition.


Fortunately, clinical studies of acupuncture have provided very encouraging data. In that study, eighteen MPE patients confirmed by histopathological and/or cytological examinations were treated by acupuncture by selecting Yunmen (LU 2), Qimen (LR 14), Zhangmen (LR 13), Jingmen (GB 25), Guanyuan (CV 4), Zhongji (CV 3), Shuidao (ST 28), and Guilai (ST 29) as the major points. The treatment was given once every other day, 3 times a week, 4 weeks as a treatment course, and the therapeutic efficacy was evaluated 1 course later. Result Of the 18 patients, 6 got complete remission, 9 got partial remission, 2 achieved stable condition, while 1 didn’t respond to the treatment, and the total effective rate was 83.3%. Of the 5 cases with encapsulated pleural effusion, 2 got complete remission and 3 got partial remission, and the total effective rate was 100.0%. The amount of pleural effusion (anteroposterior diameter of the fluid), comprehensive score of symptoms, item scores of the symptoms, and Karnofsky Performance Status (KPS) score were changed significantly after treatment (P<0.01). This date indicates that acupuncture is an effective method in treating MPE and can swiftly improve the symptoms and improve the quality of life.



Acupunctural therapy in the treatment of pleural effusion has a basis in both traditional Chinese and Western medicine theories. In Western medicine, the drainage of pleural effusion is achieved by burying tubes in the chest. The three acupoints at Qimen (LV 14), Zhangmen (LV 13), and Jingmen (GB 25) are front-mu points of the liver, spleen, and kidney, which regulate water metabolism. Any disease or discomfort in the body may result in a corresponding reaction at the corresponding front-mu points. Pleural fluid is accumulated in the membrane located in the visceral and parietal layers of the pleura. By acupuncturing Qimen, Zhangmen, Jingmen, and Yunmen (LU 2), we can regulate the qi and blood in the liver, spleen, and kidney. Further, we can treat pleural effusion by stimulating the pleura. In clinical practice, needle insertion at these four acupuncture points can rapidly improve chest oppression and pain, but it does not eliminate pleural effusion. However, a combination of kidney-governing water (metabolism) and Guanyuan (RN 4) and Zhongji (RN 3) acupuncture can rapidly discharge pleural effusion, even wrapped pleural effusion, which is intractable in both TCM and Western modern medicine.


References:


1. LI Bo, WANG Bi-yu, YANG Ming, HUANG Jin-chang. Therapeutic Observation of Acupuncture for Malignant Pleural Effusion of Moderate Volume. Shanghai Journal of Acupuncture and Moxibustion.2016;7:823-826.

2. Oleg Epelbaum, Najib M. Rahman. Contemporary approach to the patient with malignant pleural effusion complicating lung cancer. Ann Transl Med 2019;7(15):352

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