MONDAY, JUNE 14, 2021

10:00am – 10:15am EDT

Conference Opening

10:15am – 11:30am EDT

Symposia 1: Research on Acupuncture and Traditional East Asian Medicine (TEAM) for COVID-19 and Other Viral Pandemics

Speakers: Andrew Shubov, MD, Center for East-West Medicine, University of California, Los Angeles; Lisa A Conboy, MA, MS, ScDInstructor in Medicine, Part-time, Beth Israel Deaconess Medical Center, Harvard Medical School, Director of the Research Department, The New England School of Acupuncture at MCPHS University; Lisa Taylor-Swanson, PhD, MAcOM, LAc, College of Nursing, University of Utah; and Qiufu Ma, PhD, Dana-Farber Cancer Institute/Harvard Medical School

This session will highlight clinical and basic research focused on TEAM for viral infections including COVID-19.  Two clinical trials of TEAM for the treatment of COVID-19 patients will be discussed as well as additional studies of acupuncture during viral pandemics.  Dr. Ma will present data on acupuncture for inflammation which is common in viral infections.  Presentations will also cover TEAM for other common viral symptoms, and preliminary results from an ongoing RCT investigating standardized herbal medicine for COVID-19 will be featured.

Presentation details include:

Botanical Drug Research during a Pandemic; The UCLA/UCSD Experience Studying Qing Fei Pai Du Tang for COVID-19 

In March of 2020, a team of investigators embarked on the rapid development of a multicenter randomized controlled clinical trial to evaluate the effects of Qing Fei Pai Du Tang on active COVID-19. The goal was to pursue this research using the highest level of academic rigor and regulatory approval, in order to help shift the scientific community’s perception of TEAM and its potential value in pandemic response. Unfortunately, numerous challenges have led the study to be delayed until after the crest of the pandemic had fallen. This presentation will describe the processes, complexities and reasons for delay when pursuing FDA approved research on botanical drugs. These include issues related to manufacture, importation, regulatory (both FDA and institutional review board), and even political conflicts from within each institution. Strategies for streamlining these processes in future research projects will be discussed. Preliminary data about Qing Fei Pai Du Tang in COVID-19 will be shared.  

Using Chinese Herbal Telemedicine for COVID 19-Type Symptoms: What can we Learn from Different Research Models?

Coronavirus Disease 2019 (COVID-19) continues to affect much of the world and effective therapies are urgently needed. Published accounts of the use of Chinese Herbal Medicine (CHM) are promising.  This presentation will review an ongoing observational cohort study designed to describe CHM therapy, outcomes, and safety with patients experiencing symptoms possibly related to COVID-19.  We are also collecting traditional East Asian Medicine diagnostic and clinical reasoning from study practitioners to better understand how this medicine is used, and how it could be integrated with regular medical care. Describing individualized CHM treatment for symptoms that may be related to COVID-19 will provide vital preliminary data on feasibility, acceptability, tolerability, effectiveness, & safety. Findings from this study will inform future controlled trials of individualized CHM therapy for symptoms related to COVID-19 and support the use of CHM in the United States.  

Body region selectivity and intensity dependence in driving somatosensory-autonomic pathways by electroacupuncture

An inflammatory response is common in many viral infections including COVID.  While the role of acupuncture for the reduction of inflammation is suggested, the neuroanatomical basis is still poorly understood. Using novel genetic tools to manipulate specific somatosensory-autonomic pathways and using endotoxin-induced systemic inflammation as a model, Dr. Ma will present evidence supporting that electroacupuncture stimulation (ES) drives different autonomic pathways in somatotopy- and intensity-dependent manners. Low-intensity ES of the hindlimb, but not abdominal regions drive the vagal-adrenal axis, producing anti-inflammatory effects that depend on adrenal chromaffin cells expressing the neuropeptide Y (NPY). High intensity ES at the abdomen activates NPY+ splenic noradrenergic neurons via spinal reflexes; activation of these neurons can produce either anti- or pro-inflammatory effects due to disease state-dependent changes in adrenergic receptor profiles in splenocytes. Lastly, Dr. Ma will present preliminary work on identification of somatosensory neurons that drive the vagal-adrenal anti-inflammatory axis. The revelation of somatotopic organization and intensity dependency in driving distinct autonomic pathways could form a road map for optimizing stimulation parameters to improve both efficacy and safety in using acupuncture as a therapeutic modality for treating severe systemic inflammation such as in viral infections. 

11:30am – 12:00pm EDT

Panel Discussion: What Is the Global TEAM Response to Pandemics?

Panelists: Weidong Lu, MB, MPH, PHD, Dana-Farber Cancer Institute will present from a clinical perspective on how COVID patients are treated with TEAM, Claudia M. Witt, MD, MBA, Vice Dean for Interprofessionalism & Internationality, Professor of Medicine, University of Zurich, Director, Institute for Complementary and Integrative Medicine University Hospital Zurichwill discuss a TEAM narrative review on COVID-19, and Jianping Liu, MD, PhD, Professor, Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine will provide insight into COVID-19 treatment in China. An additional issue with the pandemic response has been the social and physical isolation of individuals.

The role of acupuncture and allied TEAM modalities for mental health outcomes will also be explored and expanded upon in the second symposium entitled, “Acupuncture and the Treatment of Chronic Physical and Emotional Pain”. 

12:00pm – 12:15pm EDT

Break / Networking with Exhibitors

12:15pm – 1:15pm EDT

A Special Keynote Presentation: Acupuncture and Whole Person Health

Speaker: Dr. Helene Langevin, MD, Director of NIH/NCCIH

Up to now, the bulk of research on acupuncture has focused on pain management, and great progress has occurred in this area in the last decades.  On the other hand, although acupuncture is also used clinically for enhancing and restoring health, there is comparatively little research addressing this topic.  This talk with outline NCCIH’s new Strategic Plan which is centered on the concept of Whole Person Health, and discuss how a whole person approach to acupuncture research fits into this new perspective.

1:15pm – 1:30pm EDT

Tribute in Memory of Hugh MacPherson

1:30pm – 2:00pm EDT

Poster Session / Visit Exhibitors

View poster presentations, ask questions about posters in the chat area, and visit virtual exhibit booths

2:00pm – 3:30pm EDT (concurrent sessions)

Member Symposium 1: The role of interoception in traditional East Asian medicine (TEAM)

Speakers: Lisa Taylor-Swanson, PhD, MAcOM, LAcCollege of Nursing, University of Utah; Vitaly Napadow, Ph.D., LAc, Director, Center for Integrative Pain NeuroImaging (CiPNI), Professor, Martinos Center for Biomedical Imaging, Harvard Medical School; and Peter Wayne, PhD, Director, Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women's Hospital

This symposium draws together the experience of three researchers who have evaluated the role of interoception in traditional East Asian medicine (TEAM) interventions. Interoception is commonly defined as sensation of the internal state of the body, and has been recently expanded to include the processes by which an organism senses, interprets, integrates, and regulates signals from within itself. TEAM interventions uniquely draw attention to the body’s internal state in multiple ways, and thus quantifying interoception and shows promise in improving our understanding the mechanisms underlying TEAM clinical outcomes. Interoception may be especially important in the study pain, as individuals with chronic pain have displayed impaired interoception in several studies. On a practical note, interoception is an identified NCCIH research priority and there are several funding opportunities open specific to interoception. The speakers will discuss interoception within the context of three TEAM-related interventions – Tai Chi/Qigong, acupuncture, and an acupuncture-inspired transcutaneous vagus nerve stimulation therapy. The session will open with an overview of interoception and related terminology provided by Dr. Vitaly Napadow, including the neurocircuitry involved in interoceptive processes. Dr. Napadow will then present findings from studies of Respiratory-gated Auricular Vagal Afferent Nerve Stimulation (RAVANS) - an acupuncture-inspired neuromodulatory intervention demonstrated to activate brain circuitry known to regulate interoception and evaluated as a potential treatment of chronic pain, including visceral pain and migraine. Dr. Lisa Taylor-Swanson will then present findings from a pilot study of acupuncture-associated changes in interoceptive awareness, pain severity, and pain intensity. Dr. Peter Wayne will discuss interoception-related findings from investigations of Tai Chi and QiGong, emphasizing the fundamental role of interoception in rehabilitation, and in the maintenance of physical and emotional wellbeing.  The session will conclude with a live question and answer period, for which all three presenters will be available to answer questions.

Presentation details include:

Introduction to interoception

Interoception is commonly defined as the sensation of the internal state of the body. Interoception has been recently expanded to include the processes by which an organism senses, interprets, integrates, and regulates signals from within itself. Traditional East Asian Medicine (TEAM) interventions draw attention to the body’s internal state, and thus interoception is highly relevant to TEAM clinical outcomes. In this introduction, Dr. Napadow will provide an overview of interoception, interoceptive awareness, and contextualize TEAM interventions within the interoceptive framework suggested by the recent NCCIH, NIH- sponsored workshop: “The Science of Interoception and its Roles in Nervous System Disorders: NIH Blueprint Workshop.”

Acupuncture-Inspired Therapies Targeting Interoceptive Pathways

From early texts of acupuncture and Chinese Medicine theory, breathing was considered an important variable for needling – e.g., when to insert and withdraw the needle. In fact, the rhythm of the breath is fundamental. Breathing is controlled by both autonomic and volitional processes – we don’t need to think about breathing in order to breathe, but we can also significantly speed up or slow down our respiratory rate. Conversely, the respiratory rhythm produces interoceptive afference and can itself impact cognitive, emotional, and sensory processing via inhibitory and faciliatory connections from the respiration central pattern generator, the Ventral Respiratory Group, in the medulla of the brainstem. Furthermore, acupuncture-like interventions can directly target interoceptive pathways. Transcutaneous vagus nerve stimulation (tVNS) targets the auricular branch of the vagus nerve at the ear, and is a promising therapy for clinical disorders such as migraine, depression, and visceral pain. As the primary afferent relay for the vagus nerve lies in the medulla and is differentially influenced by different phases of the respiratory rhythm, we have proposed that Respiratory-Gated Vagal Afferent Nerve Stimulation (RAVANS) can enhance brainstem targeting, leading to enhanced clinical outcomes. This talk will introduce the neurocircuitry underlying interoception and explore the known and unknown in the links between respiratory rhythm, vagus nerve physiology, and acupuncture-inspired neuromodulation.

Could acupuncture improve interoception, and would this be associated with other helpful outcomes?

Interoception is narrowly defined as the sense of the physiological condition of the body and is an NIH-identified research priority led by NCCIH. Disrupted interoceptive processes are central to the perception and chronification of pain. To date, mindfulness interventions have demonstrated improvements in pain severity by improving interoception – orienting attention to pain's sensory rather than emotional qualities.  My lab's preliminary data indicate that acupuncture may improve interoceptive awareness (IA), the self-reported interoception experience. A single acupuncture session (n=21) showed trends of improved IA domains of Not worrying, Noticing, and Body Listening as measured by the Multidimensional Assessment of Interoceptive Awareness (MAIA) scale. In this talk, Dr. Taylor-Swanson will provide an overview of the literature on interoception related to TEAM, with an emphasis on acupuncture, and discuss her lab's prior and ongoing work to discover whether acupuncture improves interoceptive awareness and whether this is an effect upon which clinicians can focus to improve pain and other symptoms experienced by our patients.

Interoception in mind-body-movement practices

At the heart of contemplative mind-body-movement practices like tai chi and qigong is skill training that aims to enhance how one accurately feels and 'knows' oneself.  Through monitoring of movement, posture and breath, in conjunction with focused meditative attention, mind-body-movement practices readily engage and train the inter-related processes of interoception, proprioception, and kinesthesis. This presentation will begin by outlining a framework that highlights a key role of interoception in tai chi and qigong (along with proprioception, and kinesthesis).  It will explore likely connections between the ability to sense oneself within an embodied state, and physical and emotional wellbeing.  It will then summarize evidence to date on how mind-body movement exercise interventions impact interoception and related processes. Methodological challenges and suggestions for future research will be discussed.

2:00pm – 3:30pm EDT (concurrent sessions)

Member Symposium 2: Is complexity science necessary for the study of East Asian Medicine during the COVID-19 pandemic?

Speakers: Lisa Conboy, MA, MS, ScD, Instructor in Medicine, Part-time, Beth Israel Deaconess Medical Center, Harvard Medical School, Director of the Research Department, The New England School of Acupuncture at MCPHS University; Tanuja Prasad MS, Apply Complexity (founder); Claudia Citovitz, PhD, MS, LAc, Director, Acupuncture Services, Research Assistant Professor, Department of Rehabilitation Medicine, NYU Medical School; and Claire M. Cassidy PhD, Windpath Healingworks LLC

This series of talks focuses on the application of Complex Adaptive Systems (CAS) science to East Asian Medicine (EAM) research and practice.  We begin our discussion with an overview of CAS science, some of its hallmarks, and applications.  Diagnosis and treatment within EAM is characterized by plurality, the peaceful coexistence of distinct modeling systems.  This plurality has presented a central challenge for acupuncture clinical research design and funding.  CAS may offer a way to bring together different types of EAM practices and medical science more generally.  This symposium reviews examples of current work using CAS models, each example using a different type of research methodology.  We highlight the example of the COVID-19 pandemic.

Presentation details include:

Complexity science as a framework for understanding East Asian Medicine (EAM)

We begin with an overview of the application of Complex Adaptive Systems (CAS) science to East Asian Medicine (EAM) research and practice.  We begin our discussion with an overview of CAS science, some of its hallmarks, and applications.  Diagnosis and treatment within EAM is characterized by plurality, the peaceful coexistence of distinct modeling systems.  This plurality has presented a central challenge for acupuncture clinical research design and funding.  CAS may offer a way to bring together different types of EAM practices and medical science more generally.  COVID-19 could be an important application.

Complexity Research to Gather Evidence on How Acupuncturists Make Clinical Decisions

We consider EAM decision-making among acupuncturists and find excellent examples of complexity in healthcare delivery.  Including such qualitative research techniques as interview studies can provide the powerful insights necessary to design high quality surveys and clinical research designs.

Is Acupuncture being studied as a Complex Intervention?  A narrative review.

HowEAM is being studied using a narrative review of the published literature.  CAS theory has been used in many disciplines such as economics and contemplative neuroscience.  Our limited narrative review identified publications proposing and/or using a ‘complex interventions’ or ‘complex systems’ framework for research in acupuncture and associated therapies. 

Complexity Science in the Pandemic: Designing and Executing Complexity-Informed Research

This is an overview of a CAS-informed pragmatic study of Chinese Herbal Medicine for suspected COVID-19 symptoms.  The observed unpredictability and heterogeneity of COVID-19 presentations and recovery trajectories demand a better understanding of how EAM works, with a potential strength being its complexity and flexibility.

3:30pm – 3:45pm EDT

End of Day Remarks