How Do You Treat Burning Mouth Syndrome in Your Practice?

The International Headache Society defines burning mouth syndrome (BMS; also known as glossodynia, stomatodynia, and by various other names) as a recurring burning sensation or dysethesia in the mouth, lasting for more than 2 hours, for more than 3 months, on a daily basis.¹ The Society's definition also includes no clinical evidence of oral mucosal lesions and no causation by other conditions or diseases.¹ Most authorities consider the above definition applicable to the primary variant of BMS. The secondary form is usually related to nutritional deficiencies, diabetes mellitus, candidiasis, conditions requiring use of antihypertensives (angiotensin-converting enzyme inhibitors), food allergy, allergy to dental products, xerostomia, gastroesophageal reflux disease, hypothyroidism, oral conditions such as fungal infections, lichen planus, and psychologic factors.

The prevalence of BMS varies from 0.7% to 15%, depending on the population investigated.² The ratio of females-to-males is 7:1, and 90% of the affected women are perimenopausal.³ The tongue is the most commonly affected site (52.7% tongue alone and 28.4% in combination with other areas).⁴ BMS can also affect the palate and lips.

Diagnosis is made by the symptoms in the absence of oral signs.

Modern biomedicine treatment involves cold drinks; ice chips; sugarless chewing gum; and avoidance of alcohol, tobacco, and spicy acidic foods. Tricyclic antidepressants, clonazepam, gabapentin, topical capsaicin, alpha-lipoic acid, and cognitive–behavioral therapy have been used with varying degrees of success.

BMS in Chinese Medicine

Every internal organ has a relationship to a specific sense organ. This relationship is usually expressed as “opens into____.” Examples include:

• Stomach/Spleen opens into the mouth.

• Heart/Small Intestine opens into the tongue.

• Liver/Gall Bladder opens into the eyes.

• Kidney/Urinary Bladder opens into the ears.

• Lung/Large Intestine opens into the nose.

The Pericardium and Triple Warmer also open into the tongue, but this is usually clinically insignificant. In clinical practice, Stomach usually produces its manifestations all over the mouth, Spleen on the lips, and Heart on the tongue, especially the tip of the tongue.

The pathogenic factors in Chinese Medicine are Wind, Cold, Heat, Dampness, Dryness, and Fire. Fire burns, is hot, is red and it dries.

Putting all of the abovementioned factors together, BMS is generally Stomach Fire, and, if it is limited to the tip of the tongue, it is usually Heart Fire; overlapping is common.

When addressing Heat/Fire (Fire is extreme Heat), one has to remember two additional facts: (1) The Heat could be due to Yin Deficiency. In Yin Deficiency, Yang goes up, producing Heat. If the Stomach Heat is due to Yin Deficiency, the normal coating on the tongue, which depends on normal digestion, will be absent. (2) Heat often combines with Phlegm to produce Phlegm Heat. If this happens to the Heart, there will be major mental symptoms, with loss of insight (Phlegm misting the Mind). These facts have to be addressed in treatment.

Diagnosis

Stomach Fire involves epigastric burning, thirst with a desire to imbibe cold drinks, and a red tongue with a yellow coating. If Heat is due to Stomach Yin Deficiency, the tongue coating will be absent. Heart Fire involves palpitation as the most common symptom. Heart houses the Mind. Hence, mental symptoms, such as restlessness, insomnia, sleep with disturbing dreams, and red tongue with redder tip are the features.

In the Five Element system, Liver is the Mother of Heart. Liver Fire can be the precursor of the Heart Fire. In such cases, the redness at the tip of the tongue will extend to the side margins of the tongue, where Liver/Gall Bladder are represented.

Treatment

Treatment directed at the pathology often produces satisfactory results.

For Stomach Fire, LI 11 reduces/clears Heat in general. CV 21, LI 4, ST 21, ST 34, and ST 44 all clear Stomach Heat. All of these aforementioned points are reduced. CV 10, CV 12, and CV 13 are stimulated by the even method to subdue Rebellious Stomach Qi.

For Stomach Yin Deficiency, ST 36, SP 6, and KI 6 are reinforced.

For Heart Fire, LI 11 clears Heat generally, HT 8 and CV 15 clear Heart Fire, and HT 5 and GV 20 calm the Mind. All of these points are reduced. SP 6 and KI 6 are reinforced to promote Yin; this cools the Fire.

If the Heart Fire is secondary to Liver Fire, the points used are LR 2, LR 3, and GB 20 to drain Liver Fire. LI 11 clears the Heat in general. All points are reduced. SP 6 is reinforced to stimulate Yin, which cools the Fire.

A course of treatment is comprised of 12–16 treatments at biweekly intervals. Thereafter, treatment is administered once per month for maintenance.

Auricular Points

Auricular points used to address BMS include Mouth, Tongue C, Tongue E, Point Zero, and Shen Men. Select according to tenderness.

Chinese Herbal Preparations

For Stomach Fire, Qing Wei San (Clearing the Stomach Powder) is used. For Heart Fire, Xie Xin Tang (Draining the Heart Decoction) is used.

Evidence for Acupuncture

In one study capillaroscopic observation showed a significant variation of the vascular pattern, which was associated with a significant reduction of the burning mouth sensation after 3 weeks of acupuncture therapy. This benefit was maintained after 18 months.⁵ Sardella et al., in a pilot study involving 10 patients, showed statistically significant reduction of pain after 8 weeks of acupuncture.⁶ Satko et al. demonstrated the success of acupuncture treatment in 178 cases of glossodynia, stomatodynia, and other stomatologic disorders of a polyetiologic nature for more than 13 years.⁷ In a randomized controlled trial comparing the effects of acupuncture with clonazepam, both were found to be equally effective but acupuncture produced fewer side-effects.⁸ Successful treatment of a case of BMS with no symptoms returning after 6 months was reported in an earlier issue of this journal.⁹ Brailo et al. reported a 55.2% reduction in burning symptoms in 16 patients with BMS after laser acupuncture.¹⁰

Illustrative Case

A 62-year-old woman presented with glossodynia of 1½ years' duration. She also suffered from anxiety, palpitations, and temporal headache, which was diagnosed as migraine. Her tongue had a yellowish coating, with a red tip and lateral margins. Her pulse was wiry. The diagnosis was BMS due to Heart Fire (red tip of the tongue, anxiety, and palpitations). The Heart Fire was secondary to Excess Liver Yang (migraine, red margins of the tongue, and the wiry pulse).

The points selected for her treatment were (notations indicate: ↑ reinforce, ↓ reduce):

• LI 11 ↓ (to reduce general Heat)

• GV 20 ↓ and HT 7 ↓ (to calm the Mind)

• HT 8 ↓ (to reduce Heart Fire)

• LR 2 ↓ LR 3↓ (to reduce Liver Yang)

• GB 8 ↓, Tai Yang ↓ (local points to address the temporal headache)

• SP 6 ↑, KI 6 ↑ (to promote Yin and cool Fire)

• LR 8 ↑ (to nourish the Liver).

Treatment was given twice per week for 8 weeks, then once per month, targeting her glossodynia and migraine. Assessment after 8 weeks showed an 85%–90% improvement in both conditions. Silybum marianum (milk thistle) was given to this patient to nourish the Liver. Dietary advice to avoid alcohol, tobacco (passive smoking), and fatty foods was emphasized.

As of this writing, this patient continues to maintain these improvements. Such cases with combined patterns are often more resistant to treatment.

Address correspondence to:

Poovadan Sudhakaran, MBBS, PhD

MastACU, MastTCM

26 Tuckers Road

Templestowe, Victoria 3106

Australia

E-mail: dr.p.sudhakaran@gmail.com

According to the International Headache Society Committee, burning mouth syndrome (BMS) is an idiopathic condition that causes an intraoral burning or dysesthetic sensation, recurring daily for more than 2 hours per day, over more than 3 months, without clinically evident causative lesions.¹ Prevalence of BMS increases with age in both males and females, but mainly affects females in the fifth to seventh decade.^2–4 BMS typically is a chronic problem of older adults, and is more common in women than men, with a 7:1 females-to-males ratio of occurrence,^2–8 and this population is prone to side-effects from medications. BMS can involve multiple sites, but the tip of the tongue is the most common location (71%), followed by the lips (50%), lateral border of the tongue, (46%) and palate (46%).⁹

A systematic review of acupuncture or acupoint injections for managing BMS showed positive outcomes when patients with BMS underwent acupuncture therapy.¹⁰ A randomized controlled trial showed that acupuncture and clonazepam are similarly effective for patients with the condition.¹¹ Another study showed that combined acupuncture/auriculotherapy was effective for reducing the intensity of the burning and improving quality of life (QoL).¹²

Treatment

Our protocol is for patients to be treated on the following acupuncture points: ear Shen Men, GB 2, LI 4, LI 11, LI 20, LR 3, KI 6, PC 6, SP 6, ST 36, CV 24, TE 2, TE 5, and TE 21; plus a variety of points depending on the patients' different burning TCM patterns, gastrointestinal (GI) problems and body constitutions.

Millennia stainless-steel needles, size 40, 0.5½” for the ear points, and size 34, 1½” for the body points, are inserted until a Qi reaction is elicited (De Qi sensation). The needles are left in place for 30 minutes.

Some BMS diagnoses according to Traditional Chinese Medicine, include:

• A patient's burning pain pattern could be on the inner lips (Liver pattern), outer lips (Spleen pattern), palatal roof (GV meridian), upper gum (Stomach pattern), and/or lower gum (Large Intestine pattern).

• A patient could have pain and burning at the tip of the tongue (Heart pattern; associated with anxiety), central dorsum of the tongue (Spleen, Stomach associated with GI problems), and/or the bilateral tongue border (Liver; emotional stress).

Results

Results of acupuncture are usually positive with 3 weekly treatments, but some patients might need more treatments. Our yet-unpublished case series showed positive results. We treated 11 patients (5 males and 6 females, ages 56–83) who were diagnosed with BMS and who were being actively treated with Klonopin.^® Acupuncture treatments were administered weekly for 5 weeks. At the first, third, and fifth weekly sessions, the patients' pain and restfulness were recorded on visual analogue scales before the acupuncture treatments. If adverse events had occurred they would have been recorded.

The ratings for pain and rest were significantly reduced during 3 time periods (pain: P = 0.001; rest: P = 0.001). There were no adverse events. These results give us additional confidence in our treatment protocols.

Greg Goddard, DDS¹

and Cynthia Diep DDS, LAc²

¹San Francisco, CA 94107

²UCLA Health Center for East-West Medicine

UCLA Collaborative Centers for Integrative Medicine

Los Angeles, CA

Address correspondence to:

Greg Goddard, DDS

456 Missouri Street

San Francisco, CA 94107

E-mail: greggtmd@yahoo.com

Burning mouth syndrome (BMS) is an idiopathic chronic pain condition characterized by intraoral burning sensation although the oral mucosa are clinically normal.^1,2 BMS is more prevalent in females in their fifth-to-seventh decades. Common presentations of the syndrome are chronic pain in the anterior two-thirds of the tongue, xerostomia with sensations of scalding, and altered taste sensations or ageusia.^3,4 Generally, the pain tends to increase and maximizes in the evening.⁴ Although the etiology of BMS is unknown, a few researchers have studied dysfunction of several cranial nerves associated with taste sensation and small-fiber sensory neuropathy of the tongue as possible causes of BMS.^3,4

Traditional Chinese Medicine and Oriental Medicine are important for addressing idiopathic conditions such as BMS. Acupuncture is the salient therapy in these systems and has proved to be as effective as benzodiazepines or anticonvulsants which are standard therapies for BMS.⁵ Acupuncture aims at establishing a balance between the Yin (represents Passivity, Cold. and Darkness) and Yang (represents Activity, Heat, and Light) forces of an individual by correcting Deficient Yin and Excess Yang.

Case Study

A 61-year-old female presented with a 2-year history of orofacial pain and complained of dryness of the mouth, pain, and a scalding sensation on the tip of her tongue and lips. She also complained of altered gustatory sensations leading to a reduced appetite. The pain increased in intensity toward the end of the day and disturbed her sleep. Her symptoms worsened with intake of hot foods and liquids. On clinical examination, no lesions or other pathologies of her oral mucosa were found. She had been advised to take 0.5 mg/day of clonazepam. Acupuncture therapy was scheduled for 5 days per week for 5 weeks; each session lasted 30 minutes. 0.25 × 25–mm sterilized needles were used for puncturing the chosen points. These points were local, distal, and potent analgesic points: ST 5; ST 6; ST 36; ST 44; GB 2; LI 4; SP 6; SI 18; TE 21; and GV 20, as shown in Table 1. The patient's symptoms were scored on a 10-point visual analogue scale (VAS) before commencement of the treatment and after completing the last acupuncture session. Her VAS symptom score was reduced substantially after 5 weeks of therapy, as shown in Table 2, and her medication was discontinued

Table 1.

The Selected Points with Needling Details for Management of BMS with Acupuncture

Session #	Acupuncture point	Needling
1	ST 5 (Taying)	0.5 cun slanting
2	ST 6 (Chiache)	0.3 cun perpendicular
3	ST 36 (Zusanli) bilateral	1 cun perpendicular
4	ST 44 (Neiting)	0.2 cun slanting upward
5	GB 2 (Tinghui)	0.3 cun perpendicular
6	LI 4 (Hegu)	1 cun perpendicular
7	SP 6 (Sanyinjiao)	1.5 cun perpendicular
8	SI 18 (Quanliao)	0.3 cun slanting
9	TE 21 (Ermen)	0.3 cun perpendicular
10	GV 20 (Baihui)	0.3 cun slanting posteriorly

BMS, burning mouth syndrome.

Table 2.

Subjective Reductions in Symptoms Graded on a 10-point VAS & Medication Use

Symptom	VAS score (before therapy)	VAS score (after therapy)
Pain in the tongue	9	2
Dryness of the mouth	9	2
Scalding sensation on tip of the tongue	10	2
Scalding sensation on lips	9	3
Altered taste perceptions	7	1
Insomnia	9	1
Low appetite	8	1

Medication use	Dose before therapy	Dose after therapy
Clonazepam	0.5 mg/day	0

VAS, visual analogue scale.

Nishitha Jasti, BNYS,

and Hemant Bhargav, MD, PhD (Yoga)

Department of Psychiatry

National Institute of Mental Health and Neuro Sciences

(NIMHANS) Integrated Centre for Yoga

Bangalore, India

Address correspondence to:

Nishitha Jasti, BNYS

Department of Psychiatry

Integrated Centre for Yoga

NIMHANS

Hosur Road

Bangalore 560029

India

E-mail: nishitha.jasti910@gmail.com

Burning Mouth Syndrome (BMS) is a disorder of unknown etiology.¹ It is characterized by a burning sensation that occurs in clinically healthy oral mucosa.¹ BMS occurs mostly in middle-age and elderly woman and is triggered by various factors.² However, even with a females-to-males ratio of ∼7:1, BMS can be triggered by various factors in males.³ The pathogenesis seems to be complex and probably involves systemic, and/or psychogenic factors.⁴ Although various approaches to treat BMS effectively do exist, there is no definitive cure for this disorder.⁴

Studies and clinical trials investigating the effect of acupuncture on BMS have been performed.

In a study by Scardina et al., Traditional Chinese Medicine–based acupuncture treatment influenced oral microcirculation, resulting in a significant variation of the patients' vascular patterns.⁵ A significant reduction of BMS after 3 weeks of therapy was found along with the above finding. The significant reduction of BMS was permanent for 18 months following the acupuncture treatment.

In a clinical trial by Franco et al., the intensity of pain/burning decreased significantly in patients after the first treatment of combined acupuncture and auriculotherapy.⁶ In this trial, combined acupuncture/auriculotherapy was effective for reducing BMS, as noted at a 2-year follow-up.⁶

Clinical Example of I-Ching Balance Acupuncture (ICBA) Treatment for BMS

A 59-year-old Caucasian male sought acupuncture treatment for BMS, which he suffered from for ∼4 years. This BMS began after the patient underwent a coronary artery bypass grafting procedure, ∼4 years prior to his current presentation. Thereafter, he also underwent a cholecystectomy ∼3 years prior and a splenectomy ∼1 year prior, respectively, to his current presentation.

Given that the pathogenesis of BMS is presumed to involve systemic, and/or psychogenic factors, this patient's BMS imbalance was considered to be global. Therefore, the ICBA treatment strategy was defined as meridian interconversion for global balance.⁷ Given that there are no meridians in the oral cavity and tongue, virtual paths of Kidney (foot Shao Yin) and Stomach (hand Yang Ming) meridians were considered for mapping sick meridians for the oral cavity and tongue.

ICBA obeys meridian theory, and Chinese meridians are its primary diagnostic tool. ICBA's pulse diagnostics concentrates on Excess (Shi) and Deficient (Xu) conditions.⁸ To confirm the involvement of the sick meridians, ICBA pulse diagnostics was used.⁹ Foot Shao Yin and Spleen (foot Tai Yin) were detected. In addition, Pericardium (hand Jue Yin) and Gall Bladder (foot Shao Yang) Shi were determined.

After the sick meridians were confirmed with the ICBA pulse diagnostics, the following meridians and acupoints were used: Foot Shao Yin was interconverted with Large Intestine (hand Yang Ming), and foot Tai Yin was interconverted with hand Shao Yang. On the contralateral side Pericardium (hand Jue Yin) 6 and 9 were interconverted with foot Yang Ming 42 and 45, and Heart (hand Tai Yin) was interconverted with Gall Bladder (foot Shao Yang).

The above interconversion was achieved using the following acupoints: On one side: foot Shao Yin 1 and 4; foot Tai Yin 1 and 4; hand Yang Ming 1 and 4; and hand Shao Yang 1 and 4. On the other side: hand Shao Yin 3 and 7; hand Jue Yin 6 and 9; foot Shao Yang 34 and 41; and foot Yang Ming 42 and 45. The interconversion enabled the patient to receive a well-balanced truss. (Fig. 1)

FIG. 1.

Balanced truss.

This patient was treated with 2 weekly 60-minute ICBA sessions for 7 weeks. Following 14 sessions, complete dissipation of his BMS was achieved and he completed the treatment. No BMS recurrence was reported by the patient at a 2-year follow-up.

Address correspondence to:

Arkady Kotlyar PhD, DiplAC

3 Herzel Street, Apt. 1

Ness Ziona, HaMirkaz 7408402

Israel

E-mail: dr.kotlyar@chi-point.com

Burning mouth syndrome (BMS) affects up to 7% of the general population and is a chronic idiopathic pain condition that afflicts middle-age and elderly peri- and postmenopausal women preferentially. These patients present variably with nonspecific persistent symptoms of burning and intraoral pain although their mucosa are healthy.^1,2 The prevalence of BMS in the elderly population (ages 65 to 75 or older) has increased exponentially from 5.6% to 57.4% in Japan over the past decade.³ Intraoral pain, distaste, and dryness of the mouth, with variable diurnal severity and presentation are the triad of type I to type III BMS.^2,4

Evidently, great numbers of etiologic factors—including various medications, intraoral mucosal lesions, systemic physical and psychiatric diseases, and genetic polymorphisms of burning mouth sensations—need to be excluded via a comprehensive work-up. This would include taking a thorough history, performing physical and systemic examinations, and using pertinent screening tools and diagnostic tests such as imaging for making a precise diagnosis of chronic primary BMS.^1,2,4–8 Nonetheless, both the diagnosis and treatment of BMS continue to challenge professionals; this situation has been attributed to its ill-understood etiopathogenesis, pathophysiology, lack of global treatment guidelines; and absence of a gold standard of care.^1,2,4–9

Treatment Interventions for BMS

Kim et al.¹ (2018) and Siregar (2015)⁸ described a stepwise, evidence-based approach for managing BMS and found that traditional Chinese acupuncture, temporary hormone-replacement therapy, capsaicin, herbal supplements, topical analgesics, and antidepressants were relatively good modalities but not for resistant BMS. The therapies that might improve difficult-to-treat BMS are certain antipsychotics, lidocaine, relaxation, laser acupuncture therapy, repetitive transcranial magnetic stimulation, and topiramate.^{1,2,4,8,10–15} The efficacy of laser therapy for BMS continues to be weak^13–15; however, a 2013 study found that laser acupuncture produced significant improvements in patients with BMS.¹⁶

A Question About Acupuncture Use for BMS

Given the many complexities of BMS—including ill-understood etiology, pathophysiology, diagnosis, and comorbidities, absence of global treatment guidelines, and lack of a gold standard of care—management of the condition is very difficult and highly variable around the world.⁹ Therefore, a typical case of primary BMS could require an individualized symptom-centered approach with a multidisciplinary team to target the diverse key manifestations of the condition.^1,2,9 Given that several short- and long-term interventions—including complementary and alternative medicine therapies and conventional medications—have variable efficacies and fail to produce complete recovery,^2,4 a pertinent question arises: “Is medical acupuncture alone—without other complementary, alternative, and modern therapies—robustly effective for treating BMS?

Medical Acupuncture

Medical acupuncture—a cost-effective prevention and treatment modality with a relatively safe clinical profile as practiced by competent acupuncturists—is increasingly used to treat many health conditions, including BMS, around the world.¹⁷ Medical acupuncture that follows a Traditional Chinese Medicine (TCM) concept—in terms of the human body made up of polarity, the union of two opposites comprising the balance by a mutual relationship, mutual control and transmutation— targets the patient with variegated BMS holistically, striking a balance of Yin and Yang energy among the organs. Consequently, analgesia, muscle relaxation, sedation, depression relief, inflammation and spasm reductions, repairs, and immunity promotion will ensue. Additional mechanisms of acupuncture include stimulation of microcirculation (bloodstream) and neurophysiologic pathways, including affecting peripheral nerve fibers (A-delta and C), spinal cord, synapses, established reflex arcs, preganglionic neurons, and spinoreticular and spinothalamic tracts.¹⁸

Careful selection of acupuncture points and needle depths in each patient with BMS is highly desirable and is based on the principles of Western conventional biomedicine, ancient Yin and Yang theory, the Five Elements, Zang Fu, and the meridians of TCM. The most-common acupoints used to treat BMS include ST (Stomach meridian), LI (Large Intestine), KI (Kidney), LR (Liver), LU (Lung), and GV (Governing Vessels) points. The needles usually applied to both sides of the body, and systemic and local acupoints used to treat BMS, are: KI 3; KI 6 (distal/systemic); KI 7; LR 3; ST 3– ST 7; ST 36; LI 4; LI 11; LI 20; GV 20; GV 26; and LU 7. In addition, ear acupoints used to address BMS include: Shen-Men; Central Nervous System, nutritionally variant streptococci, Kidney, Spleen/Pancreas, and Mouth.^18,19

Brief Review of Acupuncture and BMS

English literature concerning acupuncture for treating BMS is limited. In a case report on chronic BMS, a patient with orofacial pain that did not respond to rescue therapy was treated with gabapentin and tramadol, and had 8 acupuncture treatment sessions at a weekly frequency. Standard needles were applied to several acupoints: ST 5, ST 6, ST 7, SI 18, GB 2, and TE 21 (local); and GV 24, LI 4, ST 36, and ST 44 (systemic). The patient was “very much improved” at a 6-month follow-up and acupuncture was considered to safe and effective for treating BMS.²⁰

In a single-arm clinical trial involving 8 patients, combined use of acupuncture and auriculotherapy to treat BMS was found to be effective and all patients were improved with better QoL at a 2-year follow-up.²¹

A systematic Chinese review comparing 9 studies included 547 randomized patients. Acupuncture in 7 of these studies produced significant improvements in patients with BMS, compared with other treatments.²² However, the included studies had questionable methodologies and were published in Chinese magazines rather than in scientific journals.²³

Scardina et al. (2010) found that traditional acupuncture was significantly effective for 30 patients with BMS; these patients' conditions were stable at an 18-month follow-up.²⁴

In a pilot study, Sardella et al. (2013) found significant reductions of intraoral pain in 10 patients with BMS who were treated with 20 sessions of acupuncture for 8 weeks.²⁵

Brailo et al. (2013) reported the use of laser acupuncture (8 sessions, each lasting 15 minutes, every other day) in 16 patients with chronic BMS. Selected acupoints were used (ST 1, ST 2, ST 3, ST 4, ST 5, LI 4, LU 7, GV 14, CV 17, SP 6, SP 9, and SP 10) at a laser wavelength of 660 nm, an output power 50, and doses of 1.5–2.0 J/cm (Medio Laser Estate, Iskra Medical, Slovenia). All patients reported reduction of their oral burning symptoms, via their VAS scores.¹⁶

Another comparative study involved 20 patients with BMS who were treated with acupuncture, at a ½-hour session, 3 times per week, for 4 weeks. Needles, of 0.25 mm in diameter and 30 mm in length, were inserted at a depth of 0.5–1 cun. The elicited response was De Qi, accompanied by redness and a feeling of numbness around the needles in the following selected acupoints: ST 8 (Stomach; tou wei); GB 2 (Gall Bladder; tinghui); TE 21 (Triple Energizer; ermen); SI 18 (Small Intestine; quan liao); SI 19 (Small Intestine; ting gong); LI 4 (Large Intestine; yuan ) on both sides of the body; as well as GV 20 (Governing Vessel; bai hui). Acupuncture was compared with clonazepam given to another 20 patients (4 tablets per day of 0.5 mg for 4 weeks). This researchers found that both interventions were equally effective in patients with BMS.²⁶

Clinical Vignette

A postmenopausal patient presented with symptoms of intense burning pain especially involving the anterior two-thirds of the tongue (dysthesias), altered taste (dysgeusia), and dryness of mouth (xerostomia) of long duration (≥ 10 months). The patient had consulted multiple doctors and used many modern therapies but had minimal or no benefit at all. On local, physical and systemic evaluation, no obvious oral lesions, systemic diseases, nor psychologic disorders were found. Furthermore, relevant laboratory investigations, psychologic screening, and imaging procedures also showed no abnormal results. This elderly female patient was diagnosed with chronic BMS and she gave oral consent for holistic treatment by a medical acupuncturist who used a pragmatic protocol that involved 30-minute sessions, 3 times per week for 4–8 weeks, and needles of 0.25 mm in diameter and 30 mm in length, inserted at a depth of the 0.5–1 cun.

The patient had a De Qi response, with redness and a feeling of numbness around the needles on these acupoints: ST 8; GB 2; TE 21; SI 18; SI 19; and LI 4 on both sides of the body; as well as GV 20. Following 6 weeks of acupuncture treatment, she reported significant improvement (90%) compared to pretreatment. She also reported further improvement with a better QoL at a 6-month follow-up. In sum, medical acupuncture by means of a specific protocol targeting an individual patient was used safely and cost-effectively as an alternative mode of intervention.

Conclusion and Summary

Medical acupuncture is an effective holistic modality for treating patients who have primary or secondary BMS. Medical acupuncture alone—using antiseptic measures, bilateral selected acupoints, specific-sized needles and depths of insertion—is relatively safe, less expensive, and fairly effective in patients with BMS. This modality may need to be combined with other suitable complementary modalities or with conventional medications to treat resistant cases of BMS. Given the limited literature, rigorous comparative studies on medical acupuncture are needed in patients with BMS in the future.

Address correspondence to:

Naseem Akhtar Qureshi MD, PhD

Publication Division

National Center for Complementary and Alternative Medicine

of Riyadh, Saudi Arabia

Alfalah locality, Al-Mizan Street

11662, Riyadh

Saudi Arabia

E-mail: qureshinaseem@live.com