Acupuncture is a system of healing which has been practised in China and other Eastern countries for thousands of years. Although often described as a means of pain relief, it is in fact used to treat people with a wide range of illnesses. Its focus is on improving the overall well being of the patient, rather than the isolated treatment of specific symptoms.
Qi
According to traditional Chinese philosophy, our health is dependent on the body's motivating energy - known as Qi - moving in a smooth and balanced way through a series of meridians (channels) beneath the skin. Qi consists of equal and opposite qualities - Yin and Yang.
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When these become unbalanced, illness may result. By inserting fine needles into the channels of energy, an acupuncturist can stimulate the body's own healing response and help restore its natural balance. The flow of Qi can be disturbed by a number of factors. These include emotional states such as anxiety, stress, anger, fear or grief, poor nutrition, weather conditions, hereditary factors, infections, poisons and trauma.
The principal aim of acupuncture in treating the whole person is to recover the equilibrium between the physical, emotional and spiritual aspects of the individual.
[ Meridians
According to the tenets of TCM, Qi is carried through our bodies along the channels, called meridians. There are 14 main meridians do not correspond to any visible anatomical structures in the body, such as nerves or blood vessels. But in Chinese medicine they are thought to embody a physical reality — that of Qi flowing through our body, providing nourishment and strength.
Twelve of the meridians are bilateral; that is, identical versions of them exist on each side of the body.
LUNG Large Intestine
Spleen Stomach
Heart Small Intestine
KIDNEY BLADDER
PERICARDIUM TRIPLE WARMER
LIVER GALLBLADDER
The other two run along the body’s midline — one along the front, the other along the back. Each of the 12 major meridians is named according to the anatomical structure, or organ, it is thought to influence.
[ Points
The meridians connect the interior and exterior of the body. Thus, according to TCM theory, placing needles in points along the meridians on the surface of the body will affect the related internal organs. In acupuncture, the flow of chi is strengthened, calmed or unblocked by the insertion of hair-thin needles of varying lengths at specific points along the meridians; the same points are used in the practice of acupressure.
There are around 400 recognised acupuncture points on the body, of which about 100 are most commonly used.
Western scientists have shown that many of these points are located at key crossways of the autonomic nervous system. This may explain, in part, why they can affect pain that the patient experiences in a part of the body far from where the needles are inserted.
[Diagnosis
Normally, the practitioner must have a diagnostic interview, such as asking the patients the questions that relate to their health problems, taking pulses and observing the tongue. The diagnosis is based on an overall analyse of the conditions and symptoms. A treatment plan is set up following the diagnosis.
The principles of Acupuncture points selection
General speaking, there are three group acupuncture points:
* Channel Points Classical points which line on the meridians.
* Extra Points May not necessarily line on the meridians
* Ashi Points Tender / trigger points
Acupuncture: efficacy, safety and practice - a BMA report
Up to five million people may have consulted a therapist specialising in complementary and alternative medicine (CAM) in the last year with an incalculable extra number consulting a doctor or other health professional practising CAM. A new report from the British Medical Association, published on 25th June 2000, looks at the usefulness, safety and availability of acupuncture - one of the most widely requested treatments.
Acupuncture: efficacy, safety and practice comes from the BMA's Board of Science and Education and is launched on the eve of the Association's week-long Annual Representative Meeting in London.
A postal survey of a random sample of UK family doctors carried out for the report found that almost half the GPs who responded had arranged acupuncture for their patients. An even higher number (58% of the 365 GPs) had arranged some kind of CAM for patients, with osteopathy and homoeopathy being next most popular.
Dr Vivienne Nathanson, Head of Health Policy at the BMA, commented: "Of the 169 GPs who reported arranging acupuncture treatment for their patients 15% provided it themselves, 57% used another doctor, 24% used a physiotherapist and only 5% had used a Traditional Chinese Medicine practitioner." Almost half of the GPs said they would like to receive some training in acupuncture in order to treat their patients in the future. The report states "Overall 79% of the GPs agreed that they would like to see acupuncture available on the NHS".
Is acupuncture effective?
The report evaluates the evidence for acupuncture as a treatment for back and neck pain, osteoarthritis, recurrent headache, nausea and vomiting, smoking cessation, weight loss, stroke and dental pain. Chapter two concludes that according to current evidence, acupuncture appears to be more effective than control interventions for nausea and vomiting (particularly for post-operative symptoms in adults), back pain, dental pain and migraine. Evidence is unclear about a specific response to acupuncture in osteoarthritis and neck pain cases. It considers that the jury is still out for its use in treating recovery from stroke, tension headache, fibromyalgia and certain joint dysfunction. The report states: "Acupuncture appears not to be superior to sham acupuncture (used as a control in research) for smoking cessation and weight loss."
Dr Nathanson commented: "We
need to see more high quality research into the effectiveness of acupuncture.
The National Institute for Clinical Excellence (NICE) has been established to
look into the value of particular treatments. We think NICE is well placed to
consider acupuncture and produce guidance for the NHS."
How safe is acupuncture?
Complications after acupuncture generally fall into three categories: physical injuries, infections and other adverse reactions. The BMA report states: "Many of the (physical) injuries can be avoided by ensuring acupuncturists are fully trained in anatomy and physiology, with particular emphasis on teaching the location and depth of major organs. Even the most basic first aid course has such a component." Inadequate or improper sterilisation techniques are a serious risk factor for infections and this is recognised by acupuncture professional bodies and reflected in their codes of practice, states the report. Transmission of infections can be avoided if all practitioners use only pre-sterile disposable needles rather than re-usable needles which require sterilisation. Other adverse reactions can include more minor events such as bleeding on withdrawal of the needle, bruising, and drowsiness. After examining all the relevant studies, the BMA report states "the incidence of adverse reactions to acupuncture appears relatively low."
An increasing number of patients are asking their GP about acupuncture and both doctors and patients find it difficult to decide which practitioners are adequately trained and qualified. Dr Nathanson said: "Anyone within the UK can use the title 'acupuncturist' and in common with many other CAM therapies, acupuncture is not regulated by statute." There are a number of organisations offering education and training with a considerable range of standards and levels. The report states: "there is a need for a consensus on the minimum standards of training required for all potential acupuncture practitioners."
Recommendations in the BMA
report include consideration to be given to the integration of acupuncture into
the NHS. Guidelines on CAM for use by both GPs and patients are urgently needed,
says the report. The Department of Health should select key CAM therapies
including acupuncture for appraisal by NICE in 2001-2002. The BMA wants to see a
national surveillance system for the reporting of adverse events. It would also
like to see a general list of all acupuncturists, medically and non medically
qualified, to help NHS doctors in the referral process . Other recommendations
relate to the need for more research and funding, regulation, communication, and
training.
Recently in USA, an expert panel convened by the National Institutes of Health
met to evaluate the scientific merits of acupuncture, a form of traditional
Chinese medicine whose roots date back thousands of years. The
two-and-a-half-day consensus conference brought together a dozen scientists and
clinicians from a wide variety of fields in a sort of “science court” to review
hundreds of studies on acupuncture’s uses, risks, and benefits. The panel found
“clear evidence” that acupuncture is effective for a limited range of
conditions: postoperative dental pain and nausea associated with surgery,
chemotherapy, and pregnancy. The group found less convincing evidence for a
number of other problems, including headache, low back pain, tennis elbow,
carpal tunnel syndrome, fibromyalgia, menstrual cramps, asthma, stroke
rehabilitation, and addiction. The report concluded that, for these conditions,
acupuncture may be effective as an adjunct or alternative to more conventional
treatment. In one case—smoking cessation—the panel found no evidence supporting
the use of acupuncture. The age-old premise behind acupuncture is that patterns
of energy, called Qi, flow through the body and help to maintain health. When
this energy flow is disrupted, disease can occur. Acupuncture aims to restore
the balance of this flow by stimulating specific points in the body with very
thin metallic needles inserted into the skin. In one form of acupuncture,
called moxibustion, heat may also be applied. Since 1996, the FDA has regulated
the use of acupuncture needles, just as it does other medical devices. Chinese
practitioners have identified approximately 400 acupuncture points, many of
which are connected by lines of energy called meridians. Treatment may involve
stimulation of points at sites far distant from where the pain or other problem
occurs. For example, the acupuncture points commonly used for asthma include
sites in the hands and ankles as well as the chest and back. Treatment is often
individualised, and points used may vary, even for people with similar health
complaints, and may change during the course of treatment. For now, Western
medical science is only beginning to understand how acupuncture may exert its
effects. Some studies have found evidence that stimulation of acupuncture points
releases opioids and neurotransmitters that may help relieve pain. Other studies
show that it may also activate the hypothalamus and the pituitary gland, alter
the secretion of neurotransmitters and hormones, and change the regulation of
blood flow. But it is still unclear which, if any, of these mechanisms is
responsible for acupuncture’s clinical effects.
There are about 1,800 acupuncturists registered with British Acupuncture Council (BAcC) in UK. There are more than 10,000 licensed acupuncture practitioners in the US, about 3,000 of whom are physicians. About 12 million visits are made to acupuncturists each year in USA. With the panel’s recommendation to increase public access to and coverage of acupuncture, it’s likely that the use of this already popular practice will continue to grow. While acupuncture may not yet be part of mainstream medical care, this comprehensive NIH review shows that the therapy is effective, at least for certain symptoms and problems, and that the practice holds promise for a number of other conditions. The panel’s review identified those studies that met specific criteria, considered the “gold standard” for medical research. Patients had to have been selected at random to receive acupuncture, another treatment, or a placebo. Studies also had to be carefully controlled to account for factors that might skew the data, include enough patients to see statistically significant results, use generally accepted acupuncture points, and provide a sufficient number of treatments. Based on these criteria, as well as presentations by researchers such as myself, the panel determined that acupuncture was effective for nausea and vomiting in certain circumstances and for postoperative dental pain. In a number of other areas, noted above, there were not enough high-quality studies available or studies found mixed results. That doesn’t necessarily mean that acupuncture is less effective for these other conditions, but there just isn’t enough data for now to make definitive statements. For arthritis, headaches, and back pain, for example, a small number of studies support the benefits of acupuncture. But further research is still needed to confirm these early results. For now, acupuncture is not widely used for pain after dental surgery. Medications work quite well for most people, so patients might not consider trying acupuncture. In cases where medication is not well tolerated or is contraindicated, acupuncture may be useful. It’s used more often for nausea and vomiting, primarily as an adjunct to other treatments. Acupuncture is most widely used for musculo-skeletal problems, such as chronic back pain or arthritis.
Moxibustion
A therapy for applying local heat over acupuncture points either indirectly by heating needles, or directly using moxa (a plant belongs to chrysanthemum family, called artemisia vulgaris) cones, or moxa sticks. When heat penetrates skin deeply, it affects the flow of qi so as to expel cold, promotes blood circulation.
Samples of acupuncture points
Hegu (LI-4)
Location: On the dorsum of the hand, between the 1st and 2nd metacarpal bones, approximately in the middle of 2nd metacarpal bone on the radial side.
Action: * Dispels exterior Wind
* Removes obstructions from the channel
Indications: Headache, pain in the neck, redness, swelling and pain of the eyes, nasal bleeding, nasal obstruction, sore throat, facial paralysis.
Zusanli (ST-36)
Location: 1 cun below the tibia tuberosity, one finger-breadth from the anterior crest of the tibia.
Action: * Strengthens the body
* Benefits Spleen and stomach
* Expels Wind and Damp
Indications: Gastric pain, vomiting, hiccup, abdominal
distension, diarrhoea, dysentery, constipation, mastitis, enteritis, aching of
the knee joint and leg, oedema, cough, asthma, indigestion, dizziness, insomnia,
mania.
Neiguan (P-6)
Location: 2 cun above the transverse crease of the wrist, between the tendons of m. palmaris longus and m. flexor radialis.
Action: * Opens the chest
* Calms the Mind
* Regulates the Stomach
Indication: Palpitation, panic attack, cardiac pain, stomach pain, nausea, morning sickness, pain on the arm and elbow.