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Acupuncture

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A doctor of acupuncture inserts needles into the patient's skin

Acupuncture, the ancient Chinese practice of healing, is an alternative treatment whose popularity has grown exponentially since its initial introduction to the Western world in the 20th century. The treatment involves the insertion of thin needles into the skin in an effort to eliminate pain and tension in the body. Although the treatment is commonly associated with Chinese medicine, similar methods have been practiced in several different ancient civilizations. In the medical treatises called the Papyrus Ebera in 1550 B.C., the Egyptians discussed 12 meridians that parallel the meridians discussed by the Chinese. Similarly, the Arabs cauterized their ears with extremely hot metal probes. The Eskimos employed sharp stones to perform simple acupuncture. Cannibals in Brazil shot tiny arrows using blow pipes to the diseased parts of their bodies. The primitive tools of these civilizations were eventually replaced by the thin metal needles commonly seen today.[1] Now the practice has since spread all over the world with practitioners being stationed all over Europe, Asia, and America. Acupuncture, once a mysterious Chinese practice, has now become the world's newest and most popular form of alternative medicine.

History

Chinese Origins

An ancient drawing depicting a Hua shou acupuncture diagram
The Chinese were the true pioneers of acupuncture. Although other civilizations had similar healing techniques, the Chinese developed the technique and formed the basis of modern acupuncture. It finds its origins in the Taoist philosophy created over 8,000 years ago. The philosophy focuses on the flow of energy within and without and the relationship between man and the universe. Inspired by the Taoist mindset, Fu Hsi, a legendary Chinese man from the Yellow River area of China created "I-Ching" or "Book of Change." The book dramatically influenced both the philosophy of the people and the foundations of Chinese medicine and subsequently acupuncture. Acupuncture bases itself on the idea of the flow of "Qi" or energy within the body.

Evidence of the Chinese use of acupuncture traces its origins to eras beyond historical documentation. Some believe that the concept originated from the legend of how some soldiers were miraculously cured of chrnoc afflictions after being shot by arrows in battle.[en.wikipedia.org/wiki/Acupunture] However, the most commonly accepted explanation traces the roots of acupuncture back to China's Stone Age. China's primitive history can be divided into two time periods: the Old Stone Age (10,000+ years ago) and the New Stone Age (4,000-10,000 years ago). In the Old Stone Age, knives made of stone were used for medical procedures. During the New Stone Age, stones were also carved into fine needles that served to treat disease. These needles, called bian stone needles, have been discovered in Chinese ruins from the New Stone Age.[2] Further evidence dates back to 1000 BC, during the Shang Dynasty. Excavations of ruins from this time revealed bronze needles, bian stone needles, and hieroglyphs displaying evidence of acupuncture and moxibustion, a process similar to acupuncture.[3][4] Metal needles replaced bian stone needles during the Warren States Era (421-221 BC) and gold and silver needles were discovered in an ancient tomb dating back to 113 BC.

Historical Records

The first official record of the practice of acupuncture can be found in the book "Nei Ching" or "The Yellow Emperor's Classic of Internal Medicine" that dates back to approximately 300 B.C. In the famous documented conversation, the emperor Huang Di and his physician Qi Bo discuss the Chinese Medical arts. The text of the conversation has since been declared the earliest book regarding Chinese medicine. The first part of the book, "Su Wen" or "Plain Questions," addresses human anatomy and physiology as well as the concepts of "Yin and Yang" and the "Five Elements." The second part of the book, "Ling Shu" or "Miraculous Pivot, Spiritual Axis" primarily addresses the practice of acupuncture. The book discusses the meridians of the body, the functions of the zang-fu organs, several different types of needles, the functions of the acupuncture points, techniques of using the needle, types of Qi (pronounced chi), and the location of 160 points on the body. Another classic text, regarded as the most influential text in the history of Chinese Medicine, also addressed the topic of acupuncture and was written by the physician Huang Fu Mi. From 260-265 A.D., Huang Fu Mi compiled ancient literature regarding medicine into the classic text "Systematic Classes of Acupuncture and Moxibustion." The text, which spans twelve volumes and describes 349 acupuncture points, is organized according to the theories of zang fu, Qi and blood, channels and collaterals, acupuncture points, and clinical application.[5][6]

Acupuncture According to the Eras of Chinese History

Acupuncture developed throughout the leadership of several different Chinese dynasties.

  • The Xu Xi family, regarded as experts in the art of acupuncture, oversaw the development of important texts and charts that expanded the knowledge of the art.
  • During the Tang Dynasty (618-907), the renowned physician Zhen Quan revised the acupuncture texts and charts and the other famous physician Sun Simio wrote "Prescription with a Thousand Gold for Emergencies" which includes data on Acupuncture from various scholars. Also during this dynasty, acupuncture became its own branch of medicine and acupuncture education became part of the Imperial Medical Bureau.
  • Under the rule of the Song Dynasty (960-1279), physician Wang Weiyi wrote "The Illustrated Manual on Points for Acupuncture and Moxibustion", which included the description of 657 acupuncture points. As a visual aid for teaching purposes, Weiyi also casted two bronze statues on which he engraved the meridians and points of the body.
  • The Ming Dynasty (1568-1644) saw the greatest advancement of the art. Some accomplishments of the time include revision of the texts, refinement of the techniques, the discovery of extra points outside the main meridians, a medical encyclopedia called "Principle and Practice of Medicine", and the text "Principles of Acupuncture and Moxibustion" which inspired the teachings of G. Soulie de Morant, the man who introduced acupuncture in Europe.[7][8]
  • Following the Revolution of 1911, Chang Khi Check took control of China and ushered in an era of Western medicine to China. Acupuncture and Chinese herbology were banned in the cities, but the practices remained popular among the poorer, folk people.[9][10]
  • In 1945, Mao Tse Tung gained control of China and restored acupuncture as the method of healing while banning the practice of Western medicine. He eventually united Traditional Chinese Medicine with Western Medicine in 1950, bringing the practice of acupuncture to the Chinese hospitals.[11][12]

Recognition by Western Medicine

Since the incorporation of Traditional Chinese Medicine into the Western-style hospitals in China, the Chinese pioneered research into acupuncture's application and clinical effects. The Western World, particularly Europe, discovered acupuncture through France's acquisition of Vietnam, which they then called the French Indochina. Dr. Nogier was a notable French doctor whose research on ear acupuncture between 1951 and 1996 built the bridge between oriental acupuncture and Western medicine.[13] When President Nixon opened the doors in to China in 1972, acupuncture gained world wide recognition as a form of medical treatment. In 1971 more attention was called to acupuncture when American journalist James Reston wrote an article in the New York Times about an emergency appendectomy he had experienced in China in which acupuncture was used as the anesthesia. [14]

Modern Practice

A doll featuring the meridians and acupuncture points.
China and Taiwan are the leaders in the development of traditional Chinese medicine, including acupuncture. 232,000 traditional Chinese medical doctors practice in these countries and 50 educational institutions produce 30,000 traditional Chinese medical doctors annually in these two countries. Other countries have also investigated the use of acupuncture. Koreans developed an extremely effective method of hand acupuncture. Russia, meanwhile, has researched sonic and reflexology treatments. The Japanese established junior colleges of acupunctures and 8500 Japanese doctors in the Oriental medical Association are working on developing methods that combine western medicine and acupuncture. Additionally, several European countries like Spain, Germany, Austria, Italy, and France have established active acupuncture centers.

American acupuncture incorporates the medical traditions from China, Japan, Korea, and other countries.[15]

The Consensus Development Conference on acupuncture held at the National Institutes of Health in 1997 stated that acupuncture is widely being practiced in the United States. Furthermore, the 2007 National Health Interview Survey estimated that 3.1 million U.S. adults and 150,000 children had used acupuncture in the previous year. Some health insurance companies, such as Group Health, include acupuncture as a part of their health plans. Today, 8000 acupuncturists practice in the U.S. and several U.S. schools have begun teaching and licensing new acupuncturists, including the UCLA medical school.[16][17]

Traditional Chinese Medical Philosophy

A diagram representing the concept of yin and yang

The Chinese along with several other Asian countries have been practicing acupuncture for thousands of years. It is a key component of traditional Chinese medicine, whose philosophy is based upon Taoist thinking. Chinese medicine views the body as a whole comprised of several systems of function known as the zang-fu. The zang systems refer to the solid organs like the liver while the fu systems are the hollow organs like the intestines.[18] Central to the Chinese philosophy is the belief that the body is a delicate balance of two opposite yet inseparable forces, the yin and the yang. Yin is said to represent the cold, slow, or passive aspects of a person and the yang is said to represent the hot, excited, or active aspects of a person. According to Chinese medical philosophy, health is the state of balance between these two forces and disease is a result of an internal imbalance of the yin and yang. The Chinese describe Qi (pronounced Chi) as the vital energy or life force, which encompasses the spiritual, emotional, mental and physical aspects of life. The Qi flows in a continuous circuit along pathways in the body known as meridians. There are fourteen known meridians in the body that act as channels, connecting the web-like matrix of at least 2,000 acupuncture points. In addition, each meridian is associated with either a yin or yang aspect.[19] Acupuncture points are the points in the body where the meridians rise to the surface of the skin. An imbalance between the yin and yang results in the blockage of the flow of Qi along the meridians. The insertion of needles into these points located on the meridians permits the manipulation and harmonization of the Qi. Thus the purpose of acupuncture is to unblock the flow of Qi and restore the balance between yin and yang, improving the overall health of the body.[20][21][22]

Clinical Application

Basics of Acupuncture

Several acupuncture needles inserted into the skin

The purpose of acupuncture is to unblock the Qi by inserting needles into the acupuncture points located on the meridians and thus restore the balance in the body.[23] Acupuncturists employ the use of very fine needles which are approximately 0.007 to .02 inches in diameter and are therefore significantly thinner than hypodermic needles. There are up to nine different types of needles that can be used, but only six are commonly used. The needles may vary in length, width, and the shape of the head. Most needles today are disposable and are discarded after one use due to medical biohazard regulations and guidelines. The upper part of the needle is wound with a thick wire or plastic which serves as a handle for the acupuncturist. Acupuncturists use several different techniques which vary based upon the patient's ailment. Some of these techniques include:

  • Raising and Thrusting
  • Twirling/Rotation
  • Combination of Raising/Thrusting and Rotation
  • Plucking
  • Scraping (sending vibrations through the needle)
  • Trembling (which also uses vibration)

With all these diverse techniques, the points can be needled anywhere in the range of fifteen to ninety degrees relative to the surface of the skin. The insertion of the needle generally causes a sensation experienced by the patient, which is called deqi (pronounced dah-chee).

General Diagnosis and Treatment

Acupuncturists treat a wide variety of diseases and ailments. In a traditional diagnosis, the acupuncturist determines which acupuncture points to utilize by interviewing the patient. The first visit to the acupuncturist involves several questions about one's health condition, lifestyle, and behavior. They observe and question the patient to determine the problem and plan of treatment. First, they inspect the face and analyze the tongue. They then listen to particular sounds of the body and ascertain whether the body has a particular odor. American acupuncture incorporates the medical traditions from China, Japan, Korea, and other countries. Following this, the practitioner inquires about chills and fever, perspiration, appetite, thirst and taste, defecation and urination, pain, sleep, and menses or leukorrhea. Finally, the acupuncturist practices the diagnostic technique of palpation in which he checks the body for tender "ashi" points and checks the palpation of the left and right radial pulses in three positions: Cun (proximal to the wrist crease), Guan (one fingers's width proximal to the wrist), and Chi (two fingers width proximal to the wrist). In Japan, acupuncturists also use the palpation of the muscles and the abdomen to diagnose.[24] Once the acupuncturist has determined the problem and created the plan of treatment, they begin to insert the needles at the appropriate points. Because the needles are so thin, most patients feel little or no pain as the needles are inserted. The treatment may occur repeatedly over several weeks or more. The effect is generally energizing or relaxing to a patient. [25]

Related Procedures

Several other procedures are designed to work with the traditional acupuncture treatments. In electro-acupuncture, the use of needles is coupled with an electrical stimulus which has a frequency of current that ranges from 5-2,000 Hz. Higher frequencies are utilized for surgery while the lower frequencies are used to relieve general pain. The Chinese use electro-acupuncture as a common method of surgical analgesia, pain relief or prevention. In sonopuncture, acupuncture points are stimulated using lasers and sound waves. The same acupuncture points are again used in moxibustion, the application of heat or the burning of specific herbs to the points. Moxibustion is used to heal bronchitis, certain types of paralysis, and arthritis. Cupping is used to stimulate the acupuncture points by applying suction through a wood, metal, or glass jar that is used as a partial vacuum. The cupping technique stimulates the area by causing blood congestion and is commonly used for soft tissue injuries and the treatment of chronic bronchitis. Auriculotherapy, ear acupuncture, has become a commonly used treatment in the United States. The procedure is based on the theory that the ear has rich nerve and blood supply, thus has connections to several parts and organs of the body.[26]Finally, the most popular alternative to traditional acupuncture is acupressure, which is basically acupuncture without needles. Acupressure practitioners use massage therapy via the fingers or an instrument with a hard, spherical head on the acupuncture points to promote similar results. A branch of acupressure is reflexology where the acupuncture points of the soles of the feet and regions of the ankle joints are massaged to cure diseases of the internal organs.[27]

Effectiveness

Proven Areas of Effectiveness

An acupuncture student inserts needles into a patient's forehead.

The treatment has been proven to cure a variety of ailments and diseases including pain, the common cold, diabetes, multiple sclerosis, and a variety of other physical ailments.[28] Headaches, an ailment that affects millions of Americans, are treated by stimulating the points located in the webs of the hand between the palms and the thumbs.[29] Common ailments that are treated are lower backache, cervical spondylosis, condylitis, arthritic conditions, allergic reactions, analgesia, and relief of muscle spasms. Clinical trials have also indicated that acupuncture may help to treat anxiety disorders and depression. Additionally, high success rates have indicated that acupuncture can help rid the body of physical dependency on substances like alcohol, tobacco, and other "hard" drugs. Though acupuncture can help rid the body of physical dependency, it cannot rid the body of psychological dependency which hinders the success of addiction treatment.[30] The National Center for Complementary and Alternative Medicine (NCCAM) currently sponsors a wide range of acupuncture research. Some areas they are currently investigating concern acupuncture's effect on pain, osteoarthritis of the knee, fertility, and posttraumatic stress disorder. Also, the National Cancer Institute is investigating the effects of acupuncture in cancer patients.[31] Overall, acupuncture seems to improve the health of all areas of the body.

Side Effects and Risks

Acupuncture presents a few side effects and risks. The U.S. Food and Drug Administration (FDA) reports a relatively small set of complications that have resulted from the inadequate sterilization of needles or the improper delivery of treatments. The improper placement of a needle can result in soreness or pain. Other side effects include fainting, local hematoma or bruising, bacterial endocarditis, contact dermatitis, and nerve damage. In more serious cases, acupuncture can cause serious effects such as infections and punctured organs. The FDA has not reported high numbers of patients who have suffered these side effects. However to avoid these risks, one should seek the help of a certified and cleanly acupuncturist.[32][33]

Why It Works

Traditional Chinese medicine is based on Taoist concepts rather than biomedical diagnoses. Yet experts familiar with both traditional Chinese medicine and biomedical diagnoses believe there is a relationship between the two. Doctors and scientists are still struggling to reconcile the abstract concepts of Chinese medicine with concrete scientific evidence, but the consensus is that acupuncture is still very effective. Felix Mann, a doctor that tried to combine his knowledge of medicine with Chinese theory to produce "medical acupuncture", attempted to explain acupuncture by proposing that the acupuncture points actually relate to the nerve endings. Some Chinese scientists claim that the idea of Qi is a metaphor and that the concepts of yin and yang created by the Chinese parallel the endocrinologic and metabolic feedback mechanism systems of the body.[34] Other experts have tried to explain acupuncture's effectiveness through several theories including:

  • The Augmentation of Immunity Theory - Some experts believe that acupuncture increases the levels of triglycerides, specific hormones, prostaglandins, white blood cell counts, gamma globulins, opsonins, and general anti-body levels.
  • The Endorphin Theory - The treatment stimulates the secretions of endorphins, especially Enkephalins, throughout the body.
  • The Neurotransmitter Theory - It affects certain neurotransmitter levels, like Serotonin and Noradrenaline.
  • The Circulatory Theory - Acupuncture seems to affect the constricting or dilating of blood vessels.
  • The Opioid System Theory - The treatment stimulates the release of opioids from the central nervous system. This release reduces pain or causes drowsiness.
  • The Gate Control Theory - Because the feeling of pain is controlled by a part of the nervous system called the "Gate" which regulates the impulse of pain, a gate that has been inundated with too many pain impulses will become overwhelmed and thus shut down. The first gates to close would be the smallest and the nerve fibers carrying the impulses of pain, "C fibers", are small. Thus when the needles inundate the nervous system with pain, the gates shut down and stop the feeling of pain.[35][36]

Skeptics

Some experts such as Stephen Barrett, M.D., argue that acupuncture has not been well-researched and that the extent to which the treatment produces an effect has been exaggerated. Much of the evidence supporting these claims consist primarily of the practitioner's observations and dubious studies. The effectiveness of acupuncture may also be attributed to the placebo effect.[37] Though these skeptics make a valid point, new evidence and research are continually proving that acupuncture is a valid form of healing.

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References

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