Acupuncture: From Yellow Emperor to Magnetic Resonance Imaging (MRI)
Acupuncture, which originated in China more than five thousand years ago, was only recently rediscovered by the West, and is now one of the most vital and "modern" of all areas of complementary and alternative medicine. Acupuncture is now widely used in the United States as a primary treatment for chronic pain, and is a very popular complementary therapy for substance abuse recovery, nausea, cancer, AIDS, immune disorders, stroke, and many other conditions.
A major component of traditional Chinese medicine, acupuncture was first codified as early as A.D. 25, and was described in the ancient text The Yellow Emperor's Classic of Internal Medicine. Use of acupuncture gradually spread to the entire Asian continent, and it was introduced to Europe by early traders and missionaries. Europeans brought the practice to America in the early 1800s, and it was also used extensively in the mid-1800s by Asian-American immigrants. In the late 1800s, it was credited by Sir William Osler, the "father of modern medicine," as the best treatment for low back pain. However, acupuncture was not accepted by many members of the modern American medical community until the 1970s, when the United States normalized relations with China. By 1998, over one million Americans annually were being treated with acupuncture, by some ten thousand licensed acupuncturists.
Despite its long history, however, no one is certain how acupuncture works. Acupuncture's healing techniques are based on principles that are very different from those of the Western scientific model. Western medicine generally deals with an illness by looking for a specific cause and trying to eliminate it. Traditional Chinese medicine takes a more holistic approach, and holds a different view of symptoms, of the causes of disease, and even of human anatomy. According to Chinese medicine, health is determined by a balanced flow of qi (or chi), the vital life energy that is said to animate all living organisms. Qi flows to all parts of the body through fourteen major energy pathways, or meridians, twelve of which are associated with specific organs. Thus, acupuncture anatomy is a multilayered, interconnecting network of energy channels that permit qi to move through the muscles and organs.
Chinese medicine views disease as the result of an excess or a deficiency of qi in various parts of the body. This imbalance of qi is influenced by many factors, including heat, cold, dampness, emotions, diet, exercise, and the spirit. Acupuncture seeks to rebalance the flow of qi by inserting special needles at any of 360 specific points along the energy meridians.
Most Western experts, however, while acknowledging that acupuncture is effective, believe that it works by triggering chemicals, including pain-killing endorphins and brain-altering neurotransmitters and neuropeptides, that influence the endocrine system, and thus affect mood, energy, and immunity. According to Dr. George Ulett, a psychiatrist and neurologist, the stimulation of motor points where nerves enter muscles releases neurohormones. To activate this mechanism, he observes, no ancient Chinese philosophy is necessary.
However, other modern researchers have applied scientific techniques that appear to confirm the existence of meridians. In the 1960s, microdissection procedures revealed evidence of a system of extremely fine ducts that correspond to acupuncture meridians. Also, radioactive isotope testing in 1985 suggested that the meridians exist. Other researchers have found evidence of a network of electrical currents that flow along the meridian pathways.
Debate over how acupuncture works is likely to continue for decades. Acupuncture at correct points is generally more effective than sham or nonspecific acupuncture. However, according to Dr. Bruce Pomeranz, a professor of zoology and physiology at the University of Toronto who conducted much of the research in this area, sham acupuncture does produce improvement in some 35 to 50 percent of people with chronic pain, while true acupuncture helps 50 to 80 percent. Perhaps sham acupuncture is a very convincing placebo, or it may be that any kind of needle insertion produces a response in some people. Despite this debate, the majority of acupuncturists apply the technique in a somewhat similar way.
To perform treatments, acupuncturists begin by taking a thorough medical history. Then they perform a physical examination, noting not just obvious characteristics of health, but also subtle factors, such as the color of the skin, body language, and the tone of voice. Additionally, the tongue is carefully examined for color, coating, and surface irregularities, since it is believed to reflect the overall health of the patient.
Acupuncturists also focus on the pulse, which is considered another indicator of the patient's overall condition. In Chinese medicine, the pulse is felt at six locations and three depths on each wrist. Qualities of the pulse reveal the balance and flow of qi throughout the body. Interestingly, current Western research indicates that subtleties in the pulse do reflect the conditions of various organs.
Then the acupuncturist organizes all the information and symptoms into clusters, and identifies patterns of disharmony and disturbances in organs. Treatment is then devised to provide energy to weak areas by redirecting the flow of energy.
Sterile, hair-thin acupuncture needles are inserted at selected points. Generally about ten to twelve needles are used, but this may vary. Acupuncture is usually painless, although some points can be acutely painful, or there may be a very slight pricking sensation, followed by a feeling of heaviness, numbness, warmth, or a mild aching, which is known as "obtaining the qi."
To potentiate acupuncture's effects, heat may be applied by burning an herb above the acupuncture point. When the patient begins to feel the heat, it is removed. Another traditional treatment is cupping, in which a glass or bamboo cup is used to create suction on the skin above a painful muscle or acupuncture point. Also, in addition to needles, the acupuncturist may apply electrostimulation, ultrasound, or laser beams.
There are several styles of acupuncture, including:
In choosing an acupuncturist, some people prefer to be treated by a Western-trained physician, who also practices conventional medicine. Insurance coverage may be easier to arrange with a licensed physician. Others seek more traditional practitioners. A typical treatment lasts about forty-five minutes and averages about $45. Initial appointments take longer and are generally more expensive. For chronic illness or physical rehabilitation, ten to twelve treatments are generally scheduled. To treat acute illness, minor injury, or a seasonal "tune-up," only one to four treatments may be needed. Visits are usually weekly, but may be more frequent early in treatment. Follow-up visits may be necessary, particularly for chronic pain.
Although acupuncture in America is most frequently used for pain, as early as 1979 the World Health Organization compiled a list of 104 conditions that acupuncture can treat, including migraine, lesions, sinusitis, common cold, tonsillitis, asthma, inflammation of the eyes, addictions, myopia, duodenal ulcer and other gastrointestinal disorders, trigeminal neuralgia, Meniere's disease, tennis elbow, paralysis, stroke, speech aphasia, sciatica, and osteoarthritis. In the United States, acupuncture is often used as a last resort for many of these conditions.
According to a review by Dr. Joseph M. Helms of the world clinical literature, the use of acupuncture throughout the world most often involves: lesions (40 percent), pain (25 percent), surgical analgesia (16 percent), neurological disorders (10 percent), substance abuse (5 percent), and psychiatric disorders (4 percent). Some conditions are beyond the scope of acupuncture treatment. It cannot relieve pain in all surgical procedures, and is not feasible for emergency medicine or trauma care.
Acupuncture presents few risks. Among the most serious common side effects are mild, transitory depression or anxiety and fatigue. Risk of infection is minimal, since needles are sterile and disposable.
Although voluminous research exists indicating the efficacy of acupuncture, much of this research does not meet Western standards. Several factors complicate acupuncture research. One is that the success of the technique is closely related to the skill of the practitioner. Another is that it is difficult to create a placebo form of acupuncture, because the patient virtually always knows when the procedure is being performed. Sometimes, researchers perform a placebo treatment by placing needles inappropriately, into "sham" acupuncture points, but it is possible that any insertion of needles will have some effect.
Nonetheless, a number of persuasive studies have been performed on many different conditions. To date, one of the best reviews of the research evidence underlying clinical acupuncture is a monograph by Stephen Birch and Dr. Richard Hammerschlag entitled Acupuncture Efficacy: A Summary of Controlled Clinical Trials, published in 1996 by the National Academy of Acupuncture and Oriental Medicine. For clinicians, this publication provides excellent details on a great deal of the clinical research cited in this chapter. Following is an examination of some of the best research on acupuncture, in which it was tested on some of the conditions for which it is most often used.
From THE BEST ALTERNATIVE MEDICINE: WHAT WORKS? WHAT DOES NOT? by Dr. Kenneth R. Pelletier.
Copyright © 2000 by Dr. Kenneth R. Pelletier, Inc.
Reprinted by permission of Simon & Schuster, Inc., New York, New York.
Unless otherwise indicated,
Dr. Kenneth R. Pelletier. All Rights Reserved.