Acupuncture
Acupuncture has probably been practised in China for around 3,500 years, but the exact date of its origin is difficult to determine. The first medical textbook on acupuncture was called the Nei Ching Su Wen; this literally means The Yellow Emperor’s Classic of Internal Medicine and it dates from about 400 BC.
Acupuncture has been known to Western doctors since the Jesuits first went to China in the seventeenth century, and it was used extensively by physicians in this country in the early part of the nineteenth century. The first edition of The Lancet in 1823 carried a detailed report of the use of acupuncture in tympany (ear infections and/or deafness) and rheumatism, praising the virtues of this technique. The author, John Elliotson, was a consultant physician at St Thomas’ Hospital in central London.
TRADITIONAL CHINESE MEDICINE
The first recorded therapeutic success with acupuncture occurs in the ‘historical records’ of some 2,000 years ago. Pein Chueh, a physician, used acupuncture to revive a dying patient already in a coma. The practice of acupuncture was progressively developed and refined throughout Chinese history until the Ching dynasty (AD 1644–1911). During this period, acupuncture fell into disrepute and was discouraged in favour of Western medicine. However, since the Communist revolution of 1948 acupuncture has been revitalised and is now widely used in China.
Acupuncture is one of the therapeutic techniques used in traditional Chinese medicine (TCM), which has its own complete system of anatomy, physiology and diagnosis: the main concepts are described in detail in the Nei Ching Su Wen. The traditional Chinese viewed the human body as a balance between two opposing forces, yin and yang: yin represents placidity or water, whereas yang represents activity or fire. If yin or yang is deficient or in gross excess, the balance between them is distorted and disease results.
The Chinese concept of health can best be defined as a normal fluctuating balance between yin and yang. Their system of diagnosis and therapy is designed to determine the imbalance of yin and yang and to correct it, therefore restoring the person’s health. To produce this change, the Chinese insert needles into acupuncture points. Most of the important acupuncture points are on 14 channels running over the body, each representing an internal organ. Qi, or vital energy, is said to flow through these channels. In disease, the flow of qi is altered and the insertion of an acupuncture needle into an appropriate point is said to correct the flow of vital energy, therefore restoring the body to good health.
The Chinese also developed a sophisticated idea of physiology (how living organisms function), and specific functions were defined for each of the 12 main organs. The Nei Ching Su Wen states that: ‘the heart fills the pulse with blood . . . And the force of the pulse flows into the arteries, and the force of the arteries ascends into the lungs.’ This describes the double circulation of blood (first passing through the lungs then through the body) some 2,000 years before the scientist William Harvey demonstrated the function of the heart and the circulation of blood in the seventeenth century.
The anatomy (acupuncture points and channels) and physiology of TCM, along with a detailed examination of the pulse and tongue, provide the basis for a TCM diagnosis. A practitioner then follows a set of empirical rules to select the appropriate acupuncture points to treat the disease and correct the imbalances (the pathogen).
Not all acupuncturists use a traditional Chinese approach. Some just treat the tender points that arise in various musculoskeletal diseases (such as arthritis). A number of clinical trials have shown that acupuncture in tender trigger points, which are also frequently acupuncture points, is effective for painful diseases.
In the treatment of pain, it is not yet clear which approach is best – the traditional Chinese diagnosis or simply treating tender trigger points. However, in non-painful diseases, such as asthma or irritable bowel syndrome, trigger points do not always occur, so to perform effective acupuncture a traditional diagnosis must be made and the points selected within the context of TCM.
HOW DOES ACUPUNCTURE WORK?
TCM practitioners can explain how and why acupuncture works and the underlying principles behind the selection of which points to treat, through their understanding of Chinese medicine. However, TCM is not firmly grounded in modern conventional science but there is considerable evidence to suggest that acupuncture points are important and special areas of the body, particularly in pain.
Research in the 1970s has shown clearly that over 70 per cent of trigger or ‘ouch’ points occurring in painful diseases were already defined as acupuncture points by the Chinese. Furthermore, many forms of therapy, particularly for diseases of the muscles, bones and joints, rely on the fact that stimulating or needling these trigger points can relieve pain.
We also know that acupuncture points have special electrical properties – they have a lower electrical resistance than the surrounding skin. However, no scientific evidence has yet been provided to prove (or disprove) the existence of the channels.
Acupuncture is used in the West primarily for painful conditions. Most research into the mechanism of acupuncture has been in this area. The gate control theory, developed by Melzack and Wall in 1965, explains that the input of pain via small nerve fibres can be inhibited within the spinal cord by the stimulation of large nerve fibres. Acupuncture has been shown to stimulate certain kinds of nerve fibres, thereby ‘closing the gate’ to pain and blocking pain perception.
The discovery of endorphins and enkephalins (the body’s own natural opiate painkillers) has also strengthened the position of acupuncture as a treatment for pain.
A number of studies have shown that acupuncture causes the release of these opiates into various areas of the nervous system.
Although there is good evidence for the mechanisms underlying the effect of acupuncture in both acute and chronic pain, there are, to date, no theories that explain how acupuncture may work in non-painful conditions such as asthma.
WHAT DOES THE TREATMENT INVOLVE?
Needles are usually a few millimetres in diameter and, depending on the type of acupuncture used and the site of the problem, may be inserted at depths varying from a few millimetres to three to four centimetres. Six to ten needles will be used in each treatment session. The needles used should always be single-use, pre-sterilised, disposable needles which will be left in place for between 5 and 20 minutes. Sometimes a small electrical current is used to stimulate the needles. Before you receive any treatment, the acupuncturist will want to take a history to make a clear diagnosis of your condition. This may involve a traditional Chinese history as well as a Western diagnosis, depending on the approach used by, and techniques of, the acupuncturist.
In skilled hands, acupuncture treatment is relatively painless. After the treatment, you may notice a temporary worsening of your symptoms, but this usually indicates that you will experience an effective response later on. The treatment usually works in stages. The first one or two treatments may produce no effect or perhaps only a brief effect, and you will usually need a course of six to eight sessions for effective symptom relief. Once you have obtained relief, it often lasts for three to nine months. After this, one or two further treatments will ‘top-up’ the therapeutic benefit.
The acupuncturist will try to manipulate the needles so that you will feel a dull bursting or numb sensation around their site of insertion. This sensation is called ‘de qi’ (pronounced dar-chee) or ‘obtaining energy’ and traditionally it is suggested that ‘de qi’ may be an important part of the treatment process.
Sometimes your acupuncturist may use other methods of stimulating an acupuncture point, such as moxibustion – the burning of the dried herb wormwood (Artemesia vulgaris) just above the surface of the skin or on the end of a needle, or placing a cup over the acupuncture point.
WHAT CAN ACUPUNCTURE TREAT?
Some acupuncture texts suggest that acupuncture is a universal system for treating almost all illnesses, but in the West it is primarily used for treating pain caused by problems in muscles, bones and joints. It may also be used to treat other illnesses such as migraine, irritable bowel syndrome or asthma. Acupuncture can also help to provide pain relief for people with cancer.
There has been quite a lot of research into acupuncture compared with some of the other complementary therapies. Research shows that it can help in headaches and migraine, dental pain and low back pain. Its use has also been well evaluated in the treatment of nausea (early morning sickness, post-anaesthetic nausea and the nausea caused by using powerful anti-cancer drugs).
There is some evidence that acupuncture may help to improve and accelerate recovery after a stroke. Although acupuncture does not appear to help people give up smoking, it can help overcome the withdrawal period from addiction to other, harder drugs.
Acupuncture may help people with asthma, although the evidence is a little uncertain at present. For many illnesses, the effect of acupuncture has still not been properly assessed.
IS IT SAFE?
Acupuncture is largely a safe treatment. A recent survey of 50,000 acupuncture treatments reported no serious adverse reactions. There are some fairly simple pieces of advice for anyone seeking acupuncture treatment.
First, you should go to a registered acupuncturist whose premises have been inspected and registered by the local health authority for the purpose of providing acupuncture. The health authority should be able to provide a list of these premises. This means that you will be given disposable (once-only use) acupuncture needles and there will be no danger of cross-infection, so you will not run the risk of picking up diseases.
If the acupuncturist is proposing to use an indwelling needle that may be left in place for a few days, then this may expose you to an increased risk of infection and is not a good idea, particularly if you have any problem with the valves of your heart.
There are also certain specific acupuncture points that should be avoided in pregnancy, although acupuncture in general is a very safe and effective treatment during pregnancy for both early morning sickness and pain.
WHOM SHOULD I SEE?
There are three main groups of acupuncturists: doctors, professional acupuncturists and physiotherapists.
The members of The British Medical Acupuncture Society are doctors and dentists. Their training usually involves several weekend acupuncture courses and is directed mainly at the treatment of pain. They may learn a small amount of TCM but most doctors in the UK will use Western acupuncture techniques.
Professional acupuncturists usually attend a three- or four-year training course, which may result in a university degree. These acupuncturists are well versed in the use of TCM and are registered with the British Acupuncture Council.
The Acupuncture Association of Chartered Physiotherapists also offers extensive training in TCM, a course that is fairly similar in detail to that attended by professional acupuncturists. However, many of its members use acupuncture more simply, to treat painful conditions as part of their physiotherapy practice.
These three organisations will provide you with detailed information about the acupuncturists available in your area (see Useful addresses).
