|Acupuncture: The Needle in the Haystack by Dr. Cathy Rosenbaum, Rx integrative Solutions
The first Chinese Medicine text was written around 3000 B.C. when medicine, philosophy, and religion were closely aligned. Chinese Medicine draws from Ayurvedic principles even though the latter system of practices is rooted in the Hindu religion. Chinese Medicine, one of the oldest in recorded medical history, was based on local Taoism and later, Buddhism suggesting the body interacts with, and is inseparable from, its environment. Taoists talked about Yin/Yang as two complementary forces in the paths of life. Wu Xing, or the Five Elements, describes metal, wood, water, fire, and earth, the last three of which were taken from Ayurveda.
Chinese Medicine was practiced until 1911 until the revolution when it was frowned upon as unscientific and replaced by Allopathic Medicine as the country began its journey toward a democracy. There was a ban on Chinese Medicine until the 1950’s when Integrative Medicine and Allopathic Medicine came together. Chinese Medicine practitioners became barefoot doctors in rural areas of the country and allopathic physicians were encouraged by the government to get trained in Chinese Medicine. I visited a barefoot doctor clinic in Chengdu, China in 2002 during my travels to study herbal research and global healthcare solutions. Ultimately a new term, Traditional Chinese Medicine (TCM), was born, based more on scientific research, and replacing the term Chinese Medicine based more on anecdotal remedies handed down from generation to generation. Today, TCM is common throughout China.
In the USA, French physicians were performing acupuncture as early as the 1700’s, but it was not until the 1960’s that TCM as we know it today came alive in our country. Nevada was the first state to license non-physicians as acupuncturists in 1973. Both Yin/Yang and the Five Elements are diagnosed by radial pulse and tongue observations and are expressed to some degree in every person and in the universe, requiring us to work in harmony with nature and not against it. Qi is the life force that runs through Yin/Yang and the Five Elements. These principles were taught from childhood through adulthood, including keeping a healthy whole body which is thought to give a person a ticket to heaven. Evidence of healing comes from expression of compassion, kindness, service, and love. These characteristics in turn enhance the flow of Qi, or life energy, through invisible meridians throughout the body.
TCM practice starts with observing a wrist pulse, the tongue, the overall smell of the patient, the skin, and body build to assess balance or any imbalance of Yin/Yang in the patient. The TCM practitioner looks at the patient, watches how she moves, speaks, watches some of her emotional characteristics (e.g., talks a little or a lot, is calm or fidgety). That may be the extent of the history taking. An allopathic physician who also practices TCM will, in addition, take a health/medical history for the patient. When imbalance occurs, several interventions may be recommended to rebalance Yin/Yang in the patient as well as the patient with her universe. Interventions can include massage, meditation, herbs, nutritional recommendations, exercise, and acupuncture. Once diagnostics are complete and a health goal is established, acupuncture along with other modalities (i.e., herbs and/or massage) may be combined to help achieve the goal. Acupuncture can be used to balance energy composed of universal opposing forces, also known as Yin and Yang, for good health.
Acupuncture, one of the key components of TCM, which has been practiced for thousands of years, starts with the belief that life energy (Qi) flows through meridians or tracks around the entire body. Chinese Qi is analogous to prana, mana, maya, and orgone in Ayurvedic systems, and Ki in the Japanese healing system. Meridian based therapies were first recorded in the book the Yellow Emperor’s Inner Classic written in 2698 B.C. According to TCM beliefs, there are 12 main meridians and two secondary meridians. Meridians are called 1) lung, 2) large intestine, 3) stomach, 4) spleen, 5) heart, 6) small intestine, 7) bladder, 8) kidney, 9) pericardium, 10) triple Warmer, 11) gallbladder, 12) liver, 13) conception vessel or Ren, 14) Governor Vessel. Meridians touch the skin’s surface at over 2,000 acupuncture points. From a Western allopathic perspective, there is no physical proof that meridians exist per se as there are for nerves in the nervous system. According to the Five Element theory, each meridian, or Yin/Yang combination of two meridians, is associated with one of the elements. Lung (arm-yin) and large intestine (arm-yang) correspond with metal; stomach (leg-yang) and spleen (leg-yin) correspond with earth; heart (arm-yin) and small intestine (arm-yang) correspond with fire; bladder (leg-yang) and kidney (leg-yin) correspond with water; pericardium (arm-yin) and triple Warmer (arm-yang) correspond with fire, and gallbladder 9leg-yang) and liver (leg-yin) correspond with wood.
Acupuncture is a procedure involving the placement of sterile needles into the skin by an experienced practitioner to stimulate specific anatomic points in the body for therapeutic purposes. Sometimes electrodes are attached to any one of the six needle types during a session and used in combination with a variety of electroacupuncture techniques. Very small microampere electrical impulses will flow through the acupuncture points. In 1996, the FDA approved the use of acupuncture needles for licensed acupuncture practitioners and requires needles to be sterile, nontoxic, and labeled for and disposed of after single use to protect consumers. Needles vary in length, diameter, and head shape, and their insertion and manipulation in the skin is rarely painful and feel more like a bee sting. Needle punctures may draw as small amount of blood from the skin.
In 1997, a National Institute of Health panel issued a position statement that acupuncture is effective for post operative nausea and vomiting, chemotherapy related nausea and vomiting, and pregnancy related nausea. The World Health Organization recognizes TCM and acupuncture as interventions for gynecological disorders (PMS), gastrointestinal disorders (peptic ulcer, indigestion), urogenital disorders (stress incontinence), respiratory disorders (emphysema), musculoskeletal and nervous system disorders osteoarthritis pain, headaches, back pain), and emotional disorders (anxiety, depression), among others.
Based on a 2007 National Health Interview Survey, an estimated 3.1 million Americans responded that they had tried acupuncture in the past year for pain or musculoskeletal complaints (i.e., back pain, joint pain, neck pain, severe headaches, migraines) (Diener). According to the American College of Physicians and the American Pain Society, for patients who do not improve with self-care options, clinicians should consider the addition of non-pharmacologic therapy with proven benefits for chronic low back pain (Chou), exercise therapy, acupuncture, massage therapy, yoga, or progressive relaxation (weak recommendation, moderate-quality evidence) (Chou). According to the NIH Consensus Conference, “both animal and human laboratory and clinical experience suggest that the majority of subjects respond to acupuncture, with a minority not responding.”
When evaluating acupuncture efficacy research for pain management it is important to consider the placebo effect (Linde). If a person experiencing acupuncture believes it will help with pain and expect positive results, she/he will typically report pain relief at some level (Walling). Acupuncture is thought to activate the brain’s opioid system (receptors).
Are there risks or side effects to acupuncture?
The National Institutes of Health has concluded acupuncturists have a very good safety record when they use sterile needles and follow proper needle insertion practice. Yet, for some, changes in appetite, sleep, bowel or urination patterns, or emotional state may be triggered after experiencing acupuncture. It is also common to have a sensation of deep relaxation or even mild disorientation immediately following the treatment. These effects should wear off within 24-48 hours (Leung). Rare risks of acupuncture include bruising/bleeding at the needle insertion sites, fainting, muscle spasms, and nerve damage. A few people have reported more serious reactions, such as dizziness, sweatiness, or nausea (Peuker). Acupuncture is contraindicated to needle the abdomen and lumbosacral areas of pregnant women.
Types of Acupuncture
Traditional acupuncture involves puncturing the skin at Qi points along the meridians to regulate the flow of Qi and balance Yin/Yang and Five Element forces. Very fine needles are inserts with a quick thrust and then twisted gently. Patients will report a little jolt of energy when the needle is inserted properly. Needles are left in place for 30 -45 minutes then removed.
Auricular acupuncture involves applying needles to the outer ear. Each ear is believed to have over 100 acupuncture points. For perspective, the major meridians are thought to overlap the ear on either side. Medical acupuncturists may use this type of acupuncture for treating nicotine and alcohol dependence.
Korean acupuncture developed in 1971 by Tae Woo Yoo involves hand meridians Qi points. Needles or self-adhesive acupressure pellets may be used to achieve balance. Korean hand acupuncturists believe the entire meridian map is represented on the hand.
Medical acupuncture is the application of needles to meridian points to reduce symptoms by affecting sensory input to the nervous system through the release of neuropeptides like endorphins. It does not include TCM, its underlying philosophy, or diagnostic techniques. As defined by the American Board of Medical Acupuncture it is the “medical discipline having a central core of knowledge embracing the integration of acupuncture from various traditions into contemporary biomedical practice.” This practice entails the practitioner memorizing needling protocols for symptoms and/or diseases and ignores Taoist and medical hypotheses of TCM. Medical acupuncture was created for doctors of medicine, chiropractors, and osteopathic physicians who may or may not believe in the existence of Qi or meridians in the body.
Most U.S.A states require certification or training to perform acupuncture excluding North Dakota and South Dakota. Check with your state laws for more information by visiting http://www.acupuncture.com/statelaws/statelaw.htm.
Most states license acupuncturists (LAc) through a national certification exam. Look for acupuncturists in your state who are recognized by the National Certification Commission on Acupuncture and Oriental Medicine www.nccaom.org or the Accreditation Commission for Acupuncture and Oriental Medicine www.acaom.org. There are over 150 schools of acupuncture training in the U.S.A. For more information visit the American Association of Acupuncture and Oriental Medicine www.aaaomonline.org , and the Council of Colleges of Acupuncture and Oriental Medicine www.ccaom.org . To follow acupuncture research, visit www.clinicaltrials.gov or The Society for Acupuncture Research www.acupunctureresearch.org .
Questions to ask the acupuncturist before treatment begins:
- Is this acupuncturist licensed?
- Where is acupuncture practiced? Acute care, ambulatory care, long term care, private office practice, spas.
- Does acupuncture hurt? Most people feel a little pinch when the needle is inserted. Inserted needles are then flicked by hand or electrically eliciting a minor response.
- Are the needles sterile?
- What is acupuncture used for? How many people with my condition have you successfully treated?
- Is acupuncture covered by insurance? Rarely, yes. Check with them first.
- Will acupuncture interfere with my medications or reduce the need for medications?
- How often should I see my acupuncturist?
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Diener HC, Kronfeld, K, Boewing G, Lungenhausen M, Maier C, Molsberger A, Tegenthoff M, Trampisch HJ, Zenz M, Meinert R [GERAC Migraine Study Group]. Efficacy of acupuncture for the prophylaxis of migraine: a multicentre randomized controlled clinical trial. Lancet Neurol 2006;5:310-316.
Johnston MF, Hays RD, Hui KK. Evidence-based effects size estimation: an illustration using the case of acupuncture for cancer-related fatigue. BMC Complementary and Alternative Medicine 2009;9:1-26 doi:10.1186/1472-6882-9-1.
Leung PC, Zhang L, Cheng K. Acupuncture: complications are preventable not adverse events. Chin J Integr Med 2009;15:229-232.
Linde K, Witt CM, Streng A, Weidenhammer W, Wagenpfeil S, Brinkhaus B, Willich S, Melchart D. The impact of patient expectations on outcomes in four randomized controlled trials of acupuncture in patients with chronic pain. Pain 2007;128:264-271. doi: 10.1016/j.pain.2006.12.006
Manheimer E, Ezzo J, Hadhazy V, Berman B. Published reports of acupuncture trials showed important limitations. J Clin Epidemiology 2006;59:107-113. doi: 10.1016/j.jclinepi.2005.06.003
Peuker ET, White A, Ernst E, Pera F, Filler TJ. Traumatic complications of acupuncture. Therapists need to know human anatomy. Arch Fam Med 1999;8:553-558.
Walling A. Therapeutic modulation of the psychoneuroimmune system by medical acupuncture creates enhanced feelings of well-being. J Am Ac Nurse Practitioners 2006:18:135-143. doi: 10.1111/j.1745-7599.2006.00115.x