Traditional Medicine and Complementary/Alternative Medicine

Acupuncture consultation

Dr. Hongguang Dong

Background

There are estimates that suggest that 80% of the world uses alternative treatment as their primary means of medical care (1). Therefore, it is timely and appropriate to introduce acupuncture which has been used successfully for several thousand years in China and other Asian countries.

Acupuncture has evoked a lot of public interest and has had a remarkable growth and following in the United States and Europe. The use of acupuncture was documented in Europe in the 19th and 20th centuries. Acupuncture and its related theories has grown rapidly and became important to the Western health care system, for the simple reason that it works. This fact was further expressed by the First Consensus Development Conference on Acupuncture held by US National Institutes of Health (NIH). The chairman of the expert panel, Dr. Ramsay concluded that data supporting acupuncture are "as strong as those for many accepted Western medical therapies" (2).

What is acupuncture and it’s theoretical basis?

Acupuncture is a part of Traditional Chinese medicine (TCM) used to prevent and treat diseases and has been in existence for at least 2000 years. Acupuncture is based on the concepts of Yin, Yang, qi ( pronounced as chee), and meridians. The treatment is applied by piercing the skin with very fine sharp needles. Acupuncture is defined as "puncturing with a sharp instrument", but the original term in Chinese includes both "needling" and "moxibustion" which is a specific method to burn herbs, usually mugwort.

According to TCM theory there are patterns of qi, which is vital energy or life force that flows through pathways in the body called meridians. Any potential disruptions of the flow of this qi flow are believed to be responsible for diseases. Acupuncture can therefore be used to correct imbalances of the flow of the qi by stimulating the applied needles or by applying moxibustion at the identified acupuncture points. These points are the locations where the qi coursing through the meridians is transported to the body surface. There are 361 "regular meridian points" which fall on the 14 main meridians. The performance of acupuncture involves syndrome differentiation, which is based on the diagnostic principle of Chinese medicine. TCM uses four major diagnostic methods : inspection, auscultation and olfaction, interrogation and palpation. Decisions must also to be made about depth and direction of needle insertion, type of needle manipulations, duration that needles are left in place, and the frequency and total number of treatment.

The deqi response (needling sensation) is a crucial factor in achieving acupuncture effects. It involves the feeling of "soreness, numbness, expansion, heaviness" by the patient . At the same time, the doctor should feel heaviness and tension around the needles. There are very few known side effect related to acupuncture treatment as to date.

What is known about the biological effects of acupuncture ?

Many studies in animals and humans have demonstrated that acupuncture can cause multiple biological responses. These responses can occur locally, i.e. at or close to the site of application, or at a distance, mediated mainly by sensory neurons to many structures within the central nervous system. This can lead to activation of pathways affecting various physiological systems in the brain as well as in the periphery. A focus of attention has been the role of endogenous options in acupuncture analgesia. Considerable evidence supports the claim that opioid peptides are released during acupuncture and that the analgesic effect of acupuncture is at least partially explained by their actions. The fact that opioid antagonists such as naloxone reverse the analgesic effect of acupuncture further strengthens this hypothesis. Stimulation by acupuncture may also activate the hypothalamus and the pituitary gland, resulting in a broad spectrum of systemic effects. The alteration of the secretion of neurotransmitters and neurohormones and changes in the regulation of blood flow, both centrally and peripherally, have been documented. There is also evidence of alterations in immune functions produced by acupuncture. How these physiological changes mediate clinical effects is unclear at present (2).

The fact remains that even if some of traditional Eastern medical concepts, such as the circulation of qi, the meridian system, and other related theories, are difficult to reconcile with contemporary biomedical information, these concepts still continue to play an important role in the evaluation of patients and the formulation of treatment in acupuncture (2).

What are the indications for acupuncture

Acupuncture can be effectively used as the sole complete treatment of an indicated disorder or it can be used as the support or adjunct to treatment in many medical and surgical disorders. The World Health Organization has recommended the use of acupuncture in the treatment of a wide range of medical problems, including (3):

Indications in Gynaecology and Obstetrics

Precautions

• Extreme anxiety

• Extreme hungry

• Exhaustion

• In pregnancy, certain locations such as lower abdomen, lumbosacral region and certain points such as Hegu (Li 4), Kunlun (UB 60), Sanyinjao (Sp 6) should be avoided

• Puncturing in the area of blood vessels and vital organs

Is acupuncture covered by health insurance?

Yes, Acupuncture is covered by the Swiss national health insurance (Lamal) since Jun 1999

Reference List

1. Reardon, T. R. Alternative Medicine An Objective Assessment. Fontanarosa, B. F. 5. 2000. JAMA and Archives/ Journals.
2. NIH Consensus Conference. Acupuncture. JAMA 1998;280:1518-24.
3. World Health Organization. Viewpoint on Acupuncture. World Health Organization 1979.
4. Hou, JL. Acupuncture and Moxibustion therapy in Gynecology and Obstetrics. 1995. Beijing,China, Sc.& Techn.
5. Maciocia, G. Obstetrics and Gynecology in Chinese medicine. 1998. Churchill Livingstone.
6. Helms JM. Acupuncture for the management of primary dysmenorrhea. Obstet.Gynecol. 1987;69:51-56.
7. Cai X. Substitution of acupuncture for HCG in ovulation induction. J.Tradit.Chin Med 1997;17:119-21.
8. Chen BY. Acupuncture normalizes dysfunction of hypothalamic-pituitary-ovarian axis. Acupunct.Electrother.Res. 1997;22:97-108.
9. Stener-Victorin E, Waldenstrom U, Tagnfors U, Lundeberg T, Lindstedt G, Janson PO. Effects of electro-acupuncture on anovulation in women with polycystic ovary syndrome [In Process Citation]. Acta Obstet.Gynecol.Scand. 2000;79:180-88.
10. Yu J, Zheng HM, Ping SM. [Changes in serum FSH, LH and ovarian follicular growth during electroacupuncture for induction of ovulation]. Chung Hsi I Chieh Ho Tsa Chih 1989;9:199-202, 195.
11. Stener-Victorin E, Waldenstrom U, Nilsson L, Wikland M, Janson PO. A prospective randomized study of electro-acupuncture versus alfentanil as anesthesia during oocyte aspiration in in-vitro fertilization. Hum.Reprod. 1999;14:2480-84.
12. Siterman S, Eltes F, Wolfson V, Zabludovsky N, Bartoov B. Effect of acupuncture on sperm parameters of males suffering from subfertility related to low sperm quality. Arch.Androl 1997;39:155-61.
13. Siterman S, Eltes F, Wolfson V, Lederman H, Bartoov B. Does acupuncture treatment affect sperm density in males with very low sperm count? A pilot study [In Process Citation]. Andrologia 2000;32:31-39.
14. Brill JR. Acupressure for nausea and vomiting of pregnancy: a randomized, blinded study [letter; comment]. Obstet.Gynecol. 1995;85:159-60.
15. Dundee JW, McMillan CM. Clinical uses of P6 acupuncture antiemesis. Acupunct.Electrother.Res. 1990;15:211-15.
16. Lee A, Done ML. The use of nonpharmacologic techniques to prevent postoperative nausea and vomiting: a meta-analysis [see comments]. Anesth.Analg. 1999;88:1362-69.
17. Cardini F, Weixin H. Moxibustion for correction of breech presentation: a randomized controlled trial [see comments]. JAMA 1998;280:1580-84.
18. Wang QA, Zhao YY. Treatment of urinary retention due to postoperative anal pain. J.Tradit.Chin Med 1991;11:199-200.

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Edited by Aldo Campana,