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Medical Acupuncture

Medical Acupuncture

Dr. Vinay Varma

Acupuncture in Modern Medicine

Acupuncture is an important prestigious heritage of Chinese people. Traditional Chinese medicine which includes acupuncture has been largely integrated with Western medicine in China. Patients entering hospitals and clinics may opt, if they wish, for the whole spectrum of antibiotics or other modern drugs, or they may prefer to take the door that leads to the traditional Acupuncture department. Western or Chinese, who do we discuss medicines in such isolated and culturally relative terms, while disciplines like mathematics and physics know no such boundaries. Since traditional and Western medicines have the same object to cure and help suffering humanity. They should not have to compete but rather compete but rather complement each other for the ultimate good of the patient. For the patient whose only wish is to get well as quickly as possible, without any harmful effects, this is all that matters for the patient.

Considerable controversy has surrounded Acupuncture, on the one hand extravagant claims have been made for its efficacy while, on the other hand, it has been criticized for its lack of Scientific standing. There are fake training centers, fake acupuncturists. Unfortunately, every profession has its incompetents, quacks and confidence tricksters. Acupuncture practitioners may have more than their fair share of these because there is no agreed standard of training which must be reached before one may practice acupuncture.

So what is a Scientific Method?

At the close of the last century, T. H. Huxley defined science as organized common sense and the method of organization came to be known as Scientific method. The scientific method consists of observations inference and experiment, followed by the formulation of hypothesis, theories and laws which in turn are subject to verification or otherwise by further experiments. Acupuncture was born from keen observations of clinical facts. Aldous Huxley states that a needle stuck into one’s foot should improve the headache or functioning of one’s liver is obviously incredible, it can not be believed because, in terms of currently accepted physiological theory it makes no sense. Within our system of explanation there is no reason why the needle prick should be followed by an improvement of headache or liver function. Therefore, we say it can’t happen. The only trouble with this argument is that, as a matter of empirical fact, it does happen, inserted at precisely the right point, the needle in the foot regularly affects the function of liver, or improves the headache. What should we do about events which by all the rules, ought not to occur, but which nevertheless occur? Two course are open to us, we can either shut our eyes with the hope that, if we don’t look at them, they will go away and leave us in peace or alternatively we can accept them ? accept them for time being as inexplicable anomalies and confirm, that is what I have done.

It is believed that acupuncture developed in both India and China, independently of each other. If we go back to the Indian medical classics, known as Vedas, said to have been written about 7000 years ago, we find “needle therapy” mentioned there. The oldest known Chinese book on acupuncture, Nei Ching, did not appear before fourth century before Christ and historical data indicate that the Nei Ching was probably written around the second or Third century B. C. One volume of the Vedas, known as Suchi Veda, translated as the “art of piercing with a needle,” was written approximately 3,000 years ago and deals entirely with acupuncture, and described 180 points known as “MARMA”, which are said to heal or kill. The whole knowledge of Shalya Chikitsa or acupuncture is arranged in an orderly manner in eight volumes of the famous ancient Classic Sushruta Sanhita. Nevertheless, one cannot argue the fact that the acupuncture was more developed by the Chinese than the Indians, and presented to the World in a more complete fashion.

So, What is Acupuncture?

The word Acupuncture is derived from Latin. In Latin, acus = needle, pungra = to prick, to prick a needle for treatment is acupuncture. The combination of acupuncture and moxibustion is known in Chinese as Chen Chiu [needle and heat therapy.] Acupuncture treatment is usually carried out by inserting very fine needles at acupuncture points. Acupuncture point means a specific spot on the body surface where needling is done to get particular therapeutic response. The practice of cauterizing a part of the ear or body with a hot metal probe is very common in rural India and many Asian countries even today, is nothing but rudimentary form of acupuncture. The Eskimos of instance, are still using sharpened stones for treating their illnesses. The Bantus of South Africa scratch certain areas of their skin to ally the symptoms of many illnesses, while in Brazil there is a tribe whose method of treating illnesses is to shoot tiny arrows from a blow pipe on to a specific areas on the surface. Karate, the martial art of unarmed combat from Japan is yet another variation of acupuncture. Moxibustion represents a special form of point stimulation and involves burning pieces of drug plants generally the moxa leaf, either on needle so as to conduct heat into the body, or in some cases actually on the surface of the skin directly or indirectly by using some kind of barriers like ginger of garlic slices.

Mechanism’s of Acupuncture

Acupuncture is not a drug, it is a complete science OR healing system by it self, having several effects to regulate the function of the human body and to increase its resistance by enhancing the immune system and the anti-inflammatory, analgesic, anti-spastic, anti-shock and anti-paralytic abilities of the body. So, Acupuncture effects can not be explained by single theory. Nor is acupuncture simply a trigger for releasing endorphins to create a temporary anesthetic effect by blocking nerves that transmit pain message, as currently maintained in medical circles. It is far more than that. Originally, the theory of Acupuncture is based upon an ancient Chinese concept of (w) holism. This concept views human beings not only in relation to our own integral totality of body mind, and spirit, but also as microcosmic expressions of a universe whose characteristics are inherent in every organism and in every process. Health is viewed as the maintenance of harmony between ourselves and this universe while illness in an expression of disharmony. The most fundamental biologic expression of the relative balance or imbalance of that primordial energy which the Chinese called Qi (pronounced Chi). A free and balanced flow of Qi in the body expresses harmony and health while a blockage of this energy indicates illness. Qi travels along certain pathways called meridians. There are Twelve Paired and Two Unpaired Meridians , named pertaining to particular organ. Acupuncture points and meridians have been demonstrated in 1933 by a special technique called by Kirlian Photography ( Kirlian and Kirlian of USSR and it was confirmed that acupuncture points have low electrical resistance than surrounding skin surface. Gunn and associates have correlated the acupuncture points with points of accepted anatomical structures. Most of acupuncture points correspond to motor points of muscles.

Yin and Yang Theory, Theory of Five Elements, Organ Clock and many more traditional theories not only explain Chinese Philosophy but dictates the rules to practice the art of acupuncture. These theories are difficulty to digest by others who are trained in so called Modern Medicine. But some of these are getting proved to very close to Modern Medicine, for example Organ Clock and Circadian Rhythm.

Research based on Modern Medicine started in and outside China, only after Mr. Nixon’s visit to China 1971. Recent research for a mechanism of acupuncture has primarily focused on analgesic effect of Acupuncture. Analgesic effects of acupuncture may be explained by the* Gate Control Theory* of Ronald Melzack and PD Wall, London(1965). This theory believes that all pain impulses are controlled, modulated and modified by means of a functional gate which is located in the substantia gelatinosa of the spinal cord, and at higher levels. Normally pain impulses are conducted by small diameter fibres (delta and C fibres) at the speed of 1-2 m/ sec, inhibit substantia gelatinosa cells in turn reduces its inhibition over firing of T cells to higher levels and thus pain impulses are allowed to pass and pain is felt. Non-noxious impulses of acupuncture conducted by large diameter fibres (a beta fibres) at the speed of 120 m/ sec. activates substantia gelatinosa which in turn inhibits, firing of T cells and thus no impulses are allowed to pass and thus gate is closed and pain is not experienced even though pain impulses can travel up to the level of spinal cord. This theory fails to explain analgesic effect above spinal cord level and modified theories like Two Gate Theory and Four Gate Theory have been but forward.

Dr. Bruce Pomeranz, Prof. Of Neurobiology of Toronto University and his co-worker suggest that the naturally occurring endorphin play a prominent part. Acupuncture analgesia can be explained to a large extent as being due to the release of a hormone called endorphin during Acupuncture needling. Endorphine is a naturally occurring neuropeptide having a chain of 31 amino-acids and like morphine and other opiates it has a propensity of binding on to the opiate receptors of pain cells in the brain. The present evidence suggest that, acupuncture stimulation results in a message to the brain causing release of Endorphine from the pituitary gland and mid brain raphe system Experimentally it has shown that ablation of the pituitary gland and likewise injection of Nalorphine which is a morphine antagonist annuls acupuncture analgesia. Endorphine takes some time to get release from the pituitary and this may be the reason for there being an induction period which has to elapse before an operation can commence under acupuncture analgesia. Chemical Or Humoral mechanisms are also involved in Acupuncture. For instance, if rabbit is acupunctured its pain threshold is found to rise, and if the blood from this animal is then circulated into a non-acupunctured rabbit, the pain threshold of the second animal also raises, like wise perfusion of spinal fluid from Acupunctured to non-acupunctured animal results in a similar effect showing that chemical transmitters are definitely involved in the mechanism of acupuncture. Many acupuncture points have specific effects on insertion of needles. For instance 1. Zusalani (St. 36 ) needling at this point, Phagocytosis of staphylococcus Aureus by the leucocytes increases by one to two times even in case of healthy persons. Rise in the phagocytic index from 1.74 to 3.97 and rise in the Phagocytic power from 48.2 to 71.5% have been registered on the second day after acupuncture. 2. A two to eight fold increase in antibody titre , rise in gamma-globulin a specific immunoglobulins after needling at Quchi (L. I. 11. ) and Sanyinjiao (Sp. 6) have been reported.

The last of the theories on acupuncture is that of Bio-electrical phenomenon. This theory suggests that Western medicine deals with body chemistry , the principles of working in acupuncture have to do with body physics. In 1973 at Yale University School of Medicine Burr and Associated confirmed that all living things have electrodynamics fields which can be mapped out with fine voltmeters. These fields vary with physical and mental conditions and thus may be used in diagnosing and treating a variety of disorders.

CLASSIFICATION:

Acupuncture may be classified as 1) Symptomatic acupuncture 2) Classical or Traditional acupuncture 3) Acupuncture Anesthesia . It may be further sub divided into (a) Body Acupuncture (b) Ear Acupuncture ©Scalp Acupuncture

Symptomatic acupuncture is mainly practiced by Barefoot Doctors as first line symptomatic treatment for non specific short lived illness in rural setup. Classical Acupuncture is based on (W) Holistic Approach. Total person is evaluated before treatment, regardless of the particular treatment. Acupuncture does not treat named disease but rather the cause of the disease because symptoms are just signals of a problem in the body. Although acupuncture’s effects are not permanent in treatments for analgesia and some pain disorders but they are long lasting. They are permanent when treating disorders from deafness to sterility. Acupuncture Anesthesia is one of the most impressive developments of Chinese medicines. It was in 1958, that the foundations of Modern Acupuncture Anesthesia were laid by first operation under acupuncture anesthesia at Shanghai and it was a tonsillectomy. The term Acupuncture anesthesia is really a misnomer. Although pain impulses are cut off by raising the pain threshold, other sensations like temperature, balance and vibration sense are found to remain intact. Hence it would be more accurate to use the term Acupuncture Analgesia.

Advantages:

  1. It is absolutely safe, non-toxic and free from adverse effects like over dosage, side-effects of drugs and hypersensitivity reaction.
  2. There are no major disturbance of physiological functions under acupuncture anesthesia.
  3. Hemorrhage too is very much less, and blood transfusion is less often needed.
  4. Post-operative complications are much less as compared with general anesthesia.
  5. Analgesia continues for several hours after the operation and consequently post-operative pain is very much reduced.
  6. Post-operative nausea, vomiting and respiratory complications are absent.
  7. Dehydration, electrolyte imbalance and post-operative debility are circumvented because the patient can eat or drink immediately after and even during surgery.
  8. Acupuncture anesthesia is simple safe effective and economical.

Like any other innovative procedure acupuncture anesthesia too has certain limitations and unsolved problems. While pain threshold is greatly elevated, it may not be always one hundred percent complete, and some patients may still experience varying degrees of pain during certain stages of an operation. In abdominal operations, difficulty is sometimes encountered owing to inadequate muscular relaxation and discomfort from traction on the viscera. So, in recent years Acupuncture Assisted Anesthesia is preferred in western countries. Acupuncture anesthesia (analgesia) has been tried in over 100 different types of operations in over 2 million cases with success rate of about 90% in China. Generally, it is thought to be more effective in head, neck and chest surgery. In India too, few major surgical operation are performed under acupuncture analgesia and results are encouraging. Medical acupuncture is relatively recent terminology i.e. acupuncture approach most commonly integrated by physicians into conventional medical practice

Indications:

Theoretically it is possible to help or cure by acupuncture any disease that can be affected by a physiological process. So, acupuncture can be used in many conditions. The W. H. O. at the Interregional Seminar, Beijing 1979, drew up the following provisional list of disorders that lend themselves to acupuncture treatment. The list is based on clinical experience {and not necessarily based on controlled clinical research}. Upper Respiratory Tract: Acute sinusitis Acute rhinitis Common cold Acute tonsillitis Respiratory System: Acute bronchitis Bronchial asthma (most effective in children and in patients without complication disease) Disorders of the Eye: Acute conjunctivitis Central retinitis Myopia (in children) Cataract (without complications) Disorders of the mouth: Toothache, post-extraction pain Gingivitis Acute and chronic pharyngitis Gastro intestinal Disorders: Spasm of the oesophagus and cardia Hiccough Gastroptosis Acute and chronic gastritis Gastric hyperacidity Chronic duodenal ulcer (pain relief) Acute and chronic colitis Acute bacilliary dysentery Constipation Diarrhea Paralytic ileus Neurological and Musculo-skeletal Disorders: Headache and migraine Trigeminal neuralgia Facial palsy (within three to six months) Meniers’s disease Neurogenic bladder dysfunction Nocturnal enuresis Interconstal neuralgia Cervicobrachial syndrome Frozen shoulder, tennis elbow Sciatica, Low-back pain Osteo-arthritis

The only criticism is that this list was drawn up by a panel of Western qualified clinicians. It would have been more gracious of the W. H. O to have allowed and have this list of disorder set out in their traditional equivalents as well, in listing these disorders. This list has many drawbacks and is not acceptable to all. In ancient times, even disease like tuberculosis, malaria etc had been treated by acupuncture. But now it is proved that in these disease acupuncture cannot play the key role and effective medicines have been found. One should remember that acupuncture is neither panacea for the disease not it is alternative to modern medicine. There is nothing like alternative medicine. However a cure depends upon how well the cause of the disease is understood and in consequences to what extent it can be eliminated and Acupuncture should be used were it can give better and long lasting results compare to modern medicine. One should know the limitations of Acupuncture first. Acupuncture will never replace conventional medical treatment. As we learn more about it, the possibilities of using acupuncture alongside ‘orthodox’ medicine will increase. Acupuncture should be practiced as a Branch of Medicine. Acupuncture is highly effective in management of musculoskeletal and neuropathic pains by virtue of its well know analgesic effects, cervical spondylosis low back ache, sciatica, arthritis, trigeminal neuralgia, migraine, pain of secondary cancer (course of cancer cannot be influenced by acupuncture at present ) or any acute or chronic painful condition. Results are long lasting without side effects which is the main advantage over modern medicine in case of chronic pains. All most all non-progressive paralytic conditions respond well to acupuncture treatment. Acupuncture hastens the speed of natural recovery and should be combined with rehabilitation and physiotherapy techniques to improve quality of life. Respiratory ailments potentially accessible to acupuncture intervention include allergic rhinitis, sinusitis, and bronchitis. Gastrointestinal ailments include gastritis, irritable bowel syndrome, hepatitis, and hemorrhoids. Gynecological problems include dysmenorrhea and infertility. Genitourinary problems include irritable bladder, prostatitis, male infertility, and some forms of impotence. In ophthalmology so called incurable eye conditions like optic atrophy retinitis pigmentosa, high myopia, skin disorders vitiligo, psoriasis etc. Acupuncture, particularly when applied to the external ear, has proven valuable for managing substance abuse problems and reducing prescriptions for narcotic analgesics. One of the most socially visible for acupuncture, this application has gained the respect of rehabilitation programs internationally. For mental and emotional disturbances, acupuncture can be useful as a transient aid in early and acute emotional states such as anxiety, excitability, worry, early stages of depression, and fearful states In malignancies, acupuncture can be considered as an additional therapy to combat the secondary effects of conventional therapy, and as an adjunct in pain management. Off late, acupuncture is indicated by N I H, USA to alleviate side effects of anti malignancy drugs like resistant nausea and vomiting. In recent years, people with HIV have been using acupuncture to enhance the immune system and reduce pain, to manage HIV-related disorders and symptoms and the side effects of anti-retroviral therapy , to help in the process of recovery from drug and alcohol addiction, and to cope with stress and emotional disorders.

Complications

Complications of acupuncture ( acupuncture accidents ) can occur from improper technique, lack of skill, or failure to observe certain guidelines and are very much preventable.

    1. Pain on insertion of the needle may be because of:
        1. Bad acupuncturist
        2. Bad needle
        3. Bad posture
        4. Bad patient

       

 

    1. Bleeding sometimes occurs on withdrawal of the needle. This may be considered a benign complication

 

    1. Fainting – uncommon as with any injection

 

    1. The Forgotten Needle – therapist may forget to remove the needle after treatment

 

    1. Bent, Broken or Stuck Needles

 

    1. Infection – if needles are not sterilized properly. A personal set of needles are used to take away the fear of AIDS/ Hepatitis B

 

    1. Injury to Internal Organs or Vital Structures

 

    1. Over-Correction of certain Physiological Parameters, especially if the patient is also on drug therapy or associated with hypertension / diabetes

 

    1. Complications from Electro Acupuncture

 

    1. Addiction to Acupuncture

 

    1. Abortion – certain points in first trimester may induce abortion

 

Recent Developments – Electro Acupuncture, Transcutaneous Electrical Nerve Stimulation (TENS) Sono Acupuncture, Laser Acupuncture And Homeo Acupuncture.

The W. H. O. View point of Acupuncture is that Acupuncture should be integrated with western medicine and included in the medical curricula Acupuncture analgesia is a valuable addition to the therapeutic armory of the Qualified Anesthetist. A western trained physician may require no more than Three months Training to learn the technique in theory and practice, Special programs might be organized to reverse the unfavorable at attitudes of medical professionals and to educate the general public about the safety of the procedure, its indications and its limitations

Acupuncture as today in China, 800 diseases are being treated with Acupuncture Therapy and at least in 140 countries in the world. Many prestigious hospitals, universities, and medical schools around the world have now established departments for acupuncture research, therapy and analgesia. The Karolinska Institute, Stockholm, Sweden for instance, the Ivory tower which awards Nobel Prizes annually in Western medicine and allied science, has established a Pain Clinic with Acupuncture since 1982. Sri Lanka Best training Centre outside China having separate Minister for Traditional Medicines and Acupuncture. US Government opened the office of Alternative Medicine at the National Institute of Health and found Acupuncture can help relieve the nausea caused by chemotherapy in addition to analgesia. The FDA approved Acupuncture needles for use by licensed practitioners in 1996. BMJ 2000;321:11 ( 1 July ) issue news is that Acupuncture wins BMA approval and according to Mark Silvert, BMJ, Acupuncture should become more widely available on the NHS and family doctors should be trained in some of its techniques, a BMA inquiry has concluded. The therapy has proved effective in treating back and dental pain, nausea and vomiting, and migraine, the BMA’s Board of Science and Education has found after a two year study.

Acupuncture in India: There is mushrooming of fake acupuncturist because of lack of proper institutions.

Dr. B. K. Basu Memorial Research and Training Institute, Calcutta Recognized By W. B. Govt 1996, three Govt. Clinics in Calcutta, One month Training: Medical Officers of Bankura, Hoogly and Nadia Dist.,Dr. Kotnis Acupuncture Medical College, Ludhiana, Punjab, P. G. I. Chandigarh, few Hospitals in Delhi, Nanavati Hospital, Bombay Port Trust Hospital, G. T. Hospital and Others at Mumbai, have Acupuncture Department. S. D. M College Of Naturopathy and Yogic Science Ujre, Acupuncture for B. N. Y. S Degree, Mangalore University. ( Rajeev Gandhi University ) Many qualified Doctors are taking up Acupuncture.

CONCLUSION:

Evidence-based acupuncture is a simple method for no-drug pain control and should be taught in medical schools and made available to all physicians. (Evidence-based medicine (EBM) is the use of the best current evidence in making decisions about the care of individual patients) Acupuncture is one of the best of modality for treating the sick, It works, it is great, if it does not work, patient still can get his surgery done or medical line of treatment as many be the indication. The safety of a technique must be judged on its results in the hands of competent practitioner who use it properly. If this criterion is accepted, acupuncture per se must be seen as a very safe therapeutic system, whose complication are very rare and are easily avoided or rectified. It is does no good, at least it does no harm either. In conclusion it is clear that research on acupuncture will not be only significant for the health and welfare of the people but also important for the progress of medical science. As we learn more about it, the possibilities of using acupuncture alongside ‘orthodox’ medicine will increase When acupuncture is combined with modern medicine, the patient benefits. Combining Western medicine and Acupuncture is what Dr. Vinay Varma is practicing to bring smile by relieving pains and thus Adding Life to Years.

TIPS:

Where to go for Acupuncture?

Acupuncture should be practiced as a Branch of Medicine; so go to a practitioner who is fully qualified to treat western medical conditions, as well as being fully trained in acupuncture.

For live demonstrations, or Further Details, please feel free to contact Dr. Vinay Varma , Anand Polio and Pain Relief Centre, Eureka Colony, Op: SBI Zonal Office Sholapur Road, Keshwapur, Hubli, 580023. Phone: 283977

Anand Polio and Pain Relief Centre, Eureka Colony, Op: SBI Zonal Office Sholapur Road, Keshwapur, Hubli, 580023. Phone: 283977

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