Acupuncture is an integral part of Traditional Chinese Medicine. Traditional Chinese acupuncturists understand patterns of health and illness according to the flow of Qi (energy) in the body and apply needles or moxibustion to stimulate acupoints situated along energy channels called meridians. Acupuncture is now becoming an accepted part of modern clinical healthcare, particularly for conditions such as pain management.
History of Acupuncture
“Acupuncture” is a European term that was coined by Willem Ten Rhyne, a Dutch physician, for the practice he observed on his visit to Japan in the 17th century. It literally means “to puncture with a needle”, from the Latin acus (needle) and punctura (puncture). Acupuncture can be defined as a method of stimulating certain points on the body by inserting special needles in order to modify the perception of pain, normalise physiological functions and treat or prevent disease. Its aim, like the other practices in Traditional Chinese Medicine, is to restore the balance of yin and yang in the body and to harmonise the flow of the energy known as Qi, which is disrupted in illness.
The Huang Di Nei Jing (The Yellow Emperor’s Classic of Internal Medicine) is the first record of the teachings that form the foundation of Traditional Chinese Medicine. The book emphasises three of the ideals of Taoist philosophy – balance, harmony and moderation in all things.
The Chinese practised acupuncture for several centuries before knowledge of it reached the rest of the world – it was first practised in Korea in about 600 AD and soon after in Japan. The West first learned of acupuncture in the 17th century when Jesuit missionaries brought European medical practice to China. At this time, Western medicine was still based on the four humours and used purges, leeches and herbs. However, Western physicians and surgeons had a good knowledge of anatomy, derived from dissection.
Acupuncture reached its zenith during the Ming dynasty (1368-1644), then declined during the Qing dynasty (1644-1911) under Manchu rule and Western influence. During this period, herbal medicine was emphasised more than acupuncture and, in 1822, the authorities ordered the
closure of the acupuncture-moxibustion department of the Imperial Medical College. In Europe, acupuncture came to be widely practised by the medical profession during the first half of the 19th century, and good results were reported in the treatment of pain and rheumatism. In 1823, acupuncture was mentioned in the first issue of The Lancet. However, it gradually fell into disrepute when practitioners failed to employ it in a selective and discerning manner. However, now a growing number of Western doctors practise acupuncture to supplement conventional treatment.
There are two main types of acupuncture. In traditional Chinese acupuncture, the acupoints are selected in accordance with traditional Chinese theories, such as the individual “pattern of disharmony”, rather than a Western medical diagnosis. In medical acupuncture, certain trigger points are needled to treat pain. Although doctors who use acupuncture make no use of Chinese theories, there is a close correlation between trigger points and acupuncture points for pain.
Modern acupuncture needles are usually made of stainless steel and are single-use, disposable needles. In general, one of the first things a patient will want to know before commencing treatment is “Will it hurt?” In skilled hands, it is not a particularly painful experience. It is much less traumatic than an injection, as it involves the use of a very small-gauge “atraumatic” needle. The Chinese often use moxibustion with acupuncture. This involves burning moxa, the dried leaves of the herb mugwort (Artemisia vulgaris), near particular acupoints.The heat is believed to help stimulate the acupoints and flow of Qi.
The Chinese believe that for acupuncture to obtain its maximum effect, a patient should feel a “needling sensation”, which involves manipulating the needle after insertion into an acupoint. The patient may experience a dull, aching, heavy, numb, sore, distending or warm sensation around the needle. This is known in Chinese as De Qi, and signifies the arrival of Qi at the needle. Sometimes, sensations may radiate along the path of a channel (meridian) on which the acupoint is situated – the so-called “propagated channel sensation” (PCS). Interestingly, needling trigger points produces the same sort of local sensation.
Generally, only a few needles (perhaps 6-10) are inserted during a treatment. They are usually left in place for about 20 minutes before being removed. It is common for patients to experience a degree of relaxation during and following acupuncture. Some patients may experience drowsiness or go to sleep; others say they feel elated and “high” for a short time. These effects may be due to release of endorphins (opioid, pain-relieving chemicals which are produced by the brain).
In general, acute conditions will respond quickly and need few treatments. Chronic disorders respond more slowly and require a more prolonged course of treatment. However, individuals vary quite considerably in their response to acupuncture. Sometimes, immediate relief may be experienced on insertion of a needle, but in other situations three or four sessions may be required before any benefit is noticed at all. Occasionally, patients may find improvement only some weeks after treatment.
Improvement after the first treatment may be only temporary and short-lived, but with each treatment a better and more prolonged effect should occur. Three or four treatments should be adequate to assess whether a patient will respond. If there is no response after four treatments, then it is unlikely whether treatment will work.
Most acupuncturists will continue to treat patients until they are fully recovered or until there is no further improvement in their condition. A typical course of acupuncture might consist of four to twelve sessions.
Western uses of acupuncture
Traditional Chinese acupuncturists treat a wide range of conditions, such as irritable bowel syndrome or asthma. In the West, acupuncture is mainly used for the treatment of pain, particularly neuromuscular pain. The underlying mechanism of how acupuncture works in conventional medical terms is unclear, but in all probability its therapeutic effects are mediated through the autonomic nervous system (the part of the nervous system that controls involuntary functions).
Acupuncture treatment for pain works either locally through release of encephalins (opioid, pain-relieving chemicals produced by the brain) or more centrally through nervous pathways that are mediated by neurotransmitters, such as serotonin and noradrenaline. Increasingly detailed research reveals the neurophysiological mechanisms by which acupuncture may bring about its effects.
Effectiveness of Acupuncture
It is difficult to design placebo-controlled trials that test the effectiveness of acupuncture. Researchers involved in clinical trials continue to argue about acupuncture, largely because they tend to look for specific effects compared to a placebo. No appropriate placebo has yet been developed for acupuncture. This adds to the confusion, particularly when comparing so-called “real acupuncture” (acupuncture that needles the correct acupoints) with “sham acupuncture” (acupuncture that does not use acupoints) – the difference in treatment outcome between the two seems to be much less than might be expected. In other words, it may not matter so much exactly where the practitioner places the needles – the benefit may come from the patient experiencing the whole process of having acupuncture.
Evidence for its effectiveness
Positive evidence from clinical trials, based on systematic reviews and meta-analyses of acupuncture trials, supports its use for nausea and vomiting, dental pain and headaches. The efficacy of acupuncture treatment in back pain is less clear, with one positive systematic review, one neutral and one negative review.
Inconclusive evidence exists for the treatment of stroke, asthma and neck pain, and there is clear negative evidence for the use of acupuncture in weight loss and giving up smoking. However, the effect of acupuncture in smoking cessation trials is similar to that of nicotine patches. Acupuncture is currently used in at least 84 per cent of pain clinics in the UK and in primary care for painful and non-painful symptoms.
Needling trigger points
One particularly effective aspect of acupuncture is the practice of needling trigger points (or intramuscular stimulation) in the treatment of pain. Interestingly, the pain referral pattern emanating from a myofascial trigger point often radiates along the pathway of a meridian, and it seems possible that some of the traditional meridian ideas may have developed as a consequence.
Is Acupuncture Safe?
Although serious side-effects may occur with acupuncture, they are rare. They include local infection and local tissue damage, such as bruising. Very rarely, serious damage to superficial nerves or internal organs may cause events such as a punctured lung or kidney. The chances of a needle breaking are extremely small, but if one does there may be problems due to the migration of broken or embedded needle fragments.
Two surveys of acupuncture safety, involving 66,000 consultations, demonstrated a very low incidence of minor side-effects, but warned against some preventable ones. The transmission by acupuncture needles of infections such as hepatitis B and C is a very real possibility. Unsterilised needles probably caused millions of liver disease cases in China and Japan. It is vitally important to use disposable needles. It is also essential to establish a clear diagnosis before initiating acupuncture treatment, particularly for persistent pain.The reason for this is that in theory, at least, acupuncture might mask a disease because it can reduce pain, breathlessness and other troublesome symptoms.
FINDING A PRACTITIONER
The British Medical Acupuncture Society keeps a register of doctors trained in acupuncture techniques and the British Acupuncture Council can also recommend practitioners.
In Australia, contact the Australian Acupuncture and Chinese Medicine Association (AACMA). When you receive acupuncture, check the practitioner is using disposable needles. Always tell the practitioner if you are pregnant (certain acupoints should be avoided). Avoid alcohol, large meals, hot baths or showers and strenuous exercise immediately before or after treatment as they may counteract the effect of treatment.