Certainly anyone reading this has an understanding that acupuncture is one of the great pillars of traditional medicine. Acupuncture has a long and varied history. In a world of changing healthcare options and expectation, what role does the acupuncturist play? This commentary is not meant to be antagonistic – so don't shoot the messenger. I pulled several books from my shelf just to get a picture of how the art of acupuncture is discussed. Here are a few excerpts:
"In most Asiatic countries modern scientific medicine has not penetrated very deeply. This is owing not only to the lack of personnel and facilities available and to the lack of a system which would enable the physician to carry out his task and to make a decent living in the rural districts where he is needed most, but also to the very foreignness of scientific medicine to the majority of the people. We cannot expect a village that lives today very much as it did centuries ago to accept modern science with far-reaching social and economic changes and without educational preparation. As a result of these physical conditions most people in Asia do not receive medical care from physicians trained in modern medical schools but from indigenous practitioners who follow the precepts of ancient and medieval medicine. The medical systems of the past are still very much alive. Their study is of the greatest interest not only to the historian of medicine who wishes to understand the history of civilization but also to the modern physician whose endeavor it must be to overcome obsolete theories and practices and to replace them with the more effective techniques of scientific medicine…"
"Acupuncture therapy, a shining pearl in Chinese medicine, has spread throughout the world in recent years. The rest of the world is beginning to see the value of acupuncture which the Chinese have known for thousands of years. Unlike Western medical treatment, acupuncture utilizes simple tools and boasts a low instance of adverse side effect. Combined with marked efficacy, it has been widely accepted and welcomed by both doctors and patients."
"Long before there were X-ray machines, CAT scans, and blood tests, traditional healers used noninvasive methods to ascertain personal health, talents, and character. From their understanding came a deep appreciation for the unity of the mind, body, and spirit. For the Oriental diagnostician, the body is the physical manifestation of the soul. Body and soul are one. The body is both a symptom and a symbol for the spirit."
"The Chinese developed a highly complex and sophisticated system of empirical laws based on countless observations of illness and response to treatment, which resulted in a number of ground rules to guide a doctor as to how to improve his patient's condition. The astonishing fact is that application of these apparently odd-sounding laws appears to work in a highly significant proportion of patients. Clearly if it did not do so then acupuncture would not have been adopted within both Western and Eastern cultures to such a degree."
"…prior to the ascendance of the style of acupuncture which has come to be called Traditional Chinese Medicine (TCM), the style in which most acupuncturists in the United States and almost all acupuncturists in the People's Republic of China are currently trained. The fact that TCM acupuncture is, in fact, only one style of acupuncture has been well documented by several writers in recent years. A discussion of the merits or drawbacks of this style could fill an entire book and I will not belabor that question here. Suffice it to say that while a great deal has been written on the practice of TCM acupuncture, other styles from Japan, Korea, Vietnam, or pre-TCM Chinese lineages are only recently being explored by most American acupuncturists as viable, clinically effective alternatives."
The quotes above were pulled from pretty much randomly selected texts off the shelf in my office - they show a considerable disparity of philosophy regarding acupuncture. Acupuncture does encompass a broad range of philosophies and techniques, and most practitioners now also use other modalities such as herbals and manual therapies. While pursuing my pain management program, it was interesting to note how much the philosophy of integrative care has come to be seen as the standard of care – individual techniques (ie: only acupuncture, or only surgery) simply do not have as good an outcome as a synergistic combination of therapies to fully meet the needs of the patient. Some respond very well to traditional needle therapies, some need nutritional or herbal therapy, some need active stretching or rehabilitation, and unfortunately some need surgery. A large part of my practice focuses on patients who have already had surgery and are now trying to recover – acupuncture has a tremendous effect on their pain, but they need to get into an active program of exercise to recover the lost muscle tone. The combination of therapies just works better.
Another current example of change would be the progressive growth of "dry needling." When I first heard the term, it was specifically a technique of orthopedists using a hypodermic needle to perforate areas of soft tissue congestion (can anyone say "ah-shi" points?) multiple times.
The most recent flyer I received clearly showed the practitioner using acupuncture needles down along the para-spinal points – a very different practice indeed. The course was open to any level of healthcare practitioner – home care nurse to physical therapist. How did this specific medical technique get so diluted that it became a freestyle acupuncture technique??? Clearly not all change is good.
Hopefully the concept I am trying to relate is clear – despite the variety within the profession, as a practitioner one needs to be very clear on what techniques they use and why. There are always going to be articles and texts that define acupuncture differently, state what it can or can't do, dictate what techniques should be used, etc., etc., etc. The question comes down to you as an individual.
Take the time with patients to explain what you are going to do and why. Discuss your exam findings, the points you will use, and what you expect to happen. Also, don't be afraid to recognize the limits of what acupuncture can do and refer for appropriate complimentary care – these can exponentially improve the response to your care, and the patient will see that you have their best interest in mind. As always, good care requires thorough documentation – make sure to record updated history, findings, treatments, other care, and the patient's response to treatment.
References
Chronic pain afflicts over 20% of the adult population. Sadly, most MDs have essentially no education in treating pain, beyond offering a few toxic medications. Then they tend to steer people with pain away from those health practitioners who are trained. This puts the acupuncture community on the front lines for addressing this epidemic.
When the body is going through a stressful event, the sympathetic system is activated. This activation will help the body with a life-threatening situation. If this state is activated for prolonged periods of time, it starts to consume energy. These traumatic events that generate stressors in the autonomic nervous system (ANS) will eventually become internalized.
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One of the things that makes acupuncture so difficult to measure is that the medicine actually does contain some esoteric aspects. There have been numerous studies that demonstrate the neurochemical reasoning behind why acupuncture points stimulate the autonomic nervous system to enact change However, not all the benefits of TCM can easily be measured by randomized, controlled trials. But does that make them fundamentally and definitively untrue?
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