Dr Hansie Wong Integrative Medicine USA 12:05-13:00 WS #31: An Overview of Acupuncture
Acupuncture An Overview Hansie Wong, MD 8 June 2018
Disclaimers Bias: I do acupuncture and believe it has a place for some conditions. I have no financial interest associated with this session.
Acupuncture: An Overview Background/History Mechanisms of action Uses Safety profile Basic TCM theory Technicalities Experiential application
4 Pillars of TCM Acupuncture Qigong Massage therapy Herbal medicine
What is Acupuncture? needle piercing The insertion of needles into specific points on the body for therapeutic purposes
History >2000 yrs ago developed by the Chinese 2 nd century BC: Huang Di Nei Jing 282AD Comprehensive Manual of Acupuncture and Moxibustion 1601: Zhen Jiu Da Cheng Nixon s trip to China 1971 1970s: NZ Director General of Health toured China 2007: MoH approved acupuncture but still unregulated in NZ
How Does Acupuncture Work? Eastern Explanation acupuncture unblocks and balances the energy flow through the body bi-directional regulation of physiologic functions Western Explanation: Counter-pain Gate Theory of Pain Electrical Theory of Pain Endorphins Autonomic Nervous System
Medical Acupuncture Acupuncture that has been successfully incorporated into medical practices in Western countries Respects the contemporary understanding of neuromuscular anatomy and pain physiology while embracing the Chinese concept of qi Puts acupuncture in a framework that aligns with Western medical training
What is Acupuncture Used For?
Effective in: 1997 NIH Consensus on Acupuncture Adult post-op and chemotherapy n/v Post-op dental pain Adjunct treatment or acceptable alternative for: addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma
2003 WHO Recommendations WHO Acupuncture: Review and Analysis of Reports on Controlled Clinical Trials. 2003
1. Diseases, symptoms or conditions for which acupuncture has been proved through controlled trials to be an effective treatment: Adverse reactions to radiotherapy and/or chemotherapy Allergic rhinitis (including hay fever) Biliary colic Depression (including depressive neurosis and depression following stroke) Dysentery, acute bacillary Dysmenorrhoea, primary Epigastralgia, acute (in peptic ulcer, acute and chronic gastritis, and gastrospasm) Facial pain (including craniomandibular disorders) Headache
1. Diseases, symptoms or conditions for which acupuncture has been proved through controlled trials to be an effective treatment: Hypertension, essential Hypotension, primary Induction of labour Knee pain Leukopenia Low back pain Malposition of fetus, correction of Morning sickness Nausea and vomiting Neck pain Pain in dentistry (including dental pain and temporomandibular dysfunction) Periarthritis of shoulder Postoperative pain Renal colic Rheumatoid arthritis Sciatica Sprain Stroke Tennis elbow
2. Diseases, symptoms or conditions for which the therapeutic effect of acupuncture has been shown but for which further proof is needed: Abdominal pain (AGE or spasm) Alcohol dependence and detox Bell s Palsy Bronchial asthma Cancer pain Cardiac neurosis Earache Female infertility Facial spasm Female urethral syndrome Fibromyalgia and fasciitis Gastrokinetic disturbance Gouty arthritis Hypo-ovarianism Insomnia Labour pain Lactation deficiency Male sexual dysfunction, nonorganic Ménière disease Neuralgia, post-herpetic Neurodermatitis Obesity Opium, cocaine, and heroin dep
2. Diseases, symptoms or conditions for which the therapeutic effect of acupuncture has been shown but for which further proof is needed: Osteoarthritis Pain d/t endoscopy Pain in thromboangiitis obliterans PCOS Post-extubation in children Post-op convalescence Pre-menstrual syndrome Prostatitis, chronic Pruritis Radicular and pseduo-radicular pain syndrome Raynaud Syndrome, primary Recurrent UTI Reflex Sympathetic Dystrophy Sjögren s Syndrome Spine pain, acute Stiff neck TMJ dysfxn Tietze Syndrome Tobacco dependence Tourette Syndrome Ulcerative colitis, chronic Vascular dementia Whooping cough
3. Diseases, symptoms or conditions for which there are only individual controlled trials reporting some therapeutic effects, but for which acupuncture is worth trying because treatment by conventional and other therapies is difficult: Chloasma Choroidopathy, central serous Colour blindness Deafness Hypophrenia Irritable colon syndrome Neuropathic bladder in spinal cord injury Pulmonary heart disease, chronic Small airway obstruction
4. Diseases, symptoms or conditions for which acupuncture may be tried provided the practitioner has special modern medical knowledge and adequate monitoring equipment: Breathlessness in chronic obstructive pulmonary disease Coma Convulsions in infants Coronary heart disease (angina pectoris) Diarrhoea in infants and young children Encephalitis, viral, in children, late stage Paralysis, progressive bulbar and pseudobulbar
Research Limitations Placebo???? sham acupuncture Acupuncture for an unrelated condition Insertion at non-acupuncture points Non-insertive simulated acupuncture True vs sham acupuncture Belief and expectations
Bottom Line Consider acupuncture for treatment of pain, acute or chronic. Consider acupuncture as an adjunct for difficult-to-treat chronic conditions like depression/anxiety, FMG, RSD, etc. Consider acupuncture for your TLC patients.
Is it safe???
Risks/Adverse Events Bleeding/bruising Contact dermatitis Local inflammation Syncope Infection Rare: pneumothorax, needle retention Special conditions: hemophilia, pregnancy, pacemaker
Understanding Acupuncture
Basic TCM Theory Yin/Yang Zang Fu Organs Five Elements 14 Regular Meridians
Yin and Yang Yang Hot Bright Moving External SNS Activation Rostral Posterior Head/Back Yin Cold Dim Quiescent Internal PSNS Inhibition Caudal Anterior Body/Chest
Zang Fu Organs Zang Organs (solid, yin) Lung Heart Pericardium Liver Spleen Kidney Fu Organs (hollow, yang) Large Intestine Small Intestine Sanjiao (Triple Burner) Gallbladder Stomach Bladder
Five Elements
14 Regular Meridians Invisible channels through which qi circulates 12 main meridians (6 Yang, 6 Yin) 2 midline meridians Du Mai (Yang): posterior Ren Mai (Yin): anterior
When To Use What Principles of Disease Diseases of Channels and Collaterals Diseases of the Zang Fu Organs Diseases that combine Zang Fu and Channel disorders
Point Selection Local points Distal points Ah shi tender points
Some Technicalities
Acupuncture Needles
Needle Insertion
Needle Stimulation Manual Stimulation Electrical Stimulation Moxibustion
What to Expect
Two Sensations Pinprick de qi
Acupuncture in Action!
P 6
LI 4
Take Home Points Evidence suggests that acupuncture has some benefit for many conditions. Acupuncture has a relatively low risk of harm and is safer than most medications. Consider acupuncture as an adjunct or alternative for treatment options. Remember that medicine is an art and include the patient in shared decision making.
More Info NZ Register of Acupuncturists http://www.acupuncture.org.nz NZ Acupuncture Standards Authority (NZASA) https://www.nzasa.org/ Physiotherapy Acupuncture Association of NZ http://www.paanz.org.nz
References http://www.holistic-online.com/acupuncture/acp_home.htm What is acupuncture? Healing Applications of Acupuncture How Does Acupuncture Work? http://www.mayoclinic.com/health/acupuncture/ Mayo Clinic Staff. Acupuncture. Jan 2012. http://www.medicalacupuncture.org/acu_info/articles/helmsarticle.html Helms, Joseph M. An Overview Of Medical Acupuncture. Modified from Essentials of Complementary and Alternative Medicine. Jonas WB, Levin JS, eds. Blatimore, MD: Williams & Wilkins, 1999. http://www.medicalacupuncture.org/acu_info/articles/nccaminfo.html NCCAM Information and Resources Package http://www.ncbi.nlm.nih.gov/pubmed Kelly, Robert B. Acupuncture for Pain. Am Fam Physician. 2009 Sep1;80(5):481-484. NIH Consensus Statement Online 1997 November 3-5. 15(5): in press. World Health Organization. Acupuncture: Review and Analysis of Reports on Controlled Clinical Trials. 2003.