Medical Acupuncture
Medical acupuncture is acupuncture performed by a physician or other licensed health care professional who has training in conventional medical/health sciences. Physicians also may have training in acupuncture, but most jurisdictions do not require physicians to obtain training in the field prior to treating patients using acupuncture. Such a health professional may use one or the other approach, or a combination of both, to treat a dysfunction or illness.
History of Medical Acupuncture
Acupuncture has attracted interest from physicians outside Asia for many centuries, with documented references to acupuncture from by Portuguese and Dutch clerics and traders in the 15th Century. This interest has continued down to the present, receiving considerable interest after President Nixon's visit to China in 1972, when surgeons witnessed surgical operations being carried out using acupuncture analgesia instead of anaesthetics. As a result of this interest, traditional Chinese medicine has become a global phenomena and with this interest came a desire by medical professionals to learn acupuncture without the difficult theory. Some traditional Chinese medicine theories include reference to philosophies of Taoist cosmology and to some Westerners these philosophies border on shamanism and mysticism, which they reject.
The British Medical Acupuncture Society provides training for medical doctors and allied health professionals and many countries have similar organisations. The International Council of Medical Acupuncturists (ICMART) represents practitioners of medical acupuncture from over 80 countries.
The term "acupuncture" is a Western one, derived from Latin and meaning "puncturing with needles". It was first used by the Dutchman Wilhelm Ten Rijn, who wrote a monograph in Latin on the subject (De Acupunctura) at the end of the 17th century. Traditional Chinese medicine had an influence on Europe due to exchange via the Silk Road trade routes when both goods and ideas travelled between cultures in this way.
One definition of [Western] medical acupuncture (WMA) is "WMA is a therapeutic modality involving the insertion of fine needles; it is an adaptation of Chinese acupuncture using current knowledge of anatomy, physiology and pathology, and the principles of evidence based medicine. While Western medical acupuncture has evolved from Chinese acupuncture, its practitioners no longer adhere to concepts such as yin/yang and circulation of qi, and regard acupuncture as part of conventional medicine rather than a complete “alternative medical system”. Medical acupuncture was developed by Western practitioners such as medical doctors, physiotherapists, chiropractors and osteopaths who viewed acupuncture as a technique that could be incorporated in to their practice without the necessity of learning, or believing in, the ancient Chinese medical antecedents. Central to the practice of medical acupuncture is that the observed effects of acupuncture are explainable with reference to neurophysiological / neuroendocrine mechanisms.
Medical acupuncture can also be seen as an attempt to understand the effects of acupuncture from a Western, scientific perspective rather than within the paradigm of Chinese traditional medicine, and increasingly to subject acupuncture practice to the protocols of evidence based medicine. The British Medical Acupuncture Society publishes a quarterly peer reviewed journal, Acupuncture in Medicine, which is listed on Medline and Index Medicus.
Battlefield acupuncture
The US Army trains medics in the use of medical acupuncture for pain relief for use in battle or major disasters. Forty Department of Defence doctors are licensed acupuncturists and provide training for hundreds of army medical specialists.
Differences between Classical Chinese Acupuncture, Traditional Chinese Medicine and Western Medical Acupuncture
The main differences between Classical Chinese Acupuncture, Traditional Chinese Medicine and Western Medical Acupuncture are as follows.
Classical Chinese Acupuncture is the form of acupuncture that has been practiced for thousands of years and is based on Taoist thought and elements of naturalism.
Traditional Chinese Medicine is the revised form of acupuncture and herbal medicine that was revived by Mao Zedong during the Cultural Revolution. Despite the misnomer, acupuncture based on Traditional Chinese Medicine is actually a modern form of acupuncture that has been well integrated with western medical concepts of anatomy and physiology and has been used in hospitals alongside Medical Doctors in China for well over fifty years. This modern form of acupuncture is also situated in hospitals in Korea, Japan and parts of Europe.
Medical Acupuncture is a contemporary form of acupuncture that was developed by Medical Doctors in the United States and, recently, Great Britain over the last twenty years. Key aspects of medical acupuncture include:
- The traditional theory of "points" and "meridians" is either ignored altogether or is radically reinterpreted because there is no physically verifiable anatomical or histological basis for the existence of acupuncture points or meridians.
- The concepts of disease are derived from modern Western pathology instead of Oriental medical theory, which predates use of the scientific method, and has received various criticisms based on western thinking.
- Medical acupuncture is understood to work via the western biomedical understanding of anatomy, physiology and biochemistry.
These differences are theoretical, but there are also practical differences. Whereas traditional acupuncture practitioners, at least today in the West, tend to work holistically and address deficiencies or overall energy imbalances (often inserting several or large numbers of needles and maybe leaving them in place for 20 minutes or longer, some practitioners of medical acupuncture use fewer needles (sometimes only one) and practise brief insertion (from two or three minutes right down to one second). Brief needling techniques are also used by those traditionally trained, though they may be less common.
Medical acupuncture lends itself to use in a busy practice where there is little time to spend on each patient. It also has the advantage that modern health practitioners such as doctors, physiotherapists, osteopaths, chiropractors, and podiatrists can learn it much more easily than traditional acupuncture. Such people do not have to learn another system of thought or technique; rather, they see medical acupuncture as an extension of what they are already doing
Some traditionalists state that western medical acupuncture is a watered-down version of "real" acupuncture, having at best a limited degree of effectiveness in certain situations. In some jurisdictions, the practice of needle insertion based on local physical symptoms, and without traditional acupuncture training, is called 'dry needling' to distinguish it from traditional acupuncture.
Choosing where to needle
The founding president of the American Academy of Medical Acupuncture has written that:
"The choice of needle patterns can be based on traditional principles such as encouraging the flow of qi, a subtle vivifying energy, through classically described acupuncture channels, modern concepts such as recruiting neuroanatomical activities in segmental distributions, or a combination of these two principles."
The concept of trigger points is commonly used to decide on insertion points for the needles in medical acupuncture, which are tender areas, mostly in muscles, from which pain and other sensations may radiate to distant areas. In Traditional Chinese Medicine these are considered Ah Shi points, or spontaneously tender points, which are often appropriate for needling as part of a treatment.
Another idea is to base the needling on body segments. The spinal cord is arranged segmentally, with pairs of nerve roots emerging from it along its length. These nerve root pairs supply the skin in a series of stripes, so that it is possible to say which spinal segments supply sensation to different parts of the body. A similar arrangement exists at deeper levels, so that we may speak of myotomes (related to the muscles) and sclerotomes (related to the bones and joints). In some versions of medical acupuncture the needles are inserted in segments that are related to the internal organs that one wishes to treat. This is very similar to the TCM approach of using tendino-muscular meridians or regions, which closely match the same areas.
Other simplified ways of choosing where to needle also exist, however, some practitioners of medical acupuncture think that it often makes relatively little difference where the needles are inserted, at least in quite broad terms. Certainly there seem to be some patients who react very strongly to needling and some in whom the actual site of treatment seems to be less important. A traditionally trained acupuncturist, however, might consider this belief heresy, and consider this random approach potentially harmful or even dangerous because of the effect on the body caused by insertion of needles in certain area.
Electro acupuncture
There are also many techniques of electro acupuncture (mostly developed by Japanese and European acupuncture researchers), one of which uses only 24 points. Each meridian has a so-called test point, a tonification point, and a sedation point and in electro acupuncture, a machine records the electro dermal current at the identified test point for each meridian. The values are placed into a chart and based on the clustering of the values of the test points for each meridian - the practitioner is able to identify meridians which are hyperfunctioning and hypofunctioning. If the meridian is hypofunctioning - then the tonification point is needled to increase the electronic impulse flowing through said meridian, whilst if the meridian is hyperfunctioning, then the sedation point is needled to decrease the electronic activity in the meridian. The process is called balancing the meridians and this technique requires no complex points to remember, just the 24 points on the bilateral meridians.
Mechanisms of Medical Acupuncture
Original attempts to explain the analgesic and pain control actions of medical acupuncture were:
- The gate theory of pain, first put forward some thirty years ago by Patrick Wall and Ronald Melzack, postulates the existence of gates or filters in the spinal cord that can modulate (increase or decrease) transmission of pain information within the nervous system.
- The second explanation is based on the existence of natural opiates (pain-relieving substances such as endorphins and enkephalins) in the central nervous system and elsewhere in the body
Scientific research into medical acupuncture have shown that these theories, although they support some of the possible partial mechanisms of pain relief from local and distal needling, are not quite accurate even on the pain control mechanism of acupuncture.
In recent years evidence has suggested that the anti-inflammatory actions of acupuncture are mediated via the reflexive central inhibition of the innate immune system. Both laboratory and clinical evidence have recently shown the existence of a negative feedback loop between the autonomic nervous system and the innate immunity. There is also experimental evidence that the electrical stimulation of the nervous system inhibits macrophage activation and the production of TNF, IL-1b, IL-6, IL-18, and other proinflammatory cytokines. It is therefore conceivable that along with hypnosis, meditation, prayer, guided imagery, biofeedback, and the placebo effect, the systemic anti-inflammatory actions of needling and electro-acupuncture are directly or indirectly mediated by the efferent nerve activation and inflammatory macrophage deactivation.
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