People ask me many questions about acupuncture. They seem to be
especially interested in learning how I came to study the discipline,
and this is among the toughest questions to answer. I still can't quite
fathom why I chose to spend a couple of days in the clinic of a college
of Chinese Medicine. Once I got there, I was fascinated by patients'
satisfaction with acupuncture treatment and the individual approach to
the patient. I remember most vividly an asthmatic child whose
improvement after treatment was striking and objective.
Neck-deep in the medical education system, the experience was relegated to the
back of my mind. I certainly didn't expect it to change my life.
Several years after beginning a busy practice of Obstetrics and Gynecology, I
began to develop a sense of our limitations as physicians. Though I felt I was doing a great deal of good, I was troubled. I thought about different people with problems which appear identical, yet respond very differently to therapy. My training was not helping me to address the diversity among human beings. Some symptoms almost never seem to respond to my 'MD' armamentarium, and some treatments had undesirable side effects. I was intrigued with the prospect of an additional type of treatment strategy, especially for the illnesses and patients that do not seem to be addressed well by conventional medicine.
According to my first teacher, Joseph Helms:
"Perhaps the most fertile ground for acupuncture intervention is for disorders
in their premorbid state, problems commonly encountered by primary care
providers but rarely associated with positive laboratory findings,
definitive medical diagnoses, or successful therapies. [For example,]
Fatigue…mild depression, stress-related myofascial symptoms, diminished
libido…anxiety, sleep disturbances, bowel dysfunction and immune
I was not alone, of course. There has been an unequivocal public groundswell of interest in a variety of complementary therapies. Total United States visits to alternative medicine practitioners in 1997 are estimated at 629 million, exceeding
total visits to all US Primary care physicians.
Increasingly, I was thinking about my experience with acupuncture. Reading sparked my interest further. I learned that most of the physicians in the United
States had trained in what we now call the 'Helms Course.' The 300 hour UCLA continuing education course is taught by Joseph Helms, a practitioner of Family Medicine and Acupuncture and a gifted instructor. Through a combination of lecture, practical, and self-paced videotape sessions, I built a base of knowledge and skill, and I joined a network of fascinating, like-minded physicians.
The discipline of Medical Acupuncture, acupuncture practiced by physicians, continues to grow. The American Academy of Medical Acupuncture (AAMA) has over 1800 members. The American Board of Medical Acupuncture was founded in 2000, establishing rigorous certification standards. Several hundred physicians are diplomates (board certified). Further information is available at the AAMA website.
The World Health Organization has adopted guidelines on training and standards for safe practice of Acupuncture. Over forty specific indications have been delineated as well. Further information is available at the WHO and AAMA web sites.
In November 1997, The NIH published a consensus statement on acupuncture. The document acknowledges:
"…efficacy of acupuncture in adult post-operative and chemotherapy nausea and
vomiting and post-operative dental pain. There are other situations…where acupuncture may be…included in a comprehensive management program. Further research is likely to uncover additional areas where acupuncture interventions will be useful."
The discipline is increasingly joining the realm of evidence-based medicine.
Challenges include obvious difficulties with blinding and controls, and sparse sources of funding. More subtle difficulties stem from the very nature of the discipline. Individualized treatment plans are the ideal, often formulated from a combination of acupuncture and western diagnoses. This integral feature of the discipline complicates experimental design tremendously. Despite these limitations, an increasing body of literature exists, addressing specific applications of acupuncture. Documentation is also available with regard to physiologic changes in response to treatment, including PET scan, body surface temperature, blood chemistry, and neurotransmitter changes.
The earliest major source of acupuncture theory is the Yellow Emperor's Inner Classic, dating from the second century BC. The most fundamental principle is to restore balance of yin and yang, the five elemental qualities (wood, fire, earth, metal, and water), and between the individual and his surroundings. This is accomplished through movement of Qi (pronounced 'chee'), the 'life force', through channels or 'meridians'. The meridians make up a multi-layered, interconnecting network. They are named for organs, and include their familiar, as well as metaphoric Chinese functions. For example, Kidney encompasses the kidney organ
function, as well as bones and joints, hearing, will, and motivation. A number of systems, variations on these basic themes, have evolved internationally. More recently, a more strictly anatomical approach is also gaining favor among physicians.
The majority of first-time patients present for pain and musculoskeletal disorders. Once familiar with the discipline, though, they often venture into treatment for other disorders, including psycho-emotional concerns, gastrointestinal, respiratory, gynecologic and urinary disorders. Acupuncture has also gained the respect of comprehensive drug rehabilitation programs.
Medical acupuncturists gather both western and acupuncture history and physical
data to postulate a pattern of disharmony. Treatment design can be quite complex, requiring consideration of classical teachings, neuromuscular anatomy, and treatment of trigger points, as well as recruiting the dermatomal, myotomal, sclerotomal, and sympathetic components of the pain problem.
Fine, solid needles are inserted to the depth necessary to elicit the patient's sensation of de qi or needle grab, a dull ache that radiates from the point. This can be 0.5 cm to 8 cm, depending on the location. The needles may be stimulated
when an additional activation of the acupuncture system is desired. This additional activation is accomplished through manual manipulation, by heating the needle, or by connecting the needles to an electrical stimulating device.
Patients with chronic problems are often initially seen once or twice weekly, for eight to twelve sessions, which last 30-60 minutes. Treatment plans and frequency are tailored to the individual. Acute problems tend to respond more quickly.
In the hands of a medically trained practitioner, acupuncture is a remarkably
safe and forgiving discipline. Many patients report a sensation of well being or relaxation following an acupuncture treatment. Occasionally there is a short-lived feeling of fatigue or mild depression. The risks and complications of an acupuncture treatment are the undesirable consequences of penetrating the body: syncope, puncture of an organ, infection or a retained needle. Dr. Wilks uses disposable, single-use needles, and complications are extremely rare.
Medical Acupuncture is a unique and highly adaptable discipline, which is enjoying a striking increase in popularity among physicians and patients. It has rejuvenated my enthusiasm for and enjoyment of medical practice.
9 August 2011