Medical acupuncture

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History of medical acupuncture

Medical acupuncture was created for Western practitioners such as medical doctors, physiotherapists, chiropractors and osteopaths who wish to use acupuncture based practices without the lengthy study of traditional Chinese Medicine theory which is usually required for acupuncturists. This Western version of medical acupuncture is lesser known than the traditional Chinese, but is increasing in popularity as otherwise mainstream medical practitioners in the West are seeing and taking more interest in alternative medicine. Medical acupuncture can also be seen as an attempt by orthodox Western medicine to understand the effects of acupuncture from a western scientific perspective rather than within the paradigm of Chinese traditional medicine. The British Medical Acupuncture Society publishes a quarterly peer reviewed journal, Acupuncture in Medicine, which is listed on Medline and Index Medicus.

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 seventeenth century. Traditional Chinese medicine had an influence on Europe due to exchange via the Silk Road trade routes. Goods and ideas both travelled between cultures in this way.

Acupuncture continued to attract interest from Western allopathic physicians in the eighteenth and nineteenth centuries though generally without much reference to its Oriental roots. 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. 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, all of which can be difficult for some Westerners to understand. In the United Kingdom most practitioners of acupuncture are medical acupuncturists, either medical doctors or allied health professionals. The. British Medical Acupuncture Societyprovides training for medical doctors and allied health professionals. Many countries have similar organisations and there is an International Council of Medical Acupunturists ICMART which represents medical acupuncturists from over 80 countries.

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 (TCM) 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 hosptials 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.

1. The traditional theory of "points" and "meridians" is either ignored altogether or is radically reinterpreted because there is supposedly no physically verifiable anatomical or histological basis for the existence of acupuncture points or meridians.
2. 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.
3. Medical acupuncture is understood to work via the western biomedical understanding of anatomy, physiology and biochemistry.

The principal differences between classical and medical acupuncture can be summarized as follows:

These differences are theoretical, but there are also practical differences. Whereas traditional acupuncture practitioners, at least today in the West, tend to work wholistically 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 Western acupuncturists use many 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 it can be learned much more easily than traditional acupuncture by modern health practitioners such as doctors, physiotherapists, osteopaths, chiropractors, and podiatrists. Such people do not have to learn another system of thought or technique; rather, they see acupuncture as an extension of what they are already doing^{[citation needed]}.

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.

There is relatively little research to support the use of acupuncture, traditional or modern, and very little comparative research comparing various approaches.

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 (pronounced chee), 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."^[3]

The concept of trigger points is commonly used to decide on insertion points for the needles. These are tender areas, mostly in muscles, from which pain and other sensations may radiate to distant areas^{[citation needed]}. In Traditional Chinese Medicine (TCM) 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)^{[citation needed]}. 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 medical acupuncturists 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 not very important^{[citation needed]}. A traditionally-trained acupuncturist, however, might consider this belief heresy, and consider this random^{[citation needed]} approach potentially harmful or even dangerous.

There are also many techniques of electroacupuncture (mostly developed by Japanese and European acupuncture researchers), one which uses only 24 points. Each meridian has a so-called test point, a tonification point, and a sedation point. A machine records the electrodermal current at the identified test point for each meridian. The values are placed into a chart. 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. 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. There are no complex points to remember, just 24 points on the bilateral meridians.

Mechanism

Two attempts at western medical explanation of analgesic and pain control action have been suggested:

1. The gate theory of pain, first put forward some thirty years ago by Patrick Wall and Robert 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.
2. 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 in recent decades 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.

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