Wednesday, November 06, 2013
She may look relaxed, but good acupuncture can be painful!
I am a curious soul, just like most of you. When I was a university student at National Taiwan University, I took an evening course on acupuncture. 5 minutes into my first lesson, professor Su, a well known international expert in acupuncutre, asked us to stick a few of those shiny needles into our elbow, arms and calves. Following that I practiced diligently (I mean, daily) for one year.
As I was a busy, active student, the only time I practiced was before bedtime. As a result my mother or my roommates were often horrified to discover me covered in hundreds of needles the next morning—I would fall asleep before taking them out!
I became pretty good at it, but that was just for fun. I didn't intend to become a doctor. I was purely curious about how the human body worked and how ancient wisdom interpreted this incredible human machine.
So, what is acupuncture?
Almost everyone has heard of acupuncture: that strange Chinese practice where you lay on a bed while someone sticks you with dozens of tiny needles. Many Westerners often wonder why anyone would want to be pinned like a butterfly and write off acupuncture as a sham. But I have a feeling that Chineasy fans are a curious crowd and have a lot of unanswered questions about the practice of acupuncture. Where did it come from? How does it work? And most importantly, is it effective?
Acupuncture is so ancient that no one really knows exactly how it began other than that it originated in ancient China. There are several theories including one that suggests that doctors invented acupuncture after witnessing soldiers who had been struck with arrows become suddenly cured of various medical problems. Even though its origin is mysterious, we do know for certain that acupuncture has been around for a very long time. Some ancient drawings show acupuncture and other alternative methods, still practiced today, being used as early as 1600 BCE.
Fast forward to modern times and we see acupuncture begin to decline from the 1600’s to 1950’s. This was until the famous Communist Party Chairman Mao Zedong shook things up a bit. Originally, the communist party wanted nothing to do with traditional Chinese medicine (TCM), but later, Chairman Mao realized that accepting and supporting TCM would actually allow many more Chinese to receive health care and create more jobs, while simultaneously disagreeing with Western doctors (which was a plus for the communist party at the time). Since then acupuncture and other TCMs have spread to Western countries and been subject of scientific controversy and debate around the world.
And now, onto the theory behind acupuncture! In order to understand what acupuncture is about, one must understand what Qi (sometimes spelled “chi” or “chi”) is. The character for Qi in traditional Chinese calligraphy is 氣. It features 气, the character for steam, on top of 米, the character for rice. The exact definition has been changed and debated over the years but basically, Qi is a name for energy that flows through all living things. It corresponds to the Western concept of Vitality, which is no longer considered a valid theory by Western scientists. Acupuncture's purpose is to remove blockages in the flow of Qi and promote harmony and balance in the body. Like removing dams in a stream so it can flow freely. Acupuncture is used to help a number of maladies and it is interesting to see how certain pin placements correlate to different parts of the body. A person might get acupuncture to treat migraines, depression and increase fertility. Anything which a traditional western doctor might treat - within reason (if you break your arm go to a doctor to have it put in a cast! Acupuncture only goes so far.)
According to acupuncture theory, in order for the body to be in balance Qi must be allowed to flow along certain paths, called meridians. There are 20 meridians in total and most needles will be placed somewhere along these paths. In addition to the meridians, there are other acupuncture points that are sometimes used to achieve a specific effect. I should say, that No scientific evidence has been found to suggest that something like a meridian exists in any measurable way.
Modern acupuncture needles are usually made from stainless steel wire. They are very tiny, usually only 0.16mm to 0.46mm thick. Once the needle and skin are sterilized (often disposable needles are used) the practitioner will insert the needles into the skin, sometimes using a plastic tube to guide the needle. Once the needle is inserted, the practitioner can manipulate the needle by twisting, flicking, or wiggling it up and down. This may sound painful, and sometimes it is. There are different schools of thoughts about painless acupuncture. My teacher Professor Su encouraged that we stir as much as possible to the degree that the pain is unbearable. Some doctors claim to practice ‘painless’ acupuncture. I am more with Professor Su.
So now that you know where acupuncture comes from and what it’s all about, one question still remains: does it actually work?
The short is answer is yes! In the last decade or two there have been many attempts by Eastern and Western scientists to study acupuncture empirically. Many studies have had mixed results, while some have shown mostly positive results and others mostly negative. The difficulty with the studies is creating a placebo control group. It’s pretty difficult to make someone believe they are being stuck with needles if they are not, in fact, being stuck with needles. One common method used to create a control group is called “sham acupuncture”. In sham acupuncture, needles are inserted at locations that are not used in traditional acupuncture practice. Some argue, however, that sham acupuncture could have some accidental positive effects on the patient and therefore is not a good measure of acupuncture's effectiveness.
One month ago I had to take my sister to have her tennis elbow treated in London in Chelsea Westminster Hospital. The doctor who performed the treatment used a needle, with assistance by ultrasound, to pinch the space between the muscles and tendon where inflammation occurred. It looked to me that he was performing acupuncture to her elbow! The only difference is that I did not have the luxury of having ultrasound helping me identify the precise spots.
The latest trend in scientific consensus is meta-analysis, a process where every study that can be found on a particular subject is entered into a giant database and analysed. This allows scientists to try and eliminate personal biases and faulty experiments from reaching a probable conclusion about the effectiveness of a practice such as acupuncture. In 2012, a team of Western doctors conducted a meta-analysis of acupuncture trials (17,922 patients in total) and found that acupuncture treatment were more effective at relieving pain than sham acupuncture and no acupuncture. You can view the abstract here: http://bit.ly/12ewmWH.
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