BIOMEDICAL ACUPUNCTURE FOR PAIN MANAGEMENT: AN INTEGRATIVE APPROACH

The goal of this book is to facilitate the integration of acupuncture into mainstream medicine as a complementary modality in the field of pain management.

Integrate is defined in Webster’s College Dictionary as “to meld with and become part of the dominant culture.”

Biomedical acupuncture results from the integration of conventional Western medicine and traditional Oriental medicine. This integration is harmonious, or as the Chinese say, like “milk dissolved in water,” not “oil mixed with water.”

Biomedicine is defined in the same dictionary as “the application of the natural sciences, esp. the biological and physiological sciences, to clinical medicine.” This is exactly what biomedical acupuncture means: it is the application of biological and neurophysiological principles to clinical acupuncture.

The acupuncture system presented in this book allows healthcare professionals—medical doctors (MD's), doctors of osteopathy (DOs), doctors of chiropractic (DC's), dentists, podiatrists, nurses, physical therapists, and others—to learn acupuncture within the familiar framework of biomedical principles and practice it on the basis of their own previous medical training.

Contemporary healthcare professionals have a profound understanding of basic biomedical science and clinical issues as a result of their many years of school training and clinical practice. After a short period of additional training, these professionals will easily be able to incorporate biomedical acupuncture into their routine medical practice as an effective, problem-solving modality, without having to face the difficulties of learning all the ancient procedures of classical acupuncture. This is because acupuncture has the same physiological basis as mainstream biomedicine. The quantitative method introduced here will also be of great benefit to traditionally trained acupuncturists who will find it a useful addition to their practice.

Acupuncture has been practiced for about 5000 years in China and other Asian countries. Over the course of these millennia the ancient practitioners developed many elaborate concepts and systems that reflected the religious beliefs and the medical and sociocultural traditions of their time.

Acupuncture therapy has evolved into the twenty-first century still dragging with it a collection of empirical facts which though valuable are inextricably combined with ancient concepts and methods and all the various misinterpretations that have arisen during its long history.

As acupuncture encounters modern biomedicine in societies such as the United States and China, healthcare practitioners, Western and Eastern alike, are puzzled by its ancient character: they cannot judge from a medical perspective what is right and what is wrong in this venerable healing art nor can they understand how it works. Many healthcare practitioners decide to keep away from this bizarre modality, unable to believe that it can be justified scientifically. Others, attracted by anecdotal evidence of its efficacy, spend months or years studying acupuncture and traditional Chinese medicine (TCM), but even after years of study and practice, they may still find confusing such alien concepts as Qi or “fire,” or “five elements,” and the tangled maze of meridians and the various systems of acupoints.

Clinical evidence shows that acupuncture has its own special merits which are not the same as those of the high-tech–oriented Western medicine. It is effective for a variety of health problems, but particularly for cases in which Western medicine has little to offer, and especially in the field of pain management. It is a safe, low-cost modality which is easy to administer and has no side effects; it can be effective by itself or as a complement to other medical procedures.

The integration of acupuncture into mainstream medicine, especially in pain management for neuromusculoskeletal conditions, cannot happen without biomedicalization. This inevitable process, however, is not some new and exceptional event in the history of acupuncture. During the past several thousands of years the acculturation and reacculturation of acupuncture has occurred many times as it has adapted to different cultures and geographical circumstances: in China, Japan, Korea, Vietnam, and other Southeast Asian countries. After each acculturation, acupuncture practice changed to a certain degree and usually it was enriched by new methods and ways of understanding. It has been able to survive all these changes because the underlying medical mechanisms have stayed the same, regardless of the different clinical styles of the host cultures.

Now, in the twenty-first century, an enormous amount of laboratory data and clinical evidence enable us to reach a deeper understanding than ever before of the inner workings of acupuncture, using knowledge that ranges from molecular medicine to the modern understanding of human anatomy.

Acupuncture medicine is a rich inheritance from TCM. To successfully biomedicalize this ancient healing art, its historical origin and social evolution need to be understood.

For over 20 years Professor Long-xiang Huang of the Acupuncture Research Institute of the Academy of Traditional Chinese Medicine in Beijing has meticulously studied all of the ancient acupuncture literature available in China and Japan, from archaeological relics to Qing dynasty manuscripts. Using these documents he has painstakingly traced every possible clue leading to an understanding of how the ancient practitioners created the whole theoretical web of acupuncture and its clinical application. Now, for the first time, Professor Huang has been able to reconstruct the history of the development of acupuncture from the earliest records of its beginning.

When examining their patients, the ancient Chinese practitioners felt pulsation at arterial loci (pulsing points).They believed that this pulse was caused by a vital force, which they called Qi . The difference between life and death was due to the presence or absence of Qi and all parts of the body were connected by a Qi channel or vessel. These ancient doctors diagnosed by palpating the arterial loci (pulsing points) and then they needled these points to treat a disease. Since they could not feel the pulsation along the entire presumed Qi channel, they postulated lines of connection between the acupoints on the loci of arteries, thus making a visible map of the unseen parts of the channel. Different practitioners in different times and places evolved their own ways to connect together the acupoints which they had identified, and this gave rise to a variety of theories to explain the channels or meridians. Even today traditional Chinese medical doctors are trained to feel this arterial pulsation, though only on the radial artery proximal to the wrist. The pulsing points of arteries were the earliest acupoints.

Early acupuncture theories were formed from empirical experience. For example, ancient doctors found that for treating pain or other symptoms of the genitals, lower abdomen, and lumbar areas, needling certain pulsing loci on the dorsum of the foot and medial part of the lower leg was more effective than anywhere else. Thus they drew lines to connect the effective needling points with the parts of the body that were most affected by the needling, making a visible representation of the channel which connected all the points together. In this example the arterial points on the dorsum, the medial leg, the genital area, the lumbar area, and up to the tongue were joined together and thus the “liver channel”, or “liver meridian,” was gradually formulated. The other eleven meridians that are used today evolved in a similar way.

The theory of meridians, or channels, became one of the cornerstones of TCM. As there were many different ways to delineate the same channel there were soon many different theoretical explanations. In his reconstruction of the development of ancient acupuncture practice Professor Huang shows that the ancient Chinese used the same character “mai” ( 脉 ) to represent both “channels” and “blood vessels” . In most Western textbooks, the character “mai” has been translated as “meridian” or “channel”. Even today, acupuncture practitioners must learn a large and complex map of Qi channels (meridians) and other medical principles that are based on the ancient Yellow Emperor’s Canon of Internal Medicine.

If the old practitioners had recourse to the advances of modern medicine that we now take for granted, they would not have needed to “connect the dots” to map out the unseen parts of the arterial channels.

The Yellow Emperor’s Canon of Internal Medicine (Huang Di Nei Jing), which was probably compiled between 206 bc and 220 ad, stands as a unique monument of ancient medical science. It became the foundation of traditional Chinese medicine and is still used today as a textbook by acupuncturists all over the world.

The Canon integrated the various channel theories into one system. Inconsistencies in this book reveal that the authors had differing types of medical experience and were from different historical periods. In the years that followed the appearance of the Canon, acupuncture continued to evolve by incorporating more theories, and an ever-increasing number of acupoints and channels, into the existing system. Professor Huang shows that when clinical realities did not fit into an existing theory, the facts were often suppressed to ensure the continuance of the theory. New theories were forced to coexist with old ones, in a style that the Chinese call “cutting the foot to fit the shoe.” Thus classical acupuncture as we know it today is made up of theories and clinical experience that are valuable, mixed with fallacious concepts and imperfect explanations. We should also bear in mind that we in the twenty-first century have great difficulty in understanding and correctly interpreting this ancient text, because we lack the scholastic mentality of the time in which it was created.

Scholars and scientists of the People’s Republic of China conducted an intensive research program for over four decades, utilizing a national investment of enormous human power and financial resources, but no evidence was found that could support the traditional theory of acupuncture meridians. Professor Long-xiang Huang, who is currently in charge of the national program of acupuncture research, ascribes this result to the fact that researchers were not able to separate, in his words, the “pearls” (the valuable medical facts) from the “string” (the ancient explanations) that connects them. Professor Huang emphasizes that the most valuable discovery in acupuncture theory is the interrelatedness between the parts of the body surface, and between the parts of the body surface and the internal organs. These are the immortal “pearls” of classic acupuncture.

At the present time the situation is incongruous: scientists have been exploring the physiological and molecular mechanisms of acupuncture with high-tech facilities in laboratories for more than four decades while modern medical professionals who wish to study acupuncture are still using textbooks based on The Yellow Emperor’s Canon of Internal Medicine, written 2500 years ago. We hope this situation will change soon.

Many healthcare practitioners have found the old system unnecessarily difficult and incompatible with their medical training but they have no modern system to turn to if they want to practice acupuncture. The authors of this book have developed the Integrative Neuromuscular Acupoint System (INMAS), which uses both the principles of classic acupuncture and the latest scientific explanations of the underlying mechanisms, and can be easily learned by any healthcare professional who wants to integrate acupuncture into their routine practice of pain management.

It is no more correct to refer to a single universal “traditional Chinese acupuncture” than it would be to speak of a single universal “traditional European medicine.” For example, there are more than 80 different acupuncture styles in China alone, in addition to many Japanese, Korean, Vietnamese, European and American styles.

What has enabled acupuncture to survive for such an incredibly long time in so many different geographical areas across different historical periods? It is important to understand that the longevity of acupuncture is not based on the exact procedures of any particular style, but on its powerful underlying biomedical mechanisms.

The common feature shared by all the different types of acupuncture is using needles to make lesions in the soft tissue (acu-puncture). Needles and needle-induced lesions activate the built-in survival mechanisms that normalize homeostasis and promote self-healing. This process consists of two parts: central and peripheral.

For the central mechanism needling and needle-induced lesions stimulate parts of the brain that activate the principal survival systems—the nervous, endocrine, immune, and cardiovascular systems—and normalize the physiological activities of the whole body (see Chapter 4).

In the case of the peripheral mechanism needling and the resulting lesions trigger physiological reactions around the needling sites that involve all four survival systems in desensitizing and repairing the damaged tissues. At the needling site, a cascade of survival reactions occurs, including the immune reaction, and we call this the local needling reaction (see Chapter 3).

Thus acupuncture can be defined as a physiological therapy coordinated by the brain which responds to the stimulation of manual or electrical needling of peripheral sensory nerves . In relation to this definition, there is one concept that cannot be overemphasized: that acupuncture does not treat any particular pathological symptom but normalizes physiological homeostasis and promotes self-healing. Thus acupuncture, in terms of its therapeutic mechanisms, is non-specific: acupuncture does not target any particular symptom or disease but treats the body as a whole.

Understanding this nonspecific nature of acupuncture can provide an answer to the puzzling question: what symptoms and diseases can it treat?

As a physiological therapy, the efficacy of acupuncture depends on (1) the healability of the symptom(s) or disease(s), and (2) the self-healing potential maintained by each patient.

The same symptom or disease can be completely healable in one patient but only partially healable or even not healable at all in another because the self-healing potential varies from one person to another. Therefore, acupuncture effectiveness varies from person to person. When treating the same symptom or disease, acupuncture therapy might achieve a miraculous result in patient A, partial relief in patient B, and have little or no effect in patient C. In Chapter 6, we describe our 16-point quantitative evaluation method, which is based on the discoveries of Dr H. C. Dung, for predicting the effectiveness of acupuncture treatment for each type of patient.

As early as 1890 acupuncture was recommended for lower back pain by the famous Canadian doctor Sir William Osler in his classic textbook The Principle and Practice of Medicine. Today in Western societies acupuncture is largely used in pain management, and this analgesic function is still the most studied aspect of acupuncture. We have a better understanding of the way acupuncture works when it is used to treat symptoms of soft tissue pain, and for this reason the results can be more accurately predicted than when it is used for other kinds of symptoms.

We explained above that acupuncture involves central and peripheral mechanisms. When we treat soft tissue pain, needling makes lesions directly in the painful tissues and these lesions locally activate neuroendocrine, immune and cardiovascular reactions around the needling sites in the painful tissues. These local “needle reactions” directly desensitize the painful nerves and repair the damaged soft tissues. The process of desensitization and tissue repair is often triggered immediately by the “needle reaction” at the needling sites.

When we treat internal disorders such as stomachache, we cannot directly create the “needle reaction” in stomach tissues, so we can only needle segmental nerves to activate the cutaneovisceral reflex, which creates a balance between sympathetic and parasympathetic nerves to promote self-healing of the stomach. This is an example of “indirect” treatment by acupuncture.

Clinical experience shows that acupuncture can be effective for both peripheral soft tissue pain and internal disorders, but in the case of peripheral soft tissue pain the result is more predictable because of the local needle reaction.

In pain management we transform the nonspecific effect of needling into a specific effect for specific symptoms by creating, or “inoculating” the lesions directly in the painful areas. The Chinese have an old saying that nine out of ten diseases produce pain, and according to statistics, 85% of the pain in our daily lives is soft tissue pain. This is why acupuncture is seen primarily as a modality for pain management in Western societies.

This book presents a working model, utilizing a neuroanatomically-defined system of acupoints, that is based on the integration of conventional Western medicine and traditional Oriental medicine. INMAS combines laboratory research and practical clinical experience; it is derived from two great traditions–300 years of Western analytical science and 2500 years of Oriental empiricism; and it succeeds in providing both the standardized treatment protocol that Western scientific medicine demands and the adjustable personalizable approach of Oriental medicine.

Biomedical acupuncture and INMAS are easy to understand and can be safely and effectively practiced after a short training by any healthcare professional of either Western or Oriental medical background.

While modern biomedical principles are applied both in theory and in clinical practice, the major principles of Oriental medicine are also completely retained:

1. Restoring physiological homeostasis, (the balance of yin and yang)

2. Maximizing self-healing without side-effects

3. Treating both ben (the root of the disease, the whole body) and biao (the symptoms of the disease)

NMAS has all the characteristics required by a clinical procedure:

1. Simplicity:the whole procedure from evaluation of the patient to insertion of needles can be performed in a very short time in the clinic

2. Reproducibility: all the procedures and therapeutic results are reliable and reproducible by any practitioner, beginner and experienced alike

3. Predictability:this method enables the practitioner to predict the results of the treatment as follows:

a. Whether the patient will respond to acupuncture treatment or not

b. If the patient is a responder, how many treatments will be needed to achieve pain relief

c. Whether the pain will return at some time after the initial relief is achieved

The same protocol can be applied to most patients because of the nonspecific nature of acupuncture therapy: it does not target any particular symptoms or diseases but promotes self-healing by activating the built-in survival mechanisms.

It is very commonly seen that when patients come for treatment of symptom A, they experience simultaneous relief of symptoms B and C. This nonspecific nature of acupuncture, combined with laboratory research data from neurochemistry to fMRI, has enabled us to develop an INMAS protocol that is effective for most patients, regardless of their different symptoms and diseases.

With the INMAS protocol practitioners are able to adhere to the standardization of treatment procedure that is required in modern biomedicine. To individualize the treatment for each patient, as is the essence of Oriental medicine, they can use the special procedure of INMAS and also draw on their own medical experience.

INMAS is not a “magic bullet,” a miraculous answer for everything, but it is a protocol containing the principles of both Western and Oriental medicine that can be easily learned and applied successfully by any practitioner, even a relative beginner.

We believe that the whole-person approach of traditional acupuncture is of great value and will find a deserved place in the modern healthcare system. Biomedical acupuncture offers an explanation of its neural mechanism, and thus opens the door of integrative medicine for Western healthcare professionals.

Introduction
Foreword
Preface
Table of Contents