Part 1: What is Acupuncture?
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2: The Uses of Acupuncture
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3: The Future of Acupuncture
Moderator: I’m Marty Moss-Coane. Thanks for
joining us. Acupuncture is an ancient Chinese medical tradition that
is being newly discovered in this country. Using lay language here,
it’s based on the theory that the stimulation of specific points in the
body can affect certain organs, which can restore health. While it’s
a practice that goes back thousands of years, consumers and medical practitioners
in the west are finding that it offers new philosophies and more treatment
options. Last year, the “Journal of the American Medical Association”
published a series of articles on so-called ‘alternative medicine’ and
while some treatments did not stand up to their scientific scrutiny, there
were some interesting and positive reports on acupuncture. Today on our
webcast --- What is acupuncture? How did the practice develop and
evolve? And how does sticking needles in various parts of the body
offer a person relief?
Let me introduce our guests. Dr. Ravinder
Mamtani is a Professor of Clinical Preventive Medicine and Medical Director
of the Occupational Health Center at New York Medical College, Westchester
Medical Center in Valhalla, New York. He is also the Director of
the Complementary Medicine Service and Director of courses in acupuncture
and homeopathy at New York Medical College. Nice to have you with
us.
Dr. Ravinder Mamtani [Dr. RM]: Thank you.
Moderator: And our other guest is Elizabeth Call.
She is a licensed acupuncturist in private practice, and the Dean of Clinical
Training at Tri-State College of Acupuncture in New York City. It is a
great pleasure to have you with us as well. Let me begin with you,
Elizabeth. Can give us a short history lesson on
acupuncture. Not a fair question at all. Does anyone know how
and when acupuncture started ?
Ms. Elizabeth Call [Ms. EC]: The texts that are
most respected in terms of the age of acupuncture are about 2,000 years
old. And so, it’s thought that about 2,000 years ago people discovered
the meridians and the points, actually it maybe a little bit before that.
They evolved to a more comprehensive system of meridians and points and
they’re in texts 2,000 years ago. The technology was probably a little
bit different then. They weren’t the beautiful thin, laser-sharpened needles
--- probably more like turtle carapaces, sharpened bone, sometimes bamboo,
and probably more akin to bloodletting than what we see today as acupuncture.
Moderator: And I am curious how… again, a short
history lesson… how acupuncture has evolved in the last 2,000 years.
Dr. RM: As Elizabeth said it began about 2,000
to 3,000 years ago. I think it found its way into Europe sometime
in the 17th century, and subsequently to North America. There have
been some changes of components… added to acupuncture --- for example,
laser and electrical stimulation --- these are variations of what
we call modern and classical acupuncture. So, it has undergone
several changes as well.
Moderator: I want to make sure that our listeners
and our viewers understand the philosophy behind acupuncture and
perhaps it’s important to talk a little bit about the Chinese philosophy
on health. Can you help us understand that, Elizabeth?
Ms. EC: Sure. One of the concepts for health
in Chinese medicine is the idea that ‘disease’ is ‘habituation’.
So, anything that you habitually do over-and-over again can cause disease.
You want to try to find balance in your life by not doing too much of one
particular thing. And that’s different for everyone. Chinese
medicine also has the concept of constitutional tendencies. So, the
wisdom of understanding one’s constitution will help dictate how one lives
one’s life. And so that’s the Chinese idea of health and disease
--- it is living an appropriate life for your constitution.
Moderator: Well, it sounds like what you are saying
is that living a ‘balanced’ life is important. Give us an example
of something we might do over-and-over again, which might create
some kind of medical problem or disease problem?
Ms. EC: Okay --- over-eating the wrong foods, over-drinking
the wrong drinks, over-exercising even for one’s health or the wrong type
of exercise for one’s constitution. So any of those day-to-day things
--- not sleeping enough, over-working in general, over-stimulating oneself
with work and just life in general, not resting or meditating quietly,
not spending quiet time.
Moderator: It’s a different view of health isn’t
it, than what we are used to in the west?
Dr. RM: Yeah. I think that’s an appropriate
and an important question for (the) public at-large. What the Chinese
have been saying is that good health is maintained by a constant flow of
energy in the body through the meridians. As Elizabeth said, when
there is interruption, stagnation and/ or obstruction in the flow of energy,
the disease is caused. And by doing acupuncture, i.e., putting needles
at certain designated points, you are in fact ‘correcting’ that imbalance
of energy called chi and in doing so, you are restoring the body to normal
health. And I think that view is an appropriate one in light
of the scientific understanding of acupuncture and how useful it can be
for a variety of medical conditions, as we will discuss later.
Moderator: Is there a scientific way of understanding
what chi is? As you said, chi refers to energy.
Dr. RM: I think from a medical perspective, most
people who have researched this phenomenon have not been able to measure
chi, either by physical, chemical or electrical means. A better way
to characterize the energy might be to ask a patient if they feel chi,
if you will. And so the better way to measure chi might be
an appreciation from a patient or a subject who receives acupuncture
treatments. , Have the patient or subject describe his or her experiences.
And that may be expressed in terms of warmth, tingling or other kinds of
sensations that the patient might feel.
Moderator: And it covers a range. What you
are saying is that different people might experience the treatments differently,
then.
Dr. RM: Quite right, depending on their state of
balance in terms of chi.
Moderator: Now there is another word, again, hoping
that the audience understands what we are talking about. This is
the word ‘meridian.’ And in terms of understanding acupuncture, help
us understand what meridian means.
Ms. EC: Well, actually, the term ‘meridian’ is a
cartographic term. A better term might be channel, almost like water
flow. At the time that acupuncture was evolving, the Chinese were developing
the channel system --- the canal system --- and so they likened the flow
of chi and the meridians to the flow of water in the channels that they
were building in rivers. Well, yeah, that is pretty much it.
Moderator: Well, is it helpful then to think of
the body as kind of a map? In terms of understanding some of this
philosophy?
Ms. EC: A map? I think it is more of a
field. That’s how I would describe it. And also the term chi
chi refers to bodily functions. It’s a very general term. I
think even though we translate it as energy because it is convenient, you
really have to take it as its own term because we don’t really have a word
for it in English. I think we have to expand ourselves to encompass
that word.
Moderator: Well, and I’m using this western model
and, I guess, I am stuck with it.
Ms. EC: The chi is almost like the blood flow
in our body. If you think about blood carrying energy and certainly
being a life force.
Dr. RM: I would categorize it more as life force
rather than blood flow, per se . And similar descriptions of such
energy flows have been described in other cultures as well. For example,
Hindus have a term called Prana, which I think is similar to chi
flow, as the Chinese would describe it. So, there is no question
in anyone’s mind that there exists a vital force on which basically the
human body and animal functions are sustained.
Moderator: And the meridians then are sort
of end points in the chi, again trying to figure out what this model looks
like.
Dr. RM: The meridians, as Elizabeth said, are channels
in which there is the flow of energy and on which are situated acupuncture
points. So, by needling or putting pressure at those points, you
are correcting the imbalance in the energy flow, thereby, again, restoring
the body to normal health. I mean, you can simplify it and say it’s
perhaps like a map, with several points on it. That may be an over-simplification
but I think it is close to a map, if you will.
Moderator: We have an e-mail from John in Philadelphia
who wants to know --- ‘Is acupuncture medically sound or is it an ancient
Chinese myth?’ I’m sure there is still a lot of skepticism
associated with acupuncture.
Ms. EC: Actually, Joseph Needham, a very famous
Sinologist, who is also a physiologist, said that acupuncture is a discovery
of the visceral-cutaneous reflex. Every doctor learns, McBurney’s point
for example, located on the abdomen that diagnoses appendicitis.
So, basically the visceral-cutaneous reflex is a way of discovering or
diagnosing or correcting an imbalance of the interior of the body
by the surface. There is a relationship between the interior and the surface.
And I think that western medicine just does not have the paradigms in place
to look and to discover that relationship, and I think that it is
going to expand the western scientific paradigm.
Moderator: So you are saying that it is not such
an alien concept?
Ms. EC: No, no.
Moderator: Do you want to add to that, Ravi?
Dr. RM: I was going to say that John’s question
is an important one and what Elizabeth said is appropriate. But, that there
is now sufficient scientific evidence, even looking at it from a medical
standpoint, that acupuncture is useful for a variety of conditions. This
has been tested and there is no room for doubt in so far as efficacy for
a select number of conditions is concerned. So, it is not a myth.
It is an established fact and in fact, at the recent meeting convened by
NIH[spell out] , there was absolute and clear-cut evidence in favor of
acupuncture for a select number of conditions.
Moderator: I know you mentioned this earlier but
we were talking a little bit about what ‘health’ looks like and what the
body looks like. How then, does illness or disease or injury affect
chi and the meridians? You had mentioned this earlier Ravi.
Dr. RM: As I said earlier, that if there is an injury
that occurs, whether it’s physical, chemical, or biological injury, it
is interrupting or stagnating or causing an imbalance in the flow of energy.
So what acupuncture is doing is, it’s trying to ‘correct’ that imbalance
by way of removing stagnation or removing obstruction. And in doing
so, you are therefore, restoring the body to normal balance, if you will.
Moderator: Go ahead.
Ms. EC: I was going to say that every acupuncture
student learns a poem that goes like this. It says:
Pain, no free-flow
Free-flow, no pain
And so when the chi is flowing smoothly, there is no
pain or dysfunction and when this chi is obstructed, there is pain
or dysfunction. So, the acupuncturist looks for areas and signs where
the chi is obstructed.
Moderator: Tell us a little bit about the needles.
I am sure many people listening and watching, hear the word ‘needles’ and
they get nervous. Help us understand what these needles look like.
Ms. EC: The needles are very thin and very sharp
and pointed and they are actually very flexible. They are not like
a hypodermic needle --- they are not hollow, nor are they made to
tear tissue in quite the same way as with an injection. In the 1500s,
in Japan, there was a tube that was invented to go around the needle so
that when you press the tube on the body, you distract the sensation of
the needle going in, and so treatment became a little bit more comfortable
and that’s what’s used today. That was one of the major technological
advances.
Moderator: So it doesn’t hurt? People want
to know. It does not hurt?
Ms. EC: Yes, yes. That’s right. [LAUGHS]
You feel it. I never tell my patients that they don’t feel anything
and pain is obviously very subjective in some cases. But once I tell
them that they are sort of open to it.
Moderator: You want to add to that?
Dr. RM: Yes. The needles are made out of steel
and silver alloy. So it’s a combination of metals and it’s malleable,
it’s flexible. It is very unlikely that the needles will ever break,
at least it has never happened in my practice and it hasn’t happened in
the practice of many practitioners I know. And the issue of whether
it hurts or not is an interesting one because almost every patient I see
will ask me, “Doctor, does this hurt?” And my usual response is that
the thought of the needle going in, is more scary then the pain of the
procedure. And I think that summarizes the answer to those questions.
Moderator: Are there different kinds of needles,
different lengths of needles, and depending on, I guess, what part of the
body that you are working on?
Ms. EC: It depends on how much .Some people think
of acupuncture as a counter irritative therapy. And so, it depends
on how much stimulation you want to produce. For someone who might
be older and more deficient or weaker, you might want to use thinner needles
and less stimulation. For someone who is very robust, and has a lot
of chi stagnation, you might want to use something that’s longer
and thicker, depending on the tissue, and the underlying structures as
well.
Moderator: There is something I was reading about
called ‘moxibustion’. This is, I guess, using herbs, is that right?
Ms. EC: It’s using an herb that one burns over the
point or on the point. There are different types of moxibustion.
The Japanese have a type of moxibustion burns – its about a sesame-size
little thread of moxa over a point, and then there is something that looks
like a cigar that is held over the point and the heat is there to help
stimulate the movement of chi, again, just like the needles are.
Moderator: We have another e-mail. This is
from British Columbia, from Pitt, who wants to know how does acupuncture
differ from intramuscular stimulation and, you know, we have been talking
about sticking needles inside of people, is there a difference?
Ms. EC: I think it depends on the needle technique.
I actually perform a form of intramuscular stimulation in my practice when
I am looking at, specifically, muscular skeletal dysfunction and pain.
And what I try to elicit from that is the local twitch response.
So the muscle actually jumps. And with that, there is thought that
there are some physiological changes that occur in the muscle to help it
release a holding pattern and thereby restore, just like the ancients said,
a better functioning situation in the body.
Moderator: Do you want to add to that?
Dr. RM: Yeah. I would say that these acupuncture
points are designated points. Many of them are situated in the muscles
but there are others that are situated in the skin, for example,
subcutaneously as points at the tip of your fingers. And if by this
question, the listener means ‘any point’ in muscle, then I think the question
is referring to ‘sham’ points and there is clearly a distinction to be
made between a sham point, which is a non-designated point, as compared
to real acupuncture points. So, there are differences between the
two.
Ms. EC: Actually in Japan and other Asian countries,
they think the points are not the same as described in the textbook.
So they think the points are what the patient feels and what the acupuncturist
feels. So, even within the literature, there is discussion
and some disagreement. But, you know, one of the great things about
the practice of acupuncture is everybody is right depending on the situation
that you are applying it to. And so, one of the styles that I practice
and many acupuncturists’ practice, is a style of palpation where you feel
the energy or the lack of it or the stagnation, and the patient feels that
as well.
Moderator: I’m sure you are aware that there have
been some studies critical of acupuncture, saying that they’ve stuck needles
in people indiscriminately and people have --- people, meaning patients
have --- reported feeling some degree of relief, thereby casting some doubt
on pressure points and chi and meridians.
Ms. EC: Well their points moved, what could I say.
[LAUGHTER]
Moderator: Is that the explanation?
Ms. EC: Yeah. I mean, in different people,
the points will be in different places and you have to palpate and find
the right point and inadvertently they may have just been attracted to
that point, I think.
Dr. RM: I would agree with that, but also I would hasten
to add that there have been studies that have looked at acupuncture done
properly, if you will, at designated points as compared to acupuncture
anywhere else as in sham points, and the studies have shown it is clearly
in favor of a traditional designated point approach to acupuncture which
is much more efficacious than the sham acupuncture.
Moderator: By sticking a needle in these various
points in the body, does it release endorphins? I mean, again, is
this a way of trying to understand how that would give someone some measure
of relief?
Dr. RM: I think that that needs to be explained.
What research has shown is that when you put needles at certain designated
points, there is a release of a variety of neurotransmitters and this release
occurs at the spinal cord level, at the midbrain level and at the brain
level. And most of the neurotransmitters have pain-relieving properties,
thus substantiating the pain relief effect that you see with acupuncture.
So there is sufficient, now, basic science research that has shown that
there is release of chemicals in our body as a result of being needled.
Moderator: And anti-inflammatory effects as well?
Is that part of what you are talking about?
Dr. RM: Yes. And, in fact, some of the recent
work has shown that there is a release, and again I am speaking from a
medical perspective not so much from a chi perspective if you will,
that there is release of a hormone, which in turn will cause a release
of a steroid-like substance which is used by physicians to treat bronchial
asthma and inflammation. The difference, of course, being that this
is the way that we are facilitating in a person to release his or her own
neurotransmitters to bring about a natural healing effect.
Moderator: And what would be the chi explanation,
then of how this works? I mean, in the sense that if it releases
endorphins or some kind of anti-inflammatory response? Is chi just
another way of understanding that body response?
Ms. EC: I think so. I want to point out one
thing, that is, if you look at this point, hoku or large intestine-4, it’s
used for diarrhea and constipation, for example. Now, how does the
body know whether to stop or to start ? So, my sense is that acupuncture
stimulates homeostatic mechanisms that have a very wide-reaching umbrella
affect in the body. And how does the body handle endorphins
and anti-inflammatories ? It’s not really known what the mechanism
is, but I do think that the tendency to create homeostasis is probably
the best way to describe chi.
Moderator: I do want to thank both of you very much
for talking to us about what acupuncture is. And I want to thank
you very much for joining us. I am Marty Moss-Coane. We’ll
be right back.
[END PART 1]
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