Which Diseases Can be Helped by Acupuncture?
In the field of acupuncture few good clinical research trials have been completed, and there has also been very poor follow-up assessment of many of the conditions that have been treated by acupuncturists. It is therefore impossible to give a clear idea of the success of acupuncture in some of the conditions which will be mentioned in the following sections.
It is also essential for the reader to recognize two important facts—firstly that acupuncture, like any treatment, is not a guaranteed cure for disease. Some diseases are more successfully treated (by acupuncture), whilst others are less successful, but no disease responds 100 per cent of the time to any form of treatment. Secondly, some of the suggestions that will be made to illustrate the effectiveness of acupuncture, in particular conditions, are no more than educated guesses. Information about the success rate of acupuncture is not available in some areas, and there the only advice that can be given is based on the clinical experience of individual practitioners.
Before embarking on a course of acupuncture, whatever the condition being treated, it is wise to allow a clear diagnosis to be made. This puts both the patient and the acupuncturist in the position where the complaint can be treated properly, and the results of treatment can be assessed objectively. It may be that Western medicine offers an excellent form of therapy for a particular condition, and in that instance it would be wrong to advise the patient to have acupuncture.
Many of the facts and figures quoted in the following sections are the results of clinical trials carried out in China, so it is worth while mentioning several facts about these ‘Chinese trials’. They involve the assessment of a huge number of patients, sometimes up to 10,000, but the published assessments of success and failure are often unclear, and the research is poorly designed. The Chinese also treat their patients for long periods and a stroke patient may receive one hundred or two hundred acupuncture treatments before being declared a success or a failure.
All these factors create difficulties when discussing specific diseases but, in spite of this, I have made an attempt to provide an objective assessment of the effects of acupuncture in some common diseases. It is impossible to cover the whole range of medicine in so short a chapter, so some complaints have been excluded.
It is my hope that future research work will provide information about the effects of acupuncture in a wide variety of diseases, as only with this information will acupuncture make any progress as a recognized form of therapy.
Diseases of the Muscles, Bones and Joints
The muscles, bones and joints are usually called collectively the musculo-skeletal system. When disease or damage occurs to this system it nearly always results in pain, and most people use words such as rheumatism or arthritis to describe this type of pain. Before discussing the effects of acupuncture on such pain, it is important to clarify the conditions that are collectively called ‘rheumatic’ as some rheumatic diseases respond well to acupuncture whilst others seem to respond less well.
There are three main types of damage that occur to the musculo-skeletal system; the first is a sudden injury or sprain which might be a domestic injury, or might be incurred during a sporting activity or in a car accident. This usually causes local pain and bruising lasting for a few days, or even a few weeks. The other main group is arthritis and this can be divided into two important types, Osteoarthritis and rheumatoid arthritis.
Osteoarthritis is by far the commoner type of arthritis and can be thought of as ‘wear and tear’ damage to a joint. It usually occurs in older people and tends to affect the spine (both neck and lower-back), the hips, knees, elbows and shoulders. Nobody is clear about the exact cause of Osteoarthritis; it can sometimes run in families or it may result from severe localized damage in earlier life, such as a broken bone. Osteoarthritis tends to develop in one or two of the main weight-bearing joints of the body, but it does not usually affect all the joints of the body. The pain caused by osteoarthritis fluctuates; if a person suffers from osteoarthritis of the knee there will be periods when the knee is painful, and other times when the pain is less severe.
The X-ray of an osteoarthritis joint looks ragged and shows some joint destruction, but such X-ray findings do not correlate with the pain suffered. If joint destruction is demonstrable on the X-ray the patient may not have severe pain, and conversely the patient may have severe pain with few X-ray findings. The main problem with osteoarthritis is pain, which in turn causes a general lack of mobility and limited joint movement.
Rheumatoid arthritis is far less common than osteoarthritis and represents a completely different disease process. The small, non-weight-bearing joints in the hands and feet are affected by an active destructive process. This process is poorly understood and can occasionally result in joint deformity.
Sudden injury or sprains usually respond well to acupuncture. The pain resulting from a sprained shoulder will often continue for some days or weeks after the initial injury. Once a clear diagnosis has been made acupuncture can usually be used to relieve this type of pain. Many of these ‘acute pains’ represent a self-limiting disease process; for instance a small burn is usually excruciatingly painful for a few days and then settles. If acupuncture is used as a form of pain relief for burns then its ‘pain relieving’ effect is only required for a few days. Because of the natural history of the pain it is therefore difficult to produce a clear picture of the effect of acupuncture on this type of ‘short-lived pain’. In China, acupuncture is usually given for acute pain, but in the West acupuncture is not generally available for ‘short-lived pain’ as there are not enough acupuncturists to provide this service.
The experience of a variety of acupuncturists, myself included, shows that, of the people treated for differing acutely painful conditions, about 70 per cent obtain swift and significant pain relief. If a fracture of the bone is present then the pain relief gained from acupuncture is less effective than if the injury is due to a strain or tear of the muscles, tendons or ligaments. The main advantage of treating these acute pains with acupuncture is that chronic pain can be avoided. A sudden shoulder injury may produce pain and immobility for many months, sometimes years, but if acupuncture is used when the pain occurs then it seems that chronic pain may be avoided. These ‘impressions’ about the use of acupuncture in acute pain are consistently quoted, both in the West and China, but until adequate statistical research is completed the effectiveness of acupuncture in ‘acute pain’ will remain no more than a clinical impression.
Osteoarthritis and the rheumatic pains that result from this type of joint damage, are quite a common problem. People frequently complain that their arthritic knee pain is worse in cold or damp weather and this demonstrates quite clearly the origin of the concept of pathogens in traditional Chinese medicine. The pathogen in osteoarthritis is almost always cold or damp and therefore these pains should be treated by the use of localized heat.
A great deal of research work has been done to investigate the effects of acupuncture on the pain caused by osteoarthritis. Some of this work is excellent but, for a variety of technical reasons, some is poor. Clinical trials have been completed on knee, hip, elbow, neck and lower back pain, and the information from these trials shows that significant pain relief can be achieved in about 70 per cent of those who receive acupuncture. Some work suggests that only 50 per cent of people benefit from acupuncture while other trials show 95 per cent of the patients benefiting.
The effect of acupuncture in osteoarthritis pain does not last for ever, the available research showing that its effects gradually diminish after about six to nine months. Some people may have significant pain relief for up to two years, but the majority of people who gain relief from acupuncture will require further treatment after about six months. Treatment is usually just as effective on the second or third occasion as it was initially.
Osteoarthritis is a condition that naturally causes intermittent pain and discomfort. Patients may find that their osteoarthritis knee is relatively painless for nine months and then goes through a painful period for a further six months. For this reason the effects of any treatment must be compared to the natural history of the disease process and this can cause difficulty in interpreting the results of individual treatments. Acupuncture also has a ‘magical quality’ that pills do not have, so it is difficult to sort out the effects of the ‘magic’ as compared to the real effects of acupuncture. In spite of these problems, acupuncture is a safe and effective form of treatment for osteoarthritis.
The effects of acupuncture on rheumatoid arthritis are not so clear cut. During the early, acute, inflammatory stage of rheumatoid arthritis there is some evidence to suggest that acupuncture might worsen the pain and therefore many acupuncturists do not treat acute rheumatoid arthritis. After some months the acute inflammatory stage subsides and the residual joint destruction may then lead to the development of a secondary osteoarthritis. This type of pain is amenable to acupuncture and responds in the same way as other osteoarthritic aches and pains.
Chronic pain, due to disease of the musculo-skeletal system, is frequently amenable to acupuncture treatment. The published research shows that pain which has been present for many years can respond as well as pain that has been present for only a few months; therefore, from the available information, it is fair to say that acupuncture is ‘always worth a try’ in this type of condition.
Headaches can be due to a multitude of factors; arthritis of the neck, dental problems, sinusitis, stress and tension, and head injury are a few of the many causes. Headaches have been dealt with as a separate section because they are so common and they span many of the ‘body systems’.
Migraine is a particular type of headache and worthy of special mention. Migraine can be induced by a variety of stimuli such as foods, noise and stress, and such headaches are usually accompanied by severe incapacitating pain, nausea, vomiting, and visual patterns or flashes in front of the eyes. Many people describe severe ‘tension headaches’ as migraines and although these headaches are not strictly migraines, the dividing line between other headaches and migraine is frequently rather woolly. Migraine is probably best thought of as a severe headache associated with nausea.
Headaches are a common complaint and a notoriously difficult one to treat effectively, and they can be the cause of a considerable amount of distress and marital disharmony. Acupuncture has been used to treat a wide variety of headaches, particularly migrainous headaches, and the results obtained have been very encouraging. The published work suggests that between 65-95 per cent of all headache sufferers obtain significant and long lasting pain relief from acupuncture treatment. Migraines seem to respond as well as, if not better than, other types of headache.
Acupuncture therapy for headaches may cause the headaches to vanish completely, or occur with a markedly decreased intensity and/or frequency. The pain relief resulting from acupuncture can sometimes be maintained for some years and re-treatment is usually required less frequently for headaches: than for other conditions such as osteoarthritis.
A stroke is caused by a disturbance of the blood supply to the brain. The blood vessels that normally supply blood to the brain can be compromised by becoming blocked or bleeding. This results in a deficient blood supply to the brain tissue and these events can be precipitated by a variety of factors such as raised blood pressure, hardening of the arteries and severe head injury. The brain is divided into many different functional areas, one area controlling speech, while another dominates the sensations of touch and pain. The functional impairment that occurs with a stroke depends on the area of the brain that is damaged; if the speech area is damaged by a lack of blood supply then the patient may be unable to speak properly.
In China, acupuncture is the standard treatment for strokes. In the West, the mainstays of stroke treatment are speech therapy, physiotherapy and occupational therapy, but the Chinese feel that these methods have less to offer than acupuncture. Both scalp and body acupuncture are techniques that can be used to aid recovery from a stroke. The research work so far completed suggests that acupuncture increases the blood supply to the brain, and for some unexplained reason this seems to improve functional ability and acts as a stimulus to recovery after a stroke.
Clinical trials completed by the Chinese state that some effect can be gained from acupuncture in about 80 per cent of strokes. These trials are difficult to interpret clearly as a significant number of stroke patients recover spontaneously; furthermore, the Chinese trials are poorly designed and the exact definition of the success and failure of treatment is unclear. The success rate claimed is very high but to some extent this success rate is mirrored by the experience of a variety of doctors in the West. Whatever criticism one has about Chinese research methods, Western medicine often has little to offer the stroke patient and therefore acupuncture is always worth considering. Ideally strokes should be treated within six months of the damage occurring. The patient may continue to benefit for up to two years after the stroke but, as a rule, acupuncture can effect little improvement if the damage has been present for more than two years.
The neuralgias are a collection of poorly understood and frequently painful conditions. The more common and clearly defined types of neuralgia will be discussed in the following section.
Trigeminal neuralgia usually presents with severe unilateral facial pain. Its cause is unclear but the painful facial spasms are often precipitated by cold or wind. The Chinese claim to be able to gain some improvement, with acupuncture, in about 70 per cent of cases of trigeminal neuralgia. Judging by the experience of Western acupuncturists this success rate represents a rather high figure, although acupuncture can undoubtedly have a beneficial effect on this type of pain.
Postherpetic neuralgia is the pain that occurs after an attack of shingles. Shingles is a viral infection of the nerves, and the nerves affected by shingles can occasionally continue to cause severe pain after the shingles has cleared.
Postherpetic neuralgia is an uncommon disease in China; this may be because the Chinese treat all cases of shingles with acupuncture before the postherpetic neuralgia can develop. There are other possible explanations for its decreased incidence in China, perhaps postherpetic neuralgia is affected by diet, or racial characteristics; however, it is much more reasonable to suggest that the dearth of postherpetic neuralgia in China is due to the daily treatment of shingles with acupuncture. It seems that of those patients with established postherpetic neuralgia, about 40 per cent gain some degree of long term benefit from acupuncture. If this figure could be substantiated with proper clinical research work, it would represent a significant advance in the treatment of this condition.
There are a vast number of aches and pains that are often described as neuralgic. Many of these occur as facial pain and most of them cause severe discomfort. It is always worth while to attempt to alleviate these pains by using acupuncture. Some people respond and others do not; it is impossible to give figures for success, or even estimates, without going into great detail about the exact cause and type of neuralgia being treated.
Anxiety, Depression and Other Nervous Disorders
It is difficult to be objective about the treatment of disorders such as anxiety and depression, as the problems themselves are difficult to assess objectively, and therefore no good clear figures are available about their treatment with acupuncture.
In spite of this, many acupuncturists, including the Chinese, treat a wide range of ‘mental disorders’ with acupuncture. Many people have stated that acupuncture is clearly effective in helping symptoms such as insomnia and bed-wetting, and can also create a feeling of general well-being. Patients who receive acupuncture for specific problems, such as ankle pain, will often note how well they feel after the treatment. It would be very misleading to give figures of ‘cure rates’ for these problems because such disorders naturally relapse and remit, often improving when a sympathetic listener becomes involved. I think it is fair to say, however, that acupuncture can sometimes effect mood changes that help these problems significantly.
The Chinese have completed trials on some of the more clearly defined and serious mental diseases, such as schizophrenia. In a trial involving over 400 patients they claim a 54 per cent cure rate for this disease, with a further 30 per cent showing ‘significant improvement’. These figures are exceptionally high and, if correct, are most interesting. Their criteria for evaluating a ‘cure’ or a ‘significant improvement’ are not clearly stated and so it is difficult to be sure whether these results are valid. Many claims have been made for the effects of acupuncture in the treatment of a variety of ‘nervous disorders’ but, sadly, there is no good hard evidence to substantiate or refute such claims; however, from a variety of excellent research papers it is clear that acupuncture can influence quite radically many areas of the central nervous system. This work is of a purely scientific nature and at present it is not directly applicable to the clinical effects of acupuncture therapy.
There are three major types of nerve destruction that cause paralysis. Children may be born with an incomplete nervous system, such as spina bifida, an accident may occur that destroys part of the nervous system, or a disease may be present causing destruction or dysfunction of nervous tissue.
Chinese research workers claim that acupuncture can be used to treat the symptoms of spina bifida, such as incontinence, although no claim has been made that acupuncture can affect the anatomical abnormality.
Traumatic paralysis, due to accidental destruction of the nervous system, can also be treated by a variety of acupuncture techniques. The acupuncture must be continued for a long period, sometimes daily for six months, but the results from some of the Chinese work are encouraging. They claim that some 50-60 per cent of patients are likely to gain significant return of function if treated with acupuncture, but it is wise to remember that a good number of these injuries would allow the spontaneous recovery of significant function.
Facial paralysis (Bell’s palsy) is a disease of sudden onset that causes one side of the face to lose muscular power; the cause of this is unknown. Acupuncture and moxibustion can be used to treat this and the Chinese claim a 75 per cent complete recovery rate but, again, this disease allows a significant percentage of spontaneous recovery. The Chinese also claim that a further 20 per cent gain benefit from acupuncture, although not complete recovery. Even allowing for the known level of spontaneous resolution in facial paralysis it does seem that acupuncture has something extra to offer.
Acupuncture has been claimed to be effective in Parkinson’s disease, nerve deafness, and a large variety of other problems. Some of these claims are far from proven (or disproven), but it is always wise to remember that acupuncture is a harmless technique and can sometimes give excellent results where other medical methods have failed.
Diseases of the Digestive System
There has not been a great deal of good clinical research work published about the effects of acupuncture on the digestive system, so it is difficult to be sure exactly how useful it is in such diseases. This section is therefore deliberately rather vague as it is far more sensible not to quote exact facts and figures when there is little evidence to substantiate them. Animal experiments, both in China and the West, show quite clearly that acupuncture does have an effect on the digestive system, and in spite of the lack of clinical research there are good grounds for believing that acupuncture can influence a variety of disorders within this system.
Indigestion is a symptom rather than a disease, and can be caused by a variety of factors such as over-indulgence, stress and acid regurgitation. It is important to investigate long standing indigestion so that the exact reasons for this symptom can be clearly defined.
Acid regurgitation is one of the commoner causes of indigestion and often presents with symptoms such as heartburn. The sensation of heartburn is caused by irritation due to the acid reflux from the stomach into the tube connecting the stomach to the mouth (the oesophagus). This syndrome may be called a ‘hiatus hernia’ although a variety of other names can also be used to describe exactly the same symptoms.
Acupuncture is not the treatment of choice for all types of indigestion. For instance, the best treatment for over-indulgence is to eat less, but some other causes of indigestion such as hiatus hernia and stress are definitely amenable to acupuncture therapy. Exact figures for success rates are not available, but the ‘clinical impression’ that arises from a number of acupuncturists indicates that about 60 per cent of patients gain some long-term relief of their symptoms with acupuncture. Symptoms do recur and usually require re-treatment after about six to twelve months.
An ulcer is an area of raw tissue, rather like the tissue found under the scab of a healing cut. Ulcers can occur in the stomach and are usually found either in the stomach proper (gastric ulcers), or in the part of the intestine that drains food from the stomach (duodenal ulcers). Stomach ulcers are a common problem but their exact cause is unknown.
In China acupuncture is the treatment of choice for stomach ulcers, and ulcers certainly do heal after acupuncture. Fortunately both types of stomach ulcer heal spontaneously and this creates a great deal of difficulty in assessing the curative effects of acupuncture as compared to natural remission; furthermore, there are now available some highly effective and relatively non-toxic drugs to cure ulcers.
Duodenal ulcers are associated with a high acid level in the stomach. It is unclear exactly how much this factor affects the development of duodenal ulcers, but it is fair to say that high acid levels are a factor in ulcer development. Research work by Chinese physiologists has shown, quite clearly, that acupuncture can reduce the acidity of the stomach and this may be one of the mechanisms by which acupuncture heals stomach ulcers and other digestive diseases.
A large volume of work has been published by the Chinese about the effects of acupuncture on the gall bladder. It would seem that acupuncture can cause the discharge of quite large gall stones in the faeces, obviating the necessity for most operations to remove the gall bladder. The Chinese studies are of great interest but it is too soon to draw valid long-term conclusions about this work.
Diarrhea is a symptom that can be indicative of a variety of diseases; it may be caused by an infection (dysentry), an inflammatory process (colitis), stress or dietary indiscretion. Sometimes no clear cause can be found for irregular bowel habits and these ill-defined problems are usually called ‘irritable bowel syndrome’.
Studies on bowel infections, completed in China, show that acupuncture affects the natural history of this disease. The Chinese report that recovery is quicker, and complications less frequent, if acupuncture is given in this condition. Clear evidence is also provided to show that acupuncture ‘improves’ the natural defenses of the body in these types of infection. A large body of evidence is now available, showing that acupuncture stimulates the body’s natural defenses in many infectious diseases; this again suggests another possible mechanism for the effects of acupuncture. Acupuncture can be shown to alter the activity of the immuno system, stimulating the production of immunoglobulins (chemicals that help to kill invading bacteria), and various other important substances. This measurable effect lends support to the philosophical idea that acupuncture helps the body to cure disease naturally.
Diseases such as Crohn’s disease, ulcerative colitis and colitis are collectively described as inflammatory bowel diseases. The exact cause of these problems is unknown. When inflammatory bowel disease is present the intestines become raw and inflamed and the patient usually complains of symptoms such as abdominal pain, blood loss and diarrhoea. These diseases are often difficult to treat with the available Western therapeutics, but they are sometimes amenable to acupuncture. Exact figures describing success rates are not available at present.
Irritable bowel syndrome and diarrhoea caused by stress can also be improved by acupuncture, but clear facts and figures are not available and further research is required in this field.
Piles are a common cause of human misery; they are really varicose veins occurring around the anus and rectum. Once again no clear figures are available about cure rates, but piles are said to be helped by acupuncture.
The wheeze of asthma is caused by contraction of the muscular walls of the small breathing tubes in the lung. The narrowed air tube creates a ‘turbulent’ air flow and therefore causes a wheeze, or whistle, when the asthmatic breathes. Because the tubes into the lung are narrowed, less air can get in and this decreases the oxygen supply to the body. The muscular contraction of the breathing tubes can be stimulated by a wide range of substances such as inhaled dust or pollen, and various foods.
Acupuncture causes the contracted muscular walls to dilate; the mechanism of this is unknown, but there is good Western research data to support this claim. A recent Chinese clinical trial on asthma showed that some 70 per cent of asthmatics gained a ‘good effect’ from a course of acupuncture and moxibustion (about ten treatments) once a year. The acupuncture treatment was able to decrease the frequency and intensity of asthmatic attacks over a period of a year. This result is encouraging as it shows that acupuncture and moxibustion can affect the response of the body to the environmental stimuli causing asthmatic attacks.
Bronchitis is a common lung disease, aggravated by cigarette smoke, industrial pollutants, and dust. It involves the irreparable destruction of lung tissue. There is often an asthmatic element in bronchitis as irritants such as smoke and dust cause the muscular walls of the breathing tubes to contract.
Acupuncture cannot rebuild lung tissue, but by opening up the breathing tubes it can allow the remaining lung tissue to function efficiently. The mechanism of acupuncture in bronchitis is probably much the same as in asthma, allowing more air to enter the lungs. Recent Chinese work has shown that about 50 per cent of bronchitics ‘benefit’ from acupuncture. The treatment must be repeated regularly if the effect is to be maintained.
Diseases of the Heart and Blood Vessels
In the West, diseases of the circulatory system are not commonly treated with acupuncture, but in China it is a common and acceptable form of treatment for some of these problems. A variety of animal experiments carried out in the West give clear support to the idea that acupuncture does have an effect on the circulatory system.
Angina is a type of ‘cramp’ in the heart muscles, precipitated by a poor blood supply to the heart, and it usually exhibits itself as chest pain on exercise. Using sophisticated measuring equipment the Chinese have completed a variety of trials to assess the effects of acupuncture on the heart, and they have shown a marked increase in the functional ability and efficiency of the heart muscles after acupuncture.
This is further supported by clinical work, which shows that some 80 per cent of patients with angina have improved after acupuncture. When acupuncture is used to treat angina a course of treatments is given, and then followed by booster treatments every four to six months.
The Correction of Abnormal Heart Rhythms
Heart diseases can frequently cause an abnormal rhythm to the heart beat; this may manifest itself as palpitations, an irregular heart beat, or dropped beats. Acupuncture can correct a small number of these arrhythmias. In established atrial fibrillation (irregular heart beats), acupuncture affects a small percentage of cases, some 1.5 per cent, although in recently acquired arrhythmias, acupuncture can be effective in up to 70 per cent of cases
Traditional Chinese medicine does not recognize raised blood pressure (hypertension) as a disease, and acupuncture treatment has therefore centered around the relief of the infrequent and vague symptoms associated with raised blood pressure, such a headaches and dizziness. In Western medical circles there is great debate about whether raised blood pressure should be treated as aggressively as it has been in the past. Acupuncture and moxibustion can lower the blood pressure, but there is no good work available to show how useful this is on a long or short term basis. At present, the whole concept of raised blood pressure and its treatment is unclear, and the place of acupuncture in the treatment of this problem is unknown.
A large number of Western acupuncturists are using a variety of acupuncture techniques to treat obesity, smoking and hard drug addiction. There is some excellent physiological and clinical evidence to support the use of acupuncture in these areas. The withdrawal symptoms experienced by people giving up smoking, or drugs, can be alleviated by raising the levels of endorphins in the nervous system1 Some people believe that the desire to eat is also mediated by the endorphin level in the brain. It is clear that endorphin levels throughout the nervous system can be increased by acupuncture. The techniques used to achieve an increase in endorphin levels center around the use of ear acupuncture; the ear may be electrically stimulated or a small staple or stud may be left in the ear for a week at a time. Pressing the indwelling needle seems to decrease the desire to smoke or eat, probably due to an increase in the endorphin level.
It must be stressed that acupuncture cannot replace willpower. It can only help the withdrawal symptoms, or hunger pains, experienced by those already motivated and committed to solving their particular problem.
Acupuncture seems to relieve the problem of hunger usually created by dieting. Many people who receive acupuncture to help with weight loss also go on a diet at the same time. It is difficult to assess exactly which factors are responsible for weight loss, the acupuncture or the diet, or both in combination. Most acupuncturists claim that 40-50 per cent of their patients experience some significant weight loss (about ten pounds) during treatment. The figures are vague as no useful trials have been completed in this field. It seems that ear acupuncture can help to suppress hunger, but it is unlikely to affect greed!
Some excellent research work has been done in this field, especially in Hong Kong. It is clear that acupuncture can help to solve the severe withdrawal symptoms experienced by those coming off hard drugs like heroin; however, withdrawal from drugs is only half the battle as a proper program of rehabilitation is required if hard drug addicts are to return to the community, and acupuncture can only provide assistance in part of this battle.
It is claimed that ear acupuncture helps about 40 per cent of people to give up smoking over a period of about six months. Again, it is essential to be well motivated before embarking on a course of treatment. Acupuncture does seem to decrease the desire to smoke and also to alleviate the withdrawal symptoms produced by abstinence from tobacco.
Acupuncture does have an effect on addictions and obesity, although the effect is limited and some of the claims made for acupuncture in this field may be due to other associated factors.
The Use of Acupuncture in Obstetrics
In China the major use of acupuncture in obstetrics is to provide analgesia (pain relief) during Caesarean section, and to correct foetal malpositions, such as breech (breech means when the baby is ‘bottom first’ rather than ‘head first’).
The correction of foetal malposition is achieved by applying moxibustion to an acupuncture point on the little toe. In about 60 per cent of women the foetus turns naturally prior to the thirty-fourth week of pregnancy; this can be increased to 90 per cent with the aid of moxibustion. After the thirty-fourth week, when natural version is less likely, the Chinese claim that 80 per cent of foetal malpositions will be corrected permanently by this procedure. Once corrected, the malposition does not recur, provided moxibustion is applied daily. There seems to be no available physiological basis with which to explain this finding.
Anaesthesia for Labour and Delivery
Acupuncture anaesthesia is widely used for Caesarean sections in China. A report recently published by the Chinese, discusses the results of 1,000 cases managed in this manner. The Chinese claim a 98 per cent success rate in the abolition of pain, a quicker recovery rate from the operation, less blood loss, and the obvious advantage of the mother being able to see the baby at, or soon after, birth. This report finds acupuncture a superior form of analgesia compared to other forms of pain relief (general or epidural anaesthesia) for Caesarean section. This success rate is astonishingly high and may well be a rather ‘enthusiastic’ claim.
Acupuncture can also be used to provide pain relief in normal obstetric deliveries. Adequate assessment of this form of obstetric analgesia has not yet been published, although the experience of a wide variety of acupuncturists in the West would indicate that it is a useful and effective procedure.
Acupuncture anaesthesia is widely used in China. It often provides the highlight to a ‘tourist trip’ and has been filmed for the Western media on many occasions. Acupuncture anaesthesia has been used in a wide variety of operations, from minor procedures to open heart surgery. It is undoubtedly an effective form of pain relief in the majority of people, but there is always a small percentage who fail to gain adequate analgesia from acupuncture. These failures are quoted at between one and twenty per cent, depending on the operation and the assessments used.
In general, acupuncture allows for a safer operation, with less likelihood of complications, and a swifter post-operative recovery. The main problem is that pain relief may be inadequate and this is unacceptable within the context of Western health care.
One of the main criticisms of acupuncture anaesthesia is that ‘it’s alright for the Chinese, but won’t work on Europeans’. Acupuncture anaesthesia has been used in a variety of European. centers, and the success and failure rate is much the same as in China. Acupuncture anaesthesia is a useful method of pain relief and could well be applicable to minor procedures, or post-perative pain relief, within the context of a Western medical system.
- 1 The effect of acupuncture on endorphin levels is discussed in Chapter 3.