WHAT IS Acupuncture ACUPUNCTURE?

18 Pages·2012·0.88 MB·English

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Can influence health by:
• Promoting health and well-
bbeeiinngg
LLiindda CChhun
• Preventing illness
Clinical Assistant Professor
• Treating various symptoms
Internal Medicine –Pediatrics
OSU Center for Integrative Medicine and medical conditions
The Ohio State University Wexner Medical Center
Image provided courtesy of Welcome Images
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• Acu= Greek for needle • Key component of Traditional Chinese Medicine
• Acupuncture = Puncture with needles • Practiced for 1000’s of years
• Insertion of very fine needles into the skin at specific points • To analyze and categorize symptoms and disease, TCM
utilizes concepts of:
• SSoommeettiimmeess
– Combined with electric pulse
– Used with moxibustion – Cold/heat
(herbal heat source)
– Interior/exterior
– Excess/deficiency
– Yin/yang
Image provided courtesy of Welcome Images Image from Wikipedia
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QQII
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• Qi is vital energy or life force
• Moxibustion –therapeutic application of heat to
• Circulates in the body
acupuncture points by burning herb (Artemesia
through meridians
• Health involves maintaining vulgaris)
balance and harmony of Qi • Cupping –applying suction to skin with small
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• Flow can be blocked,
deficient, excessive, • Acupressure –manual pressure applied to
imbalanced acupressure points and meridians
• Influence Qi at acupuncture
• Electroacupuncture–electric current applied to
points
needle
• Insertion of fine, metallic
needles
Image provided courtesy of Welcome Images
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• 2007 National Health Interview Survey
• Comprehensive survey of CAM use by
AAmmeerriiccaannss
• 3.1 million adults and 150,000 children
had used acupuncture in previous year
• Between 2002 and 2007 NHIS, use by
adults increased by 1 million people
Image from Wikipedia
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• Education and training requirements
for licensure vary from state to state
• Combination of Western medicine and TCM
• In Ohio, acupuncture considered an
concepts
extension of branch of medicine
•• UUttiilliizzeedd bbyy pphhyyssiicciiaannss
• Medical license or licensed
• Treats wide scope of conditions including
acupuncturist (following training at
prevention
accredited school)
• Looks at both medical paradigms
• Chinese herbal medicine excluded
• American Board of Medical Acupuncture from scope of practice of acupuncture
in Ohio
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• Community Acupuncture Network
• Treatments in community setting
• Sliding scale fee typically HOW DOES
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ACUPUNCTURE
• More affordable and accessible
• Acupuncture often more effective when WORK?
done more frequently
Image from Wikipedia
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• Stimulates
• Blood chemistry theory
– Bone regrowth
– Clotting factor Acupuncture affects concentrations of triglycerides,
• Regulates cholesterol, and phospholipids, suggesting that
acupuncture can both raise and diminish peripheral
– Blood pressure blood components, thereby regulating the body
– SSeerroottoonniinn ttoowwaarrdd hhoommeeoossttaassiiss.
• Stimulates production of
• Gate-control theory
– Cortisol
– Dynorphin Acupuncture activates non-nociceptivereceptors
– Endorphin Image provided courtesy of that inhibit the transmission of nociceptivesignals
Welcome Images in the dorsal horn, “gating out” painful stimuli.
– Enkephalin(pain modulators)
The Body Electric by Robert Becker, MD
The Vital Meridian by Alan Bensoussian
TTHHEEOORRIIEESS TTHHEEOORRIIEESS
• Autonomic nervous system theory
• Neurotransmitter theory
Acupuncture stimulates the release of
Acupuncture affects higher brain areas, stimulating
norepinephrine, acetylcholine and several types of
the secretion of beta-endorphins and enkephalinsin
opioids, affecting changes in turnover rate,
the brain and spinal cord. This influences the
normalizing the autonomic nervous system, and
immune system and the antinociceptivesystem.
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• Vascular-interstitial theory
Acupuncture manipulates the electrical system of
the body by creating or enhancing closed-circuit
transport in tissues. This facilitates healing by
allowing the transfer of material and electrical
energy between normal and injured tissues.
Image from Wikipedia
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• Chemotherapy-induced nausea and vomiting
• Post-op pain
• Neck and Lower back pain
• World Health Organization (WHO)
• Myofascialpain
recognizes the use of acupuncture in
• Osteoarthritis
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illnesses • Menstrualproblems
• Shoulder and arm pain
• Based on clinical experience, not
• Digestive problems
necessarily on controlled clinical
• Addictions
research • Asthma
• Fertility concerns
Image provided courtesy of Welcome Images
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• Addictions • Facial palsy/tics • PMS
• Anxiety • Fatigue • Pneumonia
• Arthritis • Fertility • Reproductive • FDA regulates acupuncture needles
problems
• Asthma • Fibromyalgia for use by license practitioners
• Rhinitis
• Carpal tunnel syndrome • Gingivitis • Sciatica
• Chronic fatigue • Headache • Seasonal affective • Needles manufactured and labeled
• Colitis • Hiccup disorder (SAD) according to certain standards
• Common cold • Incontinence • Shoulder pain
• Constipation •• IInnddiiggeessttiioonn • Sinusitis • Sterile, non-toxic, single use
• Dental pain •• ILroriwta bblaec bko pwaeinl syndrome •• SSmleeopk idnigs tcuersbsaantcioens • Practitioners use new set of
•• DDieaprrrehsesaion •• MMeennsotprauuasl eirregularities •• SSotrrees tshroat disposable needles
• Digestive trouble • Migraine • Tennis elbow • Swab sites with alcohol before
• Dizziness • Morning sickness • Tonsillitis
• Dysentery • Nausea • Trigeminal neuralgia insertion
• Emotional problems • Osteoarthritis • Urinary tract
• Eye problems • Pain infections
• Vomiting
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• Statistically significant differences
between acupuncture and simulated
acupuncture (modest)
• Statistically significant differences
between acupuncture and no-
RESEARCH aaccuuppuunnccttuurree ccoonnttrrooll ((llaarrggeerr))
• Similar across all pain conditions
• Noted by authors as most robust
evidence to date that acupuncture more
than just placebo
Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for chronic pain:
individual patient data meta-analysis. Archives of Internal Medicine. September 10,
2012
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• Randomized placebo-controlled trial
• Recent NCCAM-funded study
• 570 patients
published Sept 2012 Archives of
• Compared 24 acupuncture sessions
Internal Medicine over 26 weeks with sham
acupuncture or educational
• Individual patient data meta-analyses
approach
•• 2299 hhiigghh qquuaalliittyy rraannddoommiizzeedd ccoonnttrroolllleedd • WWOOMMAACC ppaaiinn aanndd ffuunnccttiioonn ssccoorreess aatt
4, 8, 14, 26 weeks
trials
• PAIN: By week 14, pain significantly
• 17,922 people decreased more in true acupuncture Image provided courtesy
group (40% decrease) compared to of Welcome Images
• Back and neck pain, OA, shoulder
sham
pain, headaches • Significant differences remained at
week 26
Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for chronic pain:
individual patient data meta-analysis. Archives of Internal Medicine. September 10, Berman BM, Lixing L, et al. Effectiveness of Acupuncture as Adjunctive Therapy in
2012 Osteoarthritis of the Knee: A Randomized Controlled Trial. Annals of Internal Medicine.
2004;141:901-910
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• Larger proportion preferred
• FUNCTION: At weeks 8, 14, 26 acupuncture (did not switch)
true acupuncture group with
significantly greater improvement • Acupuncture more likely
compared to sham beneficial if +tender points
• Acupuncture appears to be safe • Lenggth of time ppatient had
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headache –no difference
and improving function
• High attrition rate, particularly • Depressive features did not
educational group (52%!) – Image provided courtesy preclude satisfactory Iomf aWgeel cpormovei dImeda gceosu rtesy
greatest weakness of this study. of Welcome Images
treatment
Berman BM, Lixing L, et al. Effectiveness of Acupuncture as
Adjunctive Therapy in Osteoarthritis of the Knee: A Randomized Loh, L., Nathan, P., et. al., Acupuncture versus medical treatment for migraine and
Controlled Trial. Annals of Internal Medicine. 2004;141:901-910 muscle tension headaches, Journal of Neurology, Neurosurgery, and Psychiatry,
(47): 333-337
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NNAAUUSSEEAA//VVOOMMIITTIINNGG
• 48 patients with chronic
migraine and muscle tension
• 2006 Cochrane systematic
headaches
review assessing P6 stimulation
• Compared prophylactic course
• Post-operatively
of acupuncture and medical
– 2266 ttrriiaallss ((>33000000 ppaattiieennttss))
ttreattmentt showed superiority of real Image provided courtesy
of Welcome Images
• 24 out of 41 improved on P6 stimulation over sham for
acupuncture; very marked in 9 Iomf aWgeel cpormovei dImeda gceosu rtesy both nausea and vomiting
• 9 out of 36 improved on med – P6 stimulation superior to
anti-emetic for nausea,
treatment; very marked in 3
equivalent for vomiting
Loh, L., Nathan, P., et. al., Acupuncture versus medical treatment for migraine and
muscle tension headaches, Journal of Neurology, Neurosurgery, and Psychiatry,
(47): 333-337 J Altern Complement Med. 2006 Jun;12(5):489-95
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• Acupuncture effects similar to
• Chemotherapy induced
– 11 trials (>1200 patients) group CBT
showed electroacupuncture, not
• Both interventions superior to
manual, effective for first-day
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– Acupressure effective for first- Image provided courtesy
day nausea, not vomiting of Welcome Images • Treatment effects maintained
• Pregnancy induced for 3 months for both
– 6 trials (1150 patients) with • Larger trials warranted Image from Wikipedia
mixed results
J Altern Complement Med. 2006 Jun;12(5):489-95 J Nerv Ment Dis. 2007 Jun;195(6):504-13.
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• Pilot study with 73 people
• Safe and effective modality
• Received either acupuncture
or group cognitive-behavioral • No side effects
therappyy over 12 weeks • Drugg-free
• Wait-list control group • Affordable options exist
• Primary outcome measure
• Wide variety of conditions
was self-reported PTSD
Image from Wikipedia • Desired by patients
symptoms (depression,
anxiety, impairment)
Image provided courtesy
of Welcome Images
J Nerv Ment Dis. 2007 Jun;195(6):504-13.
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Step
•Collection of clinical data
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David Wang, RAC
OSU Center for Integrative Medicine Step
•Differentiation of Syndrome
Department of Family Medicine two
The Ohio State University Wexner Medical Center
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Inquiring
Observation
RReemmoovvee
Make Determine Pick Up Manipulate
Needles or
TCM Treatment Acupuncture On The
Other
Diagnosis Principle Points Points Instruments Listening and Smelling
Pulse-feeling and Palpation
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The eight principle syndrome differentiation
Etiological syndrome differentiation
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Zang-fusyndrome differentiation
Meridian syndrome differentiation
Syndrome differentiation of exogenous diseases (including
the six meridian syndrome differentiation, Wei-Qi-Ying-Xue
syndrome differentiation and San-jiaosyndrome
differentiation
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Analyze &sort Deficiency Reinforcing
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EExxcceessss
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Determine Heat
Clearing heat
Cold
The cause, the Expelling cold
location and
the nature etc.
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