The Chinese acupuncture has always been confronted by speculations and doubts in its therapeutic value. However, with the advent of modern medical studies, various studies have supported the therapeutic benefits of acupuncture most especially in managing chronic and acute pain conditions associated to specific disorders and diseases. Hence, the principal effect of acupuncture is the analgesia induced by sensory stimulation of somatic nerve fibers and activation of various biochemical responses that greatly affect cerebral (hypothalamus and endorphinergic systems) and spinal systems.
II. Introduction a. Thesis Statement Medical applications of Chinese acupuncture have always been associated with neurologic and musculoskeletal bodily functions of managing pain. As a response to the body’s need of restoring the appropriate neural functions, reducing muscular stresses and treating the abnormal areas of the skeletal musculature, the acupuncture needles are used to treat the tender points within the muscular area associated with chronic pain.
Trigger points and the point of needle entries are the primary principles of Chinese acupuncture that link the procedure itself with medical science. b. Problem Statement By the medical principles of accurate anatomy and precise physiology, trigger points are said to be associated with sympathetic hyperactivity and local chemical blockade of essential pain stimulating hormones (Bonica, Loeser and Butler et al. , 2001 p. 1834).
According to White and Ernst (1999), the ancient Chinese acupuncturists have derived the point system through careful observation guided by Taoism principles of wu-wei, which connotes the idea of submitting to the spontaneous impulses generated by “bodily nature and the underlying universal pattern of physical forces, interconnectedness, change and development in all things” (p. 33). In the study of Kaptchuk (2002), he points out the principles of Confucianism and Taosim embedded within the idea of Chinese acupuncture, such as yin-yang, qi, dampness, and wind.
Clark and Gordon (1999) support the idea by theorizing the target goal of the treatment, which is to obtain balanced and spontaneous flow of neural transmissions and musculoskeletal fiber functioning (p. 282). The primary therapeutic significances of acupuncture under pain management is (1) to increase the analgesia state of the body, and (2) to decrease the pain intensity felt during muscular intrusions and neural distortions. Pain management contributed by acupuncture involves various areas of the body, specifically cardiovascular, endocrine, neural and musculoskeletal systems.
However, limitations and contraindications of acupuncture involve a number of situations that can gravely compromise the health status of the patient. III. Discussion a. Medical Applications of Chinese Acupuncture a. 1. Chinese Acupuncture and the Underlying Principles Despite of the unclear physiological nature of acupuncture, World Health Organization recognizes the validity of four meridians or physiological systems affected by this procedure, specifically (1) musculoskeletal, (2) cardiovascular, (3) endocrine and (4) neural systems (Torshin, 2007 p.14).
According to Bonica, Loeser and Butler et al. (2001), Chinese therapists have pointed out the importance of te chi, which is the bodily energy system that entails both healing and physical abilities, at the insertion point (p. 1835). According to White and Ernst (1999), “the development of acupuncture points have resulted from strict clinical observation that certain places in the body were more likely to harbor tender points than others and that treating these points by pressure or piercing could relive pain and various other non-painful symptoms” (p.32).
The actual acupuncture technique requires stainless steel acupuncture needles of varying lengths depending on the body insertion site. According to Bonica, Loeser and Butler et al. (2001), “the needle length is dictated by the location of the point to be treated; deeper and thicker muscles usually require longer needles” (p. 1835). Needle guide tubes, which are guide cylinder instruments, are also used to quickly determine the appropriate needle insertion site through a needle piston that facilitates the placement of the needle.
Westernized Chinese acupuncture procedures usually use these needle guides to avoid misplacement of needles, while the traditional therapy generally inclines itself with hand touch-technique in determining the rightful insertion site (Bonica, Loeser and Butler et al. , 2001 p. 1835). According to Clark and Gordon (1999), acupuncture prescription improves and rejuvenates energy or chi balance from the body’s excess or deficient condition, and in return removes the body’s pathogenic components (p. 286). a. 2. Physiology Behind the Procedure.
Theoretically, acupuncture involves four specific meridian centers that control the physiological actions upon needle insertions in their appropriate insertion sites, specifically (1) heart meridian, (2) muscles (nerve stimulations are also directed within muscles’ insertion site), (3) kidneys and (4) endocrine meridian (Torshin, 2007 p. 14). According to Fuster, Hurst and Alexander et al. (2004), acupuncture therapy works by stimulating the nerve impulses present on these meridian centers, which consequently activates sympathetic systems depending on the insertion area of the body (p.2467).
Upon insertion, sympathetic reflexes induce physiological activities through endorphin substance, which possesses morphine effect. Experimental and clinical studies (Berman, Singh and Langenberg et al, 1999; Molsberger and Hillf, 1994) have determined significant increase in the body’s level of endorphins and enkephalins, which are responsible for the decrease in pain stimulation, while significant change of bodily amounts in other bodily hormones (e. g. catecholamines, etc).
Furthermore, acupuncture targets the endorphinergic system located at the hypothalamus eliciting the initial surge of sympathetic response. After the initial surge of sympathetic activity, hypothalamic vasomotor center activates in order to balance the sympathetic tone with vasodilatation and decreased cardiovascular drive upon nerve stimulation (Hopwood, Lovesey and Mokone 1997, p. 25). After the specific neural innervations of specific trigger points, sympathetic response and afferent nerve stimulation undergo two separate phases: (1) excitation and (2) depression (Cherniak, 2003 p. 452).
In the first phase (excitation; increased sympathetic response), the body experiences increased heart rate, increased cardiac output and regional vasoconstriction followed by moderate increase in the body’s blood pressure. Upon stimulation of A-delta and C nerve fibers, the initial excitatory activity results in the activation of high-threshold mechanical receptors (White and Ernst, 1999 p. 93). Needle insertion produces stimuli that excite receptors and nerve fibers in the area giving rise to different bodily sensations, such as numbness, heaviness and radiating paraesthesia (Hopwood, Lovesey and Mokone 1997, p.21).
The activation of these excitatory receptors trigger strong muscle contractions associated also with ergoreceptor and nociceptor activations. After extensive stimulation of the muscular area, endogenous opioids and chemical substances, such as endorphins and enkephalins, are released producing central inhibition of autonomic outflow. This systemic response triggers the sympathetic inhibition of the current excitatory activity channeled in afferent somatic fibers, which illicit post-stimulatory response (Moriyama 1987).
As a result, therapeutic effects of acupuncture are then produced by the activation of spinal and central reflex mechanisms and beta-endorphinergic system from the hypothalamus to the periaqueductul grey in the brain stem (White and Ernst, 1999 p. 93). a. 3. Acupuncture as Pain Management Meanwhile, according to Hopwood, Lovesey and Mokone (1997), the principal contributors of acupuncture’s analgesic effects are the somatic stimulation of pain receptors and deep muscle tissues that induce pain inhibition through the hormonal release of endogenous opioids, such as endorphins and enkephalins (p.19).
Upon its release, endorphins locally travel towards cerebrospinal fluid in order to direct its effects onto spinal nerves inducing analgesia. Other medical effects of acupuncture are related to the four systems being affected by therapy. Acupuncture is said to cure specific localized to generalized pain in various cardiovascular and kidney associated problems, such as psychosomatic heart disorder, chronic heart disease, heart neurosis, cardiac ischemia, etc (Stux, Berman and Pomeranz, 2003 p. 279).
According to White and Ernst (1999), there is a marked increase in blood flow during the commencement of the treatment due to the stimulation of sensory peripheral nerves that control vascular dilatation. With the increased blood flow, heart rate and cardiac output most expectedly increase, which consequently increase cardiac oxygen demand as well. However, according to Fuster, Hurst and Alexander et al. (2004), acupuncture provides significant reductions of catecholamine levels that consequently reduce myscardial oxygen demand (p. 2467). Berman, Singh and Langenberg et al.
(1999) have found significant increase in the levels of endorphin and enkephalin among post-acupuncture controlled subjects. In the study of Lao, Berman and Langenberg (1995), 19 samples under molar extractions are grouped into two controlled subjects, specifically the (1) acupuncture group (n=11) and (2) the placebo acupuncture group (n=8). The aim of the study is to determine the medical credibility of pain-management instituted by acupuncture. As with the results, groups treated with acupuncture have noted increased pain-free duration (mean, 181 versus 71 minutes; p?0. 046) with decreased pain intensity than those who received placebo acupuncture.
Acupuncture’s therapeutic benefits of treating pain associated to muscular cramping, cardiovascular anomalies and endocrinal imbalances largely depend on the biochemical induction caused by the stimulation and inhibition of neurotransmitters and hormonal contents of the body. According to the study of Lee (2000), acupuncture as pain management has shown evident results in treating postoperative dental pains, menstrual cramps, tennis elbow, low back pain and fibromyalgia.
Meanwhile, Lee and Ernst (2004) have found the promising effects of acupuncture in treating labor pain during pregnancy as a conventional pain control management. Aside from endorphinergic and enkephalinergic responses elicited by the therapy, various effects on the body’s neurotransmitters have been observed as well during and after the commencement of the therapy. According to Sun (2002), “acupuncture treatment have been found to affect several neurotransmitters (e. g. serotonin, acetylcholine, dopamine and catecholamine, etc.), resulting in changes in their blood serum levels” (p. 6).
These consequent changes explain the medical benefits of the therapy primarily in inducing analgesia on various ailments and diseases associated with the four systems mentioned. High levels of acetylcholine and serotonin (5-HT) levels increase during the therapy (Sun, 2002 p. 7). During this state, the duration of pain relief and/or analgesia are usually extended depending on the heightened levels of serotonin and acetylcholine (Stux, Berman and Pomeranz, 2003 p. 279).
Acupuncture is a promising pain management although medical science still requires adequate and exact definitions proving the therapeutic physiology. b. Limitations of Chinese Acupuncture a. 1. Potential Side Effects and Complications Acupuncture, as a pain management for various conditions involving essential body organs, and muscles and nerves, has its sets of advantages and disadvantages. Despite of its analgesic effects, scientific studies do not consider this yet as an official pain management procedure; although, some surgical and operations (e.g. Beijing’s brain tumor removal) have considered the effects of this therapy (Olshansky, 2000 p. 254).
Patients under anticoagulant therapies are restricted in this type of procedure due to the possibility of causing bleeding. Considering the decreased coagulating agents of the blood (e. g. fibrinogen, platelet, etc. ), needle piercing can cause untoward bleeding especially on the sensitive and bleeding prone areas, such as abdomen, thorax, etc (British Medical Association Board of Science and Education - BMABSE, 2000 p. 24).
As supported by Norris (2001), limitations of acupuncture also include situations wherein the skin integrity of the patient and peripheral circulation are both compromised in any ways (p. 133). These conditions further risks bleeding in the insertion site and can further impede peripheral circulation due to the sensory stimulation caused by the treatment. General peripheral and systemic vascular functions are usually affected by acupuncture by inhibiting ventricular extrasystoles caused by the stimulation of hypothalamus centers, specifically on the paraventricular nucleus (Fuster, Hurst and Alexander et al.
, 2004 p. 2647).
Acupuncturists usually avoid the lower portions of the body unless minor pain situations are present (BMABSE, 2000 p. 44). Meanwhile, according to Bonica, Loeser and Butler et al (2001), acupuncture is a potential source of infection and various needle-associated complications, such as toxic shock, necrotizing tissues, bacterial meningitis, spinal cord injury and pneumothorax (p. 1835). The dangers associated to this procedure usually occur if the needles being used are not properly sterilized or already worn-out.
a. 2. Contraindications of the Procedure There are five principal contraindications that need to be assessed prior to the administration of acupuncture therapy, namely (1) when surgical treatment is indicated, (2) when bacterial infections are evident, (3) when there is an increased hemorrhagic diathesis, (4) age considerations of seven years and below, and (5) patients with cases of psychiatric disorders (Roemer, Kempfle and Reuther, 2005 p. 65-66).
Acupuncture’s analgesic effects are not usually beneficial for every type of surgical cases, especially during labor wherein pain scale variations triggered by acupuncture may implicate false labor contractions, which may compromise medical interventions. Patients with bacterial infections, especially in the integument, are also restricted from this procedure due to the risks of harboring more microbes that can worsen the infection. However, Roemer, Kempfle and Reuther (2005) recommend the use of acupuncture along the insertion sites adjacent to the infected areas in order to stimulate immunologic function in the area (p.66).
Meanwhile, patients with hemorrhagic diathesis are also contraindicated to this procedure due to their marked decrease in clotting factors, severe thrombocytopenia and drug induced anticoagulant actions (e. g. warfarin therapy, etc. ). On the other hand, infants and children age 7 years old and below are strictly contraindicated to acupuncture due to the possibility of causing bleeding since clotting factors are not yet fully functional during this age category.
Aside from disease and age considerations, heparin therapy also restricts the patient from acquiring the therapy due to the same reason of causing extensive bleeding (Roemer, Kempfle and Reuther, 2005 p. 66). Lastly, psychiatric patients may experience anxiety, tension and restlessness upon commencement of acupuncture. IV. Conclusion Medical applications of acupuncture primarily revolve in the concept of pain management. By appropriately inserting these acupuncture needles, various sensory responses and biochemical changes occur inside the body, which consequently derive the effect of analgesia or pain inhibition.
Acupuncture treats muscle (e. g. cramping, etc. ), cardiovascular, neural and endocrinal (e. g. neurotransmitter and hormonal imbalances, etc. )related problems in the body. However, the said procedure also holds significant limitations that can impede to the body’s normal circulation and pain sensorium as with labor cases. Other limitations that need to be assessed include age considerations, psychiatric patients, and infected or compromised skin integrity.
The Chinese acupuncture has always been confronted by speculations and doubts in its therapeutic value. However, with the advent of modern medical studies, various studies have supported the therapeutic benefits of acupuncture most especially in managing chronic and acute pain conditions associated to specific disorders and diseases. Hence, the principal effect of acupuncture is the analgesia induced by sensory stimulation of somatic nerve fibers and activation of various biochemical responses that greatly affect cerebral (hypothalamus and endorphinergic systems) and spinal systems.
II. Introduction a. Thesis Statement Medical applications of Chinese acupuncture have always been associated with neurologic and musculoskeletal bodily functions of managing pain. As a response to the body’s need of restoring the appropriate neural functions, reducing muscular stresses and treating the abnormal areas of the skeletal musculature, the acupuncture needles are used to treat the tender points within the muscular area associated with chronic pain.
Trigger points and the point of needle entries are the primary principles of Chinese acupuncture that link the procedure itself with medical science. b. Problem Statement By the medical principles of accurate anatomy and precise physiology, trigger points are said to be associated with sympathetic hyperactivity and local chemical blockade of essential pain stimulating hormones (Bonica, Loeser and Butler et al. , 2001 p. 1834).
According to White and Ernst (1999), the ancient Chinese acupuncturists have derived the point system through careful observation guided by Taoism principles of wu-wei, which connotes the idea of submitting to the spontaneous impulses generated by “bodily nature and the underlying universal pattern of physical forces, interconnectedness, change and development in all things” (p. 33). In the study of Kaptchuk (2002), he points out the principles of Confucianism and Taosim embedded within the idea of Chinese acupuncture, such as yin-yang, qi, dampness, and wind.
Clark and Gordon (1999) support the idea by theorizing the target goal of the treatment, which is to obtain balanced and spontaneous flow of neural transmissions and musculoskeletal fiber functioning (p. 282). The primary therapeutic significances of acupuncture under pain management is (1) to increase the analgesia state of the body, and (2) to decrease the pain intensity felt during muscular intrusions and neural distortions. Pain management contributed by acupuncture involves various areas of the body, specifically cardiovascular, endocrine, neural and musculoskeletal systems.
However, limitations and contraindications of acupuncture involve a number of situations that can gravely compromise the health status of the patient. III. Discussion a. Medical Applications of Chinese Acupuncture a. 1. Chinese Acupuncture and the Underlying Principles Despite of the unclear physiological nature of acupuncture, World Health Organization recognizes the validity of four meridians or physiological systems affected by this procedure, specifically (1) musculoskeletal, (2) cardiovascular, (3) endocrine and (4) neural systems (Torshin, 2007 p.14).
According to Bonica, Loeser and Butler et al. (2001), Chinese therapists have pointed out the importance of te chi, which is the bodily energy system that entails both healing and physical abilities, at the insertion point (p. 1835). According to White and Ernst (1999), “the development of acupuncture points have resulted from strict clinical observation that certain places in the body were more likely to harbor tender points than others and that treating these points by pressure or piercing could relive pain and various other non-painful symptoms” (p.32).
The actual acupuncture technique requires stainless steel acupuncture needles of varying lengths depending on the body insertion site. According to Bonica, Loeser and Butler et al. (2001), “the needle length is dictated by the location of the point to be treated; deeper and thicker muscles usually require longer needles” (p. 1835). Needle guide tubes, which are guide cylinder instruments, are also used to quickly determine the appropriate needle insertion site through a needle piston that facilitates the placement of the needle.
Westernized Chinese acupuncture procedures usually use these needle guides to avoid misplacement of needles, while the traditional therapy generally inclines itself with hand touch-technique in determining the rightful insertion site (Bonica, Loeser and Butler et al. , 2001 p. 1835). According to Clark and Gordon (1999), acupuncture prescription improves and rejuvenates energy or chi balance from the body’s excess or deficient condition, and in return removes the body’s pathogenic components (p. 286). a. 2. Physiology Behind the Procedure.
Theoretically, acupuncture involves four specific meridian centers that control the physiological actions upon needle insertions in their appropriate insertion sites, specifically (1) heart meridian, (2) muscles (nerve stimulations are also directed within muscles’ insertion site), (3) kidneys and (4) endocrine meridian (Torshin, 2007 p. 14). According to Fuster, Hurst and Alexander et al. (2004), acupuncture therapy works by stimulating the nerve impulses present on these meridian centers, which consequently activates sympathetic systems depending on the insertion area of the body (p.2467).
Upon insertion, sympathetic reflexes induce physiological activities through endorphin substance, which possesses morphine effect. Experimental and clinical studies (Berman, Singh and Langenberg et al, 1999; Molsberger and Hillf, 1994) have determined significant increase in the body’s level of endorphins and enkephalins, which are responsible for the decrease in pain stimulation, while significant change of bodily amounts in other bodily hormones (e. g. catecholamines, etc).
Furthermore, acupuncture targets the endorphinergic system located at the hypothalamus eliciting the initial surge of sympathetic response. After the initial surge of sympathetic activity, hypothalamic vasomotor center activates in order to balance the sympathetic tone with vasodilatation and decreased cardiovascular drive upon nerve stimulation (Hopwood, Lovesey and Mokone 1997, p. 25). After the specific neural innervations of specific trigger points, sympathetic response and afferent nerve stimulation undergo two separate phases: (1) excitation and (2) depression (Cherniak, 2003 p. 452).
In the first phase (excitation; increased sympathetic response), the body experiences increased heart rate, increased cardiac output and regional vasoconstriction followed by moderate increase in the body’s blood pressure. Upon stimulation of A-delta and C nerve fibers, the initial excitatory activity results in the activation of high-threshold mechanical receptors (White and Ernst, 1999 p. 93). Needle insertion produces stimuli that excite receptors and nerve fibers in the area giving rise to different bodily sensations, such as numbness, heaviness and radiating paraesthesia (Hopwood, Lovesey and Mokone 1997, p.21).
The activation of these excitatory receptors trigger strong muscle contractions associated also with ergoreceptor and nociceptor activations. After extensive stimulation of the muscular area, endogenous opioids and chemical substances, such as endorphins and enkephalins, are released producing central inhibition of autonomic outflow. This systemic response triggers the sympathetic inhibition of the current excitatory activity channeled in afferent somatic fibers, which illicit post-stimulatory response (Moriyama 1987).
As a result, therapeutic effects of acupuncture are then produced by the activation of spinal and central reflex mechanisms and beta-endorphinergic system from the hypothalamus to the periaqueductul grey in the brain stem (White and Ernst, 1999 p. 93). a. 3. Acupuncture as Pain Management Meanwhile, according to Hopwood, Lovesey and Mokone (1997), the principal contributors of acupuncture’s analgesic effects are the somatic stimulation of pain receptors and deep muscle tissues that induce pain inhibition through the hormonal release of endogenous opioids, such as endorphins and enkephalins (p.19).
Upon its release, endorphins locally travel towards cerebrospinal fluid in order to direct its effects onto spinal nerves inducing analgesia. Other medical effects of acupuncture are related to the four systems being affected by therapy. Acupuncture is said to cure specific localized to generalized pain in various cardiovascular and kidney associated problems, such as psychosomatic heart disorder, chronic heart disease, heart neurosis, cardiac ischemia, etc (Stux, Berman and Pomeranz, 2003 p. 279).
According to White and Ernst (1999), there is a marked increase in blood flow during the commencement of the treatment due to the stimulation of sensory peripheral nerves that control vascular dilatation. With the increased blood flow, heart rate and cardiac output most expectedly increase, which consequently increase cardiac oxygen demand as well. However, according to Fuster, Hurst and Alexander et al. (2004), acupuncture provides significant reductions of catecholamine levels that consequently reduce myscardial oxygen demand (p. 2467). Berman, Singh and Langenberg et al.
(1999) have found significant increase in the levels of endorphin and enkephalin among post-acupuncture controlled subjects. In the study of Lao, Berman and Langenberg (1995), 19 samples under molar extractions are grouped into two controlled subjects, specifically the (1) acupuncture group (n=11) and (2) the placebo acupuncture group (n=8). The aim of the study is to determine the medical credibility of pain-management instituted by acupuncture. As with the results, groups treated with acupuncture have noted increased pain-free duration (mean, 181 versus 71 minutes; p?0. 046) with decreased pain intensity than those who received placebo acupuncture.
Acupuncture’s therapeutic benefits of treating pain associated to muscular cramping, cardiovascular anomalies and endocrinal imbalances largely depend on the biochemical induction caused by the stimulation and inhibition of neurotransmitters and hormonal contents of the body. According to the study of Lee (2000), acupuncture as pain management has shown evident results in treating postoperative dental pains, menstrual cramps, tennis elbow, low back pain and fibromyalgia.
