"Face the simple fact before it becomes involved.
Solve the small problem before it becomes big.
The most involved fact in the world
Could have been faced when it was simple.
The biggest problem in the world
Could have been solved when it was small."
C Lao Tsu
Chinese medicine has treated many hundreds of millions of people over the last three thousand years. It entered the U.S. in the 1700's with physicians who were trained in France, and in the 1800's with practitioners from the Orient. It was embraced to some degree by American mainstream medicine early in this century, as evidenced by references to the successful treatment of sciatica and lumbago by acupuncture in H. Gray's Anatomy, Descriptive and Surgical (1901 edition) and W. Osler's The Principles and Practice of Medicine (1892-1947 editions).
An estimated 9 to 12 million patient visits per year are made to practitioners of Chinese medicine in the U.S., most seeking acupuncture for treatment of pain symptoms after unsatisfactory results with Western medicine. There are between 9 and 10,000 practitioners of acupuncture, including about 3,000 physicians who have varying amounts of training in continuing education programs through American medical schools.
Thirty-five schools of Chinese medicine in the U.S. now train non-physician practitioners in programs lasting three to four years. In 1973 Nevada became the first state to license non-physician practitioners of acupuncture. Twenty-three states restrict the practice of acupuncture to physicians only, while the remainder have varying degrees of regulation for non-physicians.
To the Westerner, perhaps its most striking quality is its differentness from our conventional ways of thinking. This applies to its views of what health is, what causes health and illness, how healing occurs, and the language that is used to describe all this. In fact, it may seem that to understand Chinese medicine one needs to learn a different language. And indeed, as we shall see, even within Chinese medicine there are different vocabularies.
"Chinese medicine" is actually a blanket term for several different but related traditions of healing. They trace their roots to the time of the Han Dynasty about two thousand years ago and beyond. This was the golden age of philosophy, culture and medicine in China. An important product of the era was an effort by seven scholars of medicine to unify the society's medical practices. They compiled The Nei Jing, also known as The Yellow Emperor's Classic of Internal Medicine. This book was an attempt to describe the many diverse and even contradictory views of healing that had existed in China up to that time.
Yin and Yang
At the foundation of Chinese medical theory is the concept of yin-yang. Just as there are cycles of day and night, the ebb and flow of ocean tides, and the changing of the seasons, human health is also a function of ever-changing patterns of energy that are constantly seeking to be in harmony and balance. The principle of yin-yang captures this dynamic interplay.
Yin is sometimes described as the feminine principle and Yang the masculine. All of life is somehow an expression of the interplay between yin and yang. Every physiological process and symptom can be analyzed in the light of yin-yang theory. Since the ultimate goal of Chinese medicine is to balance and strengthen, every form of treatment has, in a broad sense, one of the following aims:
To tonify Yang
To tonify Yin
To eliminate excess Yang
To eliminate excess Yin
The Vivifying Force: Chi (Qi)
Yin and yang are complementary aspects of another concept at the heart of Chinese medicine, which is chi, sometimes also spelled qi. We have no equivalent word in English. Roughly translated as "life force energy" or "life activity," chi is more than just energy as we think of it in Western terms C as, for example, horsepower or wattage. Rather, chi has the qualities of life itself. As described by San Francisco practitioner Efrem Korngold, chi is what makes life possible, suggesting a "biodynamic" quality of action or movement. Chi is that intangible force that animates us and makes us alive. All that is alive has chi, and what is not alive has no chi.
The diverse traditions or schools within Chinese medicine have different languages for describing the action and qualities of chi, but the common principle is that chi flows through the body and enlivens it. Health is a function of a balanced, harmonious flow of chi and illness results when there is a blockage or an imbalance in the flow of chi.
The human being has pathways called "meridians" through which the chi flows. The body has been mapped with these meridians which pass through all its organs, and specific meridians correspond with specific organs or organ systems ("organ networks"). Health is an ongoing process of maintaining balance among all the organs and systems of the body.
The Meaning of Symptoms
Symptoms are seen as signals of trouble somewhere in the flow of chi. To only remove a symptom would be like removing a flashing generator light from your car's dashboard because you are annoyed by it, when what it is doing is signalling to you the presence of a deeper problem.
"When people come to Chinese medicine they find one person who understands how their back problem is connected to their abdominal distension, which is connected to the dryness in their eyes, which is connected to their sometimes aggressive and sometimes passive feelings. All the symptoms the person may experience become integrated, which enables them to feel like one whole person who is seeking guidance from another for help with all the parts of themselves."
Treatment of Illness
When illness arises, the practitioner thinks in terms of different qualities of the person's chi and what the chi is doing as it moves through the person -- for example, it may be stagnating or blocked in a certain place, or it may deficient or excessive. To correct these dysfunctions, the main treatments work directly with the flow of chi. The vocabulary of such work often includes such verbs as tonify, consolidate, replenish, comfort, disperse, purge, strengthen, and harmonize. In Western terms, the goals of treatment are very much in alignment with our concept of strengthening host resistance.
Perspective on Modern Health Problems
Most modern diseases are considered "chi deficiency" diseases, caused by our not maintaining or supporting a harmonious internal ecology. Chronic stress and tension deplete our inner resources and impair the flow of chi through our organ networks. Our poor diet denies the nourishment needed to keep the organ systems healthy so they can do their part in helping maintain balance. Our sedentary lifestyle further promotes the stagnation of our vital energy, with poor circulation and the accumulation of toxins in our tissues.
When our chi is depleted or blocked we become more vulnerable to infection by viruses, bacteria, or other organisms. And, we are more vulnerable to the degenerative processes that our society has come to associate with normal aging.
Because of our interconnectedness with the environment around us, the worldwide ecological crises occurring at this time are especially problematic for our health. As acupuncturist David Walker, O.M.D. of Santa Rosa, California puts it, the erosion or mismanagement of the terrain around us makes it more difficult for our inner terrain to maintain its vitality. "How can you be well living in a sea of toxicity?"
VARIETIES OF CHINESE MEDICINE
Traditional Chinese Medicine (TCM)
In the 1940's and 50's the government of communist China undertook an effort to coalesce the myriad forms of Chinese medicine into a unified system called traditional Chinese medicine (TCM). Their intent was a practical one: to integrate a large work force of traditional practitioners into Western-style hospital medicine, as a way of providing care for a large population with inexpensive and familiar methods. Contrary to what its name implies, TCM is actually a modern system and was not an idealistic effort to preserve one particular tradition.
Practitioners of TCM outnumber those of other forms of Chinese medicine in the U.S. Most American schools teach this approach. The majority of practitioners are caucasians who studied here, though many have undergone short internships in China.
The theoretical basis of TCM is the "eight principles." These are actually four pairs of complementary opposites which describe the patterns of disharmony within the person. Briefly the principles are interior/exterior, referring to the location of the disharmony in the body (internal organs versus skin or bones); hot/cold, referring to qualities of the disease pattern, such as fever or thirst versus chilliness or desire to drink warm liquids; full/empty, referring to whether the condition is acute or chronic, and whether the body's responses are strong or weak; and the balance of yin/yang, which adds further to the description of the other six principles.
TCM places a heavy emphasis on herbal medicine which is supplemented by acupuncture. For many people this is practical in that they can treat themselves on a daily basis with their herbal remedies and not have to rely on office visits for acupuncture. However, using both methods together is considered the ideal.
Also known as "five element" or "classical acupuncture," traditional acupuncture is the longest-established in the U.S. Its philosophy is that acupuncture (without herbs) is a complete medical system in itself. As explained by David Walker, "Acupuncture itself is a complicated enough art to master, and herbal medicine is another whole study. To do justice to both in the same lifetime would be very difficult."
Practitioners are trained according to the curriculum developed by J.R. Worsley who founded the College of Traditional Acupuncture in Leamington Spa, England. The theory of the five elements C fire, earth, metal, water, and wood C pervades the teaching, philosophy and methods of traditional acupuncture. The five elements are conceived of not just as basic constituents of matter, but as dynamic qualities of nature. They have been called "further descriptions of the chi energy as it goes through cyclic transformations. Everything in life is concordant with these elements..."
As chi circulates through us it is influenced by the elements as they build upon each other, and support each other in a certain orderly sequence: wood creates fire, fire creates earth, earth creates metal, metal creates water, and water creates wood. Hence, according to Dianne Connelly, "Health is the harmonious balanced cyclic interaction of these elements. Health is maintained only when the energy flowing through each of the elements is clear and lifegiving."
It is somewhat awkward to include discussion of medical acupuncture in a chapter on Chinese Medicine since it involves the importation of acupuncture techniques into the practice of Western medicine, an altogether different tradition. Because of its origins, however, we will discuss it here. Medical acupuncture is the practice of acupuncture performed by a Western-trained allopathic physician (M.D.) or osteopathic physician (D.O.). At this writing, twenty-three states allow only this kind of acupuncture.
Medical acupuncture developed in Europe as a result of the introduction of Chinese medical texts and practices by traders and missionaries in the seventeenth and eighteenth centuries. It has evolved alongside allopathic medicine in Europe where it is taught in many medical schools and used in most fields of medicine. In the U.S., training programs for physicians were first offered in the late 1970's, and by the mid-1980's medical acupuncture emerged as a medical discipline.
Most practitioners are already established in a conventional medical specialty and use acupuncture in that context. It serves as an adjunct technique as opposed to being considered a complete medical system in itself.
According to Joseph Helms, M.D., founding president of the American Academy of Medical Acupuncture and coordinator of physician education in acupuncture, Office of Continuing Education, UCLA School of Medicine, the practitioners tend to use a "hybrid" approach to acupuncture, taking the diagnostic value of as many approaches to acupuncture as possible and integrating them into the context of Western medicine. Hence, they may draw upon the eight principles used in TCM, the five elements approach of traditional acupuncture, and other systems.
Medical acupuncture conceives of the therapeutic mechanisms of acupuncture in the neurophysiologic and bioelectric terms familiar to Western science, as well as the energetic models derived from the classical texts.
The American Medical Association does not yet recognize acupuncture as a specialty of medicine or as a special technique of medicine.
Ethnic Chinese Traditional Medicine
This is a more loosely defined, generic form of Chinese medicine and is usually practiced by the "Chinatown" Chinese in large urban centers in the U.S. There is no organized body of theory. Both acupuncture and herbs may be used, and some practitioners use electrical stimulation of the needles.
While practitioners of this variety are definitely a minority, Japanese acupuncture is growing in popularity among American acupuncturists. Japanese needles are considerably thinner than others, and as a result are now used by many practitioners of other forms of Chinese medicine because they are thought to be less traumatic for the patient.
Japanese acupuncture theory is devoid of herbal influence. The needling techniques are reputed to be more gentle and sensitive than other approaches. According to Daniel Kenner, L.Ac. of Santa Rosa, California and San Francisco's Meiji College of Oriental Medicine, Japanese-style training places greater emphasis on the practitioner developing "an advanced level of tactile sensitivity in locating points with the fingertips. This allows them to actually feel the chi flow and feel blockages of energy that are impalpable to the unpracticed hand." The ideal is to then use the mildest intervention possible while achieving the desired effect.
Auricular acupuncture is a technique of treating points exclusively on the ear. The points are chosen by different means C palpation for tenderness, electrode resistance, and using the patient's pulse to locate significant points.
Many of its practitioners consider this approach to be a complete medical system for treating functional and allergic disorders, and often use it exclusive of any other type of practice. It is also used for pain control and to assist in withdrawal from drug and alcohol addiction.
Work with drug withdrawal began in Hong Kong in the 1970's. In recent years there has developed a movement in the West to expand this application because of evidence of its effectiveness. Abbreviated training programs in auricular acupuncture are growing for detox technicians, nurses, and physical therapists. Some conventionally-trained practitioners question the wisdom of allowing people to practice with this briefer training.
The French neurophysiologist Paul Nogier, M.D. developed a method called "auricular medicine" or "auriculotherapy," based on neuroendocrine theory rather than Chinese medicine. Like medical acupuncture, it integrates a technique drawn from Chinese medicine into a Western context.
Eclectic Chinese Medicine
Probably the greatest number of Western practitioners of Chinese medicine would describe themselves as eclectic, at least to some degree, though their original training was in one of the above varieties. Given the richness and unique perspectives of the different models, many borrow from several sources to create their own synthesis that works best for them in their own style of practice. The rationale are expressed well by Helms, who thinks of the various models as being layered on top of one another: "Each case makes sense is a slightly different way C each case makes best sense in one model or another."
PROCEDURES AND TECHNIQUES
Diagnosis is based upon identifying patterns of signs and symptoms. These patterns reflect the condition of the internal organ networks as well as the chi. The practitioner will examine skin, complexion, bones, channels, smells, sounds, mental state, preferences, emotions, tongue, pulse, demeanor, and body build. Each of these has its own variety of qualities and nuances that help the practitioner discern patterns that underlie the person's complaints. This approach is summed up in the expression: "Inspect the exterior to examine the interior."
Some practitioners arrive at a diagnosis with very little verbal exchange with the person. In situations where the practitioner does not speak English, a rapid assessment may be made and work begun without such communication. Other practitioners may conduct an exhaustive interview, while still others will use written questionnaires to get a thorough picture of the patient's pattern of complaints.
Pulse Diagnosis. One of the more mysterious aspects of Chinese medicine to Westerners is pulse diagnosis. In Western medicine the pulse is a very simple thing and is used only to measure heart rate C the number of beats per minute.
In Chinese medicine the pulse provides a whole world of information. The primary use is as an indication of various conditions of chi moving through the person's meridians. The condition of all the organ networks is assessed via the pulse.
For example, in TCM the flow of chi through each of twelve major meridians can be assessed by the practitioner feeling the pulse at various positions on the wrist (the leg or neck can also be used). There are six basic locations and three depths on each wrist.
Each of these positions can be assessed according to many different qualities that the pulse can have C twenty-eight in TCM, other numbers in other variations of Chinese medicine.
While these qualities have esoteric sounding names such as "floating," "thick," "thin," etc., they are actually features of each pulse that we could see if we were looking at a sine wave of the pulse on an oscilloscope. The qualities may be such things as how strong each pulsation is, its length, how it trails off, and what kind of activity may be present between pulsations. Just as the Eskimo have a very rich vocabulary for describing many varieties and features of snow, in Chinese medicine there is a rich vocabulary for describing the nature of a person's pulse.
The practitioner can feel the balance and flow of chi through the person's meridians and corresponding organs. This is not only of value in diagnosis, but also in measuring progress from one treatment to the next. In addition the practitioner can discover weaknesses that would warn of future problems with certain organ systems.
Herbs. Herbal medicine probably predates acupuncture and in some settings it is the primary form of treatment. In the context of Chinese medicine, the term "herb" is actually used to describe any natural material of plant, animal, or mineral origin, or any traditional or modern preparation of the natural materials short of preparing an isolated chemical.
Chinese herbs are available in three forms. The most traditional are the raw materials themselves, which are given to the patient who takes them home and boils them up into a beverage. This may take the form of a tea which is consumed on a daily basis, one or more times, much the way a Westerner would take allopathic medicines according to a certain schedule.
The second form, a modern development, is where the herbal substances are compressed into tablet form and taken as pills. Obviously much more convenient, this eliminates the time involved in boiling the raw herbs. It also eliminates the smell which can permeate the house as a result of boiling herbs and can be strong and objectionable to some. The tablets can be difficult to swallow, especially if there is a large number of them, and some people question how well the body breaks down and absorbs substances presented in this form. Practitioners generally reply that the tablets are designed for quick breakdown in the stomach.
Finally there are herbal extracts, also convenient. These are provided in an eye dropper bottle in a concentrated form which is added to hot water and consumed as a tea. The extracts have the advantages of being easier to consume and perhaps easier for the body to assimilate than tablets. Being in a liquid form, the extracts also allow greater combinations of herbal substances to be easily mixed, and a unique "cocktail" can be easily designed for the individual patient's needs.
Acupuncture. This involves the insertion of thin, sterile, stainless steel needles into points on the surface of the body to a depth just below the surface of the skin in the epidural layer. Most acupuncturists use disposable needles, while a few use reusable needles that are sterilized.
For some people the insertion is barely noticeable, and for others there is a small pinch, sometimes followed by a sensation of numbness, tingling, ache, warmth, or heaviness. The point locations are determined by the geography of the meridians and acupuncture points on the body as described by Chinese medical theory. In some cases the needles are manually twirled to give more stimulation. A few practitioners use electrical stimulation of the needles to add even more effect (electroacupuncture).
The practitioner selects points based on the diagnosis and goals of treatment. Usually several different points are needled at the same time while the patient is in a reclining position on a table. The insertions may be for just a few seconds, or they last from twenty to forty minutes while the patient lies still and rests. Most people find the sessions very relaxing, and it is not uncommon to feel immediate effects and changes in symptoms.
In some variations of Chinese medicine the practitioner remains present with the patient throughout the treatment, continuously checking the pulse and perhaps changing needle positions in response to the ongoing feedback from it. This approach is most common among practitioners of traditional acupuncture.
In China, acupuncture is routinely used for anesthesia. In the famous Bill Moyers television series called Healing and the Mind shown nationally in 1993, millions of Americans witnessed a person having brain surgery while conscious and carrying on a conversation C all with the help of acupuncture anaesthesia.
Moxibustion. Moxibustion treatment is the burning of the herb moxa (mugwort) on an acupuncture point. Moxa is applied in the form of a fluffy, wooly-like material that is rolled up by the fingers into roughly the size of a small pea, placed in position, and then lit, usually with an incense stick. It burns slowly, introducing heat into the acupuncture point, and then is removed by the practitioner when the patient is able to feel it become hot, usually after a few seconds.
The use of moxibustion is older than that of needles, and there was a time when moxa was considered superior to all other treatments. There are different kinds of moxa and its effects are determined by such factors as its age, how tightly it is packed, how many applications are used on a given point, and its juxtaposition with needles. Also, it can be placed on a bed of salt, ginger, or a slice of garlic on the skin to introduce additional properties or influences into the point.
Moxibustion brings influences into the point that the needle cannot, especially heat. It may also be placed on the exposed tip of the needle and burned in order to change the temperature gradient of the needle.
Massage (Acupressure, Shiatsu). Acupressure and Shiatsu are sometimes called "acupuncture without needles." They are variations of massage technique in which a similar geography of points and meridians is used to guide the application of finger pressure rather than the insertion of needles. The aims are similar in terms of stimulating points and influencing the flow of chi through the meridians. Some practitioners use these methods during the course of an acupuncture session. These are discussed more thoroughly in Chapter 9.
Chi Kung. Chi kung (also spelled "qi gong") is the mother of all the martial arts. It is estimated that 1.3 million residents of Beijing use the practices of this five thousand year old tradition, with tens of millions more nationwide. In Shanghai there is even a hospital devoted to treating cancer with these methods.
Chi kung is the oriental counterpart to Western behavioral medicine and contains elements of meditation, relaxation training, visualization, movement, postures and breathing exercises. In the orient it serves both as a form of exercise for physical fitness and a self-healing tool.
The aim is to strengthen and direct the flow of chi through the body to promote health and well-being. The benefits require daily practice to accrue. This may mean a routine that takes from twenty to forty minutes per day. Some practitioners of Chinese medicine teach these techniques to their patients, while others will refer to classes taught by specialists.
In other words, two people with the same symptoms may be treated entirely differently based on their own unique inner ecology. The idea of a "standardized treatment," as is used in Western-style research, contradicts this principle. What could help re-establish balance and harmony within one person may have the opposite effect in the next.
The attitude among many practitioners has been that Chinese medicine stands on its own merit and has no need for the stamp of approval of Western science. The implicit assumption has been that over the thousands of years in which the methods have evolved, practitioners have refined their understanding based on case-by-case observation, and have communicated this collective wisdom effectively to their students or successors.
With the rise of the information age, however, a surprising amount of research has taken place both in the West and in the Orient. Many studies, particularly with herbs, have managed to side-step the issue of individualization. This is more difficult with acupuncture but there are some interesting findings with this method as well.
While the use of Chinese herbs clearly is based on a theory of energy medicine, they do lend themselves to Western-style research since they can be studied much like pharmacological substances. Their potential is very well-illustrated by the clinical research that has been conducted with cancer and heart disease.
Cancer. In modern China, cancer is the leading cause of death. Practitioners there advocate a combination of Chinese and Western medicine as the optimal cancer treatment, accompanied of course by diet, exercise and lifestyle change. The rationale for use of Chinese herbs is twofold: to attack the tumor and to support and strengthen the patient's immune responses.
Chinese medicine uses over 120 different herbs with cancer, depending on the type of cancer and its cause according to Chinese medical theory. One class of herbs used for centuries is called fu-zhen herbs. Recent studies have shown why they have proven successful.
One controlled study examined survival time of patients with stage II primary liver cancer undergoing chemotherapy or radiation. Twenty-nine of the forty-six patients receiving fu-zhen herbs along with radiation or chemotherapy survived at least one year, and ten survived for three years. Of the thirty patients who received only radiation or chemotherapy, six survived one year, and none survived three years.
Other varieties of herbs have been used as well, with the following findings:
Improved survival rates for patients with nasopharyngeal, lung, throat, and breast cancers who used herbs in combination with radiation or chemotherapy, as opposed to conventional treatment alone.,
No significant drop in white blood counts and platelet counts after three cycles of chemotherapy in a group of 11 breast cancer patients using an herbal treatment.
In 181 patients with pre-cancerous throat lesions, only 9% of those treated with herbs developed cancer within five years, as opposed to 26% in the untreated group.
A study of 40 patients with various cancers found an herbal treatment to significantly increase lymphocyte transformation.
In 272 patients with nasopharyngeal cancer, those treated with Chinese herbs and radiation had a significantly lower five-year relapse rate than those with radiation alone (12% vs. 38%). Five-year survival rates were also higher (67% vs. 48%).
In 326 patients with postoperative stomach cancer, a significantly higher percentage of those receiving herbal treatment were able to tolerate chemotherapy than those not receiving it (95% vs 79%). Other outcomes included improved weight gain, fewer complaints of low energy, and improved natural killer cell activity.
In 158 patients with late-stage stomach cancer, treatment with herbs was associated with significantly higher 3-, 5-, and 10-year survival rates than normal. Survivors also showed enhanced immune functioning.
Heart Disease. The findings with heart disease include lower oxygen consumption by the heart muscle, dilating the coronary arteries (which increases the blood supply to the heart), reducing angina, lowering blood cholesterol levels, reducing platelet aggregation and adhesion to arteries, increasing contractile force of the heart, increasing cardiac output, and reducing high blood pressure. A few examples of clinical studies include:
A study of 37 patients with coronary heart disease and 14 with acute myocardial infarction found an herbal combination to strengthen the left ventricular performance, increase oxygen supply to the myocardium, and inhibit platelet aggregation.
A placebo-controlled study of 46 angina pectoris patients found an anti-anginal rate of 85% for the herbs (versus 37% for those not receiving the herbs), and an ECG improvement rate of 45% (versus 3%).
In 110 coronary heart disease patients, herbal treatment showed an 81% effective rate for angina pectoris, improved ECG in 65%, and improved cardiac function in 57%, all significant differences to the control group.
A double blind study of the effect of another herb on 65 coronary heart disease patients found symptomatic improvement in 73% of cases (42% improvement with placebo), and ECG improvement in 60% (25% with placebo). The benefits were attributed to increased volume of coronary blood flow, bringing an increased oxygen supply to the myocardium.
A study of 136 patients with abnormal blood lipid levels found the herb rosa multiflora to be as effective as two common antihyperlipidemic drugs in reducing blood lipids.
A controlled study with 75 coronary heart disease patients compared an herbal formula to dextrose and cedilandid-D. The effects of the two treatments were similar in increasing the muscular contractile force and reduced oxygen consumption in the myocardium.
In 60 coronary heart disease patients an herbal formula was found to have positive effects on angina pectoris, blood lipids, and left cardiac function tests.
In 308 patients an herbal oil was tested for its ability to reduce blood lipids. There was a significant decrease, along with reduction in platelet aggregation rates and blood pressure.
Finally, a study of 120 cases of coronary heart disease found an herbal treatment to reduce the occurrence of angina pain in 85% of patients and improve ECG indices in 77% of patients.
It is worth noting that no adverse reactions or side effects were observed in the above studies, many of which used blood, urine, liver, and kidney tests to look for such effects.
In contrast to herbal medicine, studies of acupuncture are more difficult because the individual artistry of the practitioner is such an important part of the technique, and treatment is normally individualized for each patient. Hence there are very few studies that adhere to Western standards.
Proponents of acupuncture argue that to insist on imposing such standards to justify this form of medicine would be to our detriment. According to Joseph Helms, M.D., "Using scientifically proven mechanisms as the exclusive foundation to define acupuncture applications overlooks the heritage of empirical observations by traditional practitioners. To ignore this heritage is to deprive a contemporary physician of models of health, disorder, and treatment that are presented in classical texts, models that have been vitally useful to practitioners in many cultures during the long history of acupuncture."
Research in the West has dealt mostly with documenting its mechanisms in pain control., As Helms states, "The basic neurophysiologic and neurochemical science of the analgesic and blood chemistry dimensions of acupuncture stimulation have been very well defined. They are in fact defined more clearly than most drugs, and certainly most analgesic drugs that are commercially in use today."
Physiology of Acupuncture Effects. There is evidence that acupuncture activates the electric system, the nervous system, the blood system, and the lymph system. In terms of pain control, what Western science understands most clearly is that there is a cascade of neurotransmitters that are released as a result of acupuncture stimulation. These are the endorphins, enkaphalins, monoamines, and neurotransmitters that help inhibit pain transmission and reception through the central nervous system. Other mechanisms by which acupuncture can benefit medical conditions remain less clearly understood.
Helms is careful to point out that while the basic science is strong in describing what acupuncture does, this does not tell us how acupuncture works. From the more traditional view of Chinese medical theory, of course, this is because what really matters is how the technique influences chi, something which Western science does not yet have the tools to study.
Treating Specific Diseases. The world literature on acupuncture contains thousands of clinical studies of virtually all kinds of illness. Most are published in hundreds of medical journals in the Orient. Again, however, few apply strict Western principles of research design. On this basis, some reviewers of the research state that claims of effectiveness in treating specific ailments are not based on well-performed clinical trials.,
One study of 50 patients with chronic low-back pain (which the American Medical Association considered well-designed) found acupuncture to be an effective treatment on a short-term basis. A review of several studies led two researchers to conclude, "Taken together, the results from controlled studies with back pain suggest that a majority (of patients) will derive clinically significant short-term benefits from acupuncture."
Substance Abuse. Another apparently fruitful application is in alcoholism. A controlled study with 54 hardcore alcoholic recidivists found acupuncture treatment to bring significant reductions in expressed need for alcohol, drinking episodes, and detox admissions.,
The U.S. Department of Justice is now exploring the use of acupuncture in treatment of prisoners who are addicted to alcohol or other drugs. Dr. Michael Smith of the Department of Psychiatry, Lincoln Hospital, New York City, is using acupuncture in a probation program for drug abusers. The program is designed to control withdrawal symptoms and craving and to reduce the fears and hostilities that usually accompany drug abuse treatment settings. The program has been so successful it is being replicated in 300 other locations in the U.S. and around the world.
Cost Effectiveness. There is some interesting evidence of the cost effectiveness in conventional medical practice. Insurance statistics in France show that physicians who practice acupuncture at least half-time use considerably less laboratory examination, hospitalization, and prescriptions for medication. Also, a study in a managed care setting in the U.S. found patients receiving acupuncture had a reduction in total clinic visits and telephone consultations, and reduced laboratory, hospitalization, and prescription costs.
In China, over eight hundred studies of varying levels of scientific sophistication have been conducted on the medical effects of chi kung. This research is virtually unknown in the West. Beneficial findings have been reported for virtually all major and chronic illnesses. A computer data base of English translation summaries of these studies is being developed.
STRENGTHS AND LIMITATIONS
As a form of primary care Chinese medicine does well in certain acute conditions such as colds, flu, allergy and headache. It also has success in treatment of many chronic illnesses with which modern medicine often does not deal successfully. Conditions whose disease process is not clearly understood in allopathic terms may be readily addressed by this tradition.
Many people have experienced the frustration of being told, "Your lab tests are all normal, so there must not be anything wrong with you." Or worse yet, "The feeling you have that something is wrong must be psychosomatic. Go home and rest, or get some therapy."
It can also be used to supplement allopathic care, for instance in speeding recovery from surgery or, as we saw earlier, as an adjunct to chemotherapy or radiation in cancer treatment.
In 1979 the World Health Organization assembled a list of illnesses that lend themselves to acupuncture treatment. The list is based both on research and clinical experience world-wide. The major illnesses in each of the following categories are included: upper respiratory tract, respiratory system, disorders of the eye, disorders of the mouth, throat and teeth; gastrointestinal disorders, neurological and musculoskeletal disorders.
More recently, the American Foundation of Medical Acupuncture conducted a review of world clinical literature. Their list of the most frequent successful applications of acupuncture includes the following:
Pain (chronic, perioperative, arthritic, malignant, headache, backache, extremity, dental)
Organic lesions (cardiovascular, respiratory, gastrointestinal, skin, urological)
Neurological (peripheral and central)
Substance abuse (drugs, nicotine, food, alcohol)
Psychiatric (depression, anxiety)
This tradition's diagnostic procedures are a unique strength because they allow detection of much more subtle dimensions of health and illness than allopathy is able to address. The practitioner can recognize and intervene in disorders or dysfunction, according to Helms, "prior to the manifestation of that disorder in a dense histological form." It is in this sense that David Walker states, "Chinese medicine is at its best as preventive medicine."
A standard part of every training program is recognition of the limitations of the tradition and when to refer. Demonstration of this knowledge is also an important part of legal certification and licensing requirements. The most obvious limitations are surgery, emergency medicine (e.g. bone setting), and trauma care C which are the strengths of allopathy.
THE PRACTITIONER-PATIENT RELATIONSHIP
Practitioners cover a wide spectrum in how they view their relationship with the patient. Some of these differences represent the influence of their training, and some are a matter of individual personalities.
In classical or traditional acupuncture, the practitioner spends the entire treatment session at the patient's side, continuously monitoring the effects of the needling with pulse diagnosis, changing needle positions, perhaps adding moxibustion, and asking the patient for feedback. Essentially, this means almost continuous touch contact in one form or another. This can be felt as a very intimate, interactive process.
At the other extreme are practitioners who work in a more mechanical way C a quick insertion of needles followed by leaving the patient alone in the treatment room, perhaps for a half hour or more. This is a very different experience in terms of the relationship and sense of interpersonal involvement with the practitioner.
Some patients desire a sense of therapeutic relationship more than others. Indeed, some training programs stress that the practitioner is like an energy field which the patient enters and which provides an energetic context that potentiates the treatment; that the emotional and spiritual state of the practitioner has a direct impact on the patient, and that this will significantly influence how the patient responds. Some practitioners even meditate or pray before a session, or may view the treatment process itself as a form of meditation.
Nevertheless, there are practitioners who are convinced that the needles and herbal treatments are so powerful that a personal, caring relationship is not a major part of the healing equation.
EVALUATING PERSONAL RESULTS
There are three ways in which progress is monitored. First is the patient's subjective appraisal of his or her symptoms from treatment to treatment. Second is the practitioner's ongoing diagnostic process, mainly with pulse diagnosis and other forms of observation, at each session, and, in some cases, during the progress of the session. Third are objective tests such as laboratory reports which may be made available from a regular medical lab. The latter can be a welcome contribution, but are not a mainstay of Chinese medicine.
Practitioners' observations are considered relatively objective, but clearly there is a subjective component. Two practitioners may read a person's pulse slightly differently. What is more important is the relativeness from session to session, the changes or patterns observed over time. Hence, even though two practitioners may perceive a different baseline for a certain quality of the pulse, they should observe the same pattern of change with time. According to Joseph Helms, M.D., the reading of the pulse is subjective, but it is "objectified" by having the same practitioner be the transmitter of the information.
Most practitioners record notes on the qualities of the pulse from session to session and in this way are able to monitor change.
RELATIONSHIP TO OTHER FORMS OF MEDICINE
Chinese medicine does not view itself as exclusive of any other form of medicine. For many ailments it works well on its own, but it also can support or complement other forms of treatment. Its limitations with respect to surgery and emergency medicine were mentioned earlier, but even in these cases it can serve an important supportive role.
Many people use Chinese medicine along side conventional Western medicine with good results. As discussed earlier, it has shown important benefits in combination with radiation and chemotherapy, including reducing side effects. In pain control acupuncture has been found to enhance and be enhanced by certain allopathic drugs.
Chinese medicine is often combined with other traditions. Medical acupuncturists of course are also trained in allopathy or osteopathy. Many chiropractors are trained in acupuncture as well, and Chinese medicine is a specialty of many naturopaths who use it along with other forms of natural medicine.
This tradition tends to be a great deal less expensive than allopathy because it does not involve modern laboratory testing, high technology equipment, pharmaceuticals, or high malpractice insurance costs. Patient fees are basically for treatment time in the practitioner's office and herbal remedies for those practitioners who use herbs.
The initial session is generally longer and more expensive than subsequent treatments. Initial sessions with non-physician practitioners may range from $50-100 (more for physicians), and follow-up sessions are usually less. The number of sessions varies depending on the nature of the ailment. A typical course of acupuncture treatment may be once or twice a week for a few weeks, with treatments being spaced further apart as time progresses. More difficult chronic illnesses may require treatment over several months. The cost of herbs varies widely, and could range anywhere from $10 to $50 per month.
Insurance companies differ in their coverage, and these differences are influenced by a variety of factors including state regulations, licensure of the provider, and whether medical supervision is required. Some states authorize Medicaid to pay for alcohol and drug abuse treatment by licensed or certified acupuncturists (Oregon, California, Florida, Massachusetts, New York, and Washington). In addition, California, Florida, New Mexico, and Oregon mandate general insurance coverage for acupuncture treatment.
CHOOSING A PRACTITIONER
Although acupuncture and herbology are different kinds of treatment, most credentialing bodies consider the use of Chinese herbs as part of acupuncture practice. There is currently no separate credential just for the practice of herbology.
States vary in who they allow to practice acupuncture. At this writing, twenty-four states license, certify, or register non-physician acupuncturists:
District of Columbia
bRecently ratified, not yet in effect
Four states do not license acupuncturists but allow them to practice under the supervision of a physician:
Connecticut A Physician's Assistant (PA) may practice acupuncture under supervision of a physician.
Delaware Acupuncture performed by a non-physician requires direct supervision of a physician whereby the physician is physically present on the premises and immediately available in practitioner.
Minnesota Nurses may practice acupuncture under the auspices of "delegated medical tasks." A chiropractor may practice acupuncture if he or she meets the requirements of the state board of chiropractic examiners.
South Carolina Referral and supervision by a licensed medical doctor are required. No acupuncturist may practice without prior written approval of the state board of medical examiners.
Some medical acupuncturists tend to refer to non-physician practitioners of acupuncture as "lay acupuncturists" and take the position that acupuncture is the practice of medicine and should only be done by licensed physicians. They also hold that one should not have acupuncture until there has been a medical diagnosis by a physician, and that such practice should only be used with medical supervision. The concern, of course, is over the risk of an undiagnosed or misdiagnosed disease progressing to an incurable stage.
The non-physicians take the perspective that medical acupuncturists' primary training is in Western rather than Chinese medicine, and as a result, most lack sufficient hours of acupuncture education and training to be fully competent with this highly specialized method. Schools of Chinese medicine usually involve three to four years of study.
Some people feel more confident being treated by a Western-trained physician who can combine aspects of the two traditions. There can also be advantages to this in terms of insurance coverage. Other people seek a practitioner who is more thoroughly committed to, and grounded in, the broader philosophy and practice of Chinese medicine.
The National Commission for Certification of Acupuncturists (NCCA). This organization was chartered in 1984 to promote nationally recognized standards for safe and competent acupuncture practice. The NCCA conducts a certification exam with both written and practical portions, including clean needle techniques. Practitioners who are certified are designated "Diplomate in Acupuncture," or "Dipl.Ac. (NCCA)," and are listed in the annual Directory of National Board Certified Acupuncturists.
Ninety percent of states which license acupuncturists recognize NCCA certification or use the NCCA exam in their licensing process. This is a good credential to ask about, though it is unnecessary if the practitioner is otherwise licensed or certified by the state. Some insurance companies use NCCA certification as a criterion for reimbursement.
At this writing the NCCA in the process of developing an exam to certify competence in herbalism separately from the practice of acupuncture. It is possible that such an exam may be presented to state legislatures to regulate the practice of herbalism by practitioners who do not use acupuncture. Address: 1424 16th St. N.W., Suite 501, Washington, D.C. 20036, phone (202)232-1404, FAX (202)462-6157.
The American Association of Acupuncture and Oriental Medicine (AAAOM). Founded in 1981, this is the largest membership organization for practitioners with over 800 members. It promotes public education about acupuncture and advocacy for the profession. An "Individual Member" in AAAOM is someone who has achieved Diplomate status with the NCCA or is licensed by a state using equivalent criteria. Address: 433 Front Street, Catasaugua, PA 18032, phone (610)433-2448.
The National Accreditation Commission for Schools and Colleges of Acupuncture and Oriental Medicine (NACSCAOM). Another criterion, though less important, and one which applies to non-physician practitioners, is whether they have graduated from a program accredited by NACSCAOM. About half the current schools have this status, but many perfectly fine programs do not, as it is not a requirement in the field. Address: 1424 16th St. N.W., Suite 501, Washington, DC 20036, phone (202)265-3370.
The American Academy of Medical Acupuncture (AAMA). The AAMA was formed in 1987 to represent the education and practice interests of well-trained physician acupuncturists. It restricts its membership to physicians, M.D.'s and D.O.'s. Currently it has 600 members. Since any licensed physician is allowed to practice acupuncture regardless of training or competency, membership in the AAMA is a good guideline as to preparation.
"Full Members" have a minimum of 220 hours of formal training or the equivalent in an apprenticeship program acceptable to the AAMA; two years experience practicing medical acupuncture; and a personal endorsement by an Academy member. "Associate Members" meet part but not all of these requirements. There is no competency exam, though the AAMA anticipates the development of such an exam in the next few years. Address: 5820 Wilshire Boulevard, Suite 500, Los Angeles, California 90036, phone (213)957-5514, FAX (213)937-0959.
Ultimately, your choice of a practitioner should be based on three points. First, they should meet state legal regulations to practice. Second, you should be familiar enough with their background to know what their professional and philosophical orientation is, and that you feel comfortable with their approach. Third, and most important, you should feel comfortable in their presence and find it easy to trust them. This can be determined both in an initial, exploratory meeting, as well as by feedback or recommendations of friends or others whose judgement you respect.
The Office of Alternative Medicine, National Institutes of Health has funded four studies related to Chinese Medicine in its first wave of research grants.
Acupuncture and Depression. John J. Allen of the University of Arizona in Tucson is conducting a controlled study to test the effectiveness of acupuncture for treatment of unipolar depression in women. The study uses a "person-specific" approach to diagnosis and treatment of the patients according to Chinese medicine principles. That is, the women will receive individually-tailored acupuncture treatments using points not specific to depression.
Acupuncture and A.D.H.D. In the second study, Neil Sonenklar of Virginia Commonwealth University in Richmond is studying the use of acupuncture point therapy in treatment of A.D.H.D. (attention deficit disorder/hyperactivity) in children, and comparing it to the effectiveness of the common drug treatment, methylphenidate.
Chi Kung and Reflex Sympathetic Dystrophy. In a controlled study, Wen-Hsien Wu of the University of Medicine and Dentistry of New Jersey, Newark, is examining the effectiveness of chi kung (qi gong) in treating patients with late stage reflex sympathetic dystrophy (R.S.D.), a chronic and ultimately disabling disease caused by malfunction of the autonomic nervous system.
Tai Chi and Balance Disorders. Finally, Timothy Hain of NorthWestern University is examining the use of tai chi as an alternative treatment for people with balance disorders. Change in such factors as dizziness, falls, and postural sway will be considered in evaluating the effects of an eight week program of daily practice of this oriental discipline.
Barbara is a 36 year-old woman who had been diagnosed five years previously with endometrial cancer. During this period she had been treated with chemotherapy (adriamycin) which produced cardiomyopathy (heart damage). As a result, she developed mild congestive heart failure. She had shortness of breath and could not lie down flat on her bed. She also had a creatinine level of 4.9, which indicated that her kidneys were not functioning well.
She was scheduled for more chemo but both these conditions had made her ability to withstand the stresses of another round tenuous. She sought help from Chinese medicine to prepare herself, because her oncologist had felt that she was not a good candidate for it at this time.
Barbara began having acupuncture once per week and taking Chinese herbal extracts three times daily with hot water. The herbs were for the purpose of strengthening her heart and kidneys and improving the relationship between them. After three weeks her creatinine level had gone down to 2.3 which was the lowest it had been in two years, indicating that her kidney function had improved markedly. She also came out of congestive heart failure and could lie down flat on the table. After a month she was strong enough to qualify for chemotherapy.
According to Harriet Beinfield, "What Chinese medicine can do is not necessarily attack the disease, which in this case is cancer, but improve the function of the organs and the general health of the body, which includes the immune system. The disease and the chemotherapy had degraded her general health and the functioning of her organs. We were able to boost their function by administering treatments that particularly nourished the systems that were degraded."
Madeline is a 7 year-old girl who had chronic asthma, a chronic cough, and eczema all over her legs. She had just begun using broncho-dilators, which her mother said turned her into a "little witch" C she would become very irritable and agitated in response to the medication. She'd had no treatment for the eczema.
Her mother brought her to Chinese medicine to seek help with the behavior and mood problems. Rather than using needles, the practitioner rubbed certain acupuncture points and led her through a visualization. She was seen only once, and was also given an herbal formula to take twice daily. Within a few weeks her symptoms began to diminish, and upon a nine-month follow-up visit her asthma, cough and eczema had all cleared up.
According to Harriet Beinfield, "The skin is considered to be the third lung, and in that sense the eczema was connected with the asthma. The herbs that affect the lung also affect the skin. The Lung (organ system) likes to be moist, and when it becomes dry it becomes irritated.
"Irritation can sometimes translate into inflammation, which becomes an `itis' C like bronchitis. The herbs that were used tend to moisturize and nourish the Lung, as well help to move the chi and open the chest."
Julia is a 37 year-old woman who had been diagnosed a year earlier with multiple sclerosis. She sought help with weariness, fatigue, and sometimes clumsiness and disequilibrium. She began a regimen of acupuncture once per week accompanied by a formula of herbal extracts.
Within a month of she felt her energy level dramatically increase to where she did not feel tired in the afternoon, could stay up later at night, and could increase the activities that she had cut back on over the previous year.
According to Harriet Beinfield, the treatment served to replenish Kidney (system) and "jing" or "essence."
Harold was a 24 year-old man with extreme redness of the skin on his body, and particularly his face. He looked like he had a very severe sunburn. Some of his body was scabbed because of itching, and he had taken pharmaceuticals for dermatitis, but none of them seemed to help.
He had weekly acupuncture for three months, took a combination of herbs, and was told to modify his diet. He was also told not to eat foods that created internal heat C namely sugar, spices, or fat. He was not to drink alcohol, and was to increase his water intake so that he stayed hydrated. He was told to eat a cucumber a day which is very cooling and moisturizing.
Within two to three months Harold's redness began to recede. His improved first, followed by the rest of his body, ending with his legs.
In Chinese medicine his problem is understood as too much Heat and not enough Moisture (terms that describe the climate within the body). The herbs that were used release excess Internal Heat and Moisturize and nourish the Lung system (the skin is the third lung).
According to Harriet Beinfield, "We tried to get rid of something undesirable C in this case, Heat C as well as supply something that does not exist sufficiently C Moisture."
Julia is a 56 year-old woman who was on post-menopausal hormone replacement therapy because of extreme mood swings and hot flashes. Without the therapy she would become quite irritable and fly into rages that she felt were unfair to her children and husband.
Julia sought help from Chinese medicine because of the side effects of the therapy. One was bruising and swelling C for example, if she bumped her elbow her whole arm would swell up. Another was water retention, as she increased half a dress size, and the rings on her fingers were uncomfortably tight. She wanted to see if she could find an alternative to the drug therapy.
She went off the hormone replacement therapy and began weekly acupuncture and daily Chinese herbs. After a couple of weeks, Julia found that the herbs actually controlled her moods better than the hormone replacement therapy had. Within two months her hot flashes were also under control. She reported six months later that she felt better than she had in ten years.
As Harriet Beinfield explains, the Kidney system harbors the "jing" energy or essence of the body. Jing diminishes naturally with age, as what is used up tends not to be replenished. The diminishing of jing is what allows the hormonal imbalances to take place that cause the symptoms of menopause. Herbs can in a sense combat the natural effects of aging by replenishing the Kidney essence.
George, 41 year-old teacher, had been diagnosed with chronic prostatitis and urethritis which long-term antibiotics had not helped. His symptoms included difficult urination and painful ejaculations. After ten acupuncture treatments accompanied by daily herbal formulas, his symptoms disappeared.
In Chinese medicine, prostatitis and urethritis are outcomes of too much Heat (a quality of climate) in the Lower Burner (the lower abdomen and associated organs). The herbs which are used are "cooling," for the purpose of eliminating the adverse climate of excess Heat in the Lower Burner.
Heather was a 36 year-old college professor. She had a thirteen-year history of seasonal allergies with sneezing and itchy eyes, and had a great deal of nasal discharge. She had tried multiple medications which were not working for her. She also suffered from painful menstrual cramps.
She was given a series of eight weekly acupuncture treatments. In addition she was helped to modify her diet, which included avoidance of dairy products, eating regular meals at regular times, and avoiding cold food.
After the fourth treatment she reported her allergies were 90% better. Because the treatments were directed not only toward her nose but to the underlying imbalance in her organ network, her menstrual cramps also diminished over the next few months. In the following allergy season she did not need to be treated. Two years later she returned for two treatments, and she has been symptom-free for three years.
According to David Field, N.D., L.Ac., "This was a matter of balancing the energy in the body. Heather had a Damp Heat condition which was caused by a weakness in her Liver. She was expressing this Heat through her eyes and her nose. The drainage of fluid was the way that the body was trying to deal with the accumulation of Damp Heat. The treatment drained the Dampness and the Heat."
Marie was a 30 year-old woman who had suffered a constant, deep chest pain for over a year. Her husband was a physician and she had had dozens of tests looking for heart irregularities, with no positive finding. Her pain was permanently gone after one acupuncture treatment.
According to Dan Kenner, L.Ac., "A lot of people with chest pain have a compression in the rib cage, and if you release it, then the pain is gone. She had neuromuscular tension stored up in the musculature surrounding the rib cage. The acupuncture served to release the tension by loosening the contraction in the muscles, balancing the nervous system, and improving circulation."
Janet, in her early forties, had low back pain and ulcerative colitis. One morning she noticed blood in her stool. In previous episodes she had gone to the hospital, but based on her experience there she decided to call her acupuncturist first.
According to Dan Kenner, L.Ac., "In cases like this, one treatment can often stop the crisis. There are two points associated with the large intestine on both sides of the fifth lumbar on the back. Through pulse diagnosis, palpation, and by manipulating the needle, I found that these points were blocked. After they opened up there was immediate relief of the low back pain and intestinal cramping. With one treatment the bleeding stopped, and did not start again.
"Acupuncture could be considered an excellent treatment for any stress-related disorder, and ulcerative colitis has a high stress component. Because of the extreme sensitivity of the nerve endings in the gastrointestinal mucosa, people that are under severe stress often have an over-stimulation that results in erosion of mucous membranes, bleeding, and copious mucus discharge.
"The treatment caused a release of chi that had congested or stagnated in the large intestine. People often somaticise their emotional stress, and where they do it depends on their individual typology. For her it was in the large intestine, whereas the next person might have heart palpitations or panic disorder."
In the fall of 1993, the sports world was shaken when a small group of Chinese female runners obliterated several long-standing world records in a span of six days. This sudden meteoric rise into international prominence by the Chinese women immediately gave rise to suspicions of drug use, which were unproven. Making the accomplishments even more unbelievable was the fact that many of the records broken had been set years before by eastern European women now known to have used illegal performance enhancing drugs liberally in their training.
Affronted by the suspicions, the Chinese sports authorities shared their secret: a rigorous training program, and a special diet that included traditional Chinese herbs and a mineral-rich potion made from the dong chong xia cao worm. World records are usually broken by mere tenths of seconds or a few seconds, and experts agree that it is unlikely that the sheer magnitude of the improvement on the old records could be attributable to hard training alone. This may be the most dramatic and visible evidence yet of the powerful effects Chinese herbs can have on the body.
Sue had been suffering from frequent anxiety attacks accompanied by rapid heartbeat, dryness of the mouth, restlessness and insomnia. Though she was using psychotherapy, she felt it had been insufficient for her needs.
In the oriental tradition such cases are often what are called "shen" disturbances. A shen disturbance is a disorder affecting a person's spirit or "soul."
Chronically anxious patients are often exhausted but unable to relax. A state of deep relaxation is often an immediate benefit of treatment, but the longer lasting benefits are a general reduction of nervousness and a re-experiencing of a sense of ease and well-being.
Dan Kenner, L.Ac., an acupuncturist in Santa Rosa, California, describes the process: "Sue slept deeply during the treatments and I allowed her to rest for a time after I was finished because the changes in her respiration, pulse and demeanor were so profound.
"After a course of eight treatments she reported that her psychotherapy was going extremely well and that her therapist was amazed at how quickly she was moving through issues with which she had struggled for years.
"Acupuncture can release unconscious `holding' of tension as the patient enters a state of deep relaxation. During this process, unconscious emotional issues may surface as well. I often suggest that patients carefully observe moods, dreams, or unusual mental states that may occur within a couple of days following treatment. These states may be part of a healing process of emotional or psychological catharsis."
. Lytle, C.D. (1993). An Overview of Acupuncture. Washington, D.C.: U.S. Department of Health and Human Services, Public Health Service, Food and Drug Administration, Centers for Devices and Radiological Health (monograph).