Acupuncture

New Evidence for an Ancient Therapy

Basking in the warm glow of a heat lamp, Sara MacKay stretches out on the table like a sunbather on a beach.

"This is so-o-o-o relaxing," she murmurs.

About to doze off, she shifts, sending a shiver down a row of sharp stainless-steel needles protruding from her neck, back and shoulders.

This is MacKay's second visit to David Molony, Ph.D., licensed acupuncturist and executive director of the American Association of Acupuncture and Oriental Medicine, who practices in the northern suburbs of Philadelphia. A 40-year-old writer from New York City, MacKay has come looking for relief from a constant dull pain in her hands.

After prodding her with his index finger, Dr. Molony has found two dozen tender spots on her shins, back, shoulders, neck and fingers and has inserted a two-inch-long needle in each area.

The needles stung when they went in, MacKay says, but they don't hurt anymore. And now, after two sessions, her hands don't hurt anymore either. That's the important part.

"My hands used to hurt so much that I couldn't write a letter longhand, and I was taking ibuprofen several times a day," she explains. "Now, I've stopped taking Advil, and I can write again."

ANCIENT PRACTICE, NEWLY DISCOVERED

The Chinese have been practicing acupuncture--inserting needles at strategic points in the body to relieve pain, treat illness and promote health--for centuries. Acupuncture is just one facet of Traditional Chinese Medicine, which dates back some 5,000 years. Despite that long history, acupuncture was largely unknown in the United States until 1972, when former President Richard Nixon reestablished ties with China. New York Times correspondent James Reston, covering the event, suffered an attack of appendicitis. After an emergency appendectomy and a post-op recovery eased by acupuncture, Reston wrote a column testifying to its pain-relieving potential.

Today, millions of Americans get acupuncture yearly, most often for relief from chronic pain, back problems, addiction, headaches, menstrual discomfort and arthritis. Acupuncturists use the therapy to treat a wide array of other health concerns, from weight problems to insomnia to morning sickness.

Though the American Medical Association considers acupuncture unproven, scientific research is building a convincing case for the age-old practice, finding it effective in treating a variety of ills. Some medical schools offer acupuncture courses to medical students. Impressed by its track record and the fact that side effects are minimal, an estimated 5,000 M.D.'s and more than 7,000 Oriental medicine practitioners practice acupuncture in the United States. Increasingly, insurance companies are covering the treatment.

MAINTAINING HARMONIOUS BALANCE

How can needles inserted in the back, shoulders, neck and shins relieve pain in the hands or, for that matter, treat arthritis?

In the traditional Chinese view--a perspective less mechanistic than our own--it's simple. According to ancient Chinese precepts, maintaining good health is a matter of maintaining a harmonious balance of qi, or chi, (pronounced chee), or vital energy, in the body.

Normally, qi flows freely along invisible internal channels, or "meridians," that traverse the body. Stress, poor nutrition, injuries or lack of exercise, however, can create obstructions in the meridians that keep qi from flowing freely. Like a stream that's been dammed, qi overflows in certain parts of the body but barely trickles into others.

"This imbalance leads to weakness, and weakness can lead to disorder," explains Dr. Molony. As a result, the body may be more susceptible to disease.

Acupuncture needles, inserted at certain "acupoints" along the meridians, trigger healing because they break up obstructions, stimulate energy or drain energy in a meridian, bringing the body back into balance and allowing qi to flow freely again, Dr. Molony explains. Of course, the needles need to be in the right spots in the correct meridians to do the trick. The right acupoint can be a distance from the ailing area.

Dr. Molony has decided in MacKay's case that an obstruction in her gallbladder meridian is leading to the pain in her hands. In the traditional Chinese view, the gallbladder and liver meridians are the organs responsible for muscles and tendons.

Since the gallbladder meridian runs through the shoulder and also runs through the hip and the leg, Dr. Molony inserts acupuncture needles in these areas. Before he inserts the needles, though, he palpates for sensitive spots. According to theory, the spots that need to be "stimulated" with needles will most likely be tender.

"The needles are so small, there usually isn't any bleeding, except in some areas with a lot of blood vessels, like the hands," he says. There's a small drop of blood where each needle has pierced MacKay's little finger--but nowhere else. (If you see an acupuncturist, make sure disposable needles are used to prevent transmission of blood-borne illnesses. Most acupuncturists use them.)

VARIATIONS ON THE ART OF ACUPUNCTURE

Acupuncturists sometimes twirl needles after inserting them or connect the needles to a low-voltage electrical source to increase stimulation of acupoints (a technique called electroacupuncture). They may also train heat lamps on the needles to increase stimulation. Some use lasers rather than needles to stimulate acupoints.

They may also use "moxibustion," placing small cones of an herb called mugwort on acupoints and burning it to produce penetrating heat. Moxibustion cones can be applied directly to the skin in such a way that prevents burns, or indirectly, on salt or a slice of ginger or other barrier or wrapped around the needle.

The protocol--how many needles are used, how deeply they're inserted, how long they're left in and whether they're used with electricity or heat--depends on the diagnosis and the preferences of the acupuncturist. So do the frequency and duration of treatments. The more advanced and entrenched the health problem, the longer the therapy.

Traditionally trained practitioners like Dr. Molony may treat patients with a combination of acupuncture, massage, acupressure (which uses finger pressure, rather than needles, on acupoints), Chinese herbs and dietary advice.

Some M.D.'s combine acupuncture and other traditional Chinese therapies, too. Others use it as an adjunct to conventional drug therapy and surgery. Acupuncture, says Christina Stemmler, M.D., a Houston physician who uses acupuncture in her practice and previously headed the American Academy of Medical Acupuncture, enables some patients to get the same results with less medication.

Dr. Stemmler says the combination of acupuncture and Western medicine can work better than either one alone. Dr. Molony, however, finds that conventional medicines sometimes interfere with acupuncture treatments. So treatment plans must be individualized.

For MacKay, Dr. Molony prescribes a few dietary changes, an herbal remedy and acupuncture. If she sticks to the regimen, MacKay should be symptom-free after a few more sessions, he says, since the treatment should clear the obstruction in her meridians and reestablish a harmonious balance of qi. If she doesn't make some necessary lifestyle changes, though, the balance of qi may shift again, especially during changes of season. Her symptoms may recur, and she may need to come back for further treatments, says Dr. Molony.

WHY IT WORKS: THE WESTERN VIEW

After devoting 20 years to the scientific study of acupuncture, Bruce Pomeranz, M.D., Ph.D., neurophysiologist, professor at the University of Toronto School of Medicine and one of the world's foremost acupuncture researchers, has yet to find compelling evidence that meridians and qi exist. But he has found compelling evidence that acupuncture works and has formulated a convincing Western-style theory to explain why it works--at least in some cases.

In a major breakthrough in 1976, Dr. Pomeranz discovered that acupuncture affects the nervous system, triggering the release of endorphins--neurochemicals that naturally alleviate pain. These findings appear to explain why acupuncture both relieves pain and alleviates addicts' withdrawal symptoms: Endorphins "may replace the missing morphinelike substances produced by the brain and ease withdrawal that way," he explains.

In subsequent research, Dr. Pomeranz and others have discovered that inserting needles at acupoints or stimulating the points with low-voltage electricity can trigger the release of the neurochemicals serotonin and cortisol. Since serotonin promotes feelings of well-being and cortisol reduces inflammation, these results may account for acupuncture's success in the treatment of depression, arthritis and asthma. He believes that more research is needed in these areas.

Although researchers have yet to document exactly how acupuncture influences hormones and metabolism, Dr. Stemmler says that, in her experience, people who undergo acupuncture seem to be able to lose excess weight effortlessly while being treated for other health conditions. Dr. Stemmler often calls weight loss a fringe benefit of acupuncture.

Some researchers speculate that acupuncture may actually retrain the nervous system so it releases appropriate amounts of neurochemicals, thereby correcting certain chronic conditions.

The neurochemical theory, however, doesn't explain everything, Dr. Pomeranz acknowledges. At this point, it doesn't explain why acupuncture relieves nausea, for instance.

"Acupuncture probably has many different mechanisms," says Dr. Stemmler, who credits acupuncture with alleviating osteoarthritis and asthma in many of her patients. She speculates that the therapy may also correct bioelectrical abnormalities in the body that contribute to illness.

THE SCIENTIFIC EVIDENCE

Hands down, the most accepted benefit of acupuncture is pain relief. Controlled clinical studies find it considerably more effective than placebo, or dummy, treatment in relieving pain. Many studies have divided patients into two groups: those who have had actual treatment (needles inserted at appropriate acupoints) and those who have had "sham" acupuncture (needles inserted at the wrong places). According to Dr. Pomeranz, who has reviewed more than a dozen such studies, 55 to 85 percent of patients who got the real thing reported relief from chronic pain, compared with just 35 percent of those who got the placebo treatment.

Several controlled clinical trials suggest that acupuncture can play a role in treating addiction as well. Research at Florida's Metro-Dade County Outpatient Substance Abuse Treatment Facility concluded that it can help drug addicts and alcoholics kick their addictions. "Whether it's effective with smoking is still up in the air," Dr. Pomeranz says.

Studies show that acupuncture can also help relieve nausea, whether it's the result of a turbulent car ride, chemotherapy or pregnancy. And other research suggests that acupuncture may help treat arthritis, asthma, bronchitis, cold symptoms, migraines, premenstrual syndrome (PMS) and tennis elbow. It may also speed recovery from stroke, partially reverse nerve damage caused by diabetes, ease bladder problems, lessen depression, lower blood pressure, speed labor and relieve hot flashes during menopause.

"But these areas are less well studied than pain relief at this point and are not as well nailed-down scientifically," Dr. Pomeranz says.

Nonetheless, practitioners and some physicians are using acupuncture in many of these less well-studied areas. The treatment seems to help, they note, and it doesn't cause the side effects that accompany drug therapy and surgery, according to Dr. Stemmler. Inserting needles at certain acupoints appears to induce labor, however, and can harm the fetus in early pregnancy. If you're pregnant and want to have acupuncture, get approval from your obstetrician first, and before treatment begins, tell the acupuncturist that you're pregnant, she adds.

"I treat most of the pain conditions that wouldn't respond to surgery," says Dr. Stemmler, who also uses acupuncture to treat sinusitis, asthma, chronic bladder inflammation, certain types of urinary incontinence, insomnia and poststroke paralysis.

Another physician, Abegael Lorico, M.D., assistant professor of obstetrics and gynecology at Allegheny University of the Health Sciences MCP­Hahnemann School of Medicine and a licensed acupuncturist, says that she offers the women she treats the option of prescription drugs or acupuncture treatment for PMS and other gynecological problems, following a complete evaluation.

"For treatment of allergies, acupuncture is beyond belief," says Haig Ignatius, M.D., a Maryland otolaryngologist who uses the ancient technique in his practice. "In effect, acupuncture gets the body's immune system to make a better decision, to stop overreacting (or being hypersensitive), and so allergy symptoms will likely improve or clear up."

WHEN TO SEE AN ACUPUNCTURIST

Even the most enthusiastic advocates of acupuncture acknowledge that Western medicine has advantages of its own. "Conventional treatment is famous for diagnosis, so I'd say go to a Western doctor for a diagnosis," Dr. Pomeranz says.

"It's always a good idea to get a diagnosis from an M.D. or a D.O.," agrees Adriane Fugh-Berman, M.D., former head of field investigations for the Office of Alternative Medicine at the National Institutes of Health in Bethesda, Maryland. "Infections should be treated with antibiotics, but many chronic conditions respond better to acupuncture than conventional treatment. And sometimes, a combination of Western and Eastern medicine works best."