Diseases of the Digestive System
There has not been a great deal of good clinical research work published about the effects of acupuncture on the digestive system, so it is difficult to be sure exactly how useful it is in such diseases. This section is therefore deliberately rather vague as it is far more sensible not to quote exact facts and figures when there is little evidence to substantiate them. Animal experiments, both in China and the West, show quite clearly that acupuncture does have an effect on the digestive system, and in spite of the lack of clinical research there are good grounds for believing that acupuncture can influence a variety of disorders within this system.
Indigestion is a symptom rather than a disease, and can be caused by a variety of factors such as over-indulgence, stress and acid regurgitation. It is important to investigate long standing indigestion so that the exact reasons for this symptom can be clearly defined.
Acid regurgitation is one of the commoner causes of indigestion and often presents with symptoms such as heartburn. The sensation of heartburn is caused by irritation due to the acid reflux from the stomach into the tube connecting the stomach to the mouth (the oesophagus). This syndrome may be called a 'hiatus hernia' although a variety of other names can also be used to describe exactly the same symptoms.
Acupuncture is not the treatment of choice for all types of indigestion. For instance, the best treatment for over-indulgence is to eat less, but some other causes of indigestion such as hiatus hernia and stress are definitely amenable to acupuncture therapy. Exact figures for success rates are not available, but the 'clinical impression' that arises from a number of acupuncturists indicates that about 60 per cent of patients gain some long-term relief of their symptoms with acupuncture. Symptoms do recur and usually require re-treatment after about six to twelve months.
An ulcer is an area of raw tissue, rather like the tissue found under the scab of a healing cut. Ulcers can occur in the stomach and are usually found either in the stomach proper (gastric ulcers), or in the part of the intestine that drains food from the stomach (duodenal ulcers). Stomach ulcers are a common problem but their exact cause is unknown.
In China acupuncture is the treatment of choice for stomach ulcers, and ulcers certainly do heal after acupuncture. Fortunately both types of stomach ulcer heal spontaneously and this creates a great deal of difficulty in assessing the curative effects of acupuncture as compared to natural remission; furthermore, there are now available some highly effective and relatively non-toxic drugs to cure ulcers.
Duodenal ulcers are associated with a high acid level in the stomach. It is unclear exactly how much this factor affects the development of duodenal ulcers, but it is fair to say that high acid levels are a factor in ulcer development. Research work by Chinese physiologists has shown, quite clearly, that acupuncture can reduce the acidity of the stomach and this may be one of the mechanisms by which acupuncture heals stomach ulcers and other digestive diseases.
A large volume of work has been published by the Chinese about the effects of acupuncture on the gall bladder. It would seem that acupuncture can cause the discharge of quite large gall stones in the faeces, obviating the necessity for most operations to remove the gall bladder. The Chinese studies are of great interest but it is too soon to draw valid long-term conclusions about this work.
Diarrhea is a symptom that can be indicative of a variety of diseases; it may be caused by an infection (dysentry), an inflammatory process (colitis), stress or dietary indiscretion. Sometimes no clear cause can be found for irregular bowel habits and these ill-defined problems are usually called 'irritable bowel syndrome'.
Studies on bowel infections, completed in China, show that acupuncture affects the natural history of this disease. The Chinese report that recovery is quicker, and complications less frequent, if acupuncture is given in this condition. Clear evidence is also provided to show that acupuncture 'improves' the natural defenses of the body in these types of infection. A large body of evidence is now available, showing that acupuncture stimulates the body's natural defenses in many infectious diseases; this again suggests another possible mechanism for the effects of acupuncture. Acupuncture can be shown to alter the activity of the immuno system, stimulating the production of immunoglobulins (chemicals that help to kill invading bacteria), and various other important substances. This measurable effect lends support to the philosophical idea that acupuncture helps the body to cure disease naturally.
Diseases such as Crohn's disease, ulcerative colitis and colitis are collectively described as inflammatory bowel diseases. The exact cause of these problems is unknown. When inflammatory bowel disease is present the intestines become raw and inflamed and the patient usually complains of symptoms such as abdominal pain, blood loss and diarrhoea. These diseases are often difficult to treat with the available Western therapeutics, but they are sometimes amenable to acupuncture. Exact figures describing success rates are not available at present.
Irritable bowel syndrome and diarrhoea caused by stress can also be improved by acupuncture, but clear facts and figures are not available and further research is required in this field.
Piles are a common cause of human misery; they are really varicose veins occurring around the anus and rectum. Once again no clear figures are available about cure rates, but piles are said to be helped by acupuncture.
Diseases of the Respiratory System
The wheeze of asthma is caused by contraction of the muscular walls of the small breathing tubes in the lung. The narrowed air tube creates a 'turbulent' air flow and therefore causes a wheeze, or whistle, when the asthmatic breathes. Because the tubes into the lung are narrowed, less air can get in and this decreases the oxygen supply to the body. The muscular contraction of the breathing tubes can be stimulated by a wide range of substances such as inhaled dust or pollen, and various foods.
Acupuncture causes the contracted muscular walls to dilate; the mechanism of this is unknown, but there is good Western research data to support this claim. A recent Chinese clinical trial on asthma showed that some 70 per cent of asthmatics gained a 'good effect' from a course of acupuncture and moxibustion (about ten treatments) once a year. The acupuncture treatment was able to decrease the frequency and intensity of asthmatic attacks over a period of a year. This result is encouraging as it shows that acupuncture and moxibustion can affect the response of the body to the environmental stimuli causing asthmatic attacks.
Bronchitis is a common lung disease, aggravated by cigarette smoke, industrial pollutants, and dust. It involves the irreparable destruction of lung tissue. There is often an asthmatic element in bronchitis as irritants such as smoke and dust cause the muscular walls of the breathing tubes to contract.
Acupuncture cannot rebuild lung tissue, but by opening up the breathing tubes it can allow the remaining lung tissue to function efficiently. The mechanism of acupuncture in bronchitis is probably much the same as in asthma, allowing more air to enter the lungs. Recent Chinese work has shown that about 50 per cent of bronchitics 'benefit' from acupuncture. The treatment must be repeated regularly if the effect is to be maintained.
Diseases of the Heart and Blood Vessels
In the West, diseases of the circulatory system are not commonly treated with acupuncture, but in China it is a common and acceptable form of treatment for some of these problems. A variety of animal experiments carried out in the West give clear support to the idea that acupuncture does have an effect on the circulatory system.
Angina is a type of 'cramp' in the heart muscles, precipitated by a poor blood supply to the heart, and it usually exhibits itself as chest pain on exercise. Using sophisticated measuring equipment the Chinese have completed a variety of trials to assess the effects of acupuncture on the heart, and they have shown a marked increase in the functional ability and efficiency of the heart muscles after acupuncture.
This is further supported by clinical work, which shows that some 80 per cent of patients with angina have improved after acupuncture. When acupuncture is used to treat angina a course of treatments is given, and then followed by booster treatments every four to six months.
The Correction of Abnormal Heart Rhythms
Heart diseases can frequently cause an abnormal rhythm to the heart beat; this may manifest itself as palpitations, an irregular heart beat, or dropped beats. Acupuncture can correct a small number of these arrhythmias. In established atrial fibrillation (irregular heart beats), acupuncture affects a small percentage of cases, some 1.5 per cent, although in recently acquired arrhythmias, acupuncture can be effective in up to 70 per cent of cases
Raised Blood Pressure
Traditional Chinese medicine does not recognize raised blood pressure (hypertension) as a disease, and acupuncture treatment has therefore centered around the relief of the infrequent and vague symptoms associated with raised blood pressure, such a headaches and dizziness. In Western medical circles there is great debate about whether raised blood pressure should be treated as aggressively as it has been in the past. Acupuncture and moxibustion can lower the blood pressure, but there is no good work available to show how useful this is on a long or short term basis. At present, the whole concept of raised blood pressure and its treatment is unclear, and the place of acupuncture in the treatment of this problem is unknown.
The Use of Acupuncture in Addiction and Obesity
A large number of Western acupuncturists are using a variety of acupuncture techniques to treat obesity, smoking and hard drug addiction. There is some excellent physiological and clinical evidence to support the use of acupuncture in these areas. The withdrawal symptoms experienced by people giving up smoking, or drugs, can be alleviated by raising the levels of endorphins in the nervous system1 Some people believe that the desire to eat is also mediated by the endorphin level in the brain. It is clear that endorphin levels throughout the nervous system can be increased by acupuncture. The techniques used to achieve an increase in endorphin levels center around the use of ear acupuncture; the ear may be electrically stimulated or a small staple or stud may be left in the ear for a week at a time. Pressing the indwelling needle seems to decrease the desire to smoke or eat, probably due to an increase in the endorphin level.
It must be stressed that acupuncture cannot replace willpower. It can only help the withdrawal symptoms, or hunger pains, experienced by those already motivated and committed to solving their particular problem.
Acupuncture seems to relieve the problem of hunger usually created by dieting. Many people who receive acupuncture to help with weight loss also go on a diet at the same time. It is difficult to assess exactly which factors are responsible for weight loss, the acupuncture or the diet, or both in combination. Most acupuncturists claim that 40-50 per cent of their patients experience some significant weight loss (about ten pounds) during treatment. The figures are vague as no useful trials have been completed in this field. It seems that ear acupuncture can help to suppress hunger, but it is unlikely to affect greed!
Hard Drug Addiction
Some excellent research work has been done in this field, especially in Hong Kong. It is clear that acupuncture can help to solve the severe withdrawal symptoms experienced by those coming off hard drugs like heroin; however, withdrawal from drugs is only half the battle as a proper program of rehabilitation is required if hard drug addicts are to return to the community, and acupuncture can only provide assistance in part of this battle.
It is claimed that ear acupuncture helps about 40 per cent of people to give up smoking over a period of about six months. Again, it is essential to be well motivated before embarking on a course of treatment. Acupuncture does seem to decrease the desire to smoke and also to alleviate the withdrawal symptoms produced by abstinence from tobacco.
Acupuncture does have an effect on addictions and obesity, although the effect is limited and some of the claims made for acupuncture in this field may be due to other associated factors.
The Use of Acupuncture in Obstetrics
In China the major use of acupuncture in obstetrics is to provide analgesia (pain relief) during Caesarean section, and to correct foetal malpositions, such as breech (breech means when the baby is 'bottom first' rather than 'head first').
The correction of foetal malposition is achieved by applying moxibustion to an acupuncture point on the little toe. In about 60 per cent of women the foetus turns naturally prior to the thirty-fourth week of pregnancy; this can be increased to 90 per cent with the aid of moxibustion. After the thirty-fourth week, when natural version is less likely, the Chinese claim that 80 per cent of foetal malpositions will be corrected permanently by this procedure. Once corrected, the malposition does not recur, provided moxibustion is applied daily. There seems to be no available physiological basis with which to explain this finding.
Anaesthesia for Labour and Delivery
Acupuncture anaesthesia is widely used for Caesarean sections in China. A report recently published by the Chinese, discusses the results of 1,000 cases managed in this manner. The Chinese claim a 98 per cent success rate in the abolition of pain, a quicker recovery rate from the operation, less blood loss, and the obvious advantage of the mother being able to see the baby at, or soon after, birth. This report finds acupuncture a superior form of analgesia compared to other forms of pain relief (general or epidural anaesthesia) for Caesarean section. This success rate is astonishingly high and may well be a rather 'enthusiastic' claim.
Acupuncture can also be used to provide pain relief in normal obstetric deliveries. Adequate assessment of this form of obstetric analgesia has not yet been published, although the experience of a wide variety of acupuncturists in the West would indicate that it is a useful and effective procedure.
Acupuncture anaesthesia is widely used in China. It often provides the highlight to a 'tourist trip' and has been filmed for the Western media on many occasions. Acupuncture anaesthesia has been used in a wide variety of operations, from minor procedures to open heart surgery. It is undoubtedly an effective form of pain relief in the majority of people, but there is always a small percentage who fail to gain adequate analgesia from acupuncture. These failures are quoted at between one and twenty per cent, depending on the operation and the assessments used.
In general, acupuncture allows for a safer operation, with less likelihood of complications, and a swifter post-operative recovery. The main problem is that pain relief may be inadequate and this is unacceptable within the context of Western health care.
One of the main criticisms of acupuncture anaesthesia is that 'it's alright for the Chinese, but won't work on Europeans'. Acupuncture anaesthesia has been used in a variety of European. centers, and the success and failure rate is much the same as in China. Acupuncture anaesthesia is a useful method of pain relief and could well be applicable to minor procedures, or post-perative pain relief, within the context of a Western medical system.
1 The effect of acupuncture on endorphin levels is discussed in Chapter 3.
ABOUT THE AUTHOR:
George T. Lewith MA, MRCGP, MRCP
George Lewith attended Trinity College, Cambridge and Westminster Hospital Medical School. He has worked as a Senior House Officer and Registrar within the Westminster and University College Hospital Teaching Groups in London. After training as a GP, he practised medicine in Australia before returning to England. He continues to lecture at Southampton University’s Department of Medicine. A member of many organisations within the field of complementary medicine, Professor Lewith holds a Diploma in Acupuncture from Nanking in China, and has acted as a consultant on complementary medicine to the American National Institute of Health and Federal Drug Administration, and the World Health Organisation.You can also see their website at http://www.complemed.co.uk
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