From The Book:
From The Book:
The Classical Chinese Medicine
The Classical Chinese Medicine
By Prof Dr Nik Omar, Malaysia
By Prof Dr Nik Omar, Malaysia
High Tech Evidence
On Acupuncture, The Medicine for
Although , almost all TCM Acupuncture techniques involve the insertion of sterile needles into specific acupuncture points, their will be certain variations in treatment, due to a practitioner’s style and training.
Acupuncture is a method of encouraging the body to promote natural healing and to improve body functioning. This is done through the classical ways by inserting acupuncture needles and applying heat (moxibustion) or electrical stimulation at very precise acupuncture points.
The classical Chinese explanation is that channels of energy run in regular patterns through the body and over it surface. These channels, called meridians, are like rivers flowing through the body to irrigate and nourish the tissues, blood flow and nervous pulses. An obstruction in the movement of these energy rivers is like a dam that back up the flow in one part of the body and restricts it flows. Any obstruction and blockages or deficiencies of energy, blood and nervous pulses would eventually lead to disease.
There are still a large number of people who do not believe that acupuncture benefit the patients in treating various diseases. They are very sceptical about the curative power of TCM and acupuncture. They thinks that acupuncture only works due to psychological approach, because when we asked the Chinese Physician, how do TCM and acupuncture works ? They simply give a simple explanation, that their forefather have been practicing acupuncture for generations, and it works very well with the patients, and therefore it is very good treatment, but there is not enough scientific evidence to convince us.
Acupuncture Is A Mystery of The Past
Acupuncture and the other forms of traditional Chinese medicine have been around in the world for the last 4 to 5 thousand years. Yet the explanation for how acupuncture and Chinese medicine as a whole works has long been a mystery, if not an object of mockery, especially among the western trained doctors. The basic theory is outline in a text from 2000 years B.C. attributed to the Yellow Emperor ( a great Emperor of ancient
In belief , it recognizes in people and nature vital energy or life force known as ‘Qi’
Qi is the source of movements ranging from voluntary muscle action to blood flow, it protects the body from external influences, and it generates warm.
Qi flows through the body and to the organs by way of an extensive system of channels known as meridians. If the flow of the force is distributed, the theory goes, the resulting deficiency, excess, or stagnation of qi causes bodily malfunction and thus illness.
Acupuncture, in which needles are inserted into specific points along meridians and manipulated, is said to restore the proper flow of qi and thereby return the body to health.
In the early days, the number of acupuncture points is 365 according to days in one year.
But today Acupuncturist recognize some 1,500 acupuncture points, most of which have no obvious relationship to heir intended target. For example, a point on the first toe which is call ‘Taichong Liv 3’ is a wonderful acupoint for hypertension, while a point near the elbow ‘ Quici Li 11’ is considered as one of the best acupoint to enhance the immune system.
Unlike Western Medicine, which the doctor will prescribe various powerful drugs to overcome health problems, acupuncture need only one or two needles to stimulate the acupoint, sends the message to the brain and balance back the disturbances of vital energy and as a whole the patient will be treated naturally without any side effects.
Theory of Yin and Yang
Another integral concept is the tension between two ever present, complementary forces of nature, Yin and Yang. When their balance is distributed, the theory goes, people get sick.
Yin condition reflect a lack of qi ; pale face, cold extremities, slow pulse, keep alone, sad, moody, depression, etc
While Yang conditions result from an excess of qi ; read face, fever, fast pulse, very sensitive, aggressive, hypertension, maniac, agitation, etc
Many theories have been put forward to explain the pain relief theory by acupuncture.
Here are few research done on the effect of acupuncture throughout the world. Some of them are explain in detail below.
1) Neurological Theories.
i) Somato-Visceral Theory ( Felix Mann 1960, Ishikawa 1949, 1962 )
ii) Gate Control Theory ( Metzack and Wall, 1965)
iii) Multiple gate Comtrol ( Zhang Xiangtong, 1970, Man and Chan, 1972)
iv) Thalamic Intergration Theory ( Zhang Xiangtong, 1972 )
v) Thalamic Neuron Theory ( Tsun Nin Lee, 1977, 1978 )
vi) Cortical Inhibitory Surround Theory, Neo-Pavlovian, 1975)
vii) Motor gate Theory ( Jayasuriya and Fernando, 1977 )
viii) Autonomic Neuron Theory ( Ionescu-Tigovista, 1973 )
2) Defence Mechanism and Tissue Regeneration Theory
Cracuim 1973 and others
3) Bioelectrical Theories
i) Kirlian and Kirlian 1939
ii) Becker et al ( 1976 )
4) Embryological Theory ( Segmental Theory)
Felix Mann ( 1972 )
5) Humoral Theories ( Neurotrasmitter Theories )
i) 5-Hydroxytryotamine - Seratonin ( Zhang Xiangtong 1974, 76)
ii) Endorphin Release Theory ( Bruce Pomeranz, 1976)
6 ) Placebo Effect Theories
By many who do not understand acupuncture theory.
7) MRI High tech Evidance ( Zang Hee Choo, 1985 )
The Theory of Pain Relief Through Acupuncture
Few years back, while visiting his native country – Korea, Dr Zang Hee Choo ,62 years old professor from University of California, U.S.A, fell from a mountain trail and injured his spine. He recall, “ I fell down like a flight, like a big jump down the mountain. The next day I returned to United States and tried to stand up after on the plane. I count stand up. I said, oh oh ,it’s a big trouble.”
Eventually, Dr Choo hobbled off the plane and make his way home, and later he began to look for some relief from pain in his back. Relatives suggested he try acupuncture. Through he initially scoffed at the idea, as a medical officer, he says, he didn’t believe in acupuncture, but due to so much suffering, he tried it. And much to his surprise, it worked. “ After 10 minutes I felt the pain melting away.”
Choo’s unexpected relief prodded his professional curiosity. As a doctor who works in Radiology Department, Choo develops ways to image the complex inner working of the body, one of his inventions was prototype PET scanner around 1975. How he wondered, could inserting needles into seemingly random points on the body possibly affect human health ?
So he decided to take a closer look, and what he found astounded him. While sticking needles into few student volunteers, he took pictures of their brains and discovered that by stimulating an acupuncture point said to be associated with vision Tungtzuliao GB 1
He can see that the point trigger the activity in the very part of the brain that control vision. That just might be the reason that acupuncture works, he figured.
Research Effect of Acupoints With MRI
Dr Choo was again wondering of how, acupuncture claims that they can treats eye problems from acupoints of Zhiyin UB 67, Tonggu UB 66 , Shugu UB 65 and Kunlun UB 60 respectively. And almost all acupuncturist hold that stimulation of these acupoints with needles will effect the eyes via the system of meridian rather than through the central nervous system.
This acupoints are not found near the eyes, but on the outside of the foot, running from the little toe to the ankle
To test that claims. Dr Choo’s strapped student volunteers into an fMRI ( functional magnetic resonance imaging ) machine. While the standard MRI provides static cross-sectional pictures of structures in the body, functional MRI goes further to reveal how those structure are working. It measures minute changes in the amount of oxygen carried in the blood, which is presumably a rough measure of glucose uptake by various tissues and thus a good indicator of which tissues are active ; the result can be viewed as colorful FMRI brain activation maps.
Choo first stimulated the eyes of the volunteers through traditional means: he flashed a light in front of them. The resulting images, as expected, showed a concentration of color – an increase in activity – in the visual cortex, the portion of the brain that is known to be involved in eye function. Then Choo had an acupuncturist stimulate the acupuncture points of Zhiyin UB 67. In one person after another, the very same region of the brain – the visual cortex lit up on the fMRI image.
As odd as it seemed, sticking a needle into someone’s foot had the very same effect as shining a light in someone’s eyes. And this was not the generalized analgesic effect produced by the primitive limbic system, that was seen in the pain studies, this was a function – specific response occurring in the brain’s cortex, the area responsible for such sophisticated functions such as speech and hearing, memory and intellect.
More the magnitude of the brain activity seen on acupuncture stimulation was nearly as strong as that elicited by the flash of light.
“ It was very exciting,” recalls Choo. “I never thought anything would happen, but it’s very clear that stimulating the acupuncture point triggers activity in the visual cortex.” To eliminate the possibility of a placebo effect, Choo also stimulate a non acupoint, in the big toe. There was no response in the visual cortex.
Next Choo tried each form of stimulation over time, twisting the needle for a moment or flashing the light, resting and repeating. As before, the fMRI images were remarkably similar for acupuncture and for light stimulation. The time-course study was also done using the three other vision acupoints of the foot. The result was again consistent, except in the case of Tonggu UB 66, each acupoint lit up the visual cortex exactly as the light stimulation had done.
This time Choo noticed something else. When the activation date were graphed to show the intensity of the response over time, he saw that there were two distinct reactions among dozen volunteers. During the acupuncture phase, some showed an increase in activity, while the others showed a decrease. In other words, in some people, oxygen consumption in that brain region increased, while the others, it decreased.
“ I figured we must have made a mistake.” Says Choo, repeating the experiment, however, he saw the same results every time. “ Finally one of the acupuncturists mentioned. ‘Oh yes, it’s the respond of Yin and Yang ! ‘
Choo asked him which subjects were Yin and which were Yang, and without seeing the data, the practitioner correctly point out who had shown an increase in activity (Yang) and those who had a decrease (Yin ) in 11 of 12 cases. “ I don’t know how to explain it,” Cho says
Like many preliminary scientific reports, Choo’s small study raises more questions than answers. Still, he has demonstrated new functional effects of acupuncture. “Classically, acupuncture was the ultimate in experimentation, people collected data for thousands of years, “ say Joie Jones. Professor of Radiological Science, University of California. “ They noticed that when you applied a needle in one position, it would have an effect in another part of the body. But the connection through the brain was never made earlier.
With these studies, we’ve demonstrated that for at least some acupuncture points it goes through the brain.”
Yet even if it does go through the brain, how does stimulating a specific point on the foot trigger activity in the part of the brain that control vision ? There is no explanation for that either, says Choo, although he suspect that that the path is along the nervous system.
“ That endorphin are released by stimulating certain types of nerves in fibers anywhere in the body, that’s understood. But that there is specific connection between your toe and your visual system is really bizarre That’s really mind – boggling “ says Pomeranz.
Despite the absence of clear cut explanations, acupuncture’s clinical results are attracting interest from mainstream medicine especially allopathic doctors. A panel of independent experts convened last year by The American National Institute of Health concluded that acupuncture is indeed effective in treating nausea due to anesthesia and chemotherapy drugs. It is also helpful in treating post-surgical and other forms of pain. Moreover, the panel noted, despite the pervasive belief in the superior clinical effects of Western Drugs, plenty of conventional treatment for chronic pain shows that the success rate of acupuncture treatment is increasing day by day.
One of the more proactive acupuncture studies used SPECT ( single photon emission computed tomography ) to record images of the brains of the patients with chronic pain.
That study by Abbas Alavi, Chief of Nuclear Medicine at the University of Pennsylvania Hospital, measured blood flow to the brain structures that are respected of releasing endorphins in response to acupuncture stimulus- the thalamus, hypothalamus, and brain stem. Comparing baseline images of people who were in pain with images taken after they received acupuncture treatment, Alavi found clear evidence of increased blood flow in the thalamus and the brain stem. He also found that treated patients felt less pain.
Like Choo, Alavi was not a believer in acupuncture or other form of Chinese medicine before doing this study. “ I thought acupuncture was more or less psychological , not an objective effect, “ he says, “I did study just for fun. I figured nothing would show up.
Gate Control Theory of Pain
According to this theory, stimulation of skin evoke nerve impulses that are trasmitted to the spinal cord system:-
i) The cells of the substantia gelatinosa (SG) in the dorsal horn, that act as a gate control system.
ii) The dorsal column fibers that project towards the brain and acting as a central control trigger which activates selective brain process that influence the modulating properties of the gate control system.
iii) The first central transmission (T) cells in the dorsal horn, that activate neutral mechanism which comprise the action system responsible for perception of pain.
The theory proposes that pain is determined by interaction among these three system.
Foto / figure
Bruce Pomeraz's model suggests that endorphin / encephalin released from a neuron binds to opiate receptors on the terminal of an excitatory neuron, partially depolarizing the terminal membrane and reducing the net depolarization produced by the arrival of the nerve impulse. The amount of neurotransmitter released from the terminal is proportional to the net depolarization, so that the less excitatory transmitter is release. The receiving cell is then exposed to less excitatory stimulation and reduces its firing rate. The figure above shows how the endorphins suppress pain. Several research workers have confirmed this finding. Pomeranz ( Canada), Lars Terenius ( Sweden), Chapman and Mayer (US), Anton Jayasuriya (Sri Lanka) and others are the leading workers on endorphins.
While Anton Jayasuriya and Wilfred Perera od Sri Lanka has shown that the endorphin mechanism can be activated with acupuncture to produce painless childbirth.
Acupuncture also has calming and tranquilizing effect. This is thought to be mediated by its action on the mid-brain reticular formation and certain other parts of the brain. Changes have been reported in chemistry of the brain tissue. For example dopamine content of the brain tissue increases after acupuncture. This dopaminergic effect may account for its effectiveness in conditions like parkinsonism where there is decrease in dopamine content of the brain.
In paralytic conditions, acupuncture treatment hastens motor recovery. Even the late cases of paralysis unresponsive to other form of therapy show improvement. This probably involve antidromic stimulation of the anterior horn cells and their reactivation through a biofeed back mechanism operating through the Renshaw and Gajal cells of the spinal cord or their cranial equivalents ( Motor Gate Theory, Jayasuriya and Fernando, 1977)
Acupuncture enhance immune action trigger the body resistance to fight against the diseases are increased. This effect is mediated by a raise in leucocyte count, antibody titer and gamma-globulins. Acupuncture is therefore, is very useful in combating infections and it is more so when the prolonged antibiotic therapy is warranted or in cases of resistance or hypersensitivity to antibiotic. This action is again specific to certain acupuncture points.
Few acupuncture points such as Bahui, Hegu, Quichi are well known as having sedative effect. EEG taken during the treatment has shown a decrease in delta and theta wave activity. This effect is the basis of utilizing acupuncture for the treatment of anxiety states, nervous, restlessness, drug addicts, anti smoking, insomnia and other behavior disorders
It has been observed that a 20 to 30 minutes continuous manipulation of ' Taichong - Liv 3' of the toe alone reduces blood pressure from 200 / 110 mm Hg to 180 / 95 mm Hg which lasts for 3 to 4 days. Same thing happen to 'Sehencong - Extra 5' where the pain of migraine can stopped within few minutes of acupuncture treatment without any drugs or pain killer.
Second Research Done On Acupuncture Needling
Release of Endorphin and Monoamines,
Through our research with others colleague, we have been able to measure a flow of acupuncture – induced endorphin. According to neuro-scientist Bruce Pomeranz of the University of Toronto, Canada, numerous studies over the past 20 years have shown that inserting needles into acupoints stimulates nerves in the underlying primitive part of the brain, known as limbic system, as well as the midbrain and the pituitary gland. Somehow that signaling lead to the release of endorphins and monoamines, the two chemicals that block pain signals in the spinal cord and the brain. The result: A well-documented generalized acupuncture analgesia
“ The endorphin story is really nailed down”, says Pomeranz. “ It looks like it’s nerves to the brain. The acupoints that have been mapped over thousands of years are likely the spot where nerves are concentrated”. But the endorphin story “doesn’t explain many of the other claims of acupuncture, “ he continues. “There have been a number of clinical trials showing that acupuncture is extremely useful for the nausea and vomiting caused by chemotherapy and early pregnancy. That’s not the endorphin system. Now body knows how that works.”
That is still the miracle mysteries behind acupuncture.
After studying the varied effects of acupuncture on the human psychologically and physiologically, the effective and scientific proven acupuncture treatments is no longer in doubt.
Acupuncture points have also been found to display the phenomena of bioluminescence when studies under high frequency radiation photography ( Kerlian and Kerlian, 1939 )
Thus there is a pile of theories explains the advantages of acupuncture treatments. In these days of advance nuclear technology , when the foolishness of acupuncture is proving wisdom and the amazing prescience of Huang Ti Emperor is obtaining every day new confirmation, what is there to prevent the most sceptical from, at least, experimenting with the power of 'qi' that has come to us through The South China sea.
This is the main reason why acupuncture has survived and spread as widely as it has. It is at present practiced in nearly every country of the world. It has cured millions of people. It has being alive for the last 5,000 years, because it is a simple, safe, effective and economical method of healing, naturally and friendly.
Catherine Dold, Bruce Pmoeranz Zang Hee Choo Abass Alavi
Department of Radiological Science, University of california.
NIH Consensus Statement On Acupucnuture.
FMRI information University of Virginia
SPECT information Duke University
Beijing Institute of Acupuncture
The National Research Institute of Medical Acupuncture, Malaysia.