Archive for tag: acupuncture

Why There is No Such Thing as Sham Acupuncture

I get really annoyed when I'm reading the results of a scientific study about the effectiveness of acupuncture, and the author concludes that actual acupuncture was "not significantly more effective than sham acupuncture." What they seem to be saying is that acupuncture is not effective at treating X condition. What they are actual discovering is that needle insertion almost anywhere in the body will have an effect on the body's condition, often providing relief from X condition.

I like this part. As Dr. Kwon always told us in Point Location class, you can still help the patient even if you don't stick the needle in the exact acupoint. This realization saved my sanity on more than one occasion when trying to palpate and count thoracic vertebrae to locate the oh-so-important points of the Governing Vessel running up the spinal column. It's supposed to be located at T6, but T7 will be good enough? Awesome. Thank you for your flexibility, ancient wisdom.

So, back to the studies that drive me nuts. Here's how they commonly shake out:

Exactly 100 patients were studied for chronic knee pain, with 25 receiving no treatment, 50 receiving actual acupuncture (inserting needles at specifically proscribed points), and 25 receiving sham acupuncture (inserting needles randomly in the body). Guess what? The patients receiving no treatment did not experience improvement. The patients receiving actual acupuncture reported a 50% improvement, and those receiving sham acupuncture reported a 45% improvement.

I call that good news. The study concludes, instead, that actual acupuncture is not significantly more effective than sham acupuncture at treating knee pain. Wrong. What they actually did is prove Dr. Kwon right -- not that he needs any additional validation, seriously -- that even when needles are inserted at the "incorrect" location, acupuncture still has therapeutic benefits for the patient. Is the goal of an acupuncture treatment for knee pain simply to eliminate the knee pain? Not exactly.

Any time acupuncture happens, that patient's body experiences a shift in energy. We can usually feel a difference in the person's pulse after treatment, compared to before. The qi (energy) has moved, and in western terms, circulation usually improves. Sure, the knee pain is improved, but the patient might also sleep better than usual that night, awake with more energy than usual the next day, or even notice that a new head cold has resolved overnight.

Were these other effects coincidental? Maybe, but probably not. Any acupuncture is better than no acupuncture, and the results of studies comparing no treatment, sham acupuncture, and actual acupuncture will often reveal this truth. In fact, this little "secret" is why I'm not against other practitioners doing acupuncture on patients. We've all heard the buzzword "dry needling," which is when say, your physical therapist needles your arm when your elbow isn't healing as nicely as you'd like. I know several chiropractors who have completed the 100-hour certification in acupuncture, and they can often be seen sticking some needles into a sore back muscle.

Some acupuncturists are completely against this concept of non-acupuncturists needling patients, but I'm pretty much OK with it. I know the patient is probably receiving some benefit regardless of whether or not the needle goes in at an exact acupoints. What's important to me is that the patient is aware that dry needling or someone sticking some needles in where it hurts is not all that acupuncture has to offer. Those techniques have benefits, but not the full array of benefits that needling specific acupoints on specific meridians can produce.

So, if you know someone who's been needled before and didn't experience a great symptom reduction, it's still worth their time to try acupuncture from an acupuncturist. Crazy, I know. It's not that other providers are doing anything wrong; it's just that they aren't receiving the more complete system of treatment via acupuncture that we acupuncture students use.

Jabbing Nerves with Needles

"I hope the points aren't just nerves being shocked by needles," I said to AOM classmate Irene. As one of the few AOM students who originally came into the program to focus on herbal preparations and dietetics, I felt particularly uninformed about this whole acupuncture thing. So, there in one of the first courses on the theory of point energetics -- what the acupoints do and how they do it -- I finally vocalized, albeit in a whisper-like fashion, my growing fear: Maybe there's no meridian or point energetics beyond just sticking a needle into a nerve and hoping it stimulates something productive in the patient's body. Sure, that might still help, but it certainly doesn't have the mystique that interested me in the first place.

2014-03-14_ancient"Moving blood and qi," "balancing energy," and "harmonizing yin and yang"...these concepts are intriguing, promising, and yes, darn near magical in my opinion. If we're just jabbing people with needles and shocking them wildly, then I'm not sure I have the buy-in that a 3-year master of science in oriental medicine degree requires. So there I sat, giving power to my secret fear by speaking it aloud, not knowing what Dr. Yihyun Kwon was going to say to pull me back over to his side of the fence, and hoping that there was something more -- more ancient, more Daoist, more qi-related in any way. (Spoiler Alert. Dr. Kwon wins!) 

Irene surprised me with her response, which I recall as being something along the lines of, "So what if acupuncture is just stimulating nerves with needles?" How could she be so callous to this deep fear that I'd been subconsciously fostering for the first three months of our program? Didn't she understand that I was sitting there, suffering in silence, desperate for some oriental medicine justification?

What Dr. Kwon went on to explain in that first Energetics class, and even more so the following year in Neurophysiology of Acupuncture class, was a concept that bridged the gap between the mysticism and the mundane. He simultaneously satisfied my cravings for evidence-based medicine as well as ancient tradition. Dr. Kwon = 2. Juli's irrational fears = 0.

Photo of Dr. Kwon with studentsYes, he explained, some points are located right beside or above a nerve -- grazing it ever so slightly and eliciting that loved or hated sensation we call "de qi," when energy arrives along that meridian. Further research and dissections have confirmed that many of those points not located at a nerve are actually located exceptionally close to an artery or vein. Here's where he blows my mind in 3...2...1....

Next, he tells us that these vessels and other structures harboring acupoints are essentially wrapped up in nerve fibers themselves. Yes, readers, we've come full circle in Juli's understanding of neurophysiology (which doesn't take long). Many acupoints are on a nerve; those that aren't, still kind of are.

And now to process this information.... Do I hate this answer? Does it ruin the grandeur of ancient energy meridian theory? Nah. I took the news fairly well, all ignorance and expectations considered. In today's health care climate, I like that modern science keeps proving acupuncture theory to be true. Time and time again, I see modern western research pointing to the validity of traditional medicine. At the end of the day, or the century, who doesn't like being told, "You're right"?

A Needle in the Ear or a Cigarette in the Hand

Can acupuncture help you stop smoking? Maybe. Like most smoking cessation plans, the most important part will be whether or not you firmly desire to quit using tobacco. If you have the will, then acupuncture might just have the way.

2014-03-05_cigActually, smoking cessation is one of the more long-standing mainstream applications of acupuncture in the United States. My husband recently asked me for ideas about the effectiveness for his co-worker who has been trying to quit, and my mind has been making the connections ever since. How does it work? Will it work? Which points should be used? How often will he need treatment? Can he do some of the work at home between acupuncture sessions?

Naturally, being just a student, I didn't know the answers to these questions without looking into them myself. Now that I feel like I have a handle on some of these factors, I'll go ahead and give you lowdown. Of course, I'm not telling anyone to try this at home, but this is what your acupuncturist might do if you walk into the clinic and ask for help in your journey to drop the cigarettes for good.

First, let's talk about the mechanisms. Why does a needle going through your skin make you want to stop smoking? Actually, there are multiple methods to this madness. On one hand (literally, on the side of your hand, via an acupoint called Tim Mee) a needle can actually make your cigarette taste bad. Personally, I think they already taste bad, but apparently people who smoke tend to like the taste. Moving on, if changing the taste of a cigarette from lightly ashy to repulsively garbagy isn't strong enough magic for you, there are other things that might still work for your stubborn self.

2014-03-05_ear 200Next, auricular acupuncture can help control your cravings, addiction, and withdrawal symptoms while trying to quit. Think ear piercing with a purpose! While ear acupuncture can sound even scarier than regular body acupuncture to the faint-at-heart-newbies, rest assured that the needles are hair-thin and barely felt. I should tell you that electro-stimulation of these auricular points is also commonplace. Some commonly used ear points for smoking cessation include the following: Shen Men, Sympathetic Autonomic, Point Zero, Endocrine, etc. Your acupuncturist will add additional points depending on your individualized condition. Nope, auricular acupuncture for smoking cessation is NOT necessarily a one-size-fits-all treatment.

Now, what can the patient do at home to keep these positive no-smoking juices flowing between acupuncture sessions? Luckily, we have a plan for that, too. If you've never heard of ear seeds, you will if you seek help to quit smoking from an acupuncturist! Small seeds or magnets (fancy name--auricular pellets) with clear tape backing are stuck on the above mentioned ear points, and then the patient is instructed to squeeze them several times a day until they eventually fall off. If you shower regularly, this is generally in around three days. If you're looser with your bathing schedule, you might keep your home care going for a whole week I suppose. But, let's just pretend everyone showers more than once per week.

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Back to the main event: Can acupuncture help you quit smoking? It really is UP TO YOU. Unless your acupuncturists steals your cigs, robs you of any available currency, and prevents you from bartering in the streets for your next nicotine fix, it really is in your hands. Studies show a variety of outcomes; some are very positive indeed. If you're ready, call the clinic!

References:

Effect of Acupuncture on Smoking Cessation or Reduction: An 8-Month and 5-Year Follow-up Study. Preventive Medicine, Volume 33, Issue 5, Pages 364-372. Dong He, Jon I. Medbø, Arne T. Høstmark

Acupuncture to Stop Smoking - Yin Yang House

Turns Out, Cadaver Lab Matters

It's not that I didn't already know how important our anatomy courses in the cadaver lab were, but last week it hit home -- again. During "Advance Treatment Strategies" on Thursday evening, Eric Baker, BS, MSOM, sketched a quick diagram on the whiteboard to illustrate his point about needling techniques. Here's my attempt at re-creating it -- don't laugh; I'm clearly not in a visual design program!

2014-02-19_chart

Those are some thick needles. Ouch. Don't worry, general public, we aren't actually using thick blue needles shaped like arrows when we give you an acupuncture treatment in the clinic...not unless you made us really mad. Just kidding!

The point of this diagram was to show how some points, in some conditions, should be needled at different depths according to your diagnosis and the treatment strategy at that time. Doing so brings out the desired energetic from that point's particular bag of tricks. As Mr. Baker said in class, points can do several different things, so it's up to the needler to bring out the most applicable function for that patient's condition. In other words, we don't stick the needles in three inches just to be mean; we only do it when you need it!

So, why did this make me think of the cadaver lab? Some students try to put the whole human dissection experiences out of mind forever. Some jump in and offer to be the TA for three years straight. Some of us just hang out in between those two extremes and focus on the value of what we had the privilege to do. Keep in mind that some of my experiences and those of my classmates were not so delightful, because we were the last class to go through the old cadaver lab -- when it still looked like something out of the 1922 original Frankenstein book. Nowadays, incoming students miss out on the nightmare material, and they instead get to skip straight to 2050, which is about how futuristic our new cadaver lab seems!

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NUHS Anatomy Lab Before Renovations

No matter the year, if you have the privilege of working in the NUHS cadaver lab, consider yourself head and shoulders above the rest. Whether pushing past old dripping metal carts or pointing to one of the 12 new 42" monitors overhead, Dr. Yihyun Kwon was sure to show you the physicality of needling an acupuncture point to various depths. He's reminding you about not going too deep and accidentally hitting the median nerve under PC6 as he closes up the clamshell table and washes his hands at one of the foot-pedal operated stainless steel sinks. (No, this is not a paid advertisement. The new lab is just that awesome.)

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NUHS Anatomy Lab After Renovations

What's the point? The point is that you have tosee the acupoint, inside and out, in order to best understand how to needle it. Yes, the lab can make many students squeamish, but I wouldn't trade those stinky Wednesday nights back in 2012 for anything. I just hope that your experiences in the lab will stick with you, future students, even though you'll be missing out on some of the moreolfactoryelements due to the new state-of-the-art ventilation system!

Is Chinese Medicine Better than Western Medicine?

Is Traditional Chinese Medicine (TCM) better than conventional western medicine? Would a provider of oriental medicine and one of the ayurvedic traditions treat a patient the same way? Do naturopaths diagnose the same medical conditions as chiropractors do? 

The answer to each of these questions is probably a solid "sometimes."

2014-02-04_booksThe point is that one medical system is not necessarily better than another. Each of the above-mentioned categories exist as an entire medical paradigm, complete with its own unique way of diagnosing and treating an array of health-related issues. Did you know that your chiropractor could give you a pelvic exam, ladies? Did you know that your naturopathic doctor could give you a spinal adjustment? And what about those herbs? Why do western naturopaths have a different materia medica than we students of oriental medicine do? Is slippery elm awesome? I'll never know. And neither did the ancient Chinese, because it didn't grow there.

We've all heard that there is competition between the students, all graduating in Lombard at the same moment, as they get dumped out into a market that becomes more and more saturated every day. We all feel it from time to time -- a student of acupuncture who assumes her classes are 10,000 times more difficult than that of the massage student down the hall; the chiropractic intern who thinks he's way more important than any acupuncturist in the clinic; or the naturopath who points out that she can do everything a chiropractor can do and more!

Are they all right? Or are we all just egotistical jerks? Again, the answer is an unreassuring "sometimes."

2014-02-04_elmWhat I'm learning at NUHS is the unmistakable value of the various medical systems. My friends ask me if I scrape my tongue daily or if I've dabbled in oil pulling. No and no, I tell them. That's from the ayurvedic traditions of India, not the ancient Chinese medicine that I'm studying. Does that mean I don't think these practices have merit? Nope. I'm sure they do...I'm just not learning about them in my program. I've actually tried oil pulling, but I'm fairly certain I did it wrong, and I swallowed, which I learned later defeats the point. Whoops. I also love essential oils, and I frankly have no idea which tradition claims them.

What are we learning in the MS in Acupuncture and Oriental Medicine program at NUHS? I've memorized hundreds of acupoints -- well, a good chunk of them anyways -- and dozens of Chinese herbs, I finally realized that ginger and garlic are making it worse when I have a heat invasion, and I'm piecing together why a point on my inner wrist is so helpful for my heart palpitations. I finally learned how to spell "ayurvedic," and I hope I can pronounce "naturopathy" correctly most of the time these days.

2014-02-04_herbsMore importantly, I'm also learning that the "competition" chatter has a much bigger bark than bite. We students of oriental medicine like you students of chiropractic, naturopathy, and massage therapy, and I feel fairly confident assuming that you guys like us, too. In fact, the sheer number of students who dual enroll in more than one program at NUHS proves this point for me.

I value what the other practices and traditions bring to the overall health and well-being of the patient. I don't expect that I'll offer a patient the same knowledge and services that an ND or an MD does; I'll offer them something almost entirely different in fact. And that, my friends, is the point. We have a better shot at helping people if we work together, value each other's contributions and specialties, and keep an open mind to things that might sound crazy at first. Energy crystals...what?!