ACUPUNCTURE: A BRIEF INTRODUCTION

HISTORY

Acupuncture is one of the oldest and most commonly used forms of medical therapy in the world. The medical theories associated with acupuncture originated in China about 3,000 B.C.. The World Health Organization has approved acupuncture as an effective form of therapy, and now the National Institute of Health, prestigious universities, and many professional organizations are encouraging research on Acupuncture. Dr. Rotchford sits on the Medical Acupuncture Research Foundation's board which is active in promoting and assessing research on acupuncture.

In November of 1997 the National Institute of Health convened a consensus conference on acupuncture. They found adequate evidence to support acupuncture for the nausea and vomiting associated with surgery, chemotherapy, and/or pregnancy. They also found that there are reasonable studies showing relief of pain with acupuncture on diverse pain conditions such as menstrual cramps, tennis elbow, and fibromyalgia. They added that acupuncture may be effective as an adjunct therapy for several other conditions, including addiction, headache, low back pain, asthma, and carpal tunnel syndrome, among others. These findings are all the more significant considering how difficult it is to prove the effectiveness of acupuncture using standard research models. The full consensus statement is available on the web at http://odp.od.nih.gov/consensus

The web site http://www.medicalacupuncture.org also has resources that will answer many of your questions about medical acupuncture.

THEORY

Acupuncture is based on the Chinese definition of health that calls health a state in which adequate amounts of energy (Qi) flow in a balanced fashion through and around the body. Illness, then, indicates a breakdown in this balanced flow of energy, brought on either by outside factors (e.g., a virus or an injury) or as the result of long-standing internal imbalances that translate themselves into observable structural or functional abnormalities (e.g., back pain, or heart palpitations). For example, a practitioner of Western medicine would approach a case of a stiff, painful back by looking at physical structures--bones out of place, unequal leg lengths, pinched nerves, arthritis, etc. The medical acupuncturist would also examine the structural problems but would consider that these abnormalities may primarily be the result of an imbalance in the electrical fields in and around the body.

Western theories abound about how acupuncture might work. Clearly acupuncture effects levels of endorphins in the brain and spinal cord. Some other physiological effects of acupuncture have been measured scientifically. For me, the bottom line is that I understand only a small part of the mechanism. If I could conceptually understand why any portion of a hologram interference pattern includes the total image of the hologram, I think I would be closer to better understanding how acupuncture works.

PROCEDURE

Acupuncture involves putting needles with magnetic properties into different parts of the body in order to improve the flow of energy in and around the body. From a Western point of view, an acupuncture needle could be considered an electrode because of its magnetic properties. By placing the electrodes (needles) at selected points in the body--along the meridians, or channels in which energy flows in the body--the acupuncturist attempts to reestablish a balance in the flow of energy so that the disordered structures and functions will become healthy again.

USES AND EFFICACY

Will acupuncture treatment work for all diseases and symptoms and for all people? Like any other treatment, obviously not. Important variables in the success of treatment include the skill of the operator, the length of time symptoms have been untreated, the degree of structural changes involved, the emotional attitude of the patient, etc. The nature of acupuncture demands that all patients be treated as unique individuals whose disorders are the result of their unique personal history. Therefore, it is extremely difficult to predict with certainty the outcome of any one case. Until such time as the Western scientific method has gathered and analyzed enough data to assess the likelihood of acupuncture being successful in any particular case, practitioners usually approach treatment from a practical standpoint: let's see if it works... Individuals with problems that resist diagnosis and treatment under the Western model of medicine are especially good candidates for this approach.

Studies published by the author support that approximately 80% of patients presenting themselves to a medical acupuncturist are helped. If they are going to be helped generally they will know they have been helped within two to three treatments. Standard course of acupuncture are considered, however, to involve approximately tens sessions. There is a documented accumulative effect of acupuncture. That is, the effect of two treatments is more than one plus one. Often at least five treatments are required to experience the full potential of acupuncture's effect. I give the example of learning a new language. You might have four lessons and then on the fifth lesson there is an "a hah" I've got it response.

RISKS

Studies of about 3,000 cases of acupuncture treatment at the University of California at Los Angeles found that the only adverse effect was occasional bruising at the site of the needle insertion. If the needles are surgically sterilized like any other medical instrument, the danger of getting AIDS or any other blood-borne infection is nil; in fact, to date there is no proven case of AIDS acquired via an acupuncture needle. Disposable needles are available--ask the receptionist if you would like to buy your own--but we don't routinely use them at this clinic because we find them less effective than the silver needles. The most serious side effect seen in this clinic after more than 5,000 treatments is a pneumothorax (air in the chest cavity) that spontaneously resolved after a few days.

EXPECTATIONS

Although in China an individual may receive a dozen or so treatments merely as an introduction to intensive treatment, the expense of such an approach is often prohibitive in this country. We recommend that patients have two or three sessions to see if the acupuncture is effective before trying other options. Some people get relief immediately after a treatment; some notice improvement after a few hours, some after a few days. Usually by the end of the fifth day after a treatment people know if they've been helped by that particular treatment. Some conditions require several treatments; some do not respond at all. The number of treatments, then, varies with each person and condition. It is important to know that sometimes the symptoms become worse after a treatment and may remain so for a few days before there is any relief. This is a good sign because it indicates that the symptom is treatable and that the acupuncturist has found the vulnerable or affected area. Moreover, people sometimes have fleeting pain in other parts of their body after a treatment and may even experience a temporary return of symptoms that they haven't had for years. Again, this indicates that the energy is moving and trying to re-balance itself. Or, another way of understanding this phenomenon is that the nervous system is remembering in order to forget.

PERSONAL CARE

BEFORE TREATMENT

Be well rested and eat only a light meal. Take no alcohol, sedatives, tranquilizers or pain killers for four hours before a treatment unless directed otherwise by a physician. Continue with other routine medications prescribed by your physician.

AFTER TREATMENT

Rest for two hours after you get home and avoid alcohol, pain killers etc. during this time. If the treatment is for a painful condition, avoid strenuous activity for two days after treatment, even if you now are free of pain. Keep a written diary of the effects of each treatment--any new symptoms or changes in symptoms--so that further treatment might be more effectively directed.

COSTS AND BILLING

Because the complexity of each patient's problem varies, it is difficult to say beforehand what the exact cost will be. In general, new patients will require an extended office visit to have a complete physical and medical history (see handout on Adult Health Maintenance). Patients referred from another health care practitioner will be charged for an exam and consultation. Follow-up visits are usually considered intermediate office calls and billed the standard fees for this area. In general you can expect a total bill of about $200-$300 for your first three visits. Insurance companies, with the exception of Medicare, generally cover office visits which include acupuncture because the process of acupuncture involves continually reviewing the history and physical condition in order to make appropriate recommendations and provide on-going therapy. Moreover, the clinic does not limit therapy to acupuncture alone; we use traditional Western treatments if appropriate and acceptable to the patient. Be sure contact the office for current billing fees policies as they change from time to time.

If you are covered by Medicare, we must give you two separate bills: one for the office visit and one for the acupuncture treatment. Since acupuncture is not covered under Medicare, you will only create problems if you submit the acupuncture bill to them. Moreover, most insurance supplemental to Medicare will not cover procedures not already covered through Medicare. If your supplemental insurance policy does cover acupuncture but requires that you bill Medicare first, send in the acupuncture bill separately from the other office charges in order to avoid any confusion at Medicare.

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