|Carolyn Vachani, RN, MSN, AOCN|
|The Abramson Cancer Center of the University of Pennsylvania|
| Last Modified: December 7, 2010
Introduction to Traditional Chinese Medicine
Traditional Chinese Medicine (TCM), which includes the therapies of acupuncture, herbal medicine, and qigong (type of exercise), has been practiced in the Eastern world for thousands of years. The philosophy of TCM is based on the theory of yin and yang, opposing yet complementary phenomena, existing in a state of balance. Yin can be described as cold, slow, feminine, dark, and still; whereas yang is described as hot, fast, masculine, light, and moving. TCM views this as a process in constant motion, with yin and yang waxing and waning, but remaining in balance or equilibrium. When this balance or equilibrium is not present, pain and/or illness can occur.
Qi (pronounced “chee”) is a vital energy that results from the interaction of yin and yang. Qi flows throughout the body in a system of channels called meridians, maintaining equilibrium of bodily functions and delivering nourishing energy to our cells. When this flow is strong, balanced and unobstructed, the person is in a state of health. However, when the flow of qi is interrupted, illness or pain can occur. This can be due to emotional or physical trauma, prolonged stress, imbalanced mental or emotional state, unbalanced diet, exposure to the elements and so on. Acupuncture treats illness by connecting with these meridians, restoring the flow of qi.
TCM is just one type of acupuncture practiced today. Other types of acupuncture include five element, Japanese, Korean, auricular (uses points in the ear), French energetics, and acupressure (where pressure is used at points instead of needles). While each type of acupuncture has a different primary focus or philosophy, they all aim to restore the flow of qi.
Acupuncture techniques are used to redirect or restore the flow of qi by accessing one or more of the 12 primary meridians (and 8 additional meridians) by means of more than 360 acupuncture points, which lie along the meridians. Each meridian is connected to an organ system. The acupuncture points affect the quality and quantity of the flow of qi, in different ways, to support the functioning of the underlying organ system. For example, points along the liver meridian affect the function of the liver through the body, mind, and spirit. The acupuncture practitioner determines what points should be used based on a discussion with the patient about their health concerns, personal behavior and preferences, an examination of their pulses and tongue (color, texture).
As you can imagine, western medicine has had some difficulty grasping the concepts of yin, yang and qi. Researchers have attempted to explain how acupuncture works, but have not been very successful. Acupuncture is thought to work by affecting the nervous system, and by improving the activity of endorphins (natural pain relievers) and/or immune function (by enhancing activity of natural killer cells and lymphocytes). Evidence also suggests affects on neurotransmitters, cytokines, and neuropeptides.
The use of acupuncture in China has been traced back 50,000 BC by archaeology.
It has also been used in other Asian countries, including Japan and Korea, for centuries. Acupuncture has been used in Europe for over 500 years, but despite use in Chinatowns across the United States, it was not widely practiced in the U.S. until the 1970s. In 1976, the U.S. Food and Drug Administration classified acupuncture needles as medical devices, but it was the mid 1990’s before the National Institutes of Health held workshops and conferences related to acupuncture use. A study in 2002 reported that 8.2 million U.S. adults had received acupuncture at some time and 2.1 million had done so in the past year. The National Center for Complementary and Alternative Medicine now funds numerous studies on acupuncture to better define its role and effectiveness.
How is acupuncture performed?
The acupuncture practitioner inserts very thin needles, ranging in length from 1/2 to 5 inches (although much thinner than a typical needle), into the predetermined acupuncture points. The needles may be stimulated with energy from the practitioner, electrical stimulation or heat (also called moxibustion). The practitioner may also manipulate them by rotating, inserting the needle further or removing it part way. All of this manipulation is an attempt to obtain the flow of qi at the site. The arrival of qi may be felt by the practitioner or reported by the patient as a symptom of temperature change, numbness, itching, dull ache, grabbing or pinching feeling. The needles are left in until this occurs, which generally takes 5-30 minutes, but in some techniques, shorter needles may be left in for several days.
Patients should be sure that the practitioner uses pre-packaged, sterile, one time use needles. Failure to do so can result in infection and the possible transmission of disease from the other patients the needles were used on. The practitioner should discuss the treatment protocol (number and spacing of sessions) prior to beginning therapy.
What does treatment cost?
Patients should inquire about cost per treatment and number of treatments prior to beginning therapy. Currently, Medicare and Medicaid do not reimburse for acupuncture treatments, but some private insurers do cover all or part of the cost. Patients should call their insurer to determine coverage for their particular condition, as some may cover acupuncture for certain conditions, but not others.
What is acupuncture used to treat?
Acupuncture has not been shown to be an effective treatment for the cancer itself, but has been primarily used and studied in symptom relief, including nausea and vomiting related to chemotherapy, pain, hot flashes due to hormone therapy and, more recently, joint pains related to aromatase inhibitors. Studies have shown promising results in these areas. While many feel randomized clinical trials are important to prove efficacy, it is difficult to dismiss a therapy that has been used for thousands of years because appropriate trials have yet to be conducted. Acupuncture may be a useful therapy alone or in conjunction with standard therapies. Read more about the research that has been conducted at the National Cancer Institute.
What are the possible complications?
Acupuncture is generally safe when performed by a trained acupuncturist, but there are a few concerns specific to cancer care. Patients with low white blood cell counts (or neutropenia) should use caution due to their increased risk of infection. Sterile, single use needles should be used and the skin cleaned with alcohol prior to their insertion. Despite the theoretical concern of infection, acupuncture practitioners feel that acupuncture can boost immune function and may be of benefit to immune compromised patients.
Patients with low platelet counts (thrombocytopenia) are at increased risk for bleeding and bruising and therefore should not undergo acupuncture while their platelet counts are low. There is also a concern of inserting needles into the tumor. It is recommended that this is not done to prevent spreading of the tumor, although this has not been proven to occur with acupuncture.
Other possible complications include: fainting, nausea and exacerbation of pain. More serious complications, such as lung puncture (pneumothorax), are rare in experienced hands, and studies have found no major difference in the rates of complications based on who was performing the therapy (professional acupuncturist, trained physician, or physiotherapist).
How is an acupuncturist certified or licensed?
In the United States, 48 states now have laws regulating acupuncture practice (SD and WY do not). Six states (AL, DE, KS, MS, ND, OK) do not license acupuncturists, but allow medical or osteopathic physicians to practice acupuncture, but not all require training in the field to do so. Some states also allow acupuncture to be performed by chiropractors, dentists, podiatrists, naturopaths and nurses. View regulations by state.
National certification is offered by the National Certification Commission for Acupuncture and Oriental Medicine, which is required by many states for licensure. The educational requirements for licensing vary from state to state. In 2000, there were an estimated 11,000 licensed acupuncturists in the U.S. and this number is expected to double by 2010. In addition, about 3 thousand medical and osteopathic doctors also practice acupuncture.
How do I find a certified acupuncturist?
Ask your physician if they can recommend someone. Do you know someone who had acupuncture? Ask them about their experience and their practitioner. Search for a local practitioner on the web.
Bardia, A et al. Efficacy of complementary and alternative medicine therapies in relieving cancer pain: A systematic review. Journal of Clinical Oncology 2006; 24(34), 5457-5463.
Ezzo JM, et al. Acupuncture-point stimulation for chemotherapy-induced nausea or vomiting. Cochrane Database of Systematic Reviews 2006, Issue 2.
MacPherson, H et al. The York acupuncture safety study: prospective survey of 34000 treatments by traditional acupuncturists. British Medical Journal 2001; 323:486-487.
Micozzi. MS (Ed.) Fundamentals of Complementary and Alternative Medicine 3 rd ed, (2006). St. Louis, MO: Elsevier.
White, A et al. Adverse events following acupuncture: prospective survey of 32000 consultations with doctors and physiotherapists. British Medical Journal 2001; 323:485-486.