Modern (Western) acupuncture
It is not always realized that there is a modern or Western version of acupuncture. The term "acupuncture" is a Western one, derived from the Latin and meaning "puncturing with needles". It was first used by the Dutchman Wilhelm Ten Rijn, who wrote a monograph in Latin on the subject (De Acupunctura) at the end of the seventeenth century. Acupuncture continued to attract interest from Western doctors in the eighteenth and nineteenth centuries though generally without much reference to its Oriental roots. This trend has continued down to the present, receiving a considerable influx of interest after President Nixon's visit to China in 1972, when surgeons witnessed surgical operations apparently being carried out using acupuncture analgesia instead of anaesthetics. As a result of this interest there has grown up what may be termed modern, non-traditional, or Western acupuncture. The main differences between traditional and modern acupuncture are as follows.
- The traditional apparatus of "points" and "meridians" is either ignored altogether or is radically reinterpreted.
- The concepts of disease are derived from modern pathology instead of the ancient Chinese notions.
- Acupuncture is supposed to work via the modern understanding of anatomy and physiology.
| TRADITIONAL | MODERN |
|---|---|
| Follows rules laid down in the past | Largely ignores the old rules |
| Based on pre-scientific ideas | Based on modern anatomy and physiology |
| Practical rather than mystical but appeals to Westerners interested in mysticism | No element of mysticism |
These differences are theoretical. but there may also be practical differences. Whereas traditional acupuncture practitioners, at least today in the West, tend to insert large numbers of needles and leave them in place for at least 20 minutes, sometimes longer, some modern acupuncturists use many fewer needles (sometimes only one) and practise brief insertion (from two or three minutes right down to one second).
This form of acupuncture lends itself to use in a busy practice where there little time to spend on each patient. It also has the advantage that it can be learned quite easily, in a short time, by modern health practitioners such as doctors, physiotherapists, osteopaths, chiropractors, and podiatrists. Such people do not have to take on an alien and premodern system of thought; rather, they see acupuncture as an extension of what they are already doing.
For traditionalists, modern acupuncture appears to be a watered-down version of "real" acupuncture, having at best a limited degree of effectiveness in certain situations. However, there is little good research evidence to support the use of any form of acupuncture, traditional or modern, and even less to show that one kind is better than the other. To some extent, therefore, choosing which version to use, whether as patient or practitioner, comes down to subjective choice.
If acupuncture is not to be based on the traditional ideas, how can we
choose where to insert the needles? There are several possibilities. One
popular idea is to use the concept of trigger points. These are tender
areas, mostly in muscles, from which pain and other sensations may
radiate to distant areas. Some studies have shown a considerable degree
of correspondence between the locations of trigger points in the Western
literature and classic acupuncture points.
Another idea is to base the needling on body segments. The spinal cord
is arranged segmentally, with pairs of nerve roots emerging from it
along its length. These nerve root pairs supply the skin in a series of
stripes, so that it is possible to say which spinal segments supply
sensation to different part so the body. A similar arrangement exists at
deeper levels, so that we may speak of myotomes (related to the muscles)
and sclerotomes (related to the bones and joints). In some versions of
modern acupuncture the needles are inserted in segments that are related
to the internal organs that it is desired to treat.
Other ways of choosing where to needle also exist. However, some modern
acupuncturists think that it often makes relatively little difference
where the needles are inserted, at least in quite broad terms. Certainly
there seem to be some patients who react very strongly to needling and
in whom the actual site of treatment is not very important.
Assuming that acupuncture has more than a placebo effect, how can we
explain its action? Two main kinds of explanation have been suggested:
In summary, while it is possible to put forward a reasonably plausible
explanation for how acupuncture may work, we have to acknowledge that
much of this theorizing may be wrong or based on inadequate information.
One difficulty to date is that much of the experimental work has been
done on short-term pain relief in animals, whereas what happens when
acupuncture is used clinically in humans is different in a number of
ways. For example, in clinical acupuncture the pain relief may take
several hours or even days to develop, but may then continue for long
periods or even permanently. There is also a build-up effect with
repeated treatments. And whereas the animal experiments have mostly
used strong electrical stimulation of the needles, much clinical
acupuncture is brief and gentle, using minimal manual stimulation. For
all these reasons it is doubtful how far the available research into
acupuncture mechanisms is really applicable to clinical acupuncture in
humans.
Choosing where to needle
How does it work?
Although both these mechanisms may well be involved, they are probably
not the whole story. There is increasing evidence today to suggest that
various areas of the brain, such as parts of the limbic system
(especially the anterior cingulate cortex) are important. Another idea
which is currently attracting attention is the role of oxytocin, a
pain-relieving hormone that also causes feelings of relaxation and
tranquillity.