Friday, 17 April 2015

Acupuncture: Traditional and Modern: Reflections on Acupuncture, Osteopathy, and the history of medical science

Acupuncture:  Traditional and Modern:  Reflections on Acupuncture, Osteopathy, and the history of medical science.

Traditional Acupuncture has long used the inner and outer bladder lines, and also the Huatuo Jiaji points, 0.5 cun from the mid-line of the spine.   Very useful from a practical point of view for back pain, but also pertaining to the spinal nerves, and therefore able to influence the whole body and nervous system. 

No doubt the famous Chinese physician and acupuncturist Huatuo realized their importance, even though he didn't know the anatomical terms, as the ancient Chinese physicians didn't dissect cadavers, and were not anatomists, like their early European counterparts we beginning to become.  

Early recorded European records show that it was the ancient Greeks that began dissection and the study of anatomy, later followed by Romans such as Galen.  However the only cadavers they had access to were from convicted felons, and it the thought of being permanently crippled and maimed (as ghosts) in the underworld and the afterlife was a gruesome punishment for such criminals. Perhaps all serving as an additional deterrent, to help maintain law and order, and social harmony.

OK there might also have been a bit of grave-robbing  going on, as not doubt also happened in later centuries once medical schools were more widely established and bodies were in demand for dissection.  All together a gruesome subject  - and perhaps why a more civilized culture like ancient China did not resort to such barbarities.  After all, they knew how energy circulated in meridians the body  (from qigong practice and meditation) and were far more advanced in their own understanding of physiology in terms of qi and blood, yin and yang, excess and deficiency and so on.

To return to the Acupuncture points (and Chinese physicians such as Huatuo) the mechanism and action and underpinning neuroanatomy and physiology of these back points is now well understood.  Acupuncture here stimulates paraspinal muscle (spinalis, semi-spinalis, etc.) and their segmental spinal nerves, and feedback into the dorsal horns and associated spinal reflexes. 

One of the mechanisms of acupuncture is likely to be via alpha-delta fibres that inhibit the nocieceptive pathway in the dorsal horn of each vertebrae, and this segmental effect can influence visceral conditions, both for pain and disturbed autonomic reflexes.  The intermediate cells in the dorsal horns, by way of collateral terminals, also release the neurotransmitter enkephalin (which blocks pain transmission).

The somato-visceral reflexes involved here, pertain to underlying viscera (via the sympathetics and segmental vasomotor reflexes) and again these effects seemed to be well known to the ancient Chinese physicians and acupuncturists, as they noticed that acupuncture had benefits well beyond musculo-skeletal medicine.  They were effecting the nervous system itself, not just treating muscle and joint pain.  

Integration of modern and and ancient medicine can give a much better understanding.  Both world-views have a great deal to contribute.

For more on this see:

Tuesday, 7 April 2015

different theoretical models underpinning these (apparently) two different types of acupuncture. Osteopathic principals and modern biomedical science

Reflections on integration of Traditional Chinese Acupuncture and Western Medical Acupuncture models

The obvious thing anyone notices here is the quite different theoretical models underpinning these (apparently) two different types of acupuncture.  Are they really different?  Well, that is the question.

So called Western Medical Acupuncture justifies its efficacy according to modern bioscience, and neurology and physiology.   I must admit this does make it easier for me personally, as an osteopath to integrate this acupuncture according to Osteopathic principles. 

However, this also generates food for thought and much reflection, about the type of (osteopathy or acupuncture) treatment given: specific, symptomatic and reductionist  -  versus a more global, integrative, whole-body, whole-person, mind-body-spirit approach.  These principles were those of Andrew Still and the early osteopaths.  The global model is also the principle of traditional acupuncture.

So the differences, as I see it, between the Traditional acupuncture and modern reductionist so called Western Medical Acupuncture models, have a close parallel between the classical osteopathic paradigm (e.g. Andrew Still, Littlejohn, John Wernham) and the more reductionist, orthopaedic, quick-fix kind of osteopathy  (or chiropractic or physiotherapy) as a simplification, a symptomatic treatment, 'only treat where it hurts' type of approach.

I would like to hope that perhaps the Western Medical Acupuncture model might have some scope for the richness and sophistication that we find in Traditional acupuncture.   OK, all beginners have to start somewhere. As beginners in acupuncture (as all clinicians were, once upon a time) we all started with basics, and gradually developed our clinical skills.  But why medics cannot go beyond this primitive cut-down western medical acupuncture model is beyond me.  Perhaps it is a lack of time, or commitment to further study. 

And also the Traditional acupuncture model has to be open to scrutiny, and rigorous evaluation of evidence base.  Indeed it already is, with vast amount of research, and universities in Korea, China, and Japan generating a lot also).  And also admittedly, I'm sometimes a little disappointed with my Traditional acupuncture colleagues, and there being not quite enough modern western biomedical science (a thorough grounding in anatomy, physiology, neurology, pharmacology, rheumatology, orthopaedics, etc) in their training courses.  Although I would like to hope that this is getting better.

So good to try to help integrate these tow models:  the historical richness and sophistication of traditional acupuncture, and modern western biomedical science.  Surely this is a win-win scenario for all.  Let the debate (and friction) continue.

For more on this, see: