Western Views of Acupuncture.
In doing so, they are participating in a medical tradition founded on the opposing concepts of yin and yang and energy flow through channels or meridians, with disease being a manifestation of disturbances in this flow. The fundamental energy force in traditional Chinese medicine is qi, which protects, nourishes, and animates. Although the Western medical model does not recognize such a concept, it's possible to view this ancient Chinese tradition through contemporary eyes. For example, consider the three principal forms of qi:
Wei qi is defensive energy that surrounds the body like a protective shield and prevents pathogens and toxins from penetrating to the organs. This is what we know today as the immune system.
Zhon qi is nourishing energy. This encompasses the circulatory, digestive, and respiratory systems.
Yuan qi is ancestral, inherited energy expressed through growth, development, reproduction, and senescence. It refers to what we now consider the genetic component of life, our DNA.
This was quite an advanced system of thinking for its time, but this is the 21st century and if acupuncture is to be accepted into wider contemporary medical practice, it must stand up to scrutiny in the harsher light of evidence-based medicine. Its critics have demanded scientific explanations for it.
Accordingly, the National Institutes of Health established a consensus panel that evaluated the state of knowledge and experience about acupuncture and found "clear evidence" for its efficacy in postoperative and chemotherapy-induced nausea and vomiting and some benefit in a number of other conditions such as tennis elbow and menstrual cramps.
Although the efficacy of acupuncture can be difficult to assess because of the lack of standardization of practices, one systematic review on its antiemesis effects included only controlled trials in which a single acupuncture point, P6, was stimulated (J. R. Soc. Med. 89:303-11, 1996). The author identified 29 trials in which P6 stimulation was performed in patients with nausea associated with pregnancy, chemotherapy, or surgery; in 27 of them P6 stimulation was statistically superior to sham acupuncture.
And just this past December a randomized controlled clinical trial of acupuncture for a group of 104 women with breast cancer undergoing a highly emetogenic chemotherapy regimen found that those who were given acupuncture along with standard antiemetic pharmacotherapy experienced significantly fewer episodes of nausea during a 5-day study period (JAMA 284:2755-61, 2000).
Critics also question how the insertion of needles into points along "meridians" devised by ancient practitioners that do not correlate to any bodily system could possibly have distant or systemic effects.
We know that inserting needles into the skin and then manipulating them or using high- or low-intensity electrical stimulation results in a number of physiologic events: stimulation of small myelinated type II and III afferent nerve fibers; release of beta-endorphins and neurotransmitters such as serotonin and substance P; and activation of the dorsal horn nuclei at the spinal cord level, the brain stem level, and the hypothalamic-pituitary level.
Basic researchers continue to increase our understanding of the mechanisms by which acupuncture works, and clinical trial investigators are clarifying its potential clinical applications. As to the question of whether acupuncture deserves a place in contemporary Western medicine, we al- ready have an answer--yes.
DR. TONY V. Lu, a specialist in internal medicine who is also board certified by the American Board of Medical Acupuncture, is developing an integrative medicine program for Loyola University (Chicago) Health Systems and the system's primary care network.