Acupuncture

Acupuncture

1. Introduction

1.1 Acupuncture

1.1.1 Traditional Chinese Medicine Acupuncture vs. Western Medical Acupuncture

Acupuncture can be defined as the insertion of needles into the skin at specific sites, known as acupoints, for therapeutic means. There are variations to this theme, which may include alternative methods to stimulate the acupoints: pressure (acupressure), heat (moxibustion), laser (laser acupuncture), or currents of electricity (electroacupuncture). ok this paragraph is a bit confusing. Are there many different types of acupuncture or acupoints?

Traditional Acupuncture has been practiced in China for approximately x years. More recently the West has been practicing Western Medical Acupuncture, with the National Institute of Health (NICE) prescribing acupuncture for treatment of chronic non-specific lower back pain. While both Western, and Traditional Chinese Medicine (TCM) acupuncture use the same needling technique, there are several distinctions between their practice and use.

The first distinction between the two practices is the mechanism of action. The TCM use is based on the idea that 'qi', an essential life force, travels throughout the body along 'meridians'. The life force must be in a state of equilibrium throughout the body, however when conditions or illnesses cause a blockage, or stagnation of the qi, acupuncture is performed at selected acupoints with the aim ofto rectifying the abnormality.

Conversely the House of Lord's Select Committee defines acupuncture as the insertion of small needles into various bodily points, known as acupoints, to provide stimulation of nerve impulses. Western Medicine does not believe in existence of qi, with the mechanism of action relying on acupuncture needles stimulating the central nervous system and nerve impulses. Anotehr possible mechanism of action is the idea that acupuncture stimulates opiod receptors, this was supported by a study in which endorphrin release was increased during acupuncture, which upon administration of Naloxone (opiod receptor blocker) caused the analgesic effects to cease. However it is as not as simple, as another study on use of acuputuctire for migraine treatment found that ..... found what?

For these reasons, TCM and Western acupuncture also have widely differing uses, with the latter being used for a variety of conditions as shown in Table 1 below, and the latter only using it for symptomatic relief as an analgesic or an anaestheticagent.

Table 1: TCM Acupuncture use in China

TCM acupuncture is based on a complex scheme of full physical examination, diagnosis and cure, with a typical course for a chronic condition lasting x sessions. The acupuncturist uses the essential Four Examination Techniques, of inquiry, observation, palpation and listening. Examination often lasts x minutes, (ref) with questions asked about lifestyle and health, pulse palpation, tongue character and face pallor observation as well as voice sound being important diagnostic tools. These tools should provide the diagnosis of the whole body imbalance that occurs, which the acupuncturist seeks to rebalance and cure. There are many different acupuncture types, however our study is concerned with Syndrome Acupuncture that was practiced on volunteers. From the Four Techniques each volunteer was diagnosed with a syndrome that was being caused by the qi imbalance, with relevant specific acupuncture points needled for an individualised patient-specific approach. (acu book, chap 7) This may allow us to have a more accurate experiment true to the traditional TCM approach. (bcca?)

Conversely Western Acupuncture does not seek to be curative, with non-specific lower back pain prescribed by NICE well illustrating that Western Acupuncture does not necessarily have a known cause but is used for temporary alleviation of symptomatic pain.

1.2 Evidence Base

Acupuncture use in the West has rocketed in the past decade, a figure would be nice as would as source for this absurd accusation. however the practice of Evidence Base Medicine (EBM) leads its validity to be questioned by the scientific community. Numerous literature reviews, a Cochrane systematic review as well as a meta-analyses on acupuncture clinical trials found that these studies are poorly controlled and conducted, with further research including improved methodology in the context of rigorous RCTs being appropriate. (birch etc!) However a recent study of acupuncture systematic reviews through the last decade found that the evidence base for acupuncture is growing, with

recent evidence suggesting that acupuncture is effective for certain, but not all conditions. Everytime you sau there is evidene suggesting u need a source.

While the only condition for acupuncture that is prescribed is for chronic lower back pain, the table below created from the NHS website who cite the ‘Desktop Guide to Acupuncture' well summarises the need for greater more stringent research:

Table 2: NHS

Positive evidence

Negative evidence

Inconclusive or no evidence

chronic back pain

headache

dental pain

post-operative nausea and vomiting

osteoarthritis of the knee.

discomfort during gastrointestinal (GI) endoscopy

pain and discomfort during oocyte retrieval (a procedure used during IVF)

losing weight

smoking cessation

rheumatoid arthritis

.

addiction

depression

chronic pain

neck pain

shoulder pain

asthma

sciatica

tinnitus

insomnia

stroke

However new technologies such as use of Functional Magnetic resonance imaging (fMRI) can unequivocally show that acupuncture has a physiological effect ; however much debate surrounds the fact that needling at a non-acupoint, known as sham acupuncture has been founding to produce a physiological effect also in a varety of studies. However certain studies have shown a greater increase in specific brain region activity at acupoints, than non-acupoints.Nonetheless this poses an interesting answer to the sterile debate surrounding the placebo effects of acupuncture, and suggests that the whole holistic treatment including the consultation with the practitioner may play a large role as significant if not more so than the position of needling.

The head of complementary and alternative medicine (CAM) at Exeter university, Professor Edzard Ernst defined a CAM therapy as one which seeks to fulfil a need which is not meet by orthodox medicine,and this is very true of the physiological condition of stress, a condition which is affects two in three adults, and is poorly managed in x ppl. ?!

1.2 Stress

1.2.1 Pathophysiology of Stress

Stress can be defined as ‘

1.2.2 Stress and the Immune System: Neuroimmunomodulation

It is well known that stress causes decreased immune function, and increases likelihood of infections, and cancers, The relationship between stress and the immune system, a complex field known as ‘neuroimmunomodulation' has been well recognised. (dhaber), and It is now known that there is communication between the nervous and immune systems through a shared common biochemical language of neuroendocrine hormones, cytokines, neurotransmitters as well as their relevant receptors. There is evidence of an intricate bidirectional network between the two systems, supporting the ancient idea that the body health can be affected by mind. Figure 2 well illustrates the verified pathways that are involved in this bidirectional exchange:

There is multiple evidence to support this notion, with a recent review on the relationship between chronic stress among immune dysregulation older adults showing significant immune dysregulation among caregivers compared to non-care giving adults. It was seen that the chronically stress caregivers had lower responses to vaccines, more susceptibility to latent infections, an amplified production of inflammatory mediators as well as an accelerated rate of cellular aging. This contributes to the body of evidence which suggests that chronic stress leads to a premature immunosenescence,? the natural deterioration of the immune system that occurs through age, as well as the high correlation between death and cancer-linked depression.

Paradoxically stress also causes exacerbation of hay fever, asthma or eczema, all of which would seem to be amereliorated by immunosupression. It is important to note that several factors affect whether the immune response will be immunosuppressive or protective, such as the duration of stressor. An short term or acute stressor has been shown to cause an increase in innate and adaptive responses, such as that seen with a vaccine inoculation. Long term or chronic stressors are shown to be immunosuppressive by depleting leukocyte numbers, as well as upregulating immunomodulatory T helper responses. An important factor is also the timing of the stressor in relation to the activation of the immune response, that is if the immune response is activated early the stressor is likely to be immunoprotective. Conversely if the immune response is activated late in comparison to the onset of stressor it is likely to be immunosuppressive. Therefore the relationship between stress and the immune system is complex and still not fully understood.

The Body Mass Index is a good indication

This is your weight in kilograms divided by your height in metres squared.

Body Mass Index Value

Classification

<18.5

18.5 - 24.9

Underweight

25- 29.9

Ideal Weight

30 - 39.9

Obese

> 40

Morbidly Obese

http://www.nhs.uk/chq/pages/3215.aspx?categoryid=52&subcategoryid=143

The BMI calculation cannot take into account if you are particularly muscular, or if you are going through puberty (when your body is still developing).

The BMI for each volunteer was calculated by using the formula: weight (kg) / height (m2)

Put in methods

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