While the Western medical establishment continues to ruminate over whether this ancient therapy has validity, patients who have been treated successfully with acupuncture are convinced of its effectiveness. Demand for acupuncture is growing, not waning. Its safety record trumps that of drugs and epidural steroids. Although it cannot fit neatly into the box Western science has set up as the only acceptable gold standard—randomized, double blind, placebo-controlled study—neither can surgery. Let us explore what is known about it.
Frequently Asked Questions about Acupuncture
What are acupuncture channels or meridians 
?
I have puzzled over what acupuncture channels or meridians are for years. Do they represent the vascular system? While most channels run vertically throughout the body like the circulatory system, their course and interconnections are not the same as the circulatory system. Do channels represent the nervous system? While acupuncture points 
often fall along some part of peripheral nerves, their channel pathways do not correspond to nervous system pathways. How each channel is connected to a specific organ has also baffled me. For instance, why do we use a point along the Large Intestine channel located on the hand to treat facial pain?
A review of the history of acupuncture might shed some light. Acupuncture was discovered by serendipity. In ancient times, the Chinese found that sometimes when they accidentally struck or injured a certain point on the body, it seemed to relieve certain conditions. I can imagine how a warrior, having been struck by a spear or arrow to his back, might have awakened the next morning and realized that his nagging back pain had disappeared.
With some conditions, they found that pressing on certain locations on the body caused pain. These locations were called ashi 
points. “Ashi” literally means “ah, yes,” an exclamation I often hear when I examine patients and press on a sore spot, which I would then acupuncture. When these points were stimulated by either pressure or massage, punctured with animal bones, or warmed with heat by holding burning mugwort leaf 
near them, the condition seemed to improve. Stimulating a certain point on the lower leg (St 36), for instance, relieved stomachaches. Pressure on a point on the hand (LI 4) relieved toothaches. Some of these points, we now know, correspond to Western trigger points. Other points are known to conduct electricity better than their surrounding tissue, and anatomically they often coincide with points on peripheral nerves; still others coincide with nerve roots as they come out of the spine. The observation that stimulating certain locations on the body surface had a therapeutic effect on certain conditions was first recorded in 300 BC in the Inner Classic 
a compilation of medical teachings transmitted orally as early as 2674 BC and put into writing in 300 BC). The ancients deduced that somehow these reactive points on the body surface are connected to remote parts of the body and to internal organs through pathways. With only a rudimentary knowledge of anatomy, TCM healers devised their system of mapping these pathways and called them channels or meridians. It is as if someone, looking at the doors and windows on the outside of a house, mapped its floor plan.
The primary channels number one to twelve. Each bears the name of the organ to which it is connected. Pathways along the back were named after the six fu (hollow) organs, and are classified as Yang. Those in the front of the body are named after zhang (solid) organs, and are classified as Yin. There are only five zhang organs, but that did not pose an insurmountable problem for the Chinese. Just as they added an extra season to fit the Five Phases theory (see chapter 4), they simply added one more organ, the Pericardium, so that the primary Yin channels also totaled six. Later, two more channels, the Conception channel, traversing the front midline of the body, and the Governing channel, traversing the back midline, were added. Some points not on the original twelve channels were later found to have therapeutic effects on internal organs. Additional channels were then mapped, and these were called the Miscellaneous channels, Divergent channels, Connecting channels, and Muscle channels. With time, more points with therapeutic effects were found, and these were called Extraordinary Points.
Fig. 7a. Yin Acupuncture Channels.
Reprinted with permission of Eastland Press (O’Connor 1981 centerfold)
Fig. 7b. Yang Acupuncture Channels.
Reprinted with permission of Eastland Press (O’Connor 1981 centerfold)
Fig. 8. Ear Acupuncture Points.
Reprinted with the permission of Eastland Press (O’Connor and Bensky 1981, 478).
Fig. 9. Diagram of points on the hand corresponding to the midline of the back.
Koryo Hand Therapy, 1997. Reprinted with the permission of Dan Lobash, Ph.D., L.Ac., Hemet, California.
The Western way of naming acupuncture points by their sequential number along channels is rather dull and unimaginative when compared to the Chinese names, which are descriptive and paint a word picture of the points. The acupuncture point below the lateral malleolus (the outer anklebone), named Kunlun, is one I frequently used when treating lumbosacral disc disease with pain radiation to the leg. Kunlun is the name of the mountain range separating Xinjiang Province from Tibet. When they looked at the protuberant anklebone, the Chinese saw a mountain. Anyone would agree that the name Kunlun is far more interesting than “Urinary Bladder 60.”
Do these points on the skin actually connect to the internal organs along a pathway called a channel? It is difficult to determine. We need to keep in mind that some TCM organs represent physiologic systems rather than actual organs. An acupuncture chart will show channels traveling to organs like the liver, kidney, and spleen. Are the channel maps actually depicting an anatomical pathway leading to various organs, or are they just showing that the acupuncture points influence the physiologic systems that these organs represent? My best estimation is that some channel pathways, such as the Conception Channel that travels to the reproductive organs, are anatomical, while others are like diagrams pointing to what physiologic systems are affected by the acupuncture points on the channel. Shen Men 
(Heart 7), for instance, a point on the Heart Channel situated on the ulnar nerve at the wrist, is commonly used for sedation. The Chinese translation of Shen Men is “spirit door.” The TCM Heart actually represents the nervous system. Points on the Heart Channel are not necessarily for treating cardiac problems.
What is even more confounding is that acupuncture points used to treat diseases pertaining to an organ are not necessarily located on that organ channel. To treat constipation, logic would guide you to find points on the Large Intestine channel. Actually, the best points for constipation are found on the Stomach channel. The best point for treating nausea, instead of being on the Stomach channel, is on the Pericardium channel. For treating urinary bladder problems, the best points are not found on the Urinary Bladder channel but on the Stomach and Conception channels. I have concluded that it is more expedient to learn which acupuncture points benefit which condition than to try to select points on the basis of channels alone.
What are the various types of acupuncture?
Body acupuncture was established during the third century BC. Since then, acupuncture microsystems have been discovered. These microsystems are representations (somewhat like maps) of the entire body on various body parts such as the ear, the hand, and the scalp. Acupuncturing the appropriate points on these body parts can also have therapeutic effects. Of these, I have used ear and hand acupuncture.
Ear Acupuncture: Chinese medical literature mentioned needling the ear to treat diseases as early as the Tang dynasty (AD 618–906). But it was a French physician named Nogier who expanded on this concept and developed a comprehensive system of ear acupuncture in the 1950s. A map of the entire body can be found on the ear. This map is laid out like an inverted fetus. In general, points for the head are located around the ear lobe; those for the feet, at the top of the ear. The Chinese used a standard map (see fig. 8), but the French have taken this to a higher level. They opine that the map can vary for different individuals, and they use intricate methods to determine which map a particular person has. The average acupuncturist, however, either by using a standard ear map and an electrical point detector, or by observing the location of skin changes on the ear, can determine which points to needle. I was amazed that I could see actual dryness and peeling of the skin over an Ear point representing a diseased area in the body. Asthmatics, for instance, often have skin changes over the Lung point. Some acupuncturists use ear acupuncture exclusively. I often combined ear acupuncture with body acupuncture for synergy.
For addictive behavior, acupuncture can be effective in relieving withdrawal symptoms but does not alter behavior. There is a Hunger point on the ear, but obese patients rarely overeat because of hunger. So I tell patients that acupuncture will not make them change their lifestyles but can help them maintain new ones when they have decided to change. I used to insert an indwelling needle on the Ear Shen Men point to help alleviate withdrawal symptoms when patients decided to stop smoking, but I worried about potential infections. Later, I taped small beads on that point. Much later, I showed the patients where the point was and taught them to pinch it themselves when they had a craving for a cigarette. One patient, for whom I prescribed the nicotine patch as well as this technique, was so afraid of the side effects of the patch when she read the package insert that she decided to just pinch her ears, and was able to stop smoking.
Korean Hand Acupuncture: Korean hand acupuncture is another twentieth century development. Like so many other advances in medicine, it was discovered by serendipity. The founder of this technique, Dr. Tae-Woo Yoo, wrote that one Autumn night in 1971, he was awakened from sleep by a pain in the back of his head so severe that he could not sleep. Somehow he found himself staring at the back of his middle finger, and it occurred to him that there might be a point there to treat the pain. He proceeded to stick his finger with the tip of a ballpoint pen and indeed found a particularly painful area. He then inserted a needle into this sensitive spot and amazingly the headache was gone (1988, 23). Dr. Yoo went on to map a representation of the body on the hand and was even able to find meridians (channels) on the hand corresponding to the body meridians. In a course on Korean hand acupuncture, I learned that because there are active acupuncture points on the hand, various things we do with our hands could actually affect our health. Stimulating acupuncture points on the hand, just as on the body, can bring about physiological changes as profound as lowering blood sugar. A serious hand injury, depending on its location, can affect a distant body part. The instructor told the story of a woman who dated the onset of an intestinal disturbance to the time of her marriage. Her hand acupuncturist found a relationship between the wedding band she was wearing and her malady. This system is quite fluid. Needles need not be the only form of stimulation. Metal pellets can be taped to the hand. Treatment can also be in the form of various types of metallic rings, rendering therapy painless and therefore useful for pediatric patients. Some acupuncturists have used diode rings to help patients with attention deficit/hyperactivity disorder. When I consider all the possible microsystems that have yet to be discovered and how intricate the body is, I can’t help wondering if the body-piercing fad will have an effect on health.
How does acupuncture work?
With progress in technology, the answer to how acupuncture works is still evolving. New imaging techniques show that acupuncture actually causes functional changes in the brain and nervous system. The prevailing theory of how acupuncture works is neurohumoral. This means that the acupuncture needles send messages via the nerves to the spinal cord and to the brain where hormones are secreted. Needling acupuncture points stimulates the body to produce potent painkilling hormones called endorphins. I have often observed this endorphin-type response after the first treatment. Patients usually arise from the treatment table relaxed, and they may have even slept through the twenty-minute session. There may be an initial relief of pain, but that relief lasts only three to four hours. Some patients report feeling drowsy, and in some rare instances they may even have slight nausea. This kind of response is strikingly similar to that seen with narcotic analgesic drugs. Naloxone, a drug known to reverse the effects of narcotic painkillers, can also reverse the pain-relieving effects of acupuncture.
Patients who respond well to nonsteroidal anti-inflammatory drugs most often respond well to acupuncture. There is some evidence that needling also stimulates the pituitary gland to secrete ACTH, which in turn stimulates the adrenal gland to produce steroid hormones, known to be anti-inflammatory. There is a difference, though, between the responses to acupuncture and those to steroids. We know that when a patient whose condition responds to steroids stops the drug, the condition returns. After a course of acupuncture, however, the effect seems to be lasting. Therefore, the explanation of how acupuncture works must involve more than just its neurohumoral effect.
I was taught to feel for temperature changes on the skin to diagnose diseased areas. This simple clinical observation precludes doing expensive thermography testing, sometimes used in difficult cases to show temperature changes in diseased areas. A diseased area may be cooler than its surrounding tissue, indicating decreased circulation to the area. TCM often describes this as “blocked Qi.” An inflamed area will be hotter than its surroundings. When tissue is injured or inflamed, pain-causing chemicals called cytokines accumulate. With time, the circulation will normally remove the cytokines. But if the clean-up mechanism that should normally follow inflammation is impaired or delayed, there is prolonged swelling and pain.
In general, previous steroid injections tend to diminish the effect of acupuncture. When steroids are injected into an inflamed area, the inflammation will decrease because the steroid constricts blood vessels and diminishes blood flow to the site. The downside to steroid injections, though, is that the decreased blood flow can compromise the healing process, and the injected steroid can cause muscles and tendons to become weakened, resulting in tears and ruptures. This is the reason why Western doctors put a limit on the frequency of local steroid injections. Many of my patients told me about their experiences with steroid injections. Initially the injection seemed to be effective, but when the condition recurred, subsequent injections were no longer effective. If the injection was close to the skin surface, patients often pointed out the typical cold white scar over the injection site.
In contrast to steroid injections, acupuncture increases blood flow to the area of the body being treated, and thus promotes healing. After inserting acupuncture needles, I would see the skin around the needle turn red and become warm. Acupuncture creates tiny zones of trauma, which stimulate blood flow to them. The increased blood flow helps bring nutrients to diseased areas that were previously cold and deprived of blood. TCM practitioners called it moving Qi. Acupuncture also helps hot inflamed areas by allowing the improved circulation to remove cytokines, responsible for inflammation, from tissue. When patients asked me whether they should try the steroid injection their Western doctors recommended before trying acupuncture, I usually advised them to try acupuncture first.
Some patients may have a two-phase response to acupuncture. Their pain may initially increase and then start to diminish after a day or two. During the initial worsening stage, the increased blood flow to the area may cause further congestion before the cytokines are mobilized. For other patients, the initial worsening is followed not by improvement but only by a return to their baseline pain. Their circulation may be inadequate to clear the cytokine accumulation in the tissues, and acupuncture may not be effective for them.
Does acupuncture cure or only mask pain?
Calling a treatment a cure may be a matter of semantics. The HIV-AIDS epidemic has changed our understanding of the word “cure.” When the body’s immune system is decimated, are there any curative antibiotics, or should we view antibiotics as a treatment that controls growth of bacteria to allow the body to conquer the invaders? Acupuncture improves the blood flow to an injured or malfunctioning area to help the body heal itself. For degenerative diseases, acupuncture neither reverses nor halts degeneration. Patients with conditions such as degenerative disc disease or degenerative arthritis who improve after the initial course of therapy do better with booster treatments at regular intervals.
Mrs. N. came to me barely able to walk even with the help of a walker. She was in agony with back and leg pain from lumbar spinal stenosis. After seven semi-weekly treatments, she improved greatly and was able to walk using just a cane. I felt gratified when I saw her strutting to the local supermarket. After a month without treatment, she returned, again a basket case. I then had to start over with weekly treatments and then space regular boosters at three-week intervals to maintain her improved state.
Another patient, Mr. A., who was seventy-three, gave a history of awakening on Thanksgiving Day with severe right leg pain. Two days later, he was doubled over in pain and walked with a limp. A CT scan showed lumbar spinal stenosis. Neither a steroid epidural nor sixteen chiropractic manipulations helped him. Four months later, when Mr. A. came to see me, he was able to walk only fifty feet and stand for only twenty minutes before pain in his leg set in. His hobby was deep-sea salmon fishing, but he was unable to continue because standing while catching fish caused pain in his leg. After four weekly treatments, Mr. A. was able to walk five blocks and remain standing for forty minutes. After eleven treatments, he went deep-sea fishing and was able to catch a thirty-pound salmon. After the fifteenth treatment, he came for a booster at monthly intervals, and he was able to bring me smoked salmon from his catch.
Is the response to acupuncture just a placebo effect?
Double-blind studies used in drug research are difficult to apply to acupuncture. Patients know whether they have been needled or not. The closest investigational method is to use sham acupuncture points. Some skeptics remain unconvinced that acupuncture therapy is effective.
Kathy, a pet hospital administrator, came to see me for treatment of her asthma. Her symptoms were quite severe, so I recommended not only acupuncture but also herbs. I gave her my routine warning about the negative aspects of herbal therapy: the time required to prepare them, the cost, and the bad taste and smell. I was surprised when she said she knew all about that. A veterinarian in her hospital used complementary care, both herbal therapy and acupuncture, for animals. She said that during high allergy season, the hospital was swamped with dogs whose owners sought acupuncture for their pets. The results were good. I asked her how they were able to keep the animals still for the treatments. Interestingly, they did it by pre-medicating the animals with a homeopathic remedy called Calming. That, along with having the owners present, seemed to work well.
The fact that response to acupuncture is as effective in animals as it is in humans would certainly argue against a placebo effect. Studies also show that during acupuncture there are measurable humoral (natural chemicals in the blood) changes and actual blood flow changes in the brain.
Do different people respond differently to acupuncture?
It did not take me long to discover that not everyone responds to acupuncture. Early in my career, my Aunt Pansy referred her close friend Jennie to me. Aunt Jennie was in her eighties and suffered from shoulder pain. When I examined her, she had typical tendonitis of the shoulder, involving the rotator cuff. She had tenderness over the location of the rotator cuff, and signs of impingement where the pain worsened when she tried to raise her arm above her head. I had treated other patients with the same problem successfully, so I readily recommended acupuncture. Desperate to find relief, Aunt Jennie agreed to try it. The morning after I treated her, Aunt Jennie called me to say her shoulder pain was even worse. I was chagrined and embarrassed at not being able to help my aunt’s friend. I instructed her to ice the area and prescribed an anti-inflammatory, advising her not to get any more acupuncture. I then realized the truth of Dr. Lai’s precept: acupuncture only redistributes energy. When the patient’s energy is low, if not replenished, acupuncture will not be effective. Aunt Jennie, a frail octogenarian, may have had a circulatory system inadequate to the task of carrying away the pain-causing cytokines. In general, I found that older patients with multiple medical problems were less likely to respond to acupuncture. In such cases, they should be pre-treated with herbs to improve overall energy. This concept was difficult to communicate to patients, who were eager for relief and came expecting acupuncture to be their answer. Many also came with the Western purist mindset that one should try only one mode of treatment at a time in order to know which one actually helped. Convincing them to think outside the box was difficult.
Some cases are too advanced from an anatomical perspective for acupuncture to be effective. With a herniated disc or spinal stenosis, important determinants are the size of the herniation and the degree of stenosis influencing how severely the nerve root is being pinched. In spinal stenosis, the opening between two vertebrae where the nerve root emerges is narrowed. The cause may be that the disc, which is situated like a washer between the two vertebrae, has degenerated or herniated, resulting in some swelling and inflammation, blocking the opening. Acupuncture acts to widen the opening by decreasing the disc inflammation and by relaxing the tightened muscles that hold the vertebrae together. If the opening is extremely narrow, acupuncture’s effect may not widen the opening enough to relieve compression of the nerve. Acupuncture has often been recommended for stroke rehabilitation. Here again, researchers have shown that the response to acupuncture depends on the size and location of the brain tissue injured. Margaret Naeser, Ph.D., found that among stroke patients with arm and leg paralysis, those who respond to acupuncture have some preserved isolated finger movement, and their brain CT scans show the size of the infarct (area of dead cells) to be less than 50 percent of the periventricular white matter (an area of the brain). Patients who have larger sized strokes did not respond to acupuncture (Naeser 1996).
When I am asked whether acupuncture is effective for a particular condition, I no longer give a glib general answer. Cases often need to be individualized. The sharing of experiences by acupuncturists and further research can offer important and useful guidelines.
Conditions Treatable with Acupuncture
Whenever patients came to me seeking acupuncture, I relied on my Western understanding of their disease process. I required that patients either have a primary physician overseeing their care, or at least have a Western diagnosis. There is evidence that about 80 percent of patients who respond to acupuncture begin to improve within three treatments. With this in mind, I would then proceed without initial expensive tests. If, after the initial three treatments, there was no improvement, there was still time to order tests. If the patient’s condition began to improve, further testing was not needed. Often, with our Western mindset, we do not think immediately of acupuncture as a viable option when first presented with a malady. Over the years, I have found that there are some common conditions for which acupuncture has proven to be a good first option.
Musculoskeletal Pain
Soft tissue injuries and inflammation such as cervical and lumbar disc disease, tendonitis, tennis elbow, plantar fasciitis, carpal tunnel syndrome, and tension headaches all respond well to acupuncture. In my acupuncture practice, treating back pain was about as common as treating colds. The earlier I began treatment, the more rapid the response. If I treated a young robust patient with a recent back injury, he or she was usually able to return to work within a week, and the symptoms completely resolved in a matter of three weeks. Such acute cases responded far more quickly than chronic back pain cases because the vicious cycle of pain and muscle tightening had not yet set in. When there is pain, the muscles tighten to splint the diseased area, causing more pain and further muscle tightening.
For muscle spasm, acupuncture may work in two ways. The needling improves circulation to the muscles and causes them to relax. Needling muscles also initiates a reflex cycle of contraction followed by relaxation (Gunn 1997, 109–112) This phenomenon is similar to what happens when the doctor taps the knee to evaluate reflexes while the patient is in a sitting position. When struck at the knee tendon, the thigh muscles contract, causing the knee to pop out in extension. What naturally follows is a relaxation of the thigh muscle causing the knee to then fall back down into the resting flexed position. The technique called Intramuscular Stimulation (IMS), originated by Chan Gunn, M.D., is directed at needling tense muscles. I trained in it in Canada and found it very effective, but when I tried to use it in the United States, I found that my American patients were not such willing subjects because the technique is more painful than conventional acupuncture. I therefore used a modification of it. Instead of needling multiple tight muscles many times to achieve the relaxation, I directed one needle to an area of muscle tightness and used electrical stimulation to enhance spreading of the stimulation.
An interesting aside is that Dr. Gunn taught that unilateral tinea pedis (a fungal infection known as athlete’s foot) often responded to needling at the lumbar spine. He explained that when nerves emerging from the lumbar spine are pinched, the nervous and circulatory flow to the feet are diminished, and that leads to lowered immunity to the fungus. With needling, pressure to the nerve is relieved and blood flow becomes normalized. As a result, skin immunity of the foot on that side is restored. I had a patient who complained of lumbar back pain with sciatica. I treated her back problem with acupuncture and witnessed fulfillment of Dr. Gunn’s prediction. When her back pain was relieved, she told me that the longstanding fungus skin infection of the foot on that same side also cleared.
Recently, allopathic medicine has been rethinking the origin of arthritis. Perhaps arthritic pain begins with muscle tightening. Joints are the interface between two bones insulated by cartilage, connected by ligaments, and held together by muscles. It is possible that joint inflammation actually begins when the muscles around the joint tighten, causing more friction between the cartilages covering the two bones. Part of the effect of acupuncture is to relax the muscles surrounding joints thereby reducing this friction.
Reports have emerged showing that the drug Botox, derived from Botulinum toxin, which causes muscle paralysis, can be injected into back muscles to reduce pain. Actually, acupuncture needles have been achieving the same effect for thousands of years at far less cost. Another recent study looked at Botox’s effect on the flexion contracture of wrist and hand muscles in stroke victims (Brashear, et al. 2002). With a stroke, the brain’s function of balancing flexion and extension of limbs is lost, and the stronger flexor muscles become dominant. Botox was injected to see if the flexor muscles could be relaxed to normalize the limbs. The study showed improvement not only in the Botox subjects but some improvement in the placebo subjects as well. A plausible explanation for the response in the placebo subjects is that their muscles were poked with needles while receiving the placebo injections. Those needles, to some degree, caused the muscles to go through contraction followed by relaxation.
Upper and Lower Respiratory Problems
My later experience with acupuncture taught me the importance of keeping an open mind. On my first day in ACTCM class, when the instructor suggested that sinusitis could be cured with acupuncture and herbs, I scoffed. Since then, I have used acupuncture frequently to help reverse congestion in both the nose and the eustachian tubes. People frequently travel by air with nasal congestion caused by either colds or nasal allergies. Upon the plane’s descent, the passenger feels pressure or pain in his or her ears because the eustachian tubes, which normally equalize air pressure between the ears and the outside atmosphere, are constricted from swelling in their walls. The same process that causes a stuffy nose with colds or allergies occurs in the eustachian tubes. After the flight, the unequalized pressure in the eustachian tubes can cause the patient to feel as if the ears are plugged for a long time. Acupuncture enhances blood flow to the eustachian tubes and thereby reduces the congestion and widens the passageways.
When treating nasal allergies, I used a similar technique to open up the nasal passages and added immune-boosting acupuncture points such as LI 4 and St 36 (Joos, et al. 2000). To treat asthma, I have used similar points coupled with points that enhance breathing, such as Lu 7 and UB 13. These points lower Qi and likely dilate bronchial tubes. In most of these cases, my therapy also included herbs to replenish energy.
Autonomic Dysfunctions
The autonomic nervous system, responsible for controlling so many internal organ functions, can often be regulated using acupuncture. One physician acupuncturist colleague told me long ago that he had successfully used acupuncture to treat pancreatitis. Usually the points used in these treatments are remote from the organ, and the remoteness of the points has promulgated an aura of mystery around this Eastern approach. I believe that there is a scientific explanation. When I trained in anesthesiology, I was taught that to perform spinal anesthesia for knee surgery, we needed to block the nerves not only up to a level where the sensory nerves to the knee emanate from the spinal cord but to a much higher level. This is because there are some sympathetic nerve fibers running along the peripheral nerves to the knee, and if the spinal anesthetic missed those nerves as they emerged from the spinal cord at a higher level, the patient would have pain during surgery. Many acupuncture points are located on peripheral nerves. It is probable that there are autonomic nerves accompanying these peripheral nerves, not completely mapped out in our anatomy books. This could explain why acupuncturing points on the limbs influence heart rate, bowel motility, and uterine contractions. With conditions involving organ dysfunction, such as irritable bowel or constipation, acupuncture stimulates the nerves supplying the area in order to normalize the function. In contrast, Western drugs act unidirectionally; one drug is used to slow down intestinal motility when it is too fast, and another drug is used to stimulate the bowel when it is too slow.
Scar Tissue
Treating scar tissue using Western methods poses a challenge. With reoperation, the trauma of the surgery often leads to further scarring. Steroid injections help sometimes, but not always. Acupuncture, by the same mechanism of improving blood flow to an area, can successfully shrink scar tissue. Mr. W., age seventy-five, had right knee pain for three years following a freak accident when he fell on an open knife, lacerating that knee. The laceration was sutured, but the wound re-bled, and required re-suturing. Since then, Mr. W. had suffered from chronic right knee and right hip pain. Sharp jabbing pains, beginning in the knee and radiating up his thigh, often punctuated the chronic pain. He walked with a limp. Mr. W. underwent arthroscopic exploration seven months before consulting with me, but his symptoms had not improved with this procedure. I felt that the jabbing pain was caused by scar tissue, and I acupunctured his scar as well as the knee joint, hip joint, and lower back. After ten treatments, Mr. W. greatly improved and was able to walk ten blocks. Seven months after beginning treatment, he was able to walk three miles without pain, and the spontaneous jabbing pains disappeared. He then was maintained on monthly therapy.
Another patient, Mr. L., age fifty-five, had undergone a vasectomy. The surgery was complicated by an infection, causing pain in his right groin. The surgeon reoperated and removed a granuloma (an excessive growth of tissue the body forms to isolate foreign material commonly seen as a reaction to splinters). After the second surgery, Mr. L. continued to have pain in his right groin, which was tender when it was bumped; the pain worsened after intercourse. I treated with weekly acupuncture, and the pain resolved after about eight months of treatment. It occasionally recurred, but one or two booster acupuncture treatments easily controlled it.
Headaches
Treating vascular headaches such as migraines has been challenging. The classic explanation of how these headaches develop is that there is an inherent instability in the blood vessels in the brains of migraine sufferers. When there is a temporary decrease in blood flow to the brain because of this instability, a message is sent to the heart to pump more blood to the head. The increased blood flow to the scalp is what causes the headache. Drugs that specifically constrict this reflexive increase in blood flow are sometimes effective for treatment. In my experience with acupuncture, using classic points recommended in textbooks has not been very successful. In later years, if a patient’s headaches responded to sumatriptin, a drug specific for vascular headaches, I would not consider treating him or her with acupuncture.
Robert, the husband of one of my patients, was such a case. Robert’s wife told me he was suffering from severe cluster headaches, and was taking sumatriptin as regularly as vitamins. I told her that I doubted if I could help him. Despite my gloomy forecast, one day, in desperation, he came to see me. He said that his symptoms were related to the weather. They were much worse during the rainy season. During the drought we had in San Francisco, he was headache-free. He found sumatriptin helped, but he became dependent on it. When I examined him, the muscles in his neck were extremely tense. It then occurred to me that the worsening of his symptoms during rainy weather might be similar to the phenomenon seen among arthritics who can sense when it will rain more accurately than the meteorologists. I wondered if his neck muscle tension might be an accompaniment of some degree of degenerative cervical disc disease. When I acupunctured the tense muscles and advised Robert to improve the ergonomics at his computer workstation, his headaches resolved and he stopped taking sumatriptin. My experience with his case has taught me that not all vascular headaches are purely vascular in origin. If there is a muscle tension component to the headache, I have found acupuncture can help. In a 2002 issue of Time magazine devoted to headaches, the authors, quoting research findings, also suggest that the prevailing explanation for migraines may be too simplistic (Gorman and Park 2002, 79–82). Headaches may result from many factors.
Reflex Sympathetic Dystrophy
Carrie, in her thirties, sustained a severe hand injury while water-skiing. Some bones were broken and some tendons were severed. After multiple surgeries, she suffered from chronic pain accompanied by coldness and pallor in her hand called sympathetic dystrophy (also known as causalgia). In these cases, there is an excessive sympathetic response to the injury. The blood vessels to the injured area constrict, resulting in diminished blood flow to the area, a very difficult condition to treat. I acupunctured a point in the armpit (Ht 1) in the location of the brachial plexus and points (Baxie) between her fingers where the interdigital nerves emerge. With the treatments, her hand warmed up. In the past, as an anesthesiologist, I used to inject local anesthetic into these points to numb the nerves to the hand or fingers for surgery. For this condition, I did not need to inject a drug. Just needling the points proved very effective. Since treating Carrie, I have used this approach successfully on other patients with reflex sympathetic dystrophy.
Reproductive Tract Disorders
One of my first successes while still a student at ACTCM was using acupuncture to treat an ER co-worker’s epididymitis. In my integrated practice, there were many more women than men seeking acupuncture for reproductive tract disorders. Perhaps it is because information about acupuncture has been more widely publicized for women’s health than for male reproductive problems. Nevertheless, I believe acupuncture is effective in treating reproductive tract problems of both genders. I have treated many cases of menstrual pain, female infertility, and the pain from endometriosis, a condition where the lining of the uterus somehow is implanted outside the uterus. In fact, whenever a member of my office staff had menstrual pain, I would acupuncture her and get her back to work with full relief within a half hour.
There is a point on the medial aspect of the lower leg, San Yin Jiao (Spleen 6), that I used frequently to treat reproductive tract disorders. The location of the point is actually on the path of the posterior tibial nerve. One day I used this point to treat a leg condition. After I inserted the needle, the patient exclaimed that she felt the sensation in her genital area. Urologists have successfully used electrical stimulation of this same point, Spleen 6, to treat urinary bladder dysfunction (Klinger, et al. 2000; Mc Guire 1983). The posterior tibial nerve actually is a nerve supplying the muscles to the leg and foot. How can it affect the genitourinary tract? The genitourinary tract is supplied by the pudendal nerve, which shares the nerve roots S2 and S3 with the posterior tibial nerve. Urology researchers believe that stimulating the posterior tibial nerve sends an antidromic impulse (going in a direction opposite to the normal) up to the S3 nerve root, which then travels down the pudendal nerve (Mc Guire 1983). Antidromal nerve conduction is another explanation of how stimulating distant acupuncture points can affect internal organs.
Acupuncture in a Third-World Setting
Medical missions have been my passion ever since I became a Christian while an undergraduate at the University of California, Berkeley. I participated in many projects in various parts of the world, including Taiwan, Macao, Xinjiang, and Yunnan, China. My frustration was seeing a need but not being able to meet it with Western medicine. Without the infrastructure I was accustomed to, I could not apply what I did as a Western practitioner to situations in impoverished countries. When taking a history to diagnose diseases of the colon, I was taught to ask the patients what their stools looked like: were there any tarry or any pencil-slim stools, and so forth. How was I to do that when people use outhouses? Many Western diagnoses are based on laboratory tests. Many places I visited had no labs.
When I heard that there would be a new opportunity to do medical mission work in a town called Tokmok in Kyrgyzstan, and that the clinic soon to be opened would be providing acupuncture as one of the services, I volunteered to go. I first went to observe the building of the clinic in the year 2000, and subsequently returned for six- to eight-week stints in 2001 and 2002.
Kyrgyzstan is in Central Asia. To its north is the oil rich country of Kazakhstan. To its southeast, the beautiful snowcapped Tian Shan (Heavenly Mountain) range separates it from Xinjiang, China. Directly south, Tajikistan separates it from Afghanistan. And to its west, is Uzbekistan, whose city, Samarkand, was depicted in the Arabian Nights. It was part of the Soviet Union until its dissolution in 1991.
The population is made up of occidental Russians; Central Asians from Kyrgyz; Uzbek and Tajik tribes; and Dungan people, who are originally from the Chinese provinces of Shanxi and Gansu. Their ancestry can be traced to mixed marriages between Arab Silk Road traders and the Hui inhabitants of these two provinces. The Qing dynasty emperor ordered them to leave China because he suspected this mixed-race Muslim group of being insurrectionists. They fled westward, crossing the formidable Tian Shan mountain range. Survivors of this arduous migration settled in Kazakhstan and Kyrgyzstan.
In affluent Western countries, fast foods and physical inactivity have led to the diseases of diabetes, obesity, and hypertension. In Central Asia, the same diseases are prevalent, but the source is different. The people’s high consumption of carbohydrates and saturated fats is a habit originating from their past nomadic lifestyle. Many raised sheep and ate lamb. A family of modest means once invited me to lunch. From the taste, I could tell that the rice pilaf served was cooked in mutton fat. Harsh winters required the people to preserve fruits and vegetables. Bread and jam became common staples. Tea is commonly sweetened with jam. Whenever I made a house call, I was regularly invited to sit at the family’s low dining table situated on a platform, and have tea with jam before leaving. While diseases in Central Asians are the same as those commonly seen in the West, the lack of resources in this region of the world dictated a paradigm shift in order to treat them. Because of their cultural mix, the people of this region proved to be receptive to Eastern health remedies, and they readily accepted acupuncture.
Luke Services International bought a large restaurant that had gone out of business and converted it into the Hope Clinic. Some of the walls did not extend all the way up to the ceiling, and some of the rooms had mirrors on the ceiling. To avoid providing a strip show, we had to be careful which rooms to use when examining patients.
At the clinic, there were two permanent full-time Russian physicians. Nadia was a cardiologist who spoke English, and Katia was a retired pediatrician. I served mainly as the clinic acupuncturist. With so few resources, I found acupuncture very useful and began employing it in ways I had never imagined before.
Hot Flashes
Barbara was forty-three and teaching English in Kyrgyzstan. She had missed about three periods and was suffering from severe hot flashes. Ventilation was poor in the room where she held classes, and the temperature was about 90 degrees F. Even before the many negative research studies surfaced, I was never a proponent of routine estrogen replacement. For extreme symptoms such as Barbara’s, however, I have prescribed it for short-term relief. I advised her to inquire about hormone replacement therapy when she returned to the United States. Barbara said that Nadia had prescribed a local plant estrogen formula for her, which helped some, but it failed to bring adequate relief. Synthetic estrogens were unavailable locally. Having very little to lose, I decided to treat Barbara with acupuncture, using the Endocrine point on her ear. The results were dramatic. The next morning, she reported she was able to sleep through the entire night without a single hot flash awakening her. In her classroom, the students noticed that she no longer needed to use a stack of paper towels to wipe off her perspiration.
On one of the hottest days of the year, Barbara, our local guide, Misha, and I went to the museum in Bishkek, the capital city. I found the heat overpowering. Misha, who was a native, commented that even he found the heat on that July day unbearable. Barbara said, “I don’t know what you two are talking about. I feel just comfortable.” Her comment made me decide to cut back on the frequency of her treatments from daily to three times a week. At the end of six weeks, Barbara finally had a period, the first in three months. Two years later, and back in the United States, I was in contact with her. Her periods had returned to near normal, and her hot flashes were gone. For Barbara, acupuncturing the Ear Endocrine point was effective because her ovaries still retained function. For older women, further into menopause, stimulating weaker ovaries might not be as effective.
Menstrual Irregularity
Olga, a patient in her forties, had metrorrhagia (abnormally frequent menstrual bleeding). She was bleeding almost constantly throughout the month. I asked about her Pap smear and endometrial biopsy. Nadia assured me that Olga had had a gynecologic workup that ruled out cancer as a cause of the bleeding. In the United States, the treatment would be to prescribe hormones, often in the form of birth control pills, to regulate her bleeding quickly. With my integrated practice, I used herbs as well to improve circulation to the ovaries and stabilize the patient’s own hormones. With neither of these options available in Kyrgyzstan, I also ventured to treat Olga with acupuncture, using the Endocrine ear point. Remarkably, after two weekly treatments, Olga’s bleeding ceased.
Blocked Tear Duct
On another occasion, Barbara told me she suffered from tearing in one eye. I figured she had a blocked tear duct on that side. If we had been in the United States, I would have sent her to an ophthalmologist who could insert a probe into the tear duct to clear the obstruction, but that option was not available. I thought about the anatomy of the tear duct, which dives from the inner corner of the eye into the nose. There is an acupuncture point called Bitong, meaning “clear the nose,” which is located near the bridge of the nose along the path of the tear duct. I decided to acupuncture that point to improve circulation to the tear duct area and allow it to open up, as I had done so often with eustachian tube blockages. I did it, and advised Barbara to drink plenty of fluids to encourage liquefying the contents plugging her tear duct. After one treatment, the tearing stopped, and Barbara became an even more ardent believer in acupuncture with both her maladies remedied.
Varicose Veins
Using acupuncture to treat varicose veins never crossed my mind until my trip to Kyrgyzstan, where the patients begged me to treat them. They were enthusiastic because another physician-acupuncturist who preceded me had treated varicose veins with good results. I was skeptical. My understanding of varicose veins was that the one-way valves in the leg veins leak because they are weak and do not close completely, that this was an irreversible structural condition, usually hereditary, and that the only solution was mechanical. You could either strip the leaky veins for cosmetic reasons, or use elastic stockings as a source of external pressure to assist the blood flow in the leg veins. At the urging of my local colleague, Nadia, who had witnessed the good results with acupuncture, I agreed to try. To my surprise, within three weeks I was able to help a patient with a varicose ulcer heal by using acupuncture. Even more astounding was that a patient whom I was treating with acupuncture for lower back pain pointed out that when his back improved, so did his varicose veins.
I rethought the matter and considered that perhaps weak, loose valves are not the only factor causing varicose veins. When I returned home to my anatomy books, I read that nerves supply veins just as they do arteries, but that the number of nerves supplying veins is fewer than those to arteries. If the vein walls are under nervous control, they can dilate and constrict similar to the way arteries change size. When the nerves to those veins are pinched or not functioning normally, as occurs with lumbar disc disease, the veins lose normal tone. Acupuncture for lumbar disc disease improves the vitality of the nerve supply to the leg veins and, therefore, restores venous wall tone. TCM practitioners would say that the acupuncture functioned to move Qi. I related my experience to Dr. Lai, and he said he commonly used acupuncture to treat varicose veins.
Nadia and I often compared notes on various subjects. She found varicose veins and varicose ulcers very common at Hope Clinic. I agreed with her but said I found the condition far more common among Russian patients than Kyrgyz or Dungan patients. Could it be because of the differences in their habits? Varicose veins and varicose ulcers result from the inability of the blood supplying the legs and feet to return to the heart adequately. The backed-up blood increases the pressure in the leg veins, causing them to bulge. The increased pressure also causes seepage of some blood out of the vein into the skin layer where iron from red blood cells deposits, causing ugly discoloration, and eventually the skin breaks down, forming varicose ulcers. The tendency for the blood to back up in the leg veins is worsened by gravity when the legs are in a dependent position such as with sitting or standing. Western habits such as that of sitting at a desk, using a toilet, and sitting at a dining table all tend to worsen varicose veins. Kyrgyz and Dungan people, like the Japanese, by contrast, ate at low tables sitting on the floor. The pressure in their leg veins was lower than that in their Russian counterparts, who sat on chairs with their legs in the dependent position much of the time. In addition, Kyrgyz and Dungan toilets were at ground level, requiring them to squat, a position that also reduces leg vein pressure. Nadia concurred. She had never seen the condition in these two ethnic groups. She pointed out an additional factor: they habitually prostrate themselves to pray to Allah five times a day. This posture also relieves leg vein pressure.
Burn Wound
One day, while I was treating a young Dungan woman for lumbar disc disease, my nurse, Sonia, noticed that the patient had a fresh burn on both buttocks. Perhaps because of modesty, the patient never mentioned it. She had fallen backwards into a tub of hot water. The diameter of the burn area was about 4.5 cm on each side. The location must have made urination and defecation very painful and uncomfortable. The clinic did not even have Silvadene, an antibiotic ointment for burns. Extrapolating from my experience treating varicose ulcers, I reasoned that perhaps acupuncturing around the burn site would accelerate healing by increasing blood flow to the area. I asked the patient to come daily, and I needled circumferentially around her burn wounds. The areas healed in two weeks with no infection.
Meralgia paresthetica
One of my successful experiences was with a patient who had meralgia paresthetica, a condition in which there is a well-defined area of numbness, about the size of a hand, in the front of the thigh. It is usually caused by compression of the lateral femoral cutaneous nerve as it emerges from the pelvis on the way to the thigh. The compression might result from excessively tight clothing or wearing objects that rest on the area where the nerve is. In the United States, I treated a meter maid who hung her phone from the waist, leading to compression of the area. With this patient in Kyrgyzstan, the cause was not completely clear because I could not get a very detailed history, but her symptoms were easy to diagnose. The treatment is to needle around the area where the nerve emerges. The acupuncture stimulates circulation to the area, taking away the tissue edema around the nerve. In my experience, treatment for this condition is simple and very effective.
Ankle Pain from an Old Injury
The mother of Masha, one of the nurses at the clinic, had broken her leg three times in the past. She had chronic ankle pain, and usually she could hardly walk by evening. Her ankle appeared quite deformed. I treated her ankle by needling where I thought the tendons and ligaments were strained excessively by the altered mechanics of walking. At the end of my stay, she asked Nadia to tell me in English that she was grateful because she was able to put in a full day’s work. She raised cows, as did many of the locals there. Usually, about five families would take turns cow sitting for each other. One person would watch all the cows, about twenty in all, as they grazed. Before her treatments, Masha’s mom could never take part in her neighborhood’s cow-sitting pool, but now she was a happy participant.
Ankylosing Spondylitis
One day Nadia told me that a man in his early thirties would be coming from a distant village to see me because of spine and chest pain. She suspected a condition called ankylosing spondylitis, an autoimmune disease that causes gradual fusion with consequent stiffness of the spine. I asked if his blood had tested positive for the HLA-B27 antigen commonly found in patients with this condition. She told me the test was unavailable. When I saw the patient, Sasha, he indeed seemed to have the condition. He had kyphosis (hunching) of his thoracic spine, pain along most of the length of his spine, and rib pain. I remembered treating one other case in the United States, without success, and was reluctant to try. Nadia said, “You have to try; you’re his only hope.” Under these circumstances, I agreed to try. I was surprised that after the first treatment, Sasha’s rib pain disappeared; after three treatments, although his bent-over condition had not improved, he had good pain relief. After Sasha’s four treatments, my time at Hope Clinic ended. I hoped I had taught Nadia enough to continue treating Sasha.
In Kyrgyzstan, with its ethnic diversity, I felt it easy to blend in. I was especially pleased when one day a Russian woman stopped me to ask for directions to the Umeda Café, which was the café next to the condominium where I was staying. I was able to tell her in my limited Russian, learned at San Francisco State University, “It’s not far. Just walk two blocks and it will be on your left.” She thanked me, and I felt proud of my Russian fluency and for being mistaken for a local. Kyrgyzstan is on the Silk Road, which has come to mean the path where Eastern and Western cultures intersect. I brought back with me an understanding that in a part of the world where expensive Western medical resources are unavailable, an ancient Eastern remedy, acupuncture, can benefit many people.