The limits of Acupuncture : the case of Lung Diseases.
Baron Beyens, MD, Brussels.
Through more than 2000 years, the chinese medical system has evolved. It started
even before, as a mixture of demonic medicine, exorcism, shaman rituals and dances,
the use of amulets to protect and gifts on the altars of the gods hoping for cure or
relief. It used analogical references and symbolic comparisons. It projected the power
of Heaven onto the weakness of humanity, the mysteries of nature onto those of the
human organism. This proto scientific medicine lasted for centuries and, in some
ways, because of the strength of permanence, the respect for the ancestors, and the
inertia of a conservative civilisation, it still exists nowadays in the daily life of many
chinese.
It seems that acupuncture, considered as a fairly structured medical system, from
what we can see in the Nei Jing, existed before the rising of a theoretical and
complex system called TCM. But the Nei Jing does not mention any medicine,
whether herbal, animal or mineral extract. The oldest book of TCM of which we
possess copies, the Sang Han Lun, barely mentions a few acupuncture points. As if
the two systems ignored each other, as if they followed their own path without
mingling with the other. Then, but when we do not know, TCM became more
organized, it was no more just a list of medicines to put together for such and such a
condition, but slowly built up into a very sophisticated arrangement of thoughts,
stemming from observation, reasoning and experimenting. This process took time, a
very long time, with many wanderings and deviations, different schools and opinions,
opposite interpretations and commentaries of old texts, till it reached the theoretical
and practical corpus used now in chinese communities.
Along the line, but when we do not know, the acupuncture system based on the
meridians was incorporated into what had become a much more elaborated approach
of health, disease and treatment known as TCM, the medicine of the Middle
Kingdom, Zhong Yi. It was so well integrated as to grow within its larger system, and
become part of it, as if it had always been like that.
The peculiarity of a medical system, of an ethno medicine, is to be complete in itself.
The web of its reasoning, the pathway from examination to treatment, encompasses
every kind of pathological condition. It coils and winds and wraps around any
conceivable illness, around all patients, it proposes explanations and medical attitudes
for the vast variety of disease expressions. The outcome is that there is always a
treatment for a patient, there is always a prescription, whether a medicinal decoction,
powder or pill, whether a dietary suggestion or the recommendation of changes in
the life style, whether gymnastics like taijiquan or exercises ...or a prescription of
acupuncture points.
That is because acupuncture, having been merged into TCM, very naturally followed
the same path. As a result, for every patient, for every disease, for every illness, exists
a choice of points to stimulate, whether a cookbook formula or an individual
prescription. And in all the chinese medical books one can find therapeutical
proposals for tuberculosis, malaria, cholera, pneumonia or tumours.
This leads to the impression that acupuncture can treat everything, as TCM can treat
everything. But to treat does not mean to cure, as we all know very well, and as the
chinese doctors, being very pragmatic, also knew. They understood very well that
some patients need medicinal prescriptions that others had more chances of being
cured or relieved with acupuncture, and most of them are quite aware nowadays of
the power of western medicine for many conditions.
Therefore, in teaching or treating, in thinking or applying, in choosing or deciding, it
is necessary to feel the boundaries of the therapeutical possibilities of acupuncture,
especially when using the theoretical approach of TCM.
We shall focus on the pathological patterns of Organs. They illustrate a remarkable
effort to organize the symptoms in differentiated unities, using the Eight Principles
applied to the Fundamental Substances and/or to the Organs. From the didactic and
theoretical points of view it is very clear. But its practical understanding and
application needs a lot of flexibility and adaptation due to the countless degrees of
individual situations, a challenge which has been superbly met in the field of chinese
medication.
As far as acupuncture is concerned, when considered as an integral part of TCM, the
problem does not appear during the first steps leading to a diagnosis. But it is at the
moment of the therapeutical decision that the big questions arise. Can we, or can we
not use acupuncture, must we, or must we not use acupuncture? And the answer is
not simple.
The points chosen for the illness of a patient, whether stemming from a cookbook
recipe or from an individual formula come from different categories:
1. The Back Shu points and the Mu points of the Organs.
2. Specific points for the pathological patterns, like Cold, Heat, Dampness, Fire,
usually linked with the Organs which are partially responsible, like the Spleen for
Dampness, Kidneys for Cold.
3. Specific points for the Fundamental Substances, to tonify the Qi, activate the
Blood, support the Essence, transform Fluids or make them circulate, calm the Shen,
again and usually through the Organs which are more responsible than others for the
good functioning of the Fundamental Substances.
4. Points for specific symptoms usually linked with channel pathology.
The three last categories of points can be local, regional or distant, and are often
located on the meridian related to the responsible Organs. They can be Luo or Yuan
points, Qi points, Shu points (those linked through the Five Elements system),
Master points of the Extraordinary Vessels, or just points of which one usually says,
rather empirically, that they are useful for such and such a pathological condition.
But they stem from the assumption that acupuncture follows the rules of TCM and
that a point is regarded as having the same characteristics as a herb. This I discuss at
length in Revisiting Acupuncture Volume III.
That is how, in a very concise approach, how the configurations of points are
elaborated. But are all the chosen points necessary? Are they all useful? Which are the
most important ones?
And then, in a simultaneous sweep of the mind, surges a second group of questions.
In a given case, is acupuncture treatment necessary? And is it useful? In other words,
where to stop the indications for acupuncture, where are the limits?
The answer is most of the time not a yes or a no.
In modern publications, not only in Chinese but also in western languages (english,
french, german, etc.), one finds the following types of indications for acupuncture or
actual treatment protocol:
In a first group: “headache lumbar pain, insomnia, palpitations, epigastric pain,
constipation, sprains, tennis elbow, sciatic neuralgia, arthritis, trigeminal neuralgia,
indigestion, stiff Neck, sinusitis, allergic Rhinitis, abdominal pain, frozen shoulder,
tendonitis, neurasthenia, colitis, cervical neuralgia, hiccup, diarrhea, etc”. Of course
we have no objections, as all these conditions are some of the best indications for an
acupuncture treatment
In a second group we find: “convulsions, dysentery, prolapsed rectum, manicdepressive disorder, gonorrhoea, hernia, eclampsia, deafness and muteness,
erysipelas, epilepsy, intestinal abscess, optic atrophy, goitre, malaria, filarial
elephantiasis, pulmonary tuberculosis, psychosis, tetanus, leprosy, glaucoma, beriberi, etc »
We know that all these categories of diseases are not indications for acupuncture,
either because they will not be efficient, or because they are beyond the efficiency of
acupuncture, or because western medicine has better treatments for these cases. But
this situation brings up several questions:
1.Why are all these diseases still listed?
2.Can we really treat them with acupuncture?
3.Is there a chance of success?
4.In a modern western medical practice should we treat them with acupuncture?
5.If yes, should we treat them with acupuncture alone, or should we add chinese
medication or western medical treatment?
6.What do the Chinese traditional doctors do?
7.What do the Western trained medical doctors do?
In other words, is there a limit, and where is the limit? Let us take as example the
Lung Patterns of diseases according to TCM. Here is a list of classical patterns found
in a manual of TCM
1.
Excess patterns:
- Wind-Cold attacks the Lungs
- Pathological Heat attacks the Lungs
- Wind-Heat attacks the Lungs
- Fire-Heat
- Obstruction by Phlegm Heat.
- Turbid Phlegm block Lungs
- Pathological Dryness injures Lungs
- Lungs lose communication and balance
2.
Deficiency Patterns:
-
Lung Qi Deficiency
-
Lung Yin Deficiency.
The question is, for each pattern: When is acupuncture indicated, in what conditions,
and how should we apply acupuncture?
First pattern: Wind-Cold Attacks the Lungs. What are the symptoms?
-
Chills, limbs cold, afraid of cold.
Sometimes slight fever.
No sweating, or very little.
No thirst.
Headache, body aches.
Nose blocked, or runny.
Noisy breathing through the nose.
Throat irritated, cough, sneezing.
Expectorations white, thin, clear.
Tongue coating thin and white.
Pulse superficial and tight.
This pattern corresponds to our common cold, or tracheitis, or pharyngitis,
depending on the symptoms. What would happen in a western medical environment?
Either the patient will not even see a doctor, he will treat himself with light medicines
to relieve the symptoms, cough, expectorations, headache, blocked nose, etc. Or he
will see a doctor who will prescribe more or less the same kind of medication. But
normally the illness will disappear after a few days, even without any medication, like
most benign viral infections
Is it possible to treat these cases with acupuncture? Yes, to relieve the symptoms like
in western medicine. Treatment two or three consecutive days. The result will be an
alleviation of the symptoms, an improvement of the general condition, and
eventually, but this is difficult to ascertain, an acceleration of the « spontaneous »
cure. But practically of course a patient will seldom consult an acupuncturist for this
condition.
Second pattern: Wind-Heat Attacks the Lungs. What are the symptoms?
There will be signs of Wind, of Heat, of Lungs!
-
Fairly high fever.
No chills.
Headache.
Throat red, swollen, painful, tonsils swollen.
Profuse sweating.
Afraid of Wind.
Cough noisy, expectorations yellow and sticky.
Dyspnoea.
Nose secretions yellow, or dry nose with slight bleeding.
Thirst.
Constipation.
Oliguria.
Tongue red, or only the tip and the sides red, coating white, or yellow and
dry.
Pulse rapid, superficial.
This condition corresponds in western medicine with a bacterial infection of the
respiratory tract, from infected rhinitis to bronchitis.
What should be the attitude of a western doctor? To wait for a spontaneous cure is
possible but dangerous; the patient must be followed very carefully. To use
symptomatic medication like for the previous condition? It is a possibility. To
prescribe antibiotics? Certainly if the symptoms are severe.
Is acupuncture indicated for this condition? In theory yes, because there are
acupuncture treatments for every disease! But in clinical practice it is questionable,
and depends on the constitution, the intensity of symptoms, and most certainly a
close follow up...
Could one use acupuncture alone? No, only as an auxiliary treatment.
Third pattern: Lung Qi Deficiency. What are the symptoms?
-
Physical and mental tiredness, apathetic.
Breathing shallow.
Speaks with difficulty, because short of breath.
Speaks with a low voice.
Cough without strength, asthmatic like.
Expectorations clear and fluid.
Complexion pale and dull.
Afraid of cold.
Spontaneous sweating during the day.
Catches easily a cold.
Tongue coating thin and white.
Pulse empty and weak.
Fourth pattern: Lung Yin Deficiency. What are the symptoms?
-
Wasting, bad general state.
Evening fever, or vague feeling of heat at the end of the afternoon.
Red cheeks.
Feeling of Heat in the “Five Hearts”.
Night sweats
Insomnia.
Shallow breathing.
Fits of coughing:
o Dry, or
o A few expectorations, thick, sticky,
o Eventually streaked with blood.
-
Mouth and throat dry, thirsty.
Voice hoarse, or loss of voice.
Tongue red, sometimes “pealed”, or coating thin and white.
Pulse fine, rapid, without strength, empty, superficial.
These two TCM patterns correspond with different kinds of pulmonary
insufficiency, usually in elderly people, but also after a longstanding lung disease, or
in young people with weak constitutions: chronic bronchitis, emphysema,
tuberculosis, etc. Moreover these conditions are never simple, and other organs or
functions are implicated: digestive problems ( Spleen Yang Deficiency), general
exhaustion ( Kidney Yang Deficiency), Heart weakness ( Heart Qi or Heart Yang
Deficiency)
As far as western treatment is concerned the condition of the patient is chronic,
serious, usually irreversible, so the only possibility is to maintain the patient in a semistable condition, with bouts of infection and aggravation.
Acupuncture treatment is not indicated. Only in some light cases of chronic
bronchitis (a kind of Lung Qi deficiency) where many treatments might bring a
partial and transitory alleviation of the symptoms…
We have not examined all the Lung patterns because our aim was to point out that
there are limits to the indications of acupuncture in functional problems. But we do
want to stress that it is important to be cautious with the lists and treatments
proposed in the manuals. That we must use our medical knowledge, experience and
common sense. That the limit of the use of acupuncture is not a straight division.
There are blurred areas on both sides of the line. And finally that we should decide
according to the western medical diagnosis, the exclusion of other pathologies, the
individual constitution, the history of the illness, the evolution, the possibility of
close follow up. And this applies to all Zang Fu patterns.
With these few thoughts I do not pretend to answer all questions. My aim is to draw
the attention on the blur existing sometimes between the obvious indication of
acupuncture, its use as adjunct, the uselessness of its application, or even the danger
of using it in an exclusive manner.
I have taken the Lungs as example because the chinese concept of Lungs is relatively
similar to our scientific knowledge of the lungs functions, so we could elaborate
patterns comparisons and treatment decisions. But the same principle is valid for all
the Organs, and in general for all pathologies. We must learn the limits of
acupuncture, while we appreciate the vast field of its application.
In preparing this communication I realized the fragility of our situation as medical
acupuncturists confronted with a patient in certain pathological manifestations. We
must decide according to our reason, our commonsense, our knowledge and our
experience. We must not rely on books theories which, in appearance, but in
appearance only, seem to apply to everything.
Finally, let the reader remember that the books don’t decide, the
patients don’t decide, the practitioner decides.
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