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Acupuncture:
PastPresent
&Practical
Dr. Nikki Ruse
About Me
1995 Graduated New Jersey Institute of Technology, Honors College:B.S. Engineering Science
1999 M.D. from UMDNJ: New Jersey Medical School,
Major USAF, Medical Corps
Wright-Patterson AFB, OHMcGuire AFB, NJDover AFB, DE
2007Helms Medical Institute, UCLA Stanford
Weight Loss Medicine
Complementary vs Alternative
• If a non-mainstream practice is used together with conventional medicine, it’s considered “complementary.”
• If a non-mainstream practice is used in place of conventional medicine, it’s considered “alternative.”
https://nccih.nih.gov/
Types of Acupuncturists
Licensed Acupuncturists (LAc)
• Master’s level, on-site training at a nationally accredited school or college of acupuncture
• Over 2,000 hrs acupuncture/Oriental med• Required to pass the certification exam,
NCCAOM (National Commission for the Certification of Acupuncture & Oriental Medicine)
Medical Acupuncture • Physicians• Minimum of 220 hours of formal training • Amercian Board of Medical Acupuncture
– Meets/exceeds WHO/WFAS standard– www dabma.org
• Board Certification is NOT required to perform acupuncture, as an MD/DO.
Chiropractic Acupuncture
• 100 or less hours of training• Completed an approved educational
program and an evaluation, including an examination process– American Board of Chiropractic Acupuncture
(ABCA)
History of Acupuncture
• 4000 years old• China, Korea,
Japan, Taiwan, India
Joseph Helms, Acupuncture Energetics, 1995 Chapter 1
China to Europe• Written text: “Huang Di Nei Jing” (or
simply “Nei Jing”) which translates as the “Inner Classic of the Yellow Emperor.” The Nei Jing dates back to approximately 90 BC
• Christian (Jesuit) Missionary Father Placide Harvieu. Upon returning to France from China in 1671, Father Harvieu published the text “Les secrets de la Medicine des Chinois” (“Secrets of Chinese Medicine”).
https://yinyanghouse.com/acupuncture/a-brief-history-of-acupuncture-in-the-west, 4/5/2017
Acupuncture Interest in US
• 1971 James Reston wrote front-page article for New York Times– Reporter in Beijing to cover US-Chinese Ping-Pong
tournament and developed appendicitis– Emergency appendectomy required– Post-op pain alleviated by 3 acupuncture needles
• 1970s, Delegations of US physicians were impressed by major surgery performed in China on awake pts with Acupuncture
Joseph Helms, Acupuncture Energetics, 1995 Chapter 1
Hospitals• Percentage of hospitals offering one or
more complementary and alternative medicine (CAM) increased from 8 % in 1998 to >42% in 2011. Includes:– Acupuncture – Chiropractic – Homeopathy– Massage therapy, etc.
http://www.cbsnews.com/stories/2006/07/20/health/webmd/main1823747.shtmlhttp://www.aha.org/presscenter/pressrel/2011/110907-pr-camsurvey.pdf
American Hospital Assc Survey 2010
• Key reason for offering CAM– 85% indicated Patient Demand– 70% Clinical effectiveness – 58% Reflection Organizational Mission
• Budgetary constraints as the biggest obstacle for implementation of CAM programs.
http://www.cbsnews.com/stories/2006/07/20/health/webmd/main1823747.shtmlhttp://www.aha.org/presscenter/pressrel/2011/110907-pr-camsurvey.pdf
2006 Locations for CAM in hospitals
• Most common in the Midwest (Illinois, Indiana, Michigan, Ohio, and Wisconsin)
• Least common areas in the South (Alabama, Kentucky, Mississippi, and Tennessee).
http://www.cbsnews.com/stories/2006/07/20/health/webmd/main1823747.shtml
19 of 20 hospitals on U.S. News's most recent ‘America's Best Hospitals’ superselective Honor
Roll provide CAM of some type
http://health.usnews.com/articles/health/2008/01/09/embracing-alternative-care.htmlhttp://health.usnews.com/health-care/best-hospitals/slideshows/the-honor-roll-of-best-hospitals-2016-17
DukeMt SinaiCedars SinaiUniversity of MichiganUniversity of ColoradoUCLA StanfordBingham & Women’sUniv of PittsburgBarnes Jewish, Wash U
NYU Langone MCNorthwestern MemorialUCSF Med CenterNY PresbyterianUCLAJohns HopkinsMass GenCleveland ClinicMayo Clinic
• At Nellis Air Force Base, Acus Foundation is creating a standardized training curriculum and clinical model of incorporation for medical acupuncture.
http://acusfoundation.org/programs/the-nellis-project/
Needles• Insert fine (25-36 gauge), solid, blunt-
ended needles in to acupoints.
============
Qi (chee)
• Loosely translated as “Life Energy”• Funadamental concept in Eastern ideology
– China: Qi– Japan: Ki– Korea: Gi– India: Prana
Pain-Relief Guide: Acupuncture and Chinese Medicine Jamie Starkey, LAc Lead Acupuncturist, Center for Integrative Medicine Wellness Institute, Cleveland Clinic 11/03/2011
Qi (chee)• Energy in all forms
– Vitality ̶̶ Defensive Qi– Nourishing Qi ̶̶ Generational Qi
• Moving Qi that travels throughout the body along energy lines, call Meridians
• Qi flows w/o obstruction or deficiency, we are in balance, health, wellness
Acupuncture Energetics, Dr Joseph Helms
How does Acupuncture Work?Traditional Chinese Medicine
• 14 Major energy-carrying channels (meridians)
• Imbalances in the channels cause illness, pain, disease
• Acupuncture restore balance and “unblocks” meridians
Meridian Lines• Darras et al. (1987)
– Injected Technitium99 into true and sham acupuncture points, traced with scintillation camera
– At true acupuncture points• Radioisotope diffusion corresponded to
classically described meridians• Inconsistent with either
lymphatic/vascular flow– Sham points
• centrifugal diffusion pattern
Darras, J. C. Visualisation isotopique des meridiens d'acupuncture Cah de Biotherapie Vol.95 Issue pp. 13-22; 1987
How does it work?• Pomerantz et al. shown acupuncture needling
– Affects nociceptive, proprioceptive, and autonomic nerve pathways
– Local release endorphins – Spinal Cord
• Release of enkephalin/dynorphin• Enkephalin releases monoamine neurotransmitters
(serotonin/norepinephrine )• Inhibit spinal pain transmission
– Brain• Endorphins released from hypothalamus-pituitary
region• Inhibit Substance P (involved with
pain/inflammation)Pomeranz & Stux, Scientific Basis of Acupuncture, 1-34, 1986, Springer-Verlag, Quoted from http://www.medicalacupuncture.org/acu_info/priv.html
Acupuncture-Induced Analgesia• Confirmed to be mediated through the
thalamus via Functional MRI, PET and SPECT scans.– Li K, Shan B, Xu J, et al (2006). "Changes in FMRI in the
human brain related to different durations of manual acupuncture needling". Journal of alternative and complementary medicine (New York, N.Y.) 12 (7): 615-23.
– Pariente J, White P, Frackowiak RS, Lewith G (2005). "Expectancy and belief modulate the neuronal substrates of pain treated by acupuncture". Neuroimage 25 (4): 1161-7
– Alavi A et al. Neuroimaging of acupuncture in patients with chronic pain. Journal of Alternative and Complementary Medicine 1997;3:S47-53.
Acupuncture-Induced Analgesia
• Administration of Naloxone prevents acupuncture associated analgesia– Pomeranz B, Chiu D (1976). "Naloxone blockade of
acupuncture analgesia: endorphin implicated". Life Sci. 19 (11): 1757-62.
– Mayer DJ, Price DD, Rafii A (1977). "Antagonism of acupuncture analgesia in man by the narcotic antagonist naloxone". Brain Res. 121 (2): 368-72.
What Medical Conditions can Acupuncture Treatment?
• According to the Chinese . . .
Everything
World Health Organizations / NIH Conditions Appropriate for Acupuncture Therapy
GASTROINTESTINALGastritisPeptic Ulcer painNausea / VomitingDysenteryBiliary Colic
MUSCULOSKELETALRheumatoid ArthBack PainMuscular painNeck PainSciaticaKnee PainEpicondylitis
GYNECOLOGICALFetal Breech PositionInduction of LaborDysmenorrheaMorning Sickness
MISCELLANEOUSDepression HypertensionHypotensionLeukopeniaAdverse Reation to Chemo or RadiationAllergic Rhinitis
ENTFacial PainDental pain
NEUROLOGICALHeadaches Migraines Postoperative painStroke
Source: World Health Organization United Nations. “Acupuncture Review and Analysis of Reports on Controlled Clinical Trials." (2002) & Acupuncture. NIH Consensus Statement 1997 Nov 3-5; 15(5):1-34
Patient c/o
• Low Back Pain• Neck Pain• Osteoarthritis/Knee Pain• Headache• Trigeminal Neuralgia• Fatigue• Phantom Limb Pain• Depression
Contraindications
• Severe bleeding disorders– Blood thinners don’t matter
• Pacemaker is a contraindication to electro-acupuncture
Limited Benefit
• Spinal Cord injuries• Stroke• Neurodegenerative diseases
Major Adverse Events
• 1965-1997: – 10 Cases of internal injuries in US
• Brain damage/stroke• Pneumothorax• Kidney damage• Cardiac tamponade
Common, Minor Adverse Events• Survey by Ernst et al. of over 400 patients
receiving over 3500 acupuncture treatments found– Minor bleeding after removal of the needles, seen
in roughly 3% of patients. – Hematoma, seen in about 2% of patients, which
manifests as bruises.– Dizziness, seen in about 1% of patients. – Conclusion: "Acupuncture has adverse effects,
like any therapeutic approach. If it is used according to established safety rules and carefully at appropriate anatomic regions, it is a safe treatment method."
Ernst G, Strzyz H, Hagmeister H (2003). "Incidence of adverse effects during acupuncture therapy-a multicentre survey". Complementary therapies in medicine 11 (2): 93-7.
https://www.usnews.com/news/best-countries/articles/2016-08-08/fire-cupping-therapy-puts-olympic-rings-on-rio-athletes
Cupping
A technique in which a suction-like force holds cups against the skin for
several minutes.
Pain-Relief Guide: Acupuncture and Chinese Medicine Jamie Starkey, LAc Lead Acupuncturist, Center for Integrative Medicine Wellness Institute, Cleveland Clinic 11/03/2011
Cupping
Cupping
• Increases blood flow to the area of pain• Used for lingering pain conditions from old
injuries such as whiplash, low back pain or shoulder pain.
• TCM: stagnation of Qi and blood in the area of discomfort.
Pain-Relief Guide: Acupuncture and Chinese Medicine Jamie Starkey, LAc Lead Acupuncturist, Center for Integrative Medicine Wellness Institute, Cleveland Clinic 11/03/2011
Moxibustion
• a technique involving moxa, the herb mugwort (Artemisia vulgaris).
• deeply penetrate the area of discomfort with soothing warmth.
• pain-relieving effect• invigorate the flow of Qi and blood
Pain-Relief Guide: Acupuncture and Chinese Medicine Jamie Starkey, LAc Lead Acupuncturist, Center for Integrative Medicine Wellness Institute, Cleveland Clinic 11/03/2011
Moxibustion
• Moxibustion is particularly effective for cases like tight muscle spasms, low back pain, frozen shoulder, or various osteoarthritic joint pains, especially when pain is worsened by damp and cold weather.
Pain-Relief Guide: Acupuncture and Chinese Medicine Jamie Starkey, LAc Lead Acupuncturist, Center for Integrative Medicine Wellness Institute, Cleveland Clinic 11/03/2011
Electroacupuncture
Application of a pulsating electrical current to acupuncture needles as a means of stimulating the acupoints
http://www.itmonline.org/arts/electro.htm 4/5/2017
Electro-Acupuncture
• Needles placed in acupuncture points, electrodes are attached from a TENS unit.
• Device turned on, patient will feel small amount of electricity: tinging, burning, etc.
• Intensity of sensation is adjusted to pt tolerance.
Pain-Relief Guide: Acupuncture and Chinese Medicine Jamie Starkey, LAc Lead Acupuncturist, Center for Integrative Medicine Wellness Institute, Cleveland Clinic 11/03/2011
Electro-Acupuncture
• Alternating current applied for 10-20 min• Patient becomes adapted to electricity after
first 1-2 min• Cannot use if patient has pacemaker, etc..• Helps with pain and fatigue
Gua shameaning "scraping bruises“Traditional Chinese medical
treatment in which the skin is scraped to produce light bruising.
Wikipedia 4/5/2017
Gua sha
• Like a deep massage with lots of bruising• Massage oil or lubricant is placed on skin• A tool with smooth surface is used• With moderate force, the tool is rubbed
along pt’s skin in long, smooth strokes• Creates redness/bruising. Used to break up
areas of Qi Stagnation or painPain-Relief Guide: Acupuncture and Chinese Medicine Jamie Starkey, LAc Lead Acupuncturist, Center
for Integrative Medicine Wellness Institute, Cleveland Clinic 11/03/2011
Gua Sha tools
Acupuncture Microsystems
http://www.thieme.com/media/samples/pubid-687503961.pdf
A system of particular micro acupoint which constitutes a functional image of the whole organism in a clearly defined partial area.
Auricular Acupuncture
• Auricular model is a microsystem, meaning the entire body is mapped on the ear.
Auricular Acupuncture
• Discovered in 1950s by French doctor, Nogier
• Decoded functional points on the ear.• Points further refined by Chinese and
Russian schools of acupuncture• Used worldwide.
• Palpate areas of the earfor active points that correlate to areas of pain felt in the body. • Needles are placed in points that promote
pain relief and sedation. • All pain-related conditions can be
effectively addressed using this technique.
Pain-Relief Guide: Acupuncture and Chinese Medicine Jamie Starkey, LAc Lead Acupuncturist, Center for Integrative Medicine Wellness Institute, Cleveland Clinic 11/03/2011
Battlefield (Auricular) Acupuncture
• Developed: USAF Col. Richard Niemtzow, MD
ASP needle. Single use needles that stay in the ear for 3-4 days
5 Points on each ear
Military Medics
Korean Hand Acupuncture
http://www.thieme.com/media/samples/pubid-687503961.pdf
• Korean Su-Yok• 12 channels and other
reflex points• Points located on palmer
and dorsal sides of the hand
Korean Hand Acupuncture
Scalp Acupuncture
Is Acupuncture right for you?• Don’t postpone seeing a Health Care
Provider about your health problem• Licensing: Not required in Alabama• Check Board Certification groups
– www NCCAOM org– www MedicalAcupuncture.org– www CouncilofChiropracticacupuncture.org
• Check for Insurance coverage or cost of cash pay.
Board Certified Medical Acupuncturists in ALMiller, Melanie MD 159 Main StTrussville, AL 35173(205) 655-2110Family Medicinehttp://www.BirminghamIntegrativeHealth.com
Ruse, Naykala MD, DABMA 1890 Al Hwy 157, #300Cullman, AL 35058(256) 737-8052 Internal Medicinehttp://www.cullmaninternalmedicine.com
Sciacca, Robert MD, FAAMA4501 South Lake Pkwy #200Hoover, AL 35244(205) 985-7393Otolaryngology, Otalaryngic Allergy, Medical Acupuncturehttp://www.alabamaentassociates.com
Summary
• Acupuncture is a 4000 yo practice• Originated in China and other parts of Asia• Widely used in Europe and throughout the
world• Research, training and practice in the US
military• Gaining acceptance in US hospitals
Summary
• How Acupuncture works is not fully understood– Restores balance to Qi (energy,Vitality) – Inhibits spinal pain transmission
• Safe procedure• Find a well trained LAc, Medical
Acupuncturist, etc..
Summary
• There are various modalities that may be used during an acupuncture treatment– Cupping– Moxibustion– Electro-acupuncture
• Different types of acupuncture– Chinese vs Korean vs Japanese, etc.– Microsystems: Ear, Hand, etc.
THANK YOU
It has been my honor to speak with you today!
Questions?
Dr Nikki Ruse256-737-8055