Type of paper: Research Paper

Topic: Acupuncture, Treatment, Study, Medicine, Pain, Pregnancy, Health, Arthritis

Pages: 9

Words: 2475

Published: 2021/02/14

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Acupuncture has found application in medicine for millennia, as a method that uses needles inserted into certain points (energy channels) thought to restore the balance of life or energy disrupted by disease. The technique emerged in ancient China as early as the 1600-1100 BC, and embodies traditional Chinese medical beliefs that health is merely equal to the balance of energy in the body, which may be disrupted by disease. The confidence in the therapeutic potential of acupuncture flows from the belief that forces that created the universe and whose interaction result in the balance within the body and the universe. The twin forces, Yang and Eum, are expected (in theory at least) to balance to ensure perfect health. While the acupuncture is steeped in ancient traditions and beliefs, its activity has often been attributed to biochemical processes such as the secretion of endorphins into limbic structures as well as due to placebo effects (patient expectations of the pain relief effects). This paper seeks to determine the scientific foundation of acupuncture, with the goal of separating beliefs from concrete science. The paper focusses on three of the most common (and possibly most important) applications of acupuncture in modern medicine i.e. the application of acupuncture in reproductive health, as an analgesic and in the management of arthritic conditions (Berman, Swyers and Ezzo 107; West 6).

Method

Application of Acupuncture in Reproductive Health
Acupuncture has shown considerable promise in women’s and reproductive health in general. The treatment may be used to relax mothers, relieve pain without narcotic side effects and encourage healing throughout the pregnancy. According to West (2001), multiple lifestyle modifications are necessary to guarantee a healthy pregnancy while at once avoiding or expelling toxics that the human body is exposed to. Modern agricultural methods involve heavy uses of pesticides, which when coupled with metallic contamination in foods, heavy uses of antibiotics, air and water pollution, lead to inevitable hormonal imbalances that affect menstrual cycles, conception and a healthy pregnancy. For instance, women only require an additional 50 calories daily during the first six months of pregnancy, besides vitamins (A, B,C, D, E, F, and K), calcium, magnesium, iron, manganese, potassium, chromium, and copper among others. In fact, nutritional deficiency is thought to account for a majority of infertility and known physical deficits e.g. blocked fallopian tubes. Acupuncture therapy can be used to help conception by ensuring that women have a proper balance of energy. Liver imbalances (including liver qi stagnation), kidney and stomach deficiency, and qi-driven blood control (West 6). Helms (1996) says that the kidney, for instance, is considered a store of life essence, which is believed to be the source of life and subsequent differentiation into Yang and Yin (312). Acupuncture can enhance emotional balance that influences menstrual cycles, besides helping with natural birth control, as well as conception.
The treatment may also increase the probability of conception by boosting male fertility. This may be due to the excellent nutrition leading to the improvement in male fertility (e.g. zinc, vitamin E and potassium), which are more beneficial compared to supplements. A study by Siterman, Eltes and Wolfson (2000) of men with a past history of azoospermia that were treated with acupuncture indicated that such therapy resulted in increased sperm count. In a controlled trial, the treatment group received ten acupuncture sessions over the course of five weeks, during which a selection of classical points as per the traditional acupuncture traditions, were needled. The results revealed a statistically significant increase in the sperm count in the treatment group relative to the control group.
Acupuncture equally plays a role in maintaining a healthy pregnancy throughout the three trimesters, including labour management. Other than relieving the physical discomfort associated with pregnancy (and urinary problems, oedema, labour problems), acupuncture has been historically used to treat virginal bleeding, which is a sign of potential miscarriages and troubled pregnancies. Scientific research has since borne out the acupunctural treatments for virginal bleeding, even during the initial three months of pregnancy, during which time treatment is thought by some as risky (West 25). According to West (2001), acupunctural needles and transcutaneous nerve stimulation are an effective non-pharmacological treatment for some of the most difficult problems during pregnancy (92). During labour, acupuncture is effective in increasing and sustaining contractions, cervical dilation stimulation and increased the release of endorphin (West 174). However, Helms (1995, p. 56) cautions that while the associated risks are minimal, any acupuncture during pregnancy that may risk stimulating uterine activity must be avoided, including the electrical stimulation across or on the trunk among patients with pacemakers.
Multiple empirical studies have proven acupuncture to be effective in the treatment and/or management of several pregnancy and reproductive health related conditions. Helms (1995) includes information about studies conducted in 1987 in the management of primary dysmenorrhea and stimulation of follicle maturation and ovulation. In a further study, auricular acupuncture proved to be equally as effective as hormone therapy in women treated for infertility. About the same number of pregnancies were achieved among women on hormonal treatment as acupuncture, despite the fact that patients treated with hormones had markedly less hormonal and menstrual irregularities. Yet, another study established that electro-acupuncture is effective than superficial needling in the management of hot flushes among menopausal women. Other studies found acupuncture to be more effective than non-treatment or sham needling in fostering the maturation of the cervix during labour and just before an abortion. Acupuncture also reduced the length of labour among primiparous compared to non-treatment in a controlled study, as well as in another non-controlled study on a larger population.

Analgesic Effects of Acupuncture

While the use of acupuncture in pregnancy remains limited in the West, perhaps one of the most important and rising applications of acupuncture in mainstream medicine is its widespread use in surgical analgesia. This began in China in 1958, as a result of collaborative efforts between Shanghai and Xian medical practitioners. By the close of 1973, up to 25% of major surgical hospitals in the country used acupuncture analgesia. This has since been replicated across Europe and North America. There are different hypotheses explaining the analgesic effects of acupuncture based on human and animal studies. The mechanisms both intricate and likely to be a function of the interplay among psychological, physiological and neurochemical factors associated with the patients’ expectations of potential benefits of the treatment. Many studies in mechanistic acupuncture have reported only a placebo effect from the treatment.
Upwards of 20 opioid peptides and 15 neurotransmitters have been proven to have a role in analgesia, even though the exact mechanisms remain unknown for most of them. Evidence that supports the activity of endogenous opioids (including dynorphin, beta-endorphin, endomorphin and enkephalin), as well as serotonin, in acupuncture analgesia, exists. Helms (1995) includes studies such as Pomeranz et al., showing that acupuncture-induced analgesia is blocked by naloxone in both humans and mice, which in turn supports the role of endogenous opioids. These serve to block the activity of the nervous central nervous system in the recognition and processing of pain. High-intensity or low-frequency electro-acupuncture-induced analgesia needs intact efferent and afferent neurons in the central and peripheral nervous systems. Contrary to expectations, interferences with blood circulation at the needle insertion point barely influence analgesic activity. The importance of natural energy (di qi), the initial sensation from a need grab, points to the possibility that the analgesic activity of electro-acupuncture involves the central nervous system.
Functional brain research points to the possible activation of regions of the brain/brain stem associated with pain pathways related to acupuncture needling, with the brain stimulations showing similar patterns. This is at times of low intensity in the case of sham procedures like superficial needle insertion, use of retractable needles that do not penetrate the skin and/or non-meridian needling. Positron emission tomography studies point to increments in the binding of μ opioids to brain receptors following days of acupuncture. Acupuncture treatment leads to the stimulation of the limbic system, the basal anterior brain and other brain areas associated with somatosensory and affective functions. The vast majority of classical neurotransmitters are involved in the process of analgesia and nociception, as are the opioid peptides that play the role of neuropeptide regulators to specify and localize varied neurotransmitters. It is, however, assumed that there are yet more neurochemicals involved in causing the analgesic effects of acupuncture than it is already known. According to Helms (1995), acupuncture may act by activating the body’s pain regulatory system, effectively causing the changes in the perception and processing of noxious information and impulses at multiple levels of the central nervous system. The difference between the pain modulatory and the pain perception systems, is, however, schematic as against anatomic. It is controlled by a single nucleus with several transmitters being co-localized in neurons.
Acupuncture may also act through the alteration of the blood chemistry and the immune system. Specifically, electro-acupuncture is associated with elevated blood cortisol levels in both human and animal experiments. The level of blood glucose rises in situations when the pre-acupuncture level is either hypoglycemic or normal, and falls when the pre-acupuncture level is increased. Acupuncture may also reduce the concentration of triglycerides, phospholipids and cholesterol. Changes in the blood chemistry point to the ability of acupuncture heightening or diminishing peripheral blood components, effectively qualifying it as a regulatory therapy that creates a change in homeostasis. Preliminary literature associates this activity to the functioning of the immune system. This is not least because of lymphocyte blastogenesis; heightened fibrinolytic and phagocytic activity; impaired leukocyte adherence to epithelial and vascular cells and suppressed exudate reaction; increased beta globulins and gamma globulins, agglutins, opsonins, lysozymes, and complement. Acupuncture’s possible influence on the immune mechanisms may also reinforced, at least in part, by the knowledge that met-enkephalin and beta-endorphin tend to be mediators between the immune and the central nervous systems. These two substances are not only known to enhance natural killer cell activity, but met-enkephalin is elevated in vitro T-lymphocyte rosette formation off the human T-lymphocytes.

Treatment of Rheumatoid Conditions

While scientific evidence of the efficacy of acupunctural treatment and/or management for rheumatoid disorders remains inconclusive, the techniques have still found wide application in western medicine. According to Berman, Swyers and Ezzo (2000), while there is inconclusive scientific evidence from large randomised controlled trials as to the efficacy of acupuncture in the treatment of rheumatoid conditions, there is relatively reliable evidence drawn from controlled trials in support of its use as an adjunctive therapy for both fibromyalgia and osteoarthritis. The want for scientific evidence has however, not limited application of acupuncture in the treatment of arthritis, but is recommended that it is only used along with conventional treatment since it has no consequence on the progression of arthritic conditions. This may be in part due to the desperation of treating/managing such painful autoimmune conditions that have remained incurable. For instance, auricular acupuncture is widely used in the management of extreme pain conditions including muscle spasms, skin lesions, fractures and recurrent radicular nerve pain due to intervertebral disc disease or degenerative arthritis (Helm 136).
In a review of eight studies on the efficacy of acupuncture in the treatment of osteoarthritis by Berman, Swyers and Ezzo (2000), three were randomized controlled trials, while others were time series or non-randomised studies. Studies categorized as RCTs used only a small sample, to the detriment of their external validity, and showed insignificant benefits accruing from the use of acupuncture, although sham acupuncture showed marked benefits. None of the studies had the statistical power to detect the difference between sham acupuncture and acupuncture, and there were statistically significant improvements for both sham acupuncture and acupuncture when compared to baseline. It is possible that these results could be due to the fact that puncturing the skin often elicits analgesic responses or because the sham sites selected in the studies were actually acupuncture sites.
Acupuncture is an integral part of the recommended multidisciplinary treatment for fibromyalgia, along with sleep therapy, massage therapy, counselling and physiotherapy. Acupuncture is recommended, based on, as an adjunct treatment (second or third line) for patients that fail to respond to conventional medicine, are intolerant to medication and experiencing recurrent pain. Acupuncture can have improvements in key fibromyalgia symptoms, a disease that is generally considered chronic with the treatment goals focussing on pain alleviation. The treatment is also used in the management of neck pain, shoulder pain, low back pain, knee osteoarthritis, musculoskeletal pain among others. It is, however, important to point out there remains a dearth of robust studies on the efficacy of acupuncture in the treatment of both rheumatoid arthritis and fibromyalgia, as well as the safety of these treatments. Most randomized controlled trials that have shown promised had a high risk of bias (concealment of sample allocation and/or inappropriate randomization) or relied on relatively small sample sizes. Berman, Swyers and Ezzo (2000) and Helms (1995) show that it remains difficult accurately to quantify adverse effects associated with acupuncture, due to a lack of a reportign system for adverse events, despite there being anecdotal evidence of safety concerns. Adverse events that have been reported include faintness, needle bleeding pneumothorax and systemic infection. To this end care must be taken to ensure that acupuncture is not only administered by qualified and experienced practitioners, but also that positive diagnoses are made prior to the treatment.

Conclusion

Acupuncture is increasingly finding acceptance in mainstream medicine in the treatment and management of a variety of conditions, including arthritis conditions, postoperative pain management, and reproductive health. As an ancient practice characterized by widely varying traditions, the fusion of acupuncture and conventional medicine is bound to be uncomfortable and slow, but acupuncture has proven wildly popular. Many theories exist as to the physiological, neurological and biochemical effects of acupuncture, some of which have found backing in empirical research, but considerable ground remains to be covered to ensure a complete fusion of acupuncture and modern medicine. It is, however, unarguable that acupuncture has a critical role to play, but care must be taken to ensure that is only used as, and when required.

Works Cited

Berman, B.M., J.P. Swyers and J. Ezzo. "The evidence for acupuncture as a treatment for rheumatologic conditions." Rheum Dis Clin North Am; 26:103-15. Acupuncture in Medicine 18.2 (2000): 137-137. http://aim.bmj.com/content/18/2/137.1.full.pdf+html.
Helms, Joseph, M. Acupuncture Energetics: A Clinical Approach for Physicians. Berkeley, Calif., U.S.A.: Medical Acupuncture, 1995. Print.
Rhyu, Paul, H. Acupuncture Meridians and Acupuncture Points. Bloomington, IN: Authorhouse, 2010. Print.
Siterman, S, et al. "Does acupuncture treatment affect sperm density in males with very low sperm count? A pilot study." Andrologia 32 (2000): 31-9. Web.
West, Zita. Acupuncture in Pregnancy and Childbirth. Edinburgh: Churchill Livingstone, 2001. Print.

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