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III. LA RESPONSABILIDAD SOCIAL CORPORATIVA 1. Concepto
This paper was written in 1980. For an update, see "ACUPUNCTURE FOR IMMUNE-MEDIATED DISORDERS", attached.
INTRODUCTION
Acupuncture (AP) is best known for its effects in controlling pain, its value in treating alcohol and narcotic addiction and in the induction of surgical analgesia in humans and animals . It is less well known that AP has great therapeutic value in a wide variety of human and animal diseases. These effects are well established in clinical practice. Modern textbooks and journals of AP list hundreds of clinical conditions which respond (partially or completely) to AP therapy.
Some of the therapeutic effects of AP have been studied experimentally in animals and humans. In this talk we will discuss the effects of AP in stimulating the defence systems of the body. These effects are directly involved in the therapeutic value of AP in humans and
animals.
THE DEFENCE SYSTEMS OF THE BODY
Defence systems have two basic components: (a) recognition of the attack, its nature, locality and extent, and (b) activation of mechanisms to counter the attack and to repair the damage which has been done. Important defence systems of the body include the following:
a. the immune system (specific and non-specific immunity);
b. the phagocytic system (white cells and reticulo-endothelial systems) and lymphoid tissues; c. the inflammatory reaction;
d. the thermoregulatory system;
e. the recognition and control of pain and muscle spasm;
f. the sensing of damaged tissue and its controlled regeneration.
The autonomic nervous system (and its reflexes) controls to a large degree these defence systems in the body. The neuroendocrine system also allows the organism to adapt to changes in the internal and external environment. The PRIMITIVE SYSTEM of Becker (see the paper on Holistic concepts of health and disease) is also involved in the sensing and regeneration of damaged tissue, such as wounds, fractures, burns, etc.
Occasionally the defence systems develop defects which cause them to react to self rather than non-self. Examples of self-destruction include immune diseases and
auto-inflammation. Other examples are failure to recognise pain (due to congenital neurological defect or stress/excitement) with consequent risk of severe injury. One of the causal factors in cancer is uncontrolled tissue regeneration or failure of the immune system to recognise and destroy aberrant cells.
The immune system, which normally serves a useful protective function, occasionally creates problems by causing reactions to allergens which gain entry to the body by inhalation,
ingestion or by skin contact.
AP IN THE TREATMENT OF INFECTIONS
AP textbooks and journals list many human infections which may be helped by AP stimulation. Treatment is aimed at the main symptoms of the infection (such as fever, headache, vomiting, diarrhoea, pain, colic, jaundice, paralysis, etc) and at the major regions involved (such as the liver, lungs, intestine, upper limbs, etc).
Clinical infections in humans which may be helped by AP include:
Bacterial (typhoid, paratyphoid, cholera, bacillary dysentery, brucellosis, venereal disease, tuberculosis).
Viral (Virus B encephalitis, poliomyelitis, viral hepatitis, influenza, Heres Zoster).
Protozoal (Malaria, schistosomiasis, filariasis, amoebic dysentery).
Fungal (Tinea pedis).
Post-operative infection.
Clinical infections in animals: Animal AP, even in China, is much less well developed than human AP. Traditional Chinese Medicine (TCM) also relies very heavily on the use of HERBAL Medicine, especially in the treatment of animal diseases. Thus, in veterinary practice, AP as a therapy to help fight clinical infections appears to be limited (at this time) to the treatment of enteric infections (such as E. coli) in pigs and dogs, uterine infections in cows and bitches, udder infections in cows, and a few other infections.
As will be seen later, the use of AP in experimental infections and in the treatment of many clinical and experimental conditions in animals suggests that it may have wide applications in animal infections.
Experimental infections: Animals have been infected with bacillary dysentery, poliomyelitis virus, trypanosomiasis and Erlich Ascites Tumour virus. In each of these conditions AP had complete or partial effect in combatting the infection.
Further details of the antibiotic/antimicrobial effects of AP are given in Appendix 2.
AP IN THE TREATMENT OF INFLAMMATION
Inflammation is the normal defence reaction to local injury, infection, necrosis, allergy or other local irritation. Thus, inflammation is a desirable reaction and one does not try to treat inflammation per se, but to help the inflammatory response and to speed up its successful resolution. Where possible, the cause of the inflammation should be diagnosed, removed and/or treated also. In practice, many inflammations arise from non-specific or unidentified causes. In these cases, orthodox treatment consists of analgesic, anti-inflammatory, antibiotic drugs + penetrating agents and physical therapy, used in an empirical manner.
AP is a highly effective means of treating clinical inflammatory conditions in humans and animals. The needles usually are used on local points (points near the inflamed organ or area), plus some needles on distant points on meridians passing through the affected organ or area.
When they arise, associated symptoms (such as fever, cough, headache, back pain, etc) are treated by needling the relevant points for these symptoms.
Human inflammatory conditions responsive to AP in clinical practice include:
Ear, nose, throat, eye, mouth (otitis, rhinitis, sinusitis, tonsillitis, pharyngitis, opthalmitis, conjunctivitis, stomatitis, gingivitis, glossitis
Respiratory tract (tracheitis, bronchitis, pneumonia)
Gastrointestinal tract (gastritis, duodenitis, gastroduodenal ulcer, enteritis, appendicitis, colitis, proctitis)
Liver, gallbladder, pancreas, peritoneum (inflammation,pain, colic etc)
Urinary tract (nephritis, cystitis, urethritis)
Genital tract (oophoritis, salpingitis, metritis, cervicitis, and cervical erosion, vaginitis, orchitis, prostatitis)
Muscle-skeletal (myositis, bursitis, tenosynovitis, arthritis) Cardiovascular (thromboangiitis, varicose ulcers, myocardial infarct and myositis)
Lymphatic (lymphadenitis, lymphangitis)
Skin and subcutaneous tissue (eczema, dermatitis, acne, furunculosis)
Nervous tissue (neuritis, encephalitis)
Inflammatory conditions in animals which respond clinically to AP are basically similar to those in humans. However, as mentioned in the previous section, AP in animals has not been used as extensively as in humans. Veterinary AP literature mentions clinical success with inflammation in similar regions to those in humans. Examples are:
gingivitis, stomatitis, rhinitis
bronchitis, pneumonia
gastritis, enteritis,
hepatitis, cholecystitis, pancreatitis, peritonitis
nephritis, cystitis, metritis, pyometra
myositis, tenosynovitis, arthritis, laminitis
eczema, lick granuloma
mastitis, encephalitis
Klide and Kung's textbook and the books of Westermayer and Brunner list many more inflammatory conditions which are said to respond clinically to AP (see Appendix 1 of this paper).
The conditions listed above refer to uncontrolled clinical observation in humans and animals.
It could be argued that such observations do not prove that AP has anti-inflammatory effects.
However, there is direct evidence from experimental work with animals which shows that AP has powerful effects on the inflammatory response.
Experimental inflammation
Bacterial peritonitis was produced in rabbits and other laboratory animals. AP greatly reduced the volume of inflammatory exudate produced and the exudate became (bacteriologically) sterile in a much shorter time in treated animals than in the control animals.
Inflammatory granuloma was produced on the skin of the back in rats. After 8 days of treatment by AP or moxa at ST36 (TsuSanLi), treated rats produced 3.5 ml effusate, as compared with 7.0 ml in control rats.
Turpentine injection in rabbits caused severe inflammation. AP treatment increased local circulation and lymph drainage and had strong effects in resolving the
inflammation.
Perforated gastric or duodenal ulcers were produced in rabbits. AP enhanced peritoneal activity (speed of adhesion and speed of resorption of effusate) and was effective in alleviating the clinical signs.
Myocardial infarct, necrosis and cardiopathy was produced in dogs and rabbits by arterial ligation. AP at PC06 (NeiKuan) improved coronary circulation, reduced the size of the infarct and the subsequent necrosis.
These experiments were conducted by Chinese workers but other experiments in animals also confirm that AP has anti-inflammatory effects. One of the most obvious uses of AP for its anti-inflammatory effects is in surgical (operative) cases. AP analgesia or AP therapy post-surgery causes a marked reduction in the incidence of post-operative complications (wound sepsis, slow healing, intestinal atony etc). Wound healing in acupunctured animals is fast and clean. The points used are similar to those used in AP analgesia for the surgical area (see paper on AP Analgesia) but points LI04 (HoKu), LI11 (ChuChih), GV14 (TaChui) and ST36 are especially effective in controlling wound infection and fever.
AP IN THE TREATMENT OF FEVER
Clinical fever: AP is used to reduce fever in many specific and non-specific conditions in humans. For this purpose, the points most often used are LI04, LI11 and GV14. For instance, these points are used to reduce fever in influenza, poliomyelitis, malaria, typhoid, cholera etc and in post-operative sepsis. The same points are used in non-specific fevers.
Experimental fever was induced in rabbits by injection of typhoid vaccine. Needling of points ST36 and GV14 consistently reduced body temperature in the experimental rabbits but normal temperatures were not reached. However, repeated needling at these points reduced the duration of the fever as compared with the duration in control rabbits. Other Chinese experiments also confirmed the anti-febrile effects of AP in monkeys with experimental bacillary dysentery. In clinical veterinary practice, needling of points ST36; GV14; LI04;
LI11 is recommended to help reduce fever in many specific and non-specific cases.
AP EFFECTS ON ANTIBODY LEVELS
Papers presented at the AP symposium at Beijing (1979) noted strong effects of AP in stimulating the immune response in humans and animals (6). Needling TienShu (ST25) and ShangChuHsu (ST37) increased immunoglobulins and specific antibody levels in blood of rabbits and monkeys experimentally infected with bacillary dysentery and in naturally-occurring cases in humans. In clinical cases of human malaria, AP increases serum complement levels.
Injection of specific antigen into many species of experimental animals (rats, guinea pigs, rabbits, monkeys) has been used to examine the antibody response to AP. The main points which enhance antibody production are LI04; HsuanChung (GB39) penetrating to San Yin Chiao (SP06); ST36. In these experiments, AP caused a faster rise in antibody level, a higher plateau and longer persistence of antibody than in the inoculated but non- acupunctured animals.
AP EFFECTS ON PHAGOCYTES, RETICULO-ENDOTHELIAL SYSTEM AND LYMPHOID TISSUE
Under experimental conditions in humans, needling LI11 caused neutrophilia (leucocytosis), whereas needling a placebo point had no effect. In clinical medicine, LI11 (sometimes with as LI04, GV14 and ST36) is frequently used in infections and in other conditions in which activation of the neutrophils and reticulo-endothelial system is required. It is hardly
coincidence that these effects are stimulated by the same points which activate the antibody system and that these points are valuable in the therapy of infections in humans.
Similarly, in animals, points such as LI4, LI11, ST36 and GV14, cause leucocytosis and increase phagocytosis in experimental studies, as well as in clinical infections. For example, AP at LI11 caused leucocytosis in rabbits whereas placebo points did not produce this effect.
Similarly, when plasma from rabbits needled at LI11 was injected into control rabbits, they also developed leucocytosis, whereas plasma from control rabbits injected into other controls caused a leucopenia. The release of a humoral leucocytic factor has been shown by other studies. It was also shown that this effect of AP was inhibited by nerve section above the point or by local anaesthesia of the point before needling. This demonstrates that the input signal to the hypothalamus is transmitted via the peripheral sensory nerve.
Japanese workers challenged rabbits and rats with bovine serum albumin. ST36 and PangGu (new points on the limbs) were needled. Marked histological changes occurred in the lymph nodes of the acupunctured limb (enlargement of the lymph sinuses, haemorrhage, increase in mast cells and degranulation. A rapid increase in plasma cells occurred in 48 hours). It could be argued that these changes were of an inflammatory nature rather than an immune response.
However, the other data of the trial indicated definite immune enhancement of antibody production and lymphocytopenia.
AP also caused release of a humoral bactericidal factor. In experimental bacillary dysentery in rabbits and monkeys, AP at ST25 and ST37 increased the bactericidal activity of plasma by 50% after 30 minutes and by 70% after 3 hours. In these experiments, the phagocytic activity of the reticulo-endothelial system of the liver increased 46% after 6 days and 63% after 12 days of AP. The treated animals ceased to excrete the bacilli in faeces in 4-5 days, whereas control animals (untreated by AP) were still excreting bacilli after 21 days. All the symptoms (fever, abdominal pain, tenesmus, bowel frequency etc)were eliminated by AP. In 800 clinical cases of bacillary dysentery in humans, AP alone, given 1-3 times daily for 5-10 days was effective therapy in 90% of patients. The symptoms were controlled and the organisms were eliminated from the faeces.
EFFECTS OF AP ON TISSUE DAMAGE CAUSED BY X-RAYS
Rats exposed to X-rays developed anaemia and leucopenia. Needling at LI04, GB39 and SP06 caused the red cell count, haemoglobin level and while cell count to recover faster than in control rats which received the same dose of X-ray. AP has been used clinically in humans to assist recovery from nuclear exposure. Apart from its effects in haematology, nuclear
exposure also damages the immune response in humans and animals. The immunostimulant effects of AP may be helpful to patients suffering from the effects of nuclear radiation, such as that used in cancer therapy.
AP IN THE TREATMENT OF ALLERGIES
AP in human clinical allergies: AP is used to treat many human allergies, including allergies caused by inhalation, oral intake and skin contact. These conditions include asthma, hay fever, allergic rhinitis, food allergies, diarrhoea, contact allergies, allergic conjunctivitis etc.
The most important points for treatment in asthma include FeiShu (BL13) and GV14 but other points are sometimes added, including HsinShu (BL15), KeShu (BL17), TingChuan (Asthma point) and HaiLao (a new point). In hay fever and allergic rhinitis, the main points are LI04 and YingHsiang (LI20) but other points, such as LI11 and Yin Tang (Z 03, between the eyebrows) are also used.
In treating human allergies, the selection of the points is based mainly on the location of the symptom or lesions. For instance, in asthma, the main points are chosen for their action on the lung. In rhinitis the points are chosen for their action on the nose and upper respiratory tract.
Thus, in treating a food allergy in which the main symptom was nausea and vomiting, the main points would be aimed at the stomach (ChungWan (CV12); ST36, PC06). If the main symptom was biliousness and dizziness with headache, the main points would be aimed at the liver and gallbladder ((TaiChung (LV03); FengChih (GB20) with possibly ST36 added for its gastric effect).
A course of AP can often succeed in desensitising patients to their allergens, despite continued exposure to them. Examples are hay fever, migraine headache and food allergies.
AP in clinical allergies in animals: There are few reports of the use of AP in specific clinical allergies in animals. However, it might be tried in fog fever in cattle and in bronchospasm in horses (similar to asthma) and in non-specific dermatitis, and pruritus in small animals. Also many symptoms of allergies (bloat, vomiting, diarrhoea, etc) in animals are known to respond to AP, aimed at the organ, region or symptom involved.
Experimental allergy in animals: Allergic-encephalomyelitis was induced in guinea pigs by injections of an encephalogenic antigen. Needling certain points (LI11; ST36) enhanced the immune response and exaggerated the allergic response. On the other hand, needling
ChihShih (BL52) prevented the allergic response. The antiallergic effect may have been due to release of ACTH and corticosteroids. BL52 has effects on the kidney and adrenal.
AP AND ENDOCRINE RESPONSES
In the paper on AP analgesia, the role of the hypothalamus and endorphin release is discussed more fully. AP stimuli are carried via the peripheral sensory nerves and sympathetic trunks to the hypothalamus. Hypothalamic activation with subsequent activation of the pituitary, may release ACTH, MSH, TSH, gondatropins, pancreatic (insulin) tropins etc depending on which nuclei in the hypothalamus have been stimulated. This, in turn, depends on which AP points have been stimulated. Release of these hormones may cause release of corticosteroids, adrenalin, thyroid hormones, oestrogen, progesterone, oxytocin, prolactin, relaxin, insulin, etc.
Clinical endocrine disorders in humans: AP is used to treat many human endocrine disorders. If there are sufficient endocrine cells which can be activated by the trophic and/or neural stimuli, the results can be very good. However, in chronic or severe cases (especially where hormone substitution therapy has been given for a long time and has suppressed the body's ability to produce its own hormones), the results are not so good.
Examples of endocrine conditions responsive to AP include: mild goitre, mild hormonal infertility (due to oestrogen-prostaglandin-progesterone imbalance), post-parturient agalactia (prolactin, oxytocin), uterine atony at parturition (oxytocin); cervical non-dilation at
parturition (ringwomb); recurrent abortion; menopausal syndromes. ln early or mild cases of diabetes mellitus, AP at SP06; LV13 (ChangMen); BL20 (PiShu) can be very effective in controlling blood sugar and in treating pancreatitis. In diabetes insipidus, due to deficiency of the antidiuretic hormone, needling at BL23 (Shen Shu), BL28 (PangKuangShu); GB25 (ChingMen) can help.
Clinical endocrine disorders in animals: Similar conditions in animals have been helped (reproductive disorders; parturition disorders; agalactia; pseudopregnancy; polyuria; hormonal alopecia in castrated cats). However, as in other areas of veterinary AP, documentation of these effects in very scarce.
The evidence from clinical use in humans and animals suggests that some of the therapeutic effects of AP are mediated by the endocrine system.
OTHER CONDITIONS RESPONSIVE TO AP THERAPY
Earlier sections discussed many therapeutic effects of AP. These include leucocytosis, increased activity of the phagocytic, lymphoid and reticulo-endothelial systems, release of a leucocytotic factor and a bactericidal factor into plasma, enhanced antibody production, antifebrile, anti-inflammatory and anti-infectious effects. These effects help to explain the therapeutic value of AP in fighting infection, resolving inflammation and reducing fever in humans and animals. Increased haematological stimulation and immunostimulation also help to explain the effect of AP in damage caused by exposure to nuclear radiation. These effects are stimulated only by certain points.
Other points have immunosuppressant effects and help patients during the allergic reaction.
Still others act by releasing various hormones in mild endocrine disorders.
Other applications of AP in humans and animals include: pain, poor circulation, smooth muscle dysfunction, tissue damage and bleeding, paralysis, paresis and miscellaneous.
a. PAIN
Pain due to trauma, inflammation, ischaemia, muscle spasm, arthritis and other peripheral causes, can be helped, if not fully controlled, by AP.
Pain conditions in humans which respond in varying degrees to AP are: headache, toothache, eye pain, earache, neck pain; colic; pain in gastric, duodenal or colonic ulcer;
backache, sciatica; pain in the muscles and joints, phantom limb pain, angina pectoris, narcotic withdrawal pain. One of the main uses of AP in human patients is in the control of chronic peripheral pain. However, pain of central origin does not respond well.
AP is also of astonishing value in treating acute traumatic pain (fractures, dislocations, pulled muscles, contusions, abrasions, etc). For this purpose, the most important point is
YangLingChuan (GB34). GB34 is usually combined with a local point for the region involved.
AP is also of great value in treating post-operative pain (and other complications, such as inappetance, nausea, ileus and urine retention) in humans. For this purpose the main points used are the same as in AP analgesia for the region (see paper on AP analgesia). Points to assist the function of the stomach, large intestine, kidney and bladder are added, as needed.
AP is also of great value in treating post-operative pain (and other complications, such as inappetance, nausea, ileus and urine retention) in humans. For this purpose the main points used are the same as in AP analgesia for the region (see paper on AP analgesia). Points to assist the function of the stomach, large intestine, kidney and bladder are added, as needed.