9. depression (Liver, Heart).
This is obviously a long and complicated list of symptoms, all of which combine to make up a picture that is not unlike the TCM idea of old age – a slow decline of supporting Kidney energy. It is not suggested that pulling it all together 193
Table 8.1 Staging of
multiple sclerosis (after Blackwell & MacPherson 1993)
Parkinson’s disease can be cured by acupuncture, but it is reasonable to sup- pose that the known physiological effects may help with symptom control.
Using TCM reasoning, the following points could be used, but not all at once:
[ St36 Zusanli and Sp 6 Sanyinjiao – to assist with the formation and better circulation of Qi; used as a tonic and boost
[ Kid3 Taixi – stimulates both Kidney Yin and Yang
[ Du20 Baihui or moxa to Du 4 Mingmen – to access and support the energy in the Du meridian. Kid3 Taixi could also be useful
[ Liv3 Taichong – for control of muscle tremor. (Use with SI 3 Houxi if spasm is also present)
[ Ht7 Shenmen – for mask, lack of emotion
[ Ht6 or 7 – for excess or uncontrolled saliva
[ Heart points associated with speech problems (Ht5 Tongli)
[ Sp10 Xuehai – for Blood stasis in lower limbs; SJ 6 Zhigou in the upper limb. Also moxa to UB17 Geshu for general circulation. Ren 6 Qihai can be used to support body Qi
Young woman, aged 34, with an early diagnosis of multiple sclerosis. Had minor symptoms for 2 years. Sent by her general practitioner to the physiotherapy department for ‘some exercises’.
Main problem
Lack of sensory perception in the extremities: ‘a feeling that she was wearing rubber gloves on her hands and that she was walking through soft sand’. This tended to produce a slightly clumsy gait. Otherwise, few physical symptoms, slight double vision occasionally. Patient very anxious in view of her diagnosis. Impression
Stage 2 Damp Heat in the channels, producing mainly channel symptoms. Treatment
The aim was to clear channels, support the Stomach and Spleen. Points:
[ Baxie (extra points on the hand)
[ Bafeng (extra points on the foot)
[ St 36 Zusanli
[ Sp 6 Sanyinjiao.
Treatment was given twice weekly for 3 weeks, then once a week for 3 weeks. Very gentle coordination exercises were given.
Outcome
Restoration of normal sensation in limbs. Some improvement in gait. Patient much more serene. Unfortunately, the patient moved out of the area and was not treated again.
C A S E H I S T O R Y
[ All of the preceding points will have some effect on the mood of the patient because of the anticipated increase in serotonin levels. TCM suggests points such as Yintang to ‘lift the spirits’.
It is important to remember that these patients are characterized by a slowing down of body processes and a general lack of energy. Acupuncture can be a draining type of therapy and should be used with caution. How- ever, it can be seen that with a basic understanding of TCM a useful pre- scription can be drawn up for a patient manifesting with a clear neurological disease process.
Research Published research in this field has been limited. The papers from China available in the West do not help the situation. Usually the rationale for the selection of points is not given. There are two reasons for this. First, it may be assumed that the readers are perfectly familiar with the TCM the- ories guiding point selection and that no explanation is needed. Second, the feeling that Western scientific institutions will neither understand nor accept the reasons given for the selection of points may compound the natural reticence of the researchers. There are some notable exceptions, however. For example, Aune et al (1998) investigated a well defined and described Bladder syndrome with promising results and a TCM-guided choice of points.
There has been little research in which TCM syndromes have been specifically identified and described. This is a great pity because this is the cutting clinical edge of acupuncture. Many hundreds of years of empirical experience are distilled into the description of the individual syndromes. The great variety and subtlety of both differentiation and subsequent choice of points for treatment makes it difficult to standardize treatments. Unfortunately, controlled clinical trials require this kind of precision in order for the results to be analysed and quantified with any confidence.
There is now a strong move in acupuncture circles to ensure that the TCM aspect of treatment is not neglected, but carefully reported, in future trials (MacPherson et al 2002). Birch (1997) has identified the main prob- lems facing the researcher in traditionally based acupuncture, and has offered some solutions.
The current emphasis in scientific research is to specify and report on all aspects of the research protocols. This means that the underlying theo- ries are made extremely clear and the treatments specified are repeatable (MacPherson et al 2002). The Standards for Reporting Interventions in Controlled Trials of Acupuncture (STRICTA) protocol published by MacPherson et al (2002) will assist in allowing full evaluation of the sys- tems of syndrome differentiation. It is likely that only the simpler and more obvious syndromes will be examined, with those corresponding to a Western diagnosis being regarded as easier to tackle first.
A handful of interesting papers has been published, however, with regard to TCM-type treatments. Some researchers have looked at cardiac disease, particularly angina pectoris and coronary artery disease, finding that acupuncture appears to be beneficial (Bueno et al 2001, Richter et al 1991).
The proven effect of acupuncture on peristalsis and gastric motor func- tion deserves better recognition, and the papers by Chang et al (2001a, b) are worth reading. Acupuncture has been shown to be effective in treating two patients with persistent hiccups (Schiff et al 2002).
Acupuncture with clear roots in syndrome differentiation has been used with success in cases of dysmenorrhoea (Griffiths 2000, Proctor et al 2002). Porzio et al (2002), who looked at the use of acupuncture to combat menopausal symptoms in women after tamoxifen was used to treat their cancer, investigated a similar application.
The use of acupuncture for morning sickness and nausea is based entirely in TCM theory, but has been almost adopted by Western practi- tioners, first because it is so simple, involving only a few points in addition to Pe6 Neiguan, and second because it has been investigated so compre- hensively by researchers. A recent trial (Smith et al 2002) showed acupunc- ture to be an effective treatment for women who experienced nausea and dry retching during early pregnancy.
The use of syndrome differentiation has seriously complicated the approach of researchers. In their paper on the diagnosis and treatment of low back pain by traditional Chinese medical acupuncturists, Sherman et al (2001) found that only two acupoints (UB 23 and UB 40) were common to all 150 treatments for chronic low back pain, although more than 85 dif- ferent points were used. A diagnosis of Qi and Blood stagnation, or of Qi stagnation, was made for 85% of the patients, with a diagnosis of Kidney Deficiency (or one of the three subtypes) made for 33–51% of patients. As Sherman et al (2001) pointed out, selecting a single treatment that has wide applicability is certainly challenging.
More recently there has been an attempt to establish manualized research protocols (Schnyer & Allen 2001). This team has published what is, in effect, a textbook for the TCM acupuncture treatment of depressive illness, taking into consideration the various syndromes that may be con- stituted from the symptoms. Thus, a clear framework is established within which individualized treatment may be given. This is a truer pragmatic test for acupuncture than most, and is hopefully indicating a way forward for syndrome research.
Herbal medicine Use of TCM syndrome patterns in acupuncture treatment can be very rewarding, but it is important to bear in mind that treatment suggestions given here do not address the herbal component. Acupuncture is only part of a full traditional treatment, and sometimes only a minor part. Physio- therapists are not currently involved in prescribing, although things are changing. It is unlikely that the prescription of Chinese herbs will be part of normal practice for some time to come, if ever. It is, however, worth not- ing that many proprietary brands of common herb combinations are avail- able and, if advice is sought from a registered herbal practitioner, good advice could be given to the patient. The underlying principles of the syn- dromes need to be understood first in order to avoid recommending the wrong herbal combinations, and further training in TCM would be advisable.
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