Questions and Answers about Acupuncture

Anupam Sharma (AS): Dr. Brian Carter, Thank you for the prompt reply and agreeing to do this interview. Tell me, doctor, how does Acupuncture work? Please explain the science behind this traditional method of healing

Brian B. Carter (BBC): Acupuncture is based on Chinese medicine. Chinese medicine (CM) has its own system of diagnosis and treatment, and acupuncture is only one therapy within that medicine. Those who have developed CM since before 2500 B.C. (when our first literary work, the Yellow Emperor's Classic of Medicine, was written) used both symptoms and signs to diagnose disease before treating it. They developed a unique form of diagnosis called 'pattern differentiation.' Patterns are sets of specific symptoms and signs. For us, finding the signs includes the feeling the pulse and looking at the tongue.

For acupuncture specifically, there is also diagnosis according to the channels. It's actually a very complicated system of theories... not as simple as it first seems. That complexity allows for a sophisticated flexibility in diagnosis and treatment that can adapt to most clinical situations. According to modern science, acupuncture works via the immune and nervous systems. It has local peripheral nervous system and central nervous system effects. Professor and physicist Zang-hee Cho has begun to use PET scans to map the brain loci affected by specific acupuncture points. Acupuncture affects neurons, electrolytes, neuro-transmitters, and neuropeptides. But even once all that data is in, the traditional system of channels and pattern differentiation will still be the clearest map of how acupuncture works. The biomedical view of physical phenomena is not always well-integrated.

My best analogy is that your brain is a computer, and the acupuncture points are the keyboard; you do the right points, and that tells the brain how to change the configuration of the mind and body.

AS: In which diseases is acupuncture the most effective?

BBC: Most people are familiar with acupuncture's effectiveness for pain. Most importantly for pain, it can prevent chronic pain syndromes where the nervous system still produces pain signals even in the absence of the original problem. In 1997, the NIH came up with a list of diseases for which the scientific literature supported efficacy, which included nausea and vomiting, pain, tennis elbow, menstrual cramps, and fibromyalgia.

That list was much shorter than what acupuncture has traditionally treated, of course. Since 1997, even more studies have shown effectiveness for early post-stroke, acute spinal cord injury, as an adjunct in alcoholism, labor pain, migraine, post-surgical nausea and vomiting, and as part of a smoking cessation program. These are the highest quality studies: randomized placebo-controlled trials (RCT's) with more than 33 subjects per group. There are plenty more studies that don't meet that high standard, but still may offer valuable insights for clinical practice.

There is currently a study of acupuncture for high blood pressure going on at Harvard, and early reports are that it's very effective. I personally got a diabetic man disqualified from his free blood pressure medication study with a modern Chinese point prescription. Our weekly acupuncture treatments brought his blood pressure down below the study's minimum requirement. Acupuncture also is great for a number of psychological conditions. There are 17 other RCT's currently ongoing, all funded by the National Institutes of Health.

AS: Do you think that the modern western medicine has failed in curing certain kind of diseases like backaches, mental tension, or headaches?

BBC: It always depends on the cause. For backaches, we need an x-ray to see if the spine is involved. For a backache or headache due to a tumor, I would certainly want MRI's and CT scans, and surgery. Of course, for cancer, we can do drug or Chinese herb chemotherapy. Or you can do drug chemo with supportive herbs to boost the immune system. For headaches, acetaminophen, aspirin, and NSAID's are very useful, though acetaminophen is the leading cause of liver failure in hospitals, and NSAID's can cause stomach ulcers. The new triptan drugs for migraines are very helpful for the acute migraine, but may not be as good as acupuncture and herbs for preventing recurrence. For any stubborn problems, or those for which western medicine cannot find the cause, acupuncture and herbs are superior.

As far as mental tension or stress goes, acupuncture and herbs work wonders. Western medicine uses sedatives and antidepressants. Most people don't want to be sedated, some antidepressants have debilitating side effects like impotence, and others are difficult to come off of safely... some even will create a dependency of sorts such that you get a rebound depression after you've been off of them for a number of months.

AS: Alternative healing methods like yoga and meditation and acupuncture becoming more popular among the people in the west? If yes, why?

A lot of people like yoga because it's physical. Meditation is hard for fast-paced noisy-headed Americans. Most people say they just can't stop thinking. They don't realize that they're always thinking like that. We're over-stimulated here.

Acupuncture is nice because it helps you stop thinking, reduces anxiety, produces calmness. You can meditate while the needles are in. Acupuncture is more popular here than Chinese herbs are because more MD's accept it. There's enough scientific evidence, and a number of MD's are practicing acupuncture full-time. Americans still don't understand herbal formulas, or the system of medicine that underpins Chinese herbs. They're used to going to a health food store and buying the latest single herb for a single symptom. And there aren't enough Chinese style herbalists in the U.S. to expose everyone to it yet.

AS: How long have you practiced acupuncture?

BBC: I've only been practicing a few years. I follow the idea that we need to learn true classical Chinese medicine before we can innovate intelligently, so I have a couple of mentors (Philippe Sionneau and Robert Chu) who have been practicing for about 10 years each. The formal school education is just the beginning. Our generation has a lot of translating to do to get Chinese medicine into English. Probably less than 1% of the literature has been translated. We have some of the most important and basic works, but we still have a lot to learn.

My job as I see it is to be a communicator. I have written hundreds of articles on my site (The Pulse of Oriental Medicine, www.pulsemed.org) and in other magazines that have reached more than 100,000 English-speaking patients. I have books and radio appearances in the works. There's too much for any one of us to know everything, so I keep in touch with a broad range of experts - translators, scholars, MD's, authors, so that I'm speaking authentically and accurately.

AS: Do you think acupuncture offers a better treatment than the allopathic medicine? If yes, then why isn't it as popular as the latter?

BBC: Even in its country of origin, Chinese medicine has lost some popularity. When the communists took over in the 1950's, they almost destroyed the traditional medicine. They wanted to catch up with the west and get our approval. But when Mao Tse-Tung got facial paralysis, it was acupuncture that fixed him. So he ordered the systemization of TCM. Now there are 3 branches of medicine in China: Chinese, Western, and the combination of the two. The latter is the most interesting, and probably the future of all medicine. For example, you can have an elevated Alk Phos level (a liver function test), with no western gallbladder pathology, but have symptoms of pain or discomfort along the Chinese acupuncture Gallbladder channel.

I don't think we should say either acupuncture and western medicine is better. Each has their strengths and weaknesses. And to be accurate, we have to say that most of Chinese herbal medicine is allopathic, because allopathic means treating with opposites. We reduce excesses, and strengthen deficiencies, for example. What we do need to do is cooperate; practitioners of various kinds of medicine should work together for the benefit of each patient. To only use one kind of medicine is more of a religion than a medical practice. Chinese medicine practitioners need to learn what western medicine is good and bad at, and vice versa. Same goes for chiropractors, Ayurveda, Homeopathy, massage, etc.

The popularity or acupuncture in the west is a function of time, politics, and finance. Acupuncture has only been in America for 30 years. Now many insurances and workers compensations cover it, MD's are learning it, it's always in the news, sports teams are using it. There are about 800,000 MD's, and 15,000 acupuncturists in the U.S. So it'll be awhile before it's an unquestioned part of the healthcare system. Even then, we'll still have to deal with some people's egos.

AS: How can one become an acupuncturist? What are the qualifications required for becoming one? Is there a similar degree as an MBBS?

BBC: The average in the U.S. is 3-4 years of school, graduating with a Master's of Science in Traditional Oriental Medicine. Regulations vary by state. California has the highest standards; we are tested on the medicine, acupuncture, herbs, law, etc. Actually, acupuncture is only 17% of the test! Again, acupuncture is only one of Chinese medicine's therapies. The standard is slowly being raised to the PhD level. There are now 3 nationally approved PhD programs for Chinese medicine. All 3 are on the west coast. I think eventually that will be the entry level. We have to do that to get on par with the chiropractors, MD's, and DO's.

AS: What do you think is the future of Acupuncture? I mean rest of the world.

BBC: Chinese medicine has been in Australia for more than 100 years. It's all over Korea, Japan, and Taiwan. I haven't heard much about it in South America. They have it in Canada, but I think it's not well regulated or accepted. In France, you have to be an MD to practice it. So it's different everywhere. But here in America, we are doing more and more research, and the results are affirming and interesting. So I think that the MD's, who hold most of the political and financial cards in international medicine, will be less and less able to resist the importance of acupuncture. Herbal medicine has a longer battle; because, in a way, it competes with pharmaceutical medicine. It shouldn't have to, though, because some studies we have read show that herbs ameliorate drug side effects and increase their effectiveness. This has to be done in accordance with both western and eastern medical principles, though.

I think they will merge to some degree, and work together. Western medicine has great standards and tools. Chinese medicine has valuable insights and perspectives that could even help design studies and interpret study results more effectively.

AS: Why did you become an acupuncturist? What influenced you in becoming one.

BBC: Number one, I wanted to help people. I wanted to make use of my talents. Number two, I was fascinated by the fact that Chinese medicine had never separated mind, body, and emotion. I wanted to find out more about this. I've always wanted to grow and be more effective. I thought perhaps Chinese medicine could help me do that, and then I could help patients do that too.

AS: What according to you is the best thing about acupuncture, meaning how and why is it better than other systems of medicine?

BBC: Acupuncture, and Chinese medicine, both look at the whole person. We know how every part of your body links up with every other part. We know how the lungs manifest emotionally. We know what green or blue skin means. We know what foods are best for which types of people.
Western medicine is compartmentalized. They study e.g., the immune system, the digestive system, or the psychology of the individual. We know how those are related. We can take symptoms from each, diagnose a pattern, and treat all three at once. Those inter-systemic insights are one of the most important contributions of Chinese medicine.
Acupuncture has a normalizing, regulating effect. Chinese herbs can strengthen you, while western drugs generally just attack or reduce excesses (like viruses, bacteria, inflammation). We can strengthen and reduce at the same time. We're a bit more flexible. We can almost always diagnose and treat everyone. Western medicine's approach often leaves them baffled about causes and searching for silver bullet treatments. In many situations, western surgery or drugs are superior. But there are just as many situations where they need us.

AS: Is acupuncture effective in all diseases, I mean the complex ones like cancer, etc?

BBC: Acupuncture can regulate and boost the immune system. This is important in cancer. However, for the serious and complex illnesses, Chinese herbal medicine is better. I've written about how we can treat AIDS, cancer, lupus, etc. Acupuncture is essential right after a stroke. The sooner you do that, the more function you can recover.