Questions and Answers about Acupuncture
||In April 2003, I was interviewed by Anupam
Sharma, a journalist with the magazine from India, Fourth
Dimension, which reaches 171,000 readers monthly both there
and abroad. I thought youd like to read it, because
I answered a lot of the commonly asked questions about acupuncture
that I havent written about on the Pulse of Oriental
Medicine (PulseMed.org), and because you probably wont
be able to get that magazine.
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,
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
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
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.