Summary opportunity to explore it further, to see it in action

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DECEMBER 1999 VOL 17 (2)
The Use of Acupuncture for Pain Relief in a
Chinese Hospital Clinic
Vivian Hui Yun Ip
Summary
This study formed part of a medical student elective
and was conducted over a six-week period from
April to June in the Acupuncture Clinic of the First
Teaching Hospital of Tianjin Traditional Medical
College, China. It is a descriptive cross-sectional
study investigating the painful conditions for which
Chinese consult an acupuncturist. The effectiveness
of acupuncture as an analgesic was assessed
subjectively using a visual analogue scale to
estimate the amount of pain before and after
treatment. A significant improvement was seen
following acupuncture. The patients' own views on
the efficacy of acupuncture in controlling their pain
were also noted: this resulted in a mean
effectiveness rating of 74.4%.
Key words
Acupuncture, China, Pain relief, Student elective.
Background
In the 1970s, when acupuncture was rediscovered
by the West, there were many anecdotal stories of
dramatic success, but there were still many critics
who tended to reject acupuncture entirely. Since
then, an increasing amount of convincing evidence
has emerged for the mechanism of acupuncture,
especially with regard to analgesia: pain is perhaps
the most common presenting symptom in clinical
practice. There has been evidence suggesting that
acupuncture is generally effective in treating
chronic pain, helping from 55-85% of patients,
which compares quite favourably with the effect of
potent drugs (1). Nowadays, acupuncture in the UK
is most widely used for analgesia, and there have
been studies showing an overall rate of around 70%
significant relief in general practice patients (2).
Apart from being effective, it also has the advantage
of being relatively cheap, as shown in studies of
acupuncture in General Practice (3-5).
Since I have always been intrigued by
acupuncture, the elective period (6-10) in the 4th
year of my medical studies gave me an excellent
ACUPUNCTURE IN MEDICINE
opportunity to explore it further, to see it in action
and to investigate its effectiveness, especially with
regard to its analgesic properties. Where better to
carry this out than China?
My placement was at the First Teaching Hospital
of the Traditional Chinese Medical College in
Tianjin. The town is by the Bohai Gulf in the eastern
part of the North China Plain, not far from Beijing; it
covers an area of 11,305 square kilometres and is
home to some 9 million people.
The hospital was established in 1954 and
classified as a general traditional Chinese medicine
(TCM) hospital, but it combines traditional with
Western medicine, having a variety of technical
diagnostic and treatment aids such as: MRI and CT
scanners, artificial kidney colour ultrasonography,
dynamic ECG, Hyperbaric oxygen chamber, PCR
quantitative analyser, and ultrasonic Doppler
system. There are 900 beds and more than 600 outpatients a day in 25 out-patient clinics. There are 26
clinical and technical departments including:
Acupuncture and Moxibustion, Internal Medicine,
Surgery, Emergency, TCM Psychosomatic,
International Convalescent, Paediatric, Orthopaedic, Ophthalmology, Pharmacy, etc.
The hospital has been awarded prizes at national
and local levels and has obtained significant
achievements in scientific research. As an appointed
teaching hospital for undergraduate and postgraduate education, students are admitted from all
over China and from more than 40 other countries;
an international school of traditional Chinese
medicine is planned.
At first, I found the language barrier was very
much a problem, but the environment and the
friendliness of the Chinese people, together with a
little will-power, made it easier. It was only when I
was able to communicate with the people that I
could begin to learn what the indigenous Chinese
are like and appreciate their culture. I had to learn
the need for respecting elders when speaking. For
example, there are several ways of asking a person's
age. One way is for speaking to someone who is
younger than yourself, while the other is the polite
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DECEMBER 1999 VOL 17 (2)
and respectful way to ask someone who is older. If
one is ignorant of this custom, it is easy to give
offence and break the trusting relationship between
interviewer and patient.
Introduction
It has been said that Western students who wish to
study traditional acupuncture must forget their
Western ideas, as Chinese medicine holds little for
the analytic mind to grasp! This is because it is
based on holistic patterns, causal relationships, nonlinear logic, non-reductionistic views and empirical
evidence.
According to the theories of TCM, diseases,
including pain, result mainly from relative
imbalance of yin and yang: yang in excess or
deficiency or yin in excess or deficiency. Needling
specific acupoints can, according to TCM theory,
return the yin-yang balance to equilibrium by
unblocking stagnant qi to restore its flow around the
meridians (11-12).
As expected, the contrasting Western scientific
model is quite different. Since the proposal of the
gate control theory by Melzack and Wall in 1965
(13) and the discovery of stereo-specific opioid
receptors and the endogenous opioid peptides in
the 1970s (14), there has been an increasing
knowledge of pain pathways and mechanisms,
especially regarding acupuncture analgesia. It has
been suggested that the analgesic effect can be
mediated through the gate mechanism via
endorphinergic interneurons releasing enkephalin
or dynorphin and it has been postulated that
endogenous opioids and monoamines secreted
from the periaqueductal gray and the raphe nucleus
in the mid-brain also play a role (15-17).
Acupuncture has many applications in medical
practice (18), but pain seems to be the area on
which most research has focused. Macdonald et al
(19) and Petrie et al (20) have shown a 55-85%
effective rate for acupuncture groups in the
treatment of chronic pain compared to a 30-35%
rate for placebo controls. Molsberger et al (21) and
Haker et al (22) have also demonstrated the
effectiveness of acupuncture over placebo for
treating the pain of lateral epicondylitis. In a study
conducted by a medical student during her elective
in Xi'an, China, a beneficial outcome was reported
with acupuncture for chronic pain (8). Indeed
acupuncture consistently shows a beneficial
outcome and appears to help between 45% and
80% of painful conditions such as musculoskeletal
pain, back pain and migraine, often with additional
benefits such as an improved sleeping pattern and
appetite, and relief from muscle spasm (23-28).
102
However, randomised, double-blind, controlled
clinical trials in acupuncture remain difficult to
design (29).
This study was to look at the range and incidence
of conditions with which patients present at the
acupuncture clinic of a Chinese TCM teaching
hospital, to correlate these conditions with the
demographic details of the patients, and to
investigate the effectiveness of acupuncture and
related techniques in pain control.
I had prepared a protocol for this investigation
before leaving England, but when I arrived in Tianjin
I found that the organisation of the acupuncture
clinic made it impossible to carry out the protocol
as planned. Specifically, there was no separate new
patient clinic or follow-up clinic, so amendments
were made to suit the circumstances and to allow
me to follow the maximum number of patients
throughout my stay.
Method
This descriptive, population-based study was
conducted over a 5 week period in which 43
patients were studied in detail: 23 female and 20
male, with an age range of 28 to 74 years. To
minimise bias due to the variability of the
acupuncturist's skill, all the data was collected at
one clinic only where the treatment was given by
the senior acupuncturist or by one of her assistants
under supervision. All patients who came to the
clinic within the study period with a painful
condition and received acupuncture treatment were
interviewed by the author (Plate 1). Their
demographic details were noted: age, sex, mode of
referral and occupation. The type of painful
condition was recorded together with its severity,
expressed as a visual analogue score (VAS) that was
completed by the patient before starting treatment
and after completion of the acupuncture course. The
VAS was an unmarked 5cm line with 0 meaning
completely pain-free and 5 being the most pain
Plate 1. Patients in the Acupuncture Clinic.
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DECEMBER 1999 VOL 17 (2)
imaginable. A course of acupuncture lasted 14 days,
with daily sessions of 20 minutes each: this pattern
of treatment was specified by the senior clinic
doctor, Dr Yan. If the condition was chronic and
further treatment was deemed necessary, it would
be continued on a daily basis.
Unfortunately, collection of data was bounded by
the length of my elective period and thus in some
cases was necessary before completion of a course
of treatment. Data from patients undergoing a
prolonged course of treatment was collected at the
end of their course, however long it had continued.
After each patient had completed a course of
acupuncture treatment, the pain level VAS was
recorded and the subjective effectiveness of
acupuncture was assessed by asking patients to
Table 1
SUBJECTIVE SCORING SYSTEM FOR THE EFFECTIVENESS
OF ACUPUNCTURE
0 = Completely non-effective
1 = Very slightly effective
2 = Slightly effective
3 = Moderately effective
4 = Very effective
5 = Most effective
Table 2
ACUPOINT SELECTION FOR PAIN RELIEF
Low back pain radiating to the legs
Dachangshu (BL.25), Zhibian (BL.54), Chengfu (BL.36),
Yinmen (BL.37), Weizhong (BL.40), Chengshan (BL.57),
Yanglingquan (GB.34)
Lumbar back pain
Qihaishu (BL.24), Dachangshu (BL.25), Guanyuanshu
(BL.26), Shangliao (BL.31), Ciliao (BL.32), Zhongliao
(BL.33), Xialiao (BL.34)
Shoulder pain
Yanglingquan (GB.34)
Tension headache
Quchi (LI.11), Taiyang (EX-HN5)
Trigeminal neuralgia
Sibai (ST.2), Quanliao (SI.18), Juliao (ST.3), Hegu (LI.4),
Neiting (ST.44)
Neuro-vascular headache
Taiyang (EX-HN5), Yintang (EX-HN3), Shangxing (GV.23),
Baihui (GV.20), Neiguan (PC.6), Hegu (LI.4), Sanyinjiao
(SP.6), Taichong (LR.3), Fengchi (GB.20), Wangu (GB.12)
Additional points may be selected on an individual basis.
See reference (22)
ACUPUNCTURE IN MEDICINE
Plate 2. Dr Yan makes a pulse diagnosis.
record a score on a numeric scale (Table1). This was
done in a neutral manner to reduce the potential for
interviewer bias, away from the acupuncturist and
attempting not to give any impression that a
particular answer was either hoped for or expected.
Patients were assisted in scoring by being asked to
think about their capability of coping with the
activities of daily living, for example: washing,
dressing, cooking, shopping and so on. For those
patients who had already commenced acupuncture
treatment before I was able to start recording, the
initial condition was assessed retrospectively.
At the acupuncture clinic, new patients were
assessed by the acupuncturist in charge. This
involved a thorough history and examination,
together with a pulse and tongue diagnosis (Plate 2).
She would then decide the appropriateness of
acupuncture as a form of treatment and, if suitable,
the mode of treatment and its length. There is a
standard pattern of acupoint selection at the clinic
for treating specific diseases (Table 2).
Apart from point selection, the mode of treatment
also varied, for example moxibustion was used in
so-called cold syndrome. The other related forms of
treatment used in combination with the
acupuncture were: electrical stimulation of the
needles, cupping, moxibustion to the needles,
moxibustion on ginger or garlic, and acupuncture
with a heat lamp (Plates 3-4). The mode of treatment
varied between patients, with no specific pattern
between the mode of treatment and the condition
treated.
There are many different needling methods, for
example: twisting and rotating, or lifting and
thrusting, each with a different speed of application.
The needle size was also varied in needling different
parts of the body. These variations were all noted as
data for the study.
Results
Over the six weeks of the elective period, a total of
106 patients presented at the acupuncture clinic:
47 (44.3%) female and 59 (55.7%) male. The mean
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DECEMBER 1999 VOL 17 (2)
Plate 3. Acupuncture and moxibustion with garlic for headache.
Plate 4. Acupuncture with heat lamp for muscular cervical pain.
Note the circular erythematous patches from recent cupping.
age was 56.2 years, but the age group with the
largest number of patients was 61-70. A variety of
conditions was seen, but mainly stroke (37.7%), for
which acupuncture was used as a symptomatic
treatment to relieve weakness or paralysis of limbs,
and painful problems (37.7%) (Table 3).
Out of the total seen, 43 patients had painful
conditions (23 female and 20 male). The largest age
group seen with pain was between 31 and 40 years,
with the second largest being between 61 and 70.
Their mean age was 51.9 years.
In the pain group 2 patients each complained of
two ailments: headache with low back pain, and
headache with post-stroke shoulder pain. The
patients were given separate acupuncture
prescriptions for each ailment, although there was
some overlap in the points used, thus the number of
conditions reported was 45. Three patients failed to
attend for their full course of treatment, so no postacupuncture assessment could be made for them.
Of those whose data was complete, 8 others did not
complete the full 14 day course of acupuncture
before the end of my elective attachment, so the
post-acupuncture assessment was carried out before
I left Tianjin, but while their treatment course was
still in progress. This might well have influenced the
results, so the analysis has been repeated, excluding
those 8 patients (Table 4).
The mean VAS for pain pre-acupuncture is higher
than that post-acupuncture for all conditions
treated. The mean effectiveness ratings show a
similar response ranging from 60% to 70% across
all conditions except post-stroke shoulder pain
Table 3
AGE DISTRIBUTION OF CLINIC PATIENTS SEEN WITH VARIOUS CONDITIONS
Age
n (%)
Pain (%)
Stroke
Obesity
Muscle spasm
Numbness
Arteritis
Angina
Palpitation
Hypertension
Dizziness
Hydrocephalus
Prostatitis
Bell's palsy
Dementia
21-30
4(3.8)
3(7.0)
0
0
0
1
0
0
0
0
0
0
0
0
0
31-40
21(19.8)
14(32.6)
2
1
1
3
1
0
0
0
0
0
0
0
0
41-50
14(13.2)
6(14.0)
7
0
1
1
0
0
0
0
0
0
0
1
0
51-60
20(18.9)
4(9.3)
9
0
0
1
0
1
0
2
3
0
1
1
0
61-70
30(28.3)
11(25.6)
15
0
0
1
0
1
1
1
1
1
0
0
0
71-80
16(15.1)
5(11.6)
9
0
0
0
0
1
0
1
0
0
0
0
1
>80
1(0.9)
0
1
0
0
0
0
0
0
0
0
0
0
0
0
Total(%)
106(100)
43(37.7)
43(37.7)
1(0.9)
2(1.8)
7(6.1)
1(0.9)
3(2.6)
1(0.9)
4(3.5)
4(3.5)
1(0.9)
1(0.9)
2(1.8)
1(0.9)
The number of conditions exceeds the total number of patients (n) due to some patients having more than one condition.
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Table 4
MEAN VAS SCORE AND EFFECTIVENESS RATING FOR PAINFUL CONDITIONS TREATED
Condition
Musculoskeletal pain
Low back
Low back -> leg
Arthritis
Ankylosing spondylosis
Post-stroke shoulder
Headache
Tension headache
Migraine
Trigeminal neuralgia
Other
Heartburn
Total n(%)
n (%)
9 (20.0)
9 (20.0)
8 (17.8)
1 (2.2)
6 (13.3)
No exclusions
VAS (pre) VAS (post)
3.5
1.8
4.5
2.5
4.1
2.2
3.0
2.0
4.4
1.4
Effect
3.2
3.4
3.2
3.5
3.8
With exclusions
VAS (pre) VAS (post)
3.4
1.5
4.6
2.4
3.9
2.1
3.0
2.0
4.4
1.2
Effect
3.2
3.4
3.4
3.5
4.0
9 (20.0)
1 (2.2)
1 (2.2)
3.9
4.0
5.0
1.3
1.0
2.0
3.2
4.5
3.0
3.7
4.0
5.0
1.3
1.0
2.0
3.1
4.5
3.0
1 (2.2)
45 (100)
2.5
1.0
40
3.5
0
0
32
0
(pre) = pre-acupuncture, (post) = post-acupuncture, Effect = effectiveness rating
(80%) and migraine (90%); however, there was only
one patient with migraine. Thus, the results show an
effective outcome for acupuncture treatment across
the range of painful conditions studied. In poststroke shoulder pain the response could be seen
immediately on needling the point GB.34 with most
patients being able to rotate the shoulder with only
slight pain. Nonetheless, the small sample size
made analysis of individual types and positions of
pain unreliable.
The mean overall self-rated outcome of the
effectiveness of acupuncture is 71.9%, with a
standard deviation of 0.98. When those who did not
complete the full course of treatment are excluded,
the rating of the effectiveness of acupuncture is
higher, although the sample size is reduced
accordingly. This gives a mean for the patient rated
effectiveness of acupuncture of 74.4%, with a
standard deviation of 0.99.
Discussion
One of the objectives of the study was to find out the
range and incidence of conditions with which
patients present at a pain clinic in China. However,
at the Tianjin hospital there was no specific pain
clinic, since all clinics had a mixture of conditions.
Nonetheless, the results show that the largest
proportion of patients attending were those with
pain or stroke, demonstrating that, as in most other
countries, pain is a common problem for which
patients go to see a doctor in China. That the
number of stroke patients was large may be due to
the huge number of smokers and heavy drinkers in
China. Among the painful conditions seen, all were
chronic, with musculoskeletal pain being the
ACUPUNCTURE IN MEDICINE
commonest of all across every age group (Plate 5).
Within this category, low back pain with or without
radiating pain to the leg contributed the largest
number of patients. This was particularly true in the
younger age groups. In the older patients, arthritis
and post-stroke arm pain were the conditions more
frequently seen. Headache was the next commonest
condition, with tension headache being the most
widely seen, again across all age groups (Plate 6).
The largest number of patients attending the
acupuncture clinic were those aged between 61 and
70 years; this could be because the elderly generally
had more time, with the retiring age being 65 for
males and 55 for females. Amongst those with
painful conditions, the largest proportion were aged
21 to 30 years. This could be related to the cultural
health belief that while they are still young, things
are easily corrected, but if they just put up with
pain, they would have a long hard life.
Plate 5. Dr Yan inserts needles for cervical spondylosis.
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Plate 6. Dr Yan inserts needles for headache.
Most patients self-referred to the acupuncture
clinic, and many chose the hospital owing to its
excellent reputation, with recommendations from
family, friends, work colleagues or through the
media. There were occasional cases referred from
the Western hospitals when the doctors there felt
that acupuncture would be beneficial; both the
cases I saw were of low back pain. For those patients
suffering from stroke, most referrals were from the
in-patient department at the hospital, where they
would already have had a few sessions of
acupuncture; these usually need long-term
acupuncture treatment, mainly for symptomatic
control. There was also a significant proportion of
patients who had had unsuccessful treatment with
Western medicine or had suffered side-effects from
medication.
Interestingly, most people believed that
acupuncture therapy is free from side-effects,
despite the medically known risk of hepatitis in
China where hepatitis B is endemic. In view of this
I noted that disposable needles were not used at the
clinic and the method of sterilisation was soaking
the needles in 70% alcohol for a few hours, after
which they were reused. Also the acupuncturists
dealt with needle injury merely by dabbing the
puncture wound with alcohol or iodine. In addition,
during my attachment at the hospital, there was no
sharps-box and damaged needles were simply
thrown away in the dustbin.
In China, Western medicine is often used
alongside acupuncture and it is generally agreed
that the beneficial outcome of the combination of
practices is substantial. At the hospital, the
proportion of TCM and Western medicine is split in
a ratio of 2:1. In the medical school, the main bulk
of the curriculum is based on TCM theory, including
pulse and tongue diagnosis, history of TCM, and
TCM in the clinical specialties, for example: general
medicine, general surgery, paediatrics and so on, in
which acupuncture is only one part of the TCM
teaching. The medical students are also taught the
106
basics of Western medicine, so after their 5 years at
the medical school they can undergo further
education in Western medicine. Nevertheless, many
remain as TCM practitioners, but their knowledge in
Western medicine enables them to practise using a
mixture of both Chinese and Western theory,
diagnosis and techniques. For example, CT scans
and various imaging techniques, haematological
and biochemical investigations, and Western
pharmacology are integrated with TCM as part of
the routine diagnosis and investigation of most
patients. The main advantage of this system is that
for conditions in which TCM practitioners recognise
acupuncture therapy as non-beneficial, a rapid
referral into a branch of Western medicine can be
made at the diagnostic stage.
It is generally believed that Western medicine is
for acute conditions and minor illnesses like
influenza, as it is thought to treat the surface of the
disease. Therefore, people usually go to consult a
TCM practitioner for chronic conditions, believing
that TCM will treat the root of the problem. They
also believe that TCM forms a good foundation for
other medication, or interventions such as
physiotherapy, to have an effect. Moreover, they
consider that TCM plays a role in consolidating
previous treatments so that health is maintained for
a longer period of time. However, some people are
unable to endure the discomfort of acupuncture, or
they find TCM takes up too much time or is too
expensive. For example, daily acupuncture
treatment sessions may continue for 14 days, and
the bitter herbal medicine has to be boiled for a long
time, unlike Western medication which comes in
tablet form. This partly explains the reason why
Western medicine has become popular in China.
Nonetheless, more people have come to appreciate
the advantages and the disadvantages of each
system, so that a combination of practice is the most
favoured.
I found it very difficult to assess the social class of
patients, and talking to the people in China, I learnt
that occupation does not offer a good estimate of
social class. China is a communist country, implying
that people's wages are more or less the same: about
300-500 yuan per month (£23-40), apart from
professionals or government employees, whose
salary may be higher: 700-1000 yuan per month
(£54-77). People living in poverty will probably
have 50-100 yuan per month (£4-8). Where a
patient lives is a much better guide to social class.
The majority of people live in rented flats as few can
buy accommodation of their own, due to China's
political system. As a rule of thumb, in a five storey
block of flats: the 4th and 5th floors, with a view, are
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DECEMBER 1999 VOL 17 (2)
usually the most expensive, the ground floor and the
1st floor are rented at medium price, and the 2nd
and the 3rd floors are the cheapest. However, this
system does not always hold true, leaving social
class difficult to determine. Nonetheless, on
observation, most patients who attended the
acupuncture clinic were either middle or higher
class due to the fact that acupuncture therapy was
not affordable unless a patient had reasonable
earnings or large savings.
As to the effectiveness of acupuncture in treating
chronic pain, the data show a promising figure of
74.4%. However, it must be noted that this was with
subjective scoring. The visual analogue score of
pain showed a significant decrease of pain postacupuncture, but again it was a subjective
measurement. Hence, some possible confounding
factors need to be discussed.
It was generally felt that patients presenting
themselves at the acupuncture clinic had a belief in
TCM and an expectation that acupuncture would be
successful, or they would have sought another form
of treatment. From conversations with the local
Chinese, I discovered that many had their own textbooks of TCM, so that when they fall ill they can
self-diagnose and buy the appropriate medicine
from the pharmacist. Some people would therefore
already be taking Chinese herbal medicine, but may
have denied this to avoid offending the doctor.
The motivation to acquire basic TCM knowledge
and the ability to self-treat may be due partly to the
medical system in China. There is no national health
service or equivalent in China; everyone, regardless
of rich or poor, has to pay for their medical fees,
which are relatively expensive. For instance, people
need to pay 35 yuan (£3) to consult the
acupuncturist. If further investigations are necessary,
patients have to pay the additional fees. A further
200 yuan (£16) would be charged for each 14
session course of acupuncture therapy. If the
condition
requires
electroacupuncture
or
moxibustion etc, the patient has to pay extra for
these. The follow-up consultation costs another 35
to 50 yuan (£3-4). When converted to pounds
sterling this may not seem expensive, however, due
to the low earnings and low standard of living, the
medical fees are a real burden for the local Chinese.
Moreover, during the 14-day course of treatment,
many had to take time off work and pay for their
own transport (some came a long distance), and for
some a single course of treatment may not be
enough. Therefore, rather than spending money to
see the doctor, they would prefer to try selftreatment first and consult the doctor only as a last
resort. Consequently, late presentation is seen
ACUPUNCTURE IN MEDICINE
routinely in China and can sometimes lead to grave
consequences.
This private health care system in China might
also have affected our results with regard to the
effectiveness of acupuncture. It is possible that some
patients decided to discontinue their treatment due
to financial difficulties. Therefore, at the end of their
course, they might have been unrealistically positive
in terms of the effectiveness of acupuncture in order
to avoid further costly treatment.
At times during the interview one could sense a
strong need in the patients to protect the reputation
of one of the treasures of their country. For example,
although they might admit that acupuncture did not
seem to have had much effect, they would defend
the method with suggestions as to why it might not
have been effective for them: I'm too old; the
disease is too chronic; I just need more sessions, or
it's the weather. So, when asking for a subjective
opinion on the effectiveness of acupuncture,
subjective bias was inevitable.
Understandably, the cultural influence plays a
major role in the beliefs of patients and of some
doctors, indeed some deny the need for evidencebased medicine, claiming that acupuncture works
because thousands of years of experience have
proved it. Under the influence of such strong
cultural sway, there is very likely to be a placebo
effect: the patient's beliefs and expectations of
outcome influence the treatment. Furthermore, the
doctor-patient relationship at the clinic was very
paternalistic, so that the acupuncturist appeared to
speak with great authority. Her words of
encouragement and reassurance would have added
significant weight to any placebo effect. The
Plate 7. Treatment for arthritis with acupuncture, moxibustion
and heat lamp.
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DECEMBER 1999 VOL 17 (2)
a Chinese teaching hospital, and to assess the
response to treatment, paying particular attention to
painful disease. It was found that a wide variety of
conditions were treated with acupuncture, ranging
from stroke to prostatitis. Amongst the painful
conditions, chronic pain was predominant with
musculoskeletal pain being the most common. The
effectiveness was assessed subjectively in terms of a
visual analogue score pre- and post-acupuncture,
and by asking the patient to give a numeric
effectiveness score. The results showed acupuncture
and related techniques to be an effective treatment
for chronic pain.
Plate 8.
Electroacupuncture
for Bell's palsy.
outcome of acupuncture treatment could have been
influenced accordingly.
There was no particular pattern to the mode of
stimulation used. I learnt from the acupuncturist that
the different modes had their unique properties and
were used according to TCM theory and diagnosis,
interpreted through the experience of the
acupuncturist. The addition of moxibustion (30)
(Plate 7) is used to warm the channel and expel
cold, to induce the smooth flow of qi and blood,
subdue swelling and disperse accumulation of
pathogen; moxibustion with ginger is indicated in
wind-cold syndrome, and moxibustion with garlic is
for getting rid of toxins and drawing out pus.
Cupping has the function of warming and
promoting the free flow of qi and blood in the
channels and dispelling cold and dampness.
Electroacupuncture is used in numbness and
neurological problems (Plate 8), and is also for
muscular pain, when alternate current mode is the
most effective because during stimulation the
muscle contracts while in the absence of stimulation
it relaxes; therefore, in effect, this process is
equivalent to exercising the muscle.
As it was not possible for me to interview all the
patients at the beginning of their treatment since
some had started before I had arrived, these patients
were asked to rate retrospectively the severity of
their painful condition before acupuncture therapy.
This could have introduced errors through bias in
recall. Other sources of error in the study were the
small sample size, and the short period of follow-up,
which was inadequate to assess the long term
response to acupuncture in chronic pain.
Conclusion
This study was to record the conditions for which
acupuncture is used in the out-patient department of
108
Plate 9. The clinic team with students.
Acknowledgements
I would like to thank my sponsors, including the British Medical
Acupuncture Society and Kettering Old Grammar School
Foundation. Also, the kind help and encouragement of the
following were greatly appreciated: Dr B Key, Dr I Pardoe,
Professor T Southwood, and Dr L Yan, Dr H Hou and the team
at the acupuncture clinic in Tianjin (Plate 9). Without them this
project would not have been possible.
Vivian Hui Yun Ip
Birmingham University Medical School
Edgbaston, Birmingham B15 2TT (UK)
Email: [email protected]
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The use of acupuncture for pain relief in a
Chinese hospital clinic
Vivian Hui Yun Ip
Acupunct Med 1999 17: 101-109
doi: 10.1136/aim.17.2.101
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