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The World Health Organization Viewpoint On Acupuncture

R. H. Bannerman, M.D.

Abstract: A World Health Organization interregional seminar on acupuncture, moxibustion and acupuncture anesthesia was held in Beijing (Peking) in June 1979, attended by participants from twelve countries. Its purpose was to discuss ways in which priorities and standards could be determined in the acupuncture areas of clinical work, research, training, and technology transfer. Scientific investigation must be closely correlated with demonstrations of acupuncture’s clinical efficacy. Apart from acupuncture analgesia used in major surgical procedures, acupuncture also has been applied as a treatment for drug abuse, and more recently, as a diagnostic aid and in conjunction with fluoroscopy in gastrointestinal diseases. Acupuncture is clearly not a panacea for all ills; but the sheer weight of evidence demands that acupuncture must be taken seriously as a clinical procedure of considerable value.

Acupuncture has been applied as a therapeutic medical technique in China since at least two thousand years ago, when stone knifes and other sharp instruments were used. The term itself is derived from the Latin words acus - needle, and punctura - puncture.

Only two generations ago the practice of this technique was still confined to those who inherited it, and was handed down from one generation to the other – together with the “golden” needles which were then in use. The filiform needles are inserted into various parts of the body to treat a variety of diseases and, since 1958, acupuncture has been used as analgesia for surgical procedures. Needles are typically left in position for anything from fifteen to thirty minutes during treatment, and for much longer periods during surgical operations. They are manipulated in twirling or push-pull movements, or they may be activated by pulsed electrical stimulation. An acupuncture-like effect can also be obtained by deep finger pressure, so-called acupressure. Other more recent approaches to the stimulation of the recognized acupuncture “points” include the use of ultrasound and lasers.

Moxibustion represents a special form of point stimulation, and involves burning pieces of drug plants, generally the moxajleaf, either on the head of the acupuncture needle, so as to conduct heat into the body, or in some cases actually on the surface of the skin.

The medical procedure of acupuncture therapy is today being accorded greater attention in several Asian and European countries and also by WHO under its Traditional Medicine Program. This practice requires knowledge of the system of anatomy and pathophysiology which is inherent in Chinese traditional medicine. The body is thought to be pervaded by a system of energy channels in which circulates vital energy or force, termed “chi.” Most of the acupuncture points are located on these channels or meridians, although some are also located on the human ear.

Acupuncture is an important therapeutic method within the Chinese traditional system of medical theory and practice. It is often used in combination with other therapeutic measures, but some practitioners adhere strictly to traditional theory, while others use the technique empirically and in accordance with Western-style diagnosis and concepts of pathophysiology.

A WHO Interregional Seminar on Acupuncture, Moxibustion and Acupuncture Anesthesia was held in Beijing (Peking) in June 1979, attended by participants from twelve countries. Its purpose was to discuss ways in which priorities and standards could be determined in the areas of acupuncture, clinical work, research, training, and technology transfer. The group watched clinical acupuncture being used for major surgical procedures, such as brain and lung surgery, radiographic diagnosis of gastrointestinal disorders, and a variety of medical conditions. They also visited leading institutions where research is being carried out into the mechanisms of acupuncture and acupuncture analgesia.

Such investigations may contribute to the general understanding of pain and pathophysiology. As part of traditional medicine, acupuncture was developed over many centuries by empirical research and field testing. That its scientific elucidation according to international scientific standards is a relatively recent enterprise serves to add to its general scientific interest.

However, such scientific investigation must be closely correlated with demonstrations of its clinical efficacy. Many claims have been made for its usefulness; apart from its uses mentioned above, it has been applied as a treatment for drug abuse, and more recently, it has been employed as a diagnostic aid and in conjunction with fluoroscopy in gastrointestinal diseases. Clearly, it is not a panacea for all ills, and is certainly not without risk, but the sheer weight of evidence demands that acupuncture must be taken seriously as a clinical procedure of considerable value.

What is an Acupuncturist?

The question of acupuncture’s clinical application cannot be considered separately from that of training health personnel in its use. What is an acupuncturist? How much need one to know to practice acupuncture responsibly? What would an optimal training program consist of for acupuncture practice in primary health care, in surgery, and in research? What effect will international differences in nomenclature and terms have on future initiatives in acupuncture training? How can China’s experience help in this field? What are the legal and administrative obstacles to acupuncture training and practice in various countries ? What standards of professional ethics are relevant in the practice of acupuncture to assure a high quality of care to the people and to protect them from unscrupulous practitioners or inexpert treatment? Answers to these questions require serious thought now that this technique is being undertaken in many parts of the world by practitioners of different training, expertise, or professional and academic backgrounds.

Acupuncture requires further scrutiny in the context of socio-economic, cultural and health care policy. Its technical simplicity and successful application to primary health care and the work of “barefoot doctors” and other health workers, particularly in the rural areas of China, provides a model for adaptation and ready transfer to the developing countries. Any surgeon with clinical experience of work in tropical countries will readily appreciate the potential benefits that could be derived from acupuncture analgesia for both major and minor surgical procedures. Between fifteen and twenty percent of all surgical operations are now said to be performed with acupuncture anesthesia in China, and with an overall success rate of between seventy and eighty percent.

The history of acupuncture in neighboring Japan dates back more than one thousand years when it was disseminated from China. During the last century it was nearly abandoned, but the present decade has seen considerable revival of interest with the establishment of well organized training courses and research activities. Today, an estimated 6,000 doctors out of a total of 120,000 are said to practice acupuncture.

The practice was introduced to Europe during the eighteenth and early nineteenth centuries, but modern acupuncture therapy has only been developed seriously and scientifically since the end of the Second World War. Efforts have been made to explain its mechanisms and effects in Modern scientific terms, and surgical operations are now being performed using acupuncture in combination with Western analgesic techniques.

Acupuncture has long been practiced in the Chinese communities in the United States, but widespread interest in this and other aspects of Chinese traditional medicine awaited the reopening of significant communications between China and the United States.

Considerable controversy has surrounded acupuncture; on the one hand, extravagant claims have been made for its efficacy while, on the other, it has been criticized for its lack of scientific standing. It has now been introduced into several developing countries and, since 1976, WHO has organized training courses in China. Quite a number of Western-trained doctors practice it, and there is official interest and enthusiasm, particularly from the point of view of its potential usefulness as a tool in primary health care delivery. However, there is some resistance to its acceptance by physicians. So far, it has been used with considerable success for the treatment of musculoskeletal diseases, for example, low back pain, frozen shoulder or neck pain, and surgical procedures under acupuncture anesthesia are slowly gaining popularity. With adequate logistic support, training and research facilities, acupuncture will be fully accepted in these territories in the foreseeable future.

Bewildering Variety

From the outset of the WHO Interregional Seminar, it was clear that an almost bewildering variety of indications existed for the clinical application of acupuncture therapy, while opinions varied from one country to another about the disorders for which it was most recommended. It was agreed that specific contraindications to the use of acupuncture include pregnancy, needling of tumor sites, skin infections, and the presence of a cardiac pacemaker. There are obvious risks attendant on any kind of needle insertion into the body, particularly where vital structures might be punctured.

During the past decade, there has been a growing convergence between the most advanced research knowledge from physiology, biochemistry and pharmacology, and knowledge obtained by research in the field of acupuncture; that is to say, a convergence of modern international science with .traditional Chinese medicine. For example, in more than 600 cases of coronary heart disease, the effectiveness of acupuncture in relieving the symptoms was over 80 percent. In 645 cases of acute bacillary dysentery, 90 percent of the patients were cured within ten days as judged by clinical symptoms and signs and the results of stool culture. The technique is also comparatively effective in controlling fever, inflammation and pain.

From the viewpoint of Modern medicine, the principal action of acupuncture (and of moxibustion) is to regulate the function of the human body and to increase its resistance by enhancing the immune system and the antiphlogistic, analgesic, antispastic, antishock and antiparalytic abilities of the body.

Acupuncture analgesia has been tried in over 100 different types of operations, and its effects have been found to be comparatively stable in 20 to 30 kinds of common operations. Generally, it is thought to be more effective in head, neck and chest surgery, but it has also been used with satisfactory results in subtotal gastrectomies, splenectomies, total laryngectomies, and open heart surgery under extracorporeal circulation. With the extensive practice of family planning in China, large numbers of abdominal tubal ligations are done under acupuncture anesthesia; more than 80 percent were rated as excellent and good. Already more than two million surgical cases have been operated on in China under acupuncture analgesia.

Large numbers of animal experiments and clinical studies have been performed on the mechanisms of acupuncture analgesia. In the past two to three years, Chinese scientists have succeeded in developing techniques for the isolation, extraction and determination of endogenous morphine-like substances, as well as for artificially synthesizing the highly active enkephalin and its derivatives. The WHO Seminar felt that acupuncture analgesia was a valuable addition to the therapeutic armory of the qualified anesthetist.

It is clear that further exploration, applications and research on acupuncture will not be only significant for the health and welfare of the people but also important for the progress of medical science. However, many problems concerning the mechanism of these techniques remain to be elucidated.

High Standards of Training

Since acupuncture may be considered part of the practice of medicine, it is necessary to define high standards for training, and this training must be addressed to the different needs of basic scientists, primary care physicians, medical specialists, and other health professionals including auxiliary health workers. Thus a Western-trained physician may require no more than three months’ training to learn the technique in theory and practice. Graduates from China’s three-month courses in acupuncture generally study the identification and use of the 300-odd basic points. They also cover the treatment of common diseases both in theory and practice as well as traditional Chinese medical theory, including the theory of channels and vital energy.

China’s medical educational system is under review by the Chinese authorities, but basically it follows a dual track system which ensures integration of traditional-Chinese with Western medicine. Doctors trained in traditional medicine work throughout the health care system, in hospitals, clinics, specialty areas and in primary health care. Health workers, called “barefoot doctors” in rural areas, and “red medics” in urban areas, are also taught acupuncture for the treatment of a limited number of disorders such as the common cold and influenza, common skin diseases, neuralgias and sciatica.

The WHO Seminar agreed that, during training, traditional Chinese techniques and theories must be combined with established Western approaches to the diagnosis and treatment of disease.

The development of acupuncture as a safe and clinically useful method depends very much on the international transfer and exchange of information. At present, numerous obstacles exist. For example, there are only limited means for the dissemination of information, and acupuncture literature is only sporadically represented in standard computerized medical information systems such as Medline. There is, as yet, no center where information from international sources is stored and compiled for use by interested investigators.

Another significant problem concerns the nomenclature. In most medical fields, terminology units have been standardized on an international basis. In acupuncture, numerous systems are used in different countries for designation of the points, and other technical terms are translated in various ways. Most research in this field has taken place in China, yet access to the literature is limited by its relative unavailability in languages other than Chinese. No concerted effort has yet been made to translate the bulk of this material into other major Western languages.

Another serious obstacle to the transfer of acupuncture is the antagonistic attitude of many medical colleagues and allied health professionals towards accepting this therapy as a valid practice. This skepticism is paralleled by a general ignorance on the part of the general public, which makes patients in search of treatment easy prey for unscrupulous or uninformed practitioners. The elimination of such quacks, so as to assure a high level of clinical ethics and practice, would do much to make acupuncture respectable and encourage its transfer to other countries.

The WHO Seminar concluded that educational programs for collecting and disseminating available knowledge and research data will be of great importance. It recommended that special programs might be organized to reverse the unfavorable attitudes of medical professionals and to educate the general public about the safety of the procedure, its indications and its limitations. It also recorded the need in many parts of the world for more careful formulation of policies concerning the regulation of acupuncture, and suggested that the established international agencies could play an important consultative role in such efforts.

Table 1

The World Health Organization Interregional Seminar drew up the following provisional list of diseases that lend themselves to acupuncture treatment. The list is based on clinical experience, and not necessarily on controlled clinical research; furthermore, the inclusion of specific diseases are not meant to indicate the extent of acupuncture’s efficacy in treating them.
  • Upper Respiratory Tract
    • Acute sinusitis
    • Acute rhinitis
    • Common cold
    • Acute tonsillitis
  • Respiratory System
    • Acute bronchitis
    • Bronchial asthma (most effective in children and in patients without complicating diseases)
  • Disorders of the Eye
    • Acute conjunctivitis
    • Central retinitis
    • Myopia (in children)
    • Cataract (without complications)
  • Disorders of the Mouth
    • Toothache, post-extraction pain
    • Gingivitis
    • Acute and chronic pharyngitis
  • Gastro-intestinal Disorders
    • Spasms of esophagus and cardia
    • Hiccough
    • Gastroptosis
    • Acute and chronic gastritis
    • Gastric hyperacidity
    • Chronic duodenal ulcer (pain relief)
    • Acute duodenal ulcer (without complications)
    • Acute and chronic colitis
    • Acute bacillary dysentery
    • Constipation
    • Diarrhea
    • Paralytic ileus
  • Neurological and Musculo-skeletal Disorders
    • Headache and migraine
    • Trigeminal neuralgia
    • Facial palsy (early stage, i.e., within three to six months)
    • Pareses following a stroke
    • Peripheral neuropathies
    • Sequelae of poliomyelitis (early stage, i.e., within six months)
    • Meniere’s disease
    • Neurogenic bladder dysfunction
    • Nocturnal enuresis
    • Intercostal neuralgia
    • Cervicobrachial syndrome
    • “Frozen shoulder,” “tennis elbow”
    • Sciatica
    • Low back pain
    • Osteoarthritis
American Journal of Acupuncture, Vol. 8, No. 3, July-September 1980
This article was originally published in World Health – The Magazine of the World Health Organization, December 1979.
© 2015 Michigan Association of Acupuncture & Oriental Medicine


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