ACUPUNCTURE

The origin of acupuncture is based on the principles of energy medicine taught in the philosophical ideas of Chinese Taoism. It began with ancient Chinese physicians who believed that good health is dependent upon a balanced flow of vital energy known as qi or chi (both pronounced as “chee”). It has been taught that qi energy flows through the body along linear pathways called meridians, and each meridian is associated with a particular organ or organ system. The idea is that, if something blocks or hinders the flow of qi then illness results; this flow must be restored in order to restore one's health. In order to restore this flow the ancient physicians developed a method of skin stimulation using knapped stone and carved bone tools. Over time these tools were modified into the hair-thin needles that are used in acupuncture today. Today, most practitioners of Traditional Chinese Medicine (TCM) in the United States also perform acupuncture treatments.

Many Christians are understandably uncomfortable with the relationship of acupuncture to Taoism and thus avoid it completely as a therapy. The problem is that this is “throwing the baby out with the bath water” so to speak. Although medical science does not prove the existence of qi, it has actually proven the existence, structure, and activity of the meridians. For example:

There are many more scientific studies I could list but the point I'm trying to make is this: Although the existence of qi continues to be unproven by medical science the existence of the meridians themselves have been defined. You are not required to believe in the existence of qi in order to believe in the existence of meridians. So, how does acupuncture work?

Although researchers are still investigating the relationship between the meridians and sensory stimulation from acupuncture some important finds have been discovered. For example, the University of York published findings which showed that acupuncture elicits a unique response in the brain that is different from responses associated with pain. In their study the researchers used MRI scanning to track the brain's response and concluded “the responses to acupuncture are different from those to be expected from pain alone” (this refers to a sensation known as “deqi”5) Likewise, researchers at the Hull York Medical School investigated the relationship between the brain's neural responses with the sensation of deqi6 during acupuncture. Like the University of York study, this study also used MRI scans to document brain response and found that “The acupuncture needle sensations of deqi and acute pain are associated with different patterns of activations and deactivations in the brain.”7 In other words, pain response and deqi response were significantly different in the brain, according to the MRI records.

Like all other sensory information, stimulation signals from acupuncture needles sprint to the brain directly through the spinal cord.8 When the input from the spinal cord reaches the brain it immediately activates areas of the brain devoted to the reception of and response to sensory stimulation.9 Oftentimes the brain's response is to release various amounts of neurotransmitters such as endorphins (which reduce pain), neuropeptides (which can reduce nausea and vomiting) and serotonin (which can reduce fatigue) depending upon the stimulation it receives. Although there is still much to learn about the relationship between acupuncture and the brain it is known that this basic process is what makes acupuncture work. So, in the case of cancer, what exactly can acupuncture do?

Acupuncture is well-known for treating many health issues, but one must realize that it isn't a cure for cancer; instead it is a treatment for helping to alleviate symptoms resulting from the treatment of cancer such as pain, nausea, fatigue, or sleeplessness. Information published by the American College of Chest Physicians affirms that the use of acupuncture can reduce pain caused by surgery or nerve damage (neuropathy) in cancer patients and reduce instances of chemotherapy induced nausea.10 One review of studies noted that acupuncture was found to be a significant support treatment to help reduce cancer-related nausea, insomnia, pain, fatigue, hot flashes, and anxiety.11 If we look at individual studies we find the following:

These are but a mere handful of the numerous studies that have been performed to assess the value of acupuncture in health care. Clearly there is scientific and medical evidence that acupuncture can be a valuable form of supportive treatment for patients enduring the ordeal of cancer. It is worth noting, though, that just because a treatment works for one patient does not mean it will work for all patients. Each patient is unique and each case of cancer is unique. For example, one patient may be a 70 year old man with diabetes, kidney disease and a stage 4 liver cancer. Another patient may be an otherwise healthy 27 year old who's just been diagnosed with a stage 1 triple-negative breast cancer. Although each of these patients are battling cancer their cancer treatments and acupuncture treatments will be vastly different.

If you decide to try acupuncture to help reduce side effects and symptoms you will need to carefully consider who you will choose as your acupuncturist. In the United States a licensed acupuncturist must graduate from an approved school and complete at least 2,000 hours of training in a program approved by the Accreditation Commission for Acupuncture and Oriental Medicine. For United States certification the practitioner must pass the board exams given by the National Certification Commission of Acupuncture and Oriental Medicine (NCCAOM). If the acupuncturist is already a licensed medical doctor then he or she will be required to complete 200-300 hours of acupuncture training in a program approved by the American Board of Medical Acupuncture (ABMA) in most states.

It is also important to be sure that your acupuncturist is experienced in treating patients with cancer. Although acupuncture is normally a safe procedure that has a very low risk of side effects cancer patients may have special issues, such as lymphedema, radiation treatments, skin sensitivities, etc. that normal healthy people do not have. You want a practitioner who knows how to give treatment without causing or worsening side effects and symptoms. There are also certain health issues you must take into consideration before scheduling an acupuncture session (this is not a complete list):

If you have other health issues not listed above you must be sure you explain them to your licensed acupuncturist before treatment. If you have any of these conditions (even if they existed before your cancer), you absolutely must consult with your licensed physician before being treated with acupuncture. If your physician tells you that acupuncture will be okay you must be sure your acupuncturist is aware of your health issues so that he or she can give you proper treatment that will not cause or worsen symptoms. Never see an acupuncturist who is not licensed, so do not feel shy about questioning a practitioner – a true, licensed practitioner will not take offense and will welcome your questions.


ACUPRESSURE / SHIATSU / TUI NA


In its most basic definition acupressure is an ancient method of using pressure on specific points on the body to stimulate the body's natural healing. Because acupressure is a component of TCM it uses the same acupoints and meridians as acupuncture, but instead of needle stimulation it uses pressure stimulation. This is a good option for patients who have a severe aversion to needles. Other disciplines that are similar in practice and theory are Shiatsu massage and Tui Na massage. Shiatsu and Tui Na use more bodywork than just normal acupressure, but in many circles all three disciplines are lumped in together. It is thought that stimulating acupressure points relieves muscle tension, promotes blood circulation, and relieves stress. If both acupressure and Shiatsu are taken into consideration, this pressure can come from fingers, hands, knuckles, knees, elbows, and feet. In some cases the acupressure points are stimulated by artificial equipment (such as wrist bands) instead of conventional methods.

A study published in 2007 involved 160 cancer patients who were already undergoing chemotherapy and having issues with nausea. These were divided into three groups: One group received acupressure to the p6 acupoint (located on the inner wrist) along with conventional care, the second group received placebo acupressure on the si3 acupoint (near the lateral base of the pinky finger) along with conventional care, and the third group received only conventional care. The study showed that the p6 point acupressure group had a significant reduction in nausea episodes than the other two groups.17

In 2013 a study involving 64 cancer patients undergoing chemotherapy investigated the relationship between acupressure and the reduction of treatment-induced nausea. The patients were divided into groups of thirty-two; one group being the control and the other group being experimental. In the experimental group the patients were given anti-nausea medications along with acupressure on the p6 point through the use of a special wrist band; the control group was given only the anti-nausea medications. According to patient reporting the experimental group experienced a greater reduction in nausea and vomiting than the control group.18

Of course, you'll always have someone who asks about the “placebo effect” of the wristbands. Do these acupressure bands work simply because the patients expect them to work? In 2003 the University of Rochester Medical Center published a study19 on seven hundred patients with various cancers. These patients were divided into three groups: One group was the control, a second group used acupressure wrist bands, and the third group used acustimulation wrist bands (which give a mild electrical impulse). According to the lead researcher in the study, Joseph Roscoe, Ph.D., “We think that the effect of the pressure bands was primarily a placebo effect... This, and other comments like it, lead naysayers to insist that using acupressure for nausea is a waste of time. However, what they don't realize is that this same researcher continued to do studies on the topic and several years later changed his mind. In 2009 Dr. Roscoe and his team published a newer study in which the placebo effect was focused on and found that the acupressure bands actually were working to reduce radiation-induced nausea.20

Clearly, acupressure can work to help relieve the nausea caused by cancer treatments. Can it also help with pain management, fatigue or sleeplessness? There was a study published in 2010 which showed that relaxation acupressure significantly reduced cancer-related fatigue.21 However, as of this writing, completed studies on acupressure are few compared to the studies done on acupuncture. In spite of this there are many preliminary findings that show acupressure to have great potential relieving the pain, fatigue, sleeplessness and depression that comes with breast cancer treatments. Therefore, if you are interested in trying acupressure to help relieve the side effects of chemotherapy, radiation, or surgery, I strongly encourage you to speak with your oncologist about incorporating it into you health care plan. But of course, as with all treatments, there are things to consider first:

Be sure that both your oncologist and your acupuncturist/acupressurist know if you have any of this conditions. To fail to do so may result in contributing or the worsening of your health care issues. And, as always, make sure your practitioner is licensed or certified in acupressure treatment according to your region's requirements.

1 50 Years of Bong-Han Theory and 10 Years of Primo Vascular System (Kwang-Sup Soh, 2013)

2 Dr. Kim Bong Han wrote a booklet on the topic titled On the Kyungrak System”, 1964

3 The Correspondence Between Some Motor Points and Acupuncture Loci (Y.K. Liu, 1975)

4 Nuclear Medicine and Acupuncture Massage Transmission Pierre de Vernejoul, et al (1992)

5 Brain Imaging of Acupuncture: Comparing Superficial With Deep Needling (MacPherson et al, 2008)

6 “Deqi” (pronounced deh-kee' ) is described in different ways among patients. Descriptions include: Heaviness, numbness, dull pain, soreness, achiness, warmth, tingling, fullness, coolness, electric, etc. Some describe deqi as non-painful sensations traveling among acupoints. Although this happens with a vast majority of acupuncture patients (up to 85%), it does not happen with all patients.

7 Acupuncture Needling Sensation: The Neural Correlates of Deqi Using fMRI (Ashgar et al, 2010)

8 The spinal cord attaches directly into your brain and is the main conduit for delivering sensory information to your brain. This is why the spinal cord branches out into so many nerve pathways throughout your body.

9 Neural mechanism underlying acupuncture analgesia (Zhi-Qi Zhao, 2008)

10 Complementary therapies and integrative oncology in lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition) (Cassileth, 2007) Supplement pages 340-354
11 What is the evidence for the use of acupuncture as an intervention for symptom management in cancer supportive and palliative care: an integrative overview of reviews (Towler, 2013)
12 Randomized controlled trial of acupuncture for prevention of radiation-induced xerostomia among patients with nasopharyngeal carcinoma. (Meng, 2012)

13 Duke Today, Oct. 15, 2001, “Acupuncture Reduces Nausea and Vomiting, Pain After Major Breast Surgery

14 Analgesic Effect of Auricular Acupuncture for Cancer Pain; a Randomized, Blinded, Controlled Trial. (Alimi, 2003)

15 Placebo acupuncture is usually accomplished by performing acupuncture on areas that are not associated with meridians.

16 The Managament of Cancer-related Fatigue After Chemotherapy with Acupuncture and Acupressure; a Randomised Controlled Trial. (Molassiotis, 2007)

17 Acupressure for Chemotherapy-Induced Nausea and Vomiting (Dibble, 2007)

18 The Effect of Acupressure Application on Chemotherapy-Induced Nausea, Vomiting, and Anxiety In Patients With Breast Cancer (Genç, 2015)

19 URMC News, August 28, 2003 “Wrist Bands Can Ease Cancer Nausea, Especially For Patients Who Expect Them To Work” J. Roscoe

20 Acupressure Bands are Effective in Reducing Radiation Therapy-Related Nausea (Roscoe, 2009)

21 Relaxation Acupressure Reduces Persistent Cancer-Related Fatigue (Zick, 2010)