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5. The renaissance of TCM and acupuncture in the 20th century

 In 1928 the Communist party of China was formed, under the leadership of Chairman Mao Zedong. A long guerrilla war ensued and the Communist party finally took power in 1949. The Communists realized that there were little or no medical services in the rural areas and actively encouraged the use of traditional Chinese medicine to keep their troops on the move.


 In 1944, Mao zedong clearly defined the policy of uniting TCM and western medicines , proposed to scientificize, Sinocize and popularize TCM. As the ended suppression, the reviviscence of Acupuncture had resurfaced. In 1954 TCM was merged with the Chinese medical system [22].  During the early 1950's many hospital opened clinics to provide, teach and investigate the traditional methods, the main research institutes being in Beijing, Shanghai and Nanjing. From 1950’s China began to build dedicated educational systems of TCM schools and Universities [5, 22], and experimental acupuncture course newly created from 1994 in the department of acupuncture and moxibustion of TCM Universities. According to statistics from 2008 compiled by the Chinese government, there are 2,718 traditional Chinese medical hospitals, 372 traditional Chinese medical clinics and over 378,000 TCM doctors in the whole country [5]. At the same time, acupuncture and related techniques have increasingly been offered in conventional medical settings in Western societies [9].TCM clinics and schools have now been established in most countries and regions in the world [5, 7].
In hospitals, acupuncture has been integrated into the care pathways since 1959. Since then, acupuncture has become an integrated therapeutic modality both for outpatients in the clinic setting and for inpatients in the wards. It has been observed that acupuncture performed in a hospital differs in specific characteristics when compared with acupuncture performed in an outpatient setting [5, 22]. Besides acute and chronic body pain, stroke, cardiac diseases, various carcinoma, hypertension, hypotension, epilepsy, neuroimmuno suppression, female infertility, menopausal and perimenopausal syndrome, smoking, depression, and drug addiction are treated in the wards by acupuncture and moxibustion [5].

 Today acupuncture plays a more important roll in medical practice in China with the wind of integrative medicine. It is adaptable to most clinical practices and used either as the primary or a complementary treatment. At least 15.7% of the cancer patients received acupuncture, moxibustion, acu-pressure and Qi-gong therapy during the cancer patients who treated by TCM [41] .Future plans include offering acupuncture in the emergency ward and surgical centre. Acupuncture can be used as the initiating therapy for many common medical problems and can be combined with other modalities and disciplines according to the needs of the patient.

Rong Yu, Ph.D, Yu Health Care TCM Clinic, Tokyo, Japan

 

 6. Newly developed acupuncture systems

 In the past half century, acupuncture gained new momentum. The physician acupuncturist creatively developed following new systems of acupuncture.         

1. New micro-remote acupuncture system on the nose, ear, face, hand, foot and fingers. One of the most challenging aspects of acupuncture is the use of acu-points on body organs that are distant from the site of pathology. One such remote system is the application of acupuncture to specific regions of external ears or auricle. The Ling Shu states: 'The ear is the place where all the channels meet' [5,23,24], and with this statement the Chinese revised the use of auricular acupuncture in 1958 [22]. The external ear indicates an homunculus, or inverted fetus, with all the organs and parts of the body being represented on the ear. There is growing scientific evidence which not only supports its use as an effective modality [34] but also suggests that acu-points on the ear have specific connections to the central nervous system, which then affect reflexes in other parts of the body [35]..                            
  
2. Electro-acupuncture (EA), a electronic stimulator invented in 1960’s [20,22], which can generating electrical pulses of selected frequency, intensity, and pulse-width, was improved during the studies of acupuncture anaesthesia (AA) in 1970’s [36]. This technique was named electro-acupuncture (EA) to be distin­guished from manual acupuncture. Electro-acupuncture has been used to avoid prolonged, continual manual stimulation of acupuncture needles throughout long operations, under acupuncture anesthesia. Now electro-acupuncture is one of the widely used equipments for acupuncture therapy, as well as for anesthesia.               
                           
3. Water Acupuncture is injections with TCM or western medicine solutions into acu-points with ordinary injection needles, which is still expanding in clinical application [20,22].                   
                                     
4. Scalp acupuncture, a technique invented in 1970s is a direct development from the neuro-anatomy of the CNS. Although there is no clear connection between the nerves in the skin of the scalp and the brain, this method produces an effect on the brain, which could regulate the level of CGRP of brain hemorrhage patients [20,22].               
             
  Furthermore, a novel method for gene delivery, electre-acupuncture needle-mediated gene transfer combined acupuncture with modem gene therapy, was developed in1998 [29]. Efficient gene delivery with acupuncture needle carrying exogenous gene into the muscles was achieved after direct electronic stimuli. Acupuncture causes slight tissue injury, and the inflammatory reaction induced by acupuncture tissue injury helps gene transfer [31], which may be one of the mechanisms. Moreover, electronic field effect on plasmid DNA with negative charge may promote gene transfer into tissue. The mechanisms of electro-acupuncture-mediated gene transfer will need further investigation.

Rong Yu, Ph.D, Yu Health Care TCM Clinic, Tokyo, Japan

 

 

 7. The rediscovery of acupuncture through acupuncture anaesthesia

 In 1958 Acupuncture anaesthesia was discovered [22]. Acupuncture was used to control post-operative pain and then began to be used as an anesthetic for simple operations [21, 22]. In 1965, a case of pulmonary lobectomy operated with acupuncture anaesthesia was performed in Beijing Medical College [26]. The female patient had 10 acupunc­ture needles inserted in each limb, with four acu­puncturists each working on one of her limbs. After 30 minutes of needle manipulation to induce strong “deqi” Qi-arrival sen­sation, the surgeon started to make the skin incision. Acupuncture anesthesia, which is now more adequately called acupuncture analgesia (AA) [26]. The possibility of a neurochemical factor involved in mediating the effect of AA was first reported in 1973 [27]. Han et al. performed a cerebrospinal fluid (CSF) transfusion experiment in 1974 and identified serotonin (5-HT) both in the brain and spinal cord as one of the key neu­rotransmitters in mediating AA [28]. The discovery of enkephalins, the first family of endogenous opioids, by Hughes et al. in 1975 triggered the search for endogenous substrates [36]. In the same year when the discovery of enkephalin was reported, an article was published discussing the possible existence of antiopioid sub­stance (AOS) in the brain.

 How to validate the idea of neurochemical involvement like endogenous opioids in mediating AA? A rational thing to do was to check whether AA can be blocked by naloxone, the opioid receptor antagonist. After serious experiments, it was confirmed that different opioid peptides including enkephalin and dynorphin mediated low and high frequency (from 1 Hz up to 100 Hz) electro-acupuncture analgesia [36]. In these studies, the researchers designed an acu­puncture treatment for rat by fixing to the leg a thin needle that is connected to an electronic stimulator generating electrical pulses of selected frequency, intensity, and pulse-width. This was named electro-acupuncture (EA) to be distin­guished from manual acupuncture. 
In the studies using various kinds of animal models, Chiang CY et al. revealed that the peripheral nervous system is crucial in mediating the effect in acupuncture analgesia. The analgesia can be abolished if the acupuncture site is affected by injection of local anesthetis [46]. By various clinical observations, It was demonstrated that neuro­pathic pain responded preferably to 2 Hz EA (mediated by enkephalin) than that of 100 Hz, whereas the pain caused by muscle spasm in patients suffered from spinal cord injury responded preferably to 100 Hz EA (mediated by dynorphin) but not to 2 Hz EA [38,39].These results agrees with the fact that in TCM acupuncture practice, different types of needle manipulation at the same acupuncture point can result in different therapeutic effect [20, 22].

 Although studies have demonstrated that the mechanism of acupuncture analgesia (AA) is attributable to the release of opioids from the central nervous system (CNS), recent studies have revealed that, a peripheral opioid system exists which is also involved in modulating pain. Zhang et al. reported that AA is partially blocked by local application of naloxone, suggesting that peripheral opioids are released following electro-acupuncture [47].

 Another problem is: if acupuncture works effectively in the field of analgesia, why does acupuncture not always work for everyone? Actually in animals, in about 10–15% of the rat population, a standard 30-minutes EA produces no analgesic effect [26]. Other animal studies have also demonstrated the acupuncture-induced released of antiopioid substances. Early in the 1970s, a component that had an anti-opioid activity which has a molecular weight of approximately 1,000 Da was found from the brain extracts of the acupuncture tolerant rats. During the period of acupuncture tolerant (AT), there is a concomitant reduction of the analgesic effect in response to morphine, suggesting a cross tolerance to mor­phine. In the recent antiopioid substances (AOS) research, it was confirmed that cholecysto­kinin octapeptide (CCK-8) is most likely AOS) responsible for the development of acupuncture tolerant [39]. Indeed, AT can be reversed by CCK receptors antagonist proglumide and by the antiserum against CCK-8 administered intrathecally or intracerebroventricularly [40]. CCK might play an import role in determining the effectiveness of AA.
Thus, the relationship between opioids and CCK could be an example of Yin and Yang in certain measure. It is reasonable to consider that a good responder to acupuncture can be converted to a nonre­sponder by central administration of a nontoxic CCK vector resulting in an over expression of CCK in the CNS. On the other hand, a nonresponder to acupuncture can be converted to a responder by central administration of 1) CCK-B receptor antagonist L-365264, 2) antibody against CCK-8, or 3) CCK antisense oli­gonucleotide to down regulate the gene expression of CCK [40]. CCK seems to play a role in a negative feedback system against excessive opioid activity. This feedback control is achieved by multiple mechanisms, 1) high levels of opioids (whether exogenous or endogenous) promote CCK gene expression, 2) CCK-8, upon binding to CCK receptor induces allosteric changes in the nearby opioid receptors, and 3) CCK mobilizes intracel­lular calcium storage that cancels out the ability of opioids to lower calcium influx [26].  

 Surgical acupuncture anaesthesia has been used for a wide variety of major and minor operations in hospitals, it has many advantages including safety and swift post-operative recovery; however, it does not always provide complete pain relief, and the patient is easy to fatigue during the operation. Since 1980’s, acupuncture-drug balanced anaesthesia was exploited [22]. The accurate inser­tion of a needle into a specific acu-point is crucial, the correct continued manipulation of the needles in order to induce constant, strong “deqi” Qi-arrival sen­sation in operation is more important. Arrival of Qi, an important component of traditional theory of acupuncture and moxibustion, is the key factor in determining clinical therapeutic effect of acupuncture. At present, there is more subjective in the study on qi-arrival, so the key problem in research on Qi-arrival is how the Qi-arrival state is measured by an objective quantization standard. The cerebral function imaging, a new technique, may be used in objectification research on Qi-arrival [48].

Rong Yu, Ph.D, Yu Health Care TCM Clinic, Tokyo, Japan

 

8. The ultimate goal of acupunc­ture therapy

 Yin and Yang are opposite aspects of the material world, describing the innate fluctuating balance that exists in nature. Based on leads provided by Neijing and other literature, analyze origins of the three-yin and the three-yang and the their respective contents of yin and yang, indicating the principle that the order of yang-qi from more to less is Yang ming, Tai yang, Shao yang, and the order of yin-qi is Tai yin, Shao yin, Jue yin. According to the location of six zang-organs, respective yin-qi content is defined, and according to the principle of more yin-qi matches more, and less yin-qi matches less, six zang-organs match each other. The zang-organs above the diaphragm joints with the Hand- meridians, and the zang-organs below the diaphragm with the Foot-meridians, complete the nomenclature of twelve meridians. The names of the six yang-channels correspond to the yin-channels of the exterior-interior relationship, the yin-meridians link with hands (feet), and the yang-meridians also link with hands (feet). TCM, by yin-yang, illustrates living phenomena from the whole to the system and organ level in human body, and the scientific principle "yin-yang can be unlimitedly divided" and its significance, which could guide the studies on living phenomena with modern life sciences from the whole to the molecular level.

 What are the meridians and collaterals system? Meridians serve as an interface between the inner organism and external environment.  A variety studies indicate meridians and acupoints relate to:

1. the electromagnetic bio-information system,
2. the blood circulation system,
3. the nervous system, which includes neuro-humural system,
4. the organizing Centers system,
4. the bio-cybernetics-system,
5. the growth control system.


    The meridians and collaterals system overlaps and interacts with above systems but is not simply part of them. Many details of the current theories remain to be tested and clarified.
Many of the teachings of the NeiJing appear to have seamlessly transcended time, especially with today's health care and the intense focus upon disease prevention. The advantages of acupuncture and moxibustion may be evident over time through an individual's enhanced cardiovascular performance, cognitive function, or weight management, but the initial benefits must begin at the cellular level to eventually be translated into improved clinical well being and the possible prevention of disease. Constructing of TCM and Acupuncture based on molecular biology, for instance, the property analysis of genes with Yin-Yang theory, molecular dynamics in view of Yin-Yang theory, molecular definition of viscera-status theory etc., may not only promote the evolution of TCM but also elucidate the future direction of medicine.

  Despite the complexity and sophistication of current investigative work that attempts to define acupuncture processes and develop effective treatment strategies for the disorders and the diseases, the essential roots appear to always return to basic principles that may very well have been outlined in the initial versions of the Nei Jing. To the bottom line, restoring single cellular homeostasis and overall natural homeostasis (the Yin-Yang balance) is the ultimate goal of acupunc­ture therapy.

 Although acupuncture has become modernized, acupuncture effect depends on the manual needling, it’s a real world in which TCM doctors can tinker with DNA through acupuncture technique according to the personal will. It will take many researchers many years to work out all the implications, before that happens, let acupuncture help people more.

  Rong Yu, Ph.D, Yu Health Care TCM Clinic, Tokyo, Japan

 

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