Butterworth-Heinemann An imprint of Elsevier Science Limited Robert Stevenson House 1–3 Baxter’s Place Leith Walk Edinburgh EH1 3AF © Anthony Campbell 2001 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without either the prior permission of the publishers or a licence permitting restricted copying in the United Kingdom issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London W1T 4LP. Permissions may be sought directly from Elsevier’s Health Sciences Rights Department in Philadelphia, USA: phone: (+1) 215 238 7869, fax: (+1) 215 238 2239, e-mail: [email protected]. You may also complete your request on-line via the Elsevier Science homepage (http://www.elsevier.com), by selecting ‘Customer Support’ and then ‘Obtaining Permissions’. British Library Cataloguing in Publication Data Campbell, Anthony, 1933– Acupuncture in practice: beyond points and meridians 1. Acupuncture I Title 615.8(cid:2)92 ISBN 0 7506 5242 X Composition by Genesis Typesetting, Laser Quay, Rochester, Kent Printed and bound in Great Britain by Biddles Ltd, Guildford and King’s Lynn Acknowledgements I should like to thank Heidi Allen, Robert Edwards, Jackie Holding, and the rest of the team at Butterworth-Heinemann for the care and interest they have taken in the production of this book. Foreword Acupuncture is full of controversies, and none is greater than the fundamental approach we should adopt. On the one hand, the traditional practice of acupuncture has evolved over many centuries of clinical observation and been passed down by respected masters to grateful apprentices. Supporters of the traditional approach argue that its concepts of energy flow operate as a knowledge system in its own right which should not be rejected just because it does not fit in with current western understanding of the body’s mechanisms. On the other hand, the ‘modern’ approach declares that acupuncture is a relatively straightforward form of stimulation therapy that is beginning to be explained in physiological terms. So, learning complicated rules about where to place the needles and different methods of stimulating them is no longer necessary. This debate is particularly active in Britain, where Anthony Campbell is perhaps the best known proponent of the modern approach, and certainly the most articulate. He was originally attracted to acupuncture by his knowledge of and fascination for eastern philosophy. He soon came across Felix Mann, one of the first to challenge the old ideas and look afresh at what happens when a patient is needled. Anthony was instinctively sympathetic to a modern approach, and tested it carefully by many years of careful observation of his own patients. Through teaching, the rigour of his thinking has been refined in the hot fire of critical challenge by students. He has been prepared to knock down (but always politely: he is highly respectful of traditional philosophies in themselves) any icons or preconceptions that are not common sense and that hinder progress. The sum of all this wisdom and experience is accumulated in this text, which will stand as one of the most thoughtful yet accessible treatises on acupuncture of all time. This is a radical book that succeeds in demystifying acupuncture. It presents a closely argued but entirely practical approach to needling patients. It is compatible with the little we do know about the function of the nervous system, requiring no leap of faith or suspension of disbelief. Anthony Campbell does not claim to provide short-cut recipes for treating patients – that still requires careful thought and application of basic viii Foreword principles. He accepts that there are plenty of aspects of acupuncture that we still cannot explain, but reassures the reader that modern science is the best way of finding useful and meaningful answers. This book reflects the author’s truly innovative contributions in certain particular aspects of the technique, most notably what he calls the ‘acupuncture treatment areas’ that replace traditional points. He also emphasizes the likely role of the brain’s limbic system, which suggests that patients’ nervous systems must in some way be ‘prepared’ (but not simply by suggestion or belief) if acupuncture is to be really successful, which in turn leads on to an open acceptance of the essential role of ‘placebo’ in all clinical practice. This book promises to become a milestone in the debate about acupuncture and the development of a rational approach to the technique. Dr Adrian White MA BM BCh Dip.Med.Ac, Lic.Ac Preface Acupuncture has been known in the West for about 300 years. Although initially greeted with puzzlement, it attracted the attention of some Western physicians, and at times, particularly in the nineteenth century, it was used quite extensively. The main difference today is that interest in acupuncture is part of a wider enthusiasm for com- plementary and alternative medicine (CAM), and this has prompted a large number of health professionals (doctors, physiotherapists, osteo- paths, chiropractors, podiatrists, for example) to wish to learn acu- puncture in order to help their patients. They tend, however, to be discouraged by two preconceptions. One is that studying the traditional system is difficult and time-consuming, and the other is that treating patients in this way is itself time-consuming (most Western practi- tioners of traditional acupuncture leave the needles in place for 20 minutes or more). However, there is now a considerable amount of clinical experience in the West, supported by some research, to show that neither of these ideas is necessarily true. The elaborate traditional theory, though doubtless of great historical and cultural interest, does not appear to be essential in practice. It is possible to simplify the techniques con- siderably without sacrificing their clinical effectiveness. If acupuncture is approached as a form of peripheral stimulation of the nervous system it becomes much more accessible to people trained in modern anatomy and physiology. Many of us have also found that prolonged insertion of needles is unnecessary; in almost all cases brief insertion, lasting a few minutes or even a few seconds, is all that is required. It is therefore perfectly possible to fit acupuncture into a busy treatment schedule. Most of what is written about acupuncture still approaches the subject from the traditional aspect and there is relatively little available about the modern version. In consequence, many health professionals do not even realize that anything other than traditional acupuncture exists, and still less do they understand the practical advantages of studying acupuncture in the modern way. In this book I explain what x Preface modern acupuncture is and how it can be applied in practice. The book is not intended to be a substitute for hands-on instruction, for acupuncture can't be learned from books, but it will provide the knowledge and understanding needed by anyone who is considering undertaking practical tuition of this kind. It is the textbook which I use on my own courses for health professionals. Introduction Acupuncture is a method of treating certain disorders by inserting needles into various parts of the body. Its value is that it works in some disorders for which there is little or no effective treatment and that, in competent hands, it is relatively safe. Acupuncture developed in China, where it acquired an elaborate theoretical basis. Recently it has been taken up by a number of Western health professionals, many of whom have reinterpreted it in terms of modern anatomy, physiology and pathology. Today, therefore, there exist two main schools of acupuncture, traditional and modern. The principal differences between the traditional and modern schools can be summarized as follows: Traditional Modern Follows rules laid down in the past Largely ignores the old rules Based on prescientific ideas Based on modern anatomy and physiology Practical rather than mystical but No element of mysticism appeals to Westerners interested in mysticism The chief advantage of the modern approach, so far as Westerners are concerned, is that it can be assimilated easily into the rest of medical training. Also, it has given rise to some new forms of treatment, such as periosteal acupuncture, that did not form part of the traditional system. Learning acupuncture in its traditional form is a lengthy process, a fact which often leads to demands for hundreds of hours of training. The essentials of modern acupuncture, in contrast, can be grasped in much less time. In fact, I start from the position that acquiring basic acupuncture skills xii Introduction is easy. This probably surprising statement is based on certain assumptions, the main one being that you are a conventionally trained Western health professional. If you are, you already possess, without realizing it, most of the skill and knowledge you need to practise acupuncture; all you have to do is to learn to apply them in a different context. You are, in fact, in the position of Molie`re’s Monsieur Jourdain, who found that he had been speaking prose all his life without realizing it. By ‘health professional’, I mean, for example, a doctor, physio- therapist, osteopath, chiropractor, hand therapist, podiatrist, or nurse working in pain clinics and similar environments, all of whom have acquired knowledge of anatomy and physiology and are used to working as clinicians. Naturally, not all these professionals will have the same requirements or use acupuncture in the same way, but all can apply acupuncture to some extent in their practice. I wish to demystify acupuncture. By definition, the treatment consists in the insertion of needles, but there is nothing distinctive about the use of needles themselves; they are merely one effective means of stimulating the peripheral nervous system. Pressing the tissues or burning them may have similar effects; ‘acupressure’ and moxibustion are applications of this principle. Other stimuli could be applied as well, and the mechanism of action of acupuncture is probably similar to that of manual physiotherapy, osteopathy, chiropractic, and even massage. All these forms of therapy seem to act by modifying central nervous system processing, and there is a lot of overlapping among all the manual techniques. This idea makes acupuncture easier to assimilate to existing therapies. If acupuncture is approached in the way I suggest here, it becomes a technique, or set of techniques, much like any other. But please understand that this isn’t an oversimplified version, suitable only for people too lazy or too set in their ways to study ‘real’ acupuncture in its traditional form; it doesn’t, I hope, sacrifice anything worth keeping. On the contrary, it is, I believe, the most effective way of doing acupuncture, because what is unnecessary and confusing has been removed, leaving the essential core of the procedure intact. I don’t claim any great originality for my approach, nor do I deny that there are other ways of doing acupuncture that also work, but I do claim to have cut away a good deal of dead wood. Changing the metaphor, what I have tried to do is to distil, from the complex brew of acupuncture fact and fiction, a concentrated version that preserves the essence of the treatment and makes it available to any health professional. The plan of the book is as follows. In Part 1 I look at the differences between traditional and modern acupuncture and point out some commonly held misconceptions about what the traditional system actually is, or was. Finally, I define what I mean by modern acupuncture and try to provide at least a tentative explanation for how it may work in the relief of pain. Introduction xiii Part 2 is the core of the book, which contains what I take to be the essence of modern acupuncture. Here I first review the safety aspects of acupuncture, which everyone intending to practise these techniques must be familiar with. I then look at the different ways of deciding where to insert the needles that are currently in vogue in modern acupuncture. Each of these has its merits, but the fact that there are so many such ways is likely to confuse the newcomer to acupuncture. I therefore put forward my own version, based on what I call the Acupuncture Treatment Area (ATA). My aim is to equip the reader with a way of thinking about acupuncture that will free him or her from dependence on theory and allow a more creative approach to treatment. This approach has emerged from many years’ experience of teaching the subject to health professionals. Part 3 shows how the ideas set forth in Part 2 can be applied in practice. To do this I go through the various anatomical regions (head and neck, thorax, lower back, and so on), describing the acupuncture treatments that can be used in each and the kinds of effects that can be expected. This section is not intended to be a ‘cookbook’ – a set of rules about what to do in each situation. On the contrary, I want to guide the reader away from the cookbook method. The descriptions of treatments are meant to be illustrations of the principles discussed earlier, not a list of prescriptions. Plain descriptions of techniques and treatments are liable to make dry reading, so I have included a number of case histories for the sake of variety and illustration. They are not, of course, intended to provide supportive evidence for my arguments or for the effectiveness of the treatments I describe. Such evidence can come only from scientific research, which at present is sadly lacking for most claims made on behalf of acupuncture. I look at some of the manifold problems of acupuncture research in Part 4, where I also write about some specialized forms of acupuncture, such as auriculotherapy, and consider the uses of electricity in acupuncture. It isn’t essential to read the book from cover to cover. Readers with no interest in the traditional system, and who are already sure that it’s the modern version of acupuncture that appeals to them, could go directly to the practical sections. If you do this, however, please read Part 2, otherwise the reasons for choosing the treatments described in Part 3 won’t be evident to you.