Medical Acupuncture For Elsevier Senior Content Strategist: Rita Demetriou-Swanwick Content Development Specialist: Nicola Lally Project Manager: Andrew Riley Designer/Design Direction: Christian Bilbow Illustration Manager: Emily Constantino Illustrator: MPS North America S E C O N D E D I T I O N Medical Acupuncture A Western Scientific Approach Edited by JACQUELINE FILSHIE MBBS FRCA DipMedAC Consultant Anaesthetist and Honorary Senior Lecturer The Royal Marsden NHS Foundation Trust The Lister Hospital London, UK ADRIAN WHITE MA MD BM BCh Honorary University Fellow, Primary Care Group Institute of Translational and Stratified Medicine (ITSMED) University of Plymouth, UK (formerly) Editor, Acupuncture in Medicine MIKE CUMMINGS MB ChB DipMedAc Medical Director British Medical Acupuncture Society Royal London Hospital for Integrated Medicine London, UK Foreword by JOHN C LONGHURST BS MD PhD Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2016 © 2016 Elsevier Ltd. All rights reserved. Previous edition copyrighted 1998. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). ISBN 978-0-7020-4307-9 eISBN 978-0-7020-6855-3 Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Printed in China C O N T E N T S Foreword ix Acknowledgements xi Contributors xiii Abbreviations xvii Plate section SECTION Introduction 1 1 Introduction 2 1 A. White ■ M. Cummings ■ J. Filshie The history of medical acupuncture 11 2 A. Campbell SECTION Mechanisms of action 21 2 Peripheral components of acupuncture stimulation – their contribution 3 to the specific clinical effects of acupuncture 22 T. Lundeberg ■ I. Lund Neuroimaging: a window into human brain mechanisms supporting 4 acupuncture effects 59 V. Napadow ■ N.W. Kettner ■ R.E. Harris Neurophysiology of chronic pain 73 5 R. Gupta ■ P. Farquhar-Smith Acupuncture and the autonomic nervous system 86 6 E. Stener-Victorin SECTION Clinical approaches 99 3 Western medical acupuncture – the approach to treatment 100 7 M. Cummings Acupuncture without points 125 8 A. Campbell Superficial acupuncture 133 9 A. Macdonald Auricular acupuncture 144 10 T.I. Usichenko ■ E.F. Anders Electroacupuncture 167 11 D.F. Mayor Self-acupuncture 191 12 M. Forrester v Contents vi Integration of acupuncture in the health service 203 13 S. Hayhoe ■ A. White and Contributors Safety of acupuncture 214 14 A. White ■ M. Cummings SECTION Related techniques 233 4 Transcutaneous electrical nerve stimulation (TENS) 234 15 M.I. Johnson ■ J.W. Thompson† Laser acupuncture 269 16 G.D. Baxter ■ S.M. McDonough SECTION Research 278 5 A critical approach to randomised controlled 17 trials of acupuncture 279 M. Cummings ■ A. White A critical approach to systematic reviews of acupuncture 298 18 A. White SECTION Clinical use 314 6 Acupuncture for chronic pain 315 19 S. Hayhoe Acupuncture analgesia for interventions 345 20 K. Streitberger ■ T.I. Usichenko Acupuncture for gastrointestinal conditions 368 21 S. Joos Acupuncture for nausea and vomiting 376 22 K. Streitberger Acupuncture in cardiovascular medicine 394 23 J.C. Longhurst Acupuncture for neurological conditions 422 24 D.J. Grant Acupuncture in mental health 439 25 P.B. Ronan ■ H. Rampes Acupuncture for drug dependence and obesity 455 26 A. White Acupuncture for urogenital conditions 475 27 M. Pullman Acupuncture for respiratory conditions 489 28 A. White Acupuncture for ear, nose and throat conditions 503 29 A. White Contents vii Acupuncture for eye conditions 513 30 E. Rom Acupuncture for skin conditions 528 31 F. Pfab Acupuncture in gynaecology and infertility 536 32 E. Stener-Victorin Acupuncture in obstetrics 552 33 C.A. Smith Acupuncture in cancer and palliative care 566 34 C. Rubens ■ J. Filshie Acupuncture in rheumatology 586 35 L. Williamson Acupuncture in sports medicine 604 36 K.V. Trinh ■ S.J. Scott ■ E. Ho ■ L. Field Acupuncture in primary care 617 37 J. Foell Acupuncture in dentistry 637 38 M.L.T. Thayer Acupuncture in veterinary medicine 651 39 S. Lindley SECTION Appendix 664 7 Appendix 1 Dermatome/myotome maps 665 Appendix 2 Meridian/channel charts 667 Appendix 3 Standard international nomenclature for the 14 meridians 687 This page intentionally left blank F O R E W O R D I first travelled to China in 1992 where I observed acupuncture practised by Traditional Chinese Medical (TCM) acupuncturists. Upon asking for evidence underlying this ancient technique, the practitioners firmly told me that such evidence was not necessary because acupuncture had been practised for centuries, had stood the test of time, and worked well. As an academic phy- sician in the United States, this attitude certainly contrasted with my beliefs in the values of evidence-based medicine, a principle underlying my clinical and teaching philosophies. Two years later, upon returning to China, I was asked to consider collaborative research in acupuncture. My initial reaction was no, but my future collaborator, Dr. Peng Li, then professor and chair of the Department of Physiology at Shanghai Medical University, showed me his curriculum vitae containing publications in respected Western journals on the central neural mechanisms underly- ing acupuncture’s cardiovascular actions. His interests fitted closely with my own, cardiovascu- lar autonomic neuroscience. I subsequently invited Dr. Li to my laboratory at the University of California, Davis, where we embarked on a journey of discovery to uncover acupuncture’s role in cardiovascular homeostasis. Western medical practitioners often are sceptical of any legitimate role for acupuncture in dis- ease treatment, including both symptom management and the underlying pathophysiology. Their concern reflects questions about TCM theory, including the absence of verification of meridians and channels, concepts like Qi and, in the past, the overall absence of an evidence-based approach to acupuncture treatment. Additionally, while some clinical trials show added benefit to acupunc- ture over and above no therapy or standard western medical approaches, often, in controlled trials, there seems to be little difference between sham (presumably reflecting placebo) and true acu- puncture. Furthermore, many patients, typically a third of the population, do not respond well to acupuncture. These limitations coupled with little or no understanding of mechanisms underlying acupuncture’s actions fuel debate on its role in Western medicine. Recently, however, substantial evidence has been developed supporting a role for acupuncture in clinical medicine, particularly in pain management, in combination with standard western treatments or as a stand-alone therapy. Efficacy in other clinical conditions, like hypertension, is emerging. The first edition of Medical Acupuncture, published in 1998, focused on the scientific basis of acupuncture, clearly differentiating between modern western approaches and those based on TCM principles. The first edition highlighted the need for stronger clinical evidence since so much of the clinical literature was not rigorous. The second edition of Medical Acupuncture builds on the first. First and foremost, all chapters are updated and expanded. For example, the number of chapters devoted to clinical medicine have expanded threefold from seven to twenty-one. This represents not just the explosion of research but also the recognition of the many areas of potentially useful acupuncture application, in addi- tion to pain for which there has been long-standing support. New methods of study like neuro- imaging and the critical role of acupuncture’s central and peripheral neural and local tissue actions provide perspectives on new needling approaches and reflect our modern understanding of acu- puncture’s mechanisms of actions. Expansion of clinical information encompassing a wide range of disciplines ranging from dentistry to veterinary medicine highlights our new knowledge of acu- puncture’s role in many areas of clinical medicine. Importantly, this new edition includes critical discussion of not just acupuncture’s clinical usefulness alongside standard Western approaches but also limitations of our understanding both in terms of the absence of current information and its inaction in certain patients. Commentary and analysis in the second edition, in my view, is often greater than that present for many so-called standard Western approaches. ix