Volume 15 - No. 4
by Jimmy Rodrigues

1.2 billion people can't be wrong, can they?
An ancient chinese treatment gives arthritis the needle

Dr. Diane Wilson is keenly aware that she occupies a lonely position amongst her peers on the issue of acupuncture. She was, after all, the first rheumatologist in Canada to take formal training in the ancient Chinese medicinal art, and there was no stampede of imitators in her wake.

Being aware of her singularity doesn't mean Wilson's grown accustomed to it; she's still baffled by colleagues who refuse to give acupuncture a fair shake. "We don't have any cures,' she says. "If 1 could give you a cure for your arthritis, I'd use it, but 1 can't. So, 1 can watch you suffer day after day, or 1 can think, 'Maybe there's something else.'

"That's what made me venture into acupuncture. People have been using it in China for 5000 years, and it must be working or they'd have stopped, just as we stop most of our treatments that don't work. 1 don't know why other people don't think that way-as though because it's not something that was made in North America it's not worth trying.'

In fact, a growing number of doctors are giving acupuncture a chance-few of them, to be sure, as whole- heartedly as Wilson-but some are at least starting to suggest acupuncture to their patients. if only after their own interventions have failed.

Still, things are heading in the right direction, says Dr. Linda Rapson. Rapson is medical director of the Rapson Pain Clinic in Toronto and executive president of the Acupuncture Foundation of Canada (AFC) and the AFC Institute (AFCI). "The status of acupuncture in the Western medical community has risen significantly over the 23 years since 1 began my acupuncture training in 1974    she says. 'Acupuncture is now recognized as a  medical treatment by regulatory bodies in eight provinces and the Yukon.'

In Saskatchewan, Alberta and B.C., physicians have to complete the AFCI examination or the University of Alberta exam in medical acupuncture before they're allowed to practise. Quebec doesn't have an exam, but physicians have to put in at least 300 hours' training. In Manitoba, acupuncture's restricted to the treatment of pain; New Brunswick acknowledges it as 'part of practice"; and Newfoundland says it's "exclusive to doctors and dentists" (though others, Rapson says, also practise it).

A similar patchwork covers other health professionals. For example, physiotherapists (PTs) in Nova Scotia, P.E.I. and Ontario require AFCI training, but not an exam. Wilson works in a Lunenberg, N.S., clinic with a number of PTs, and 'they all do acupuncture for all sorts of things," she says. 'In fact, the family docs around town send their migraine patients to the PTs, rather than to the hospital for drugs, because we can cure migraine instantly with acupuncture.'

Indeed, says Rapson, 'among the many complementary therapies, acupuncture has become almost mainstream in the minds of many practitioners and much of the public.' So much so that the American Food and Drug Administration now estimates that U.S. citizens cough up a half-billion dollars a year for acupuncture treatments.

Acupuncture is 'a phenomenal thing,' Wilson says. Even with the little she knows about acupuncture-'compared to those who have studied it for years and years and know all the traditional Chinese medicine"-Wilson says she can work near-miracles in treating patients. There are some conditions for which acupuncture works so well she'll suggest it first, before a western intervention. For acute sacroiliac pain, she says, 'it's brilliant. It works beautifully.'

Acupuncture also works well with Raynaud's syndrome and 'individual joint swelling. It's excellent for localized pain, like a neck pain from whiplash or muscle tightness. We have protocols that have been studied in China that work really well for patients with fibromyalgia and fatigue, too."

Rapson believes acupuncture has a major role to play in the treatment of arthritis, including autoimmune forms, such as rheumatoid and psoriatic arthritis. 'Not only is there relief of pain, but there's also an anti-inflammatory effect, evidenced by decreased swelling and increased range of motion in the involved joints,' she says, 'and osteoarthritis (OA) responds to acupuncture most of the time." Rapson wryly echoes Wilson by observing that western medicine isn't always as effective as they'd like. A truly unbiased study would reveal, in fact, "that a lot of the treatment is symptomatic and doesn't get at the underlying cause, and it's under these circumstances that 1 feel it's appropriate to switch paradigms.'

Not everyone finds that so easy to do. For most western practitioners, switching paradigms-replacing traditional western modes of medicinal care with the Far Eastern model-is like trading MRI machinea*for smoke and mirrors. It doesn't appear to make scientific sense.

Acupuncture's based on the Chinese notion of life as a tension between opposite but com- plementary forces-the dark, negative force known as yin, and the light, positive force known as yang. When the two are in balance, adherents believe, we enjoy an even flow of qi (pronounced 'chee"), a "vital energy" that courses through our bodies via 14 major channels, or meridians, each of which has a specific relation to a specific organ. When the flow of qi is unchecked, we enjoy good health; when it's blocked or interrupted, sickness and disease result. According to acupuncture theory, the way to release a blockage and restore the flow is by inserting and twirling fine needles at trigger points on the body, of which there are more than 360. Practitioners are steeped in a wealth of ancient diagnostic and treatment lore, which includes exotic concepts-like the five elements, the six evils and the husband-and- wife law-that leave western traditionalists clawing for solid ground.

'While this language may sound naive and unscientific,' Rapson says, 'intrinsically the model is remarkably consistent. When one takes a [medical] history with an understanding of this paradigm in mind, there are patterns of symptoms that clearly emerge.'

The Chinese method doesn't depend on causality, Rapson points out-seeking always to know what caused a given condition, as western medicine does; instead, Chinese medicine looks for 'patterns of symptoms supported by observation of the tongue and pulse. For many years," Rapson says, 'I ignored tongue diagnosis because it sounded very strange to me."

Then she began to study it and see a correlation between the appearance of the tongue and the patient's condition, which was astonishing, until she thought back to childhood, when her doctor "always looked at our tongues. 1 don't think my wonderful old family physician had in-depth knowledge of tongue diagnosis, as the Chinese do, but 1 think he knew very well that if our tongues looked normal, we probably weren't as sick as we were pretending.'

Most doctors don't have time for such observations. They depend instead on the hard currency of clinical evidence as proof of a treatment's worth. The problem is, clinical trials of acupuncture done by exacting western standards are inconclusive.

Partly it's the nature of the exercise: In a standard placebo-controlled double-blind trial, patients are given an 'active' or an 'inert' substance; neither physician nor patient knows which. That's all but impossible with acupuncture-a trained practitioner knows when he's placing needles correctly, and an experienced patient will recognize, from the sensation (a mild ache known as de qi), whether the needle has been being placed in an "active' site. Further muddying the waters is the fact that even incorrectly placed needles will provoke some kind of response; sham acupuncture's not inert, in other words, the way a sugar pill is in place of, say, an anti- inflammatory drug.

Which means Rapson and Wilson can't cite chapter and verse from the bible of clinical science to convert skeptical colleagues. They can draw on their own experience, but, from a scien- tific perspective, that's anecdotal evidence. It doesn't carry much weight, except amongst those who are already inclined to listen.

As far as Donna Veri, an acupuncturist in Thornhill, Ont., is concerned, all the fuss misses the point. She thinks people shouldn't "get hung up on how acupuncture works. They should accept the fact that it's been used extensively in Asia for close to 5000 years, and they get amazing results.'

Veri agrees that, by western scientific terms, 'it makes no sense, but the best proof is in the results.'

 Chinese medicine and acupuncture work in systems, Veri explains, 'unlike western medicine, where you're treating a specific area. And with acupuncture you can treat a problem without actually knowing what it is. Western medicine says, 'I have to find out what it is, then I'll know how to treat it.' With acupuncture, if you have a problem in a joint, I'll treat that area and that joint. 1 don't necessarily have to know what's wrong with it-because the labels these diseases have are only significant within western medicine. Go to a Chinese doctor and tell him you have asthma, and if he goes strictly by the Chinese philosophy, asthma doesn't exist. You have a disorder of the lung system, which means the organ, the channel and the meridians, and that's what he would treat, either an excess or a deficiency in that system."

For OA of the knee, Veri would insert needles at a number of different points: "There are distal points, local points, proximal points, symptomatic points, physiological points. There are groups of points, and you'd select from these groups,' she explains. "I'd use local points around your knee, but I'd also use influential points for bone and cartilage, which are on your back, and I may use an influential point for muscles and tendons, which is on  your leg.  Then I'd use homeostatic points for balancing your system-those are general points for balancing. I'd probably use some points to enhance your immune system and  maybe some general tonification points to tonify, not just muscle tone, but general tonification of your whole body, to bring the whole body into balance."

Clearly, 'some people think acupuncture's effects are 'all in the patient's head.' Wilson doesn't think so, but she doesn't dismiss the psyche's influence: 'Anybody with a positive attitude toward any treatment is going to do better with  it. It doesn't have to be acupuncture. It could be a pill. People who have hope and think it's going to work always do better.' 

And it certainly isn't just a placebo: "Go to the track and see how many people are using acupuncture on horses. Try to tell me the horse is having a placebo reaction-that's a human phenomenon. Mice, rats, horses, dogs-there's a whole line of veterinary acupuncture, and these animals are not getting a placebo effect." 

Acupuncture works for many people. How is uncertain. The best idea resulted from the 1975 discovery of enkephalins and endorphins, the body's natural opiates:  Acupuncture needles may trigger the release of one or more of these substances, which inhibit pain signals by blocking their pathway through the spinal cord -- a view supported by the gate theory of pain proposed by Drs. Meizack and Wall.

 If you're going to try acupuncture, Wilson advises, don't abandon your medications: "When you're dealing with inflammatory arthritis, once you get joint damage, it's virtually irreversible, so 1 always encourage somebody with really hot joints to get on to something and get their joints cooled down, then start with acupuncture, and use it to maintain a remission or to keep themselves reasonably under control. If their joints are all swollen and hot, it's going to take quite a while for the acupuncture to work, so start something else at the same time."

And make sure your practitioner has been trained and certified through the Acupuncture Foundation of Canada or an equivalent body. "Don't go to someone who isn't licensed, but, in general, it's a very safe process, and there are really no side effects. The only side effect worth noting is, if you don't have coverage, it tends to cost a lot (from $25 to $70 per treatment times 10 or more treatments)."

That's because the effects are cumulative, and you might have to go every day for two or three weeks, then twice a week for a couple of weeks, then once a week, then once a month. "Each time you have it, the effects last longer," Wilson says. "It could be 10 to 20 treatments; it could be 15. It may not even be that. And then the patient doesn't have to keep coming back."

Because they're cured? No, but they're probably better.