The following articles on Acupuncture and Herbal medicine are provided for your reference.

The World Health Organization Viewpoint on Acupuncture

Abstract: A World Health organization interregional seminar on acupuncture, moxibustion and acupuncture anesthesia was held in Beijing in June 1979 attended by participants from twelve countries. Its purpose was to discuss ways in which priorities and standards could be determined in the acupuncture areas of clinical work, research, training, and technology transfer. Scientific investigation must be closely correlated with demonstrations of acupuncture's clinical efficacy. Apart from acupuncture analgesia used in major surgical procedures, acupuncture also has been applied as a diagnostic aid and in conjunction with fluoroscopy in gastrointestinal diseases. Acupuncture is clearly not a panacea for all ills; but the sheer weight of evidence demands that acupuncture must be taken seriously as a clinical procedure of considerable value.

During the past decade, there has been a growing convergence between the most advanced research knowledge from physiology, biochemistry and pharmacology, and knowledge obtained by research in the field of acupuncture; that is to say, a convergence of modern international science with traditional Chinese medicine. For example, in more than 600 cases of coronary heart disease, the effectiveness of acupuncture in relieving the symptoms was over 80 percent. In 645 cases of acute bacillary dysentery, 90 percent of the patients were cured within ten days as judged by clinical symptoms and signs and the results of stool culture. The technique is also comparatively effective in controlling fever, inflammation and pain.

From the viewpoint of modern medicine, the principle action of acupuncture (and of moxibustion) is to regulate the function of the human body and to increase its resistance by enhancing the immune system and the antiphlogistic, analgesic, antispastic, antishock and antiparalytic abilities of the body.

The World Health Organization Interregional Seminar drew up the following provisional list of diseases that lend themselves to acupuncture treatment. The list is based on clinical experience, and not necessarily on controlled clinical research: furthermore, the inclusion of specific diseases is not meant to indicate the extent of acupuncture's efficacy in treating them.

1. Upper Respiratory Tract
   
   

   Acute sinusitis Acute rhinitis Common cold Acute tonsillitis

2. Respiratory System
   
   

   Acute bronchitis Bronchial asthma (most effective in children and in patients without complicating diseases)

3. Disorders of the Eye
   
   

   Acute conjunctivitis Central retinitis Myopia (in children) Cataract (without complications)

4. Disorders of the Mouth
   
   

   Toothache, post-extraction pain Gingivitis Acute and chronic pharyogitis

5. Gastro-intestinal Disorders
   
   

   Spasms of esophagus and cardia Hiccough Gastroptosis Acute and chronic gastritis Gastric hyperacidity Chronic duodenal ulcer (pain relief) Acute duodenal ulcer (without complications) Acute and chronic colitis Acute bacillary dysentery Constipation Diarrhea Paralytic ileus

6. Neurological and Musculo-skeletal Disorders
   
   

   Headache and migraine Trigeminal neuralgia Facial palsy (early stage, i.e., within three to six months) Pareses following a stroke Peripheral neuropathies Sequelae of poliomyelitis (early stage, i.e., within six months) Meniere's disease Neurogenic bladder dysfunction Nocturnal enuresis Intercostal neuralgia Cervicobrachial syndrome "Frozen shoulder," "tennis elbow" Sciatica Low back pain Osteoarthritis

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NIH Endorses Acupuncture

(Excerpted from The Pulse, by Susie Hayes)

In November 1997, the National Institutes of Health (NIH) endorsed acupuncture as a viable treatment option for various medical conditions, including nausea and pain.

The Consensus Development Conference on Acupuncture, sponsored by NIH's Office of Complementary and Alternative Medicine and the Office of Medical Applications Research, was held November 3-5 in Bethesda, MD. Approximately 600 attendees reviewed available research data on the efficacy of acupuncture. After hearing 23 presentations on acupuncture's origin, status and efficacy, a 12 member panel of non-federal, non-advocate medical experts drafted an 18 page Consensus Statement, announcing acupuncture as an effective treatment option and encouraging more research studies, reimbursement from insurance companies, and integrating acupuncture with conventional Western medicine.

The panel concluded that acupuncture is an effective treatment for conditions including postoperative pain, chemotherapy, pregnancy-related nausea and vomiting, immune enhancement, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, back pain, carpal tunnel syndrome and asthma. The panel was enthusiastic about acupuncture's cost effectiveness and minimal risks and side effects, especially compared to conventional medical treatments. The panel chair, David J. Ramsay, DM, DPhil, President of the University of Maryland, Baltimore, considered the conference "a very exciting beginning to better integration" with Western medicine, urging the public and health care professionals to take acupuncture seriously.

Critical issues raised at the conference included the difficulties in conducting acupuncture research within the conventional parameters of western scientific research, trying to fit a "round peg" (the energy based system of acupuncture) into a "square hole" (Western scientific research). Different methods, such as outcomes research and multicentered studies, were encouraged.

"We need more high quality research to validate what appears to be useful for millions of Americans who have used acupuncture. The challenge in studying acupuncture is to integrate the theory of Chinese medicine into the conventional Western biomedical research model and into the conventional health care arena," said Ramsay. The initially skeptical panel, rigorous in scrutinizing the data, received a standing ovation from the audience after delivering a positive and encouraging final statement.

The Consensus Statement will be available on hard copy within a few months and is currently available in draft form on the World Wide Web at http://consensus.nih.gov.

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Brain Imaging Suggests Acupuncture Works, Study Says (CNN Article)

December 1, 1999

(CNN) -- Traditional Western medicine has been skeptical of the benefits of acupuncture, but researchers in New Jersey say that evidence derived from brain imaging shows the treatment helps to relieve pain.

Although it's considered a relatively new alternative in the West, acupuncture has been practiced in China for over 2,500 years. During the treatment, very fine needles are inserted slightly into the skin at certain prescribed points to relieve pain or other ailments.

Scientists at the University of Medicine and Dentistry of New Jersey (UMDNJ) compared brain images of 12 people experiencing pain with images after they received acupuncture. Under brain imaging, the brain "lights up," or shows activity, in specific areas when a person experiences pain. Following acupuncture, researchers found a marked depletion in that activity.

"We found activity subsided in 60 percent to 70 percent of the entire brain," said Wen-Ching Liu, Ph.D., a co-author of the study and assistant professor of radiology at UMDNJ.

Released at a conference of the Radiological Society of North America, the study also found the amount of pain depletion can vary from person to person, and some of the people in the study experienced a change in their pain threshold.

"The person (being tested at the time) actually experienced a high tolerance of pain. We gave a pain stimulation and after acupuncture we applied the same degree of pain stimulation. He didn't feel it," said Dr. Huey-Jen Lee, chief of neuroradiology at UMDNJ.

Although there are 401 acupoints on the body, this study focused on the Hegu acupoint, or the point on the hand between the thumb and forefinger. Most acupuncture treatments involve stimulating more than one point, but the Hegu acupoint is one that is frequently used, according to Lee.

This research backs up what many Chinese have believed for centuries -- acupuncture works to relieve pain. But how or why it works is still unclear.

Historically the Chinese have theorized that the body has an energy force call Qi (chee) running throughout it. The Qi is divided into two opposing forces, the Yin and Yang, which work together when balanced.

The flow of the Qi through a person's body influences all essential life activities, including health. If its flow is interrupted, the Yin and Yang become unbalanced, causing pain or illness.

The Chinese believe the Qi flows through special pathways or meridians. Acupuncture points are specific locations where these pathways come to the surface of the skin. The procedure is said to restore balance to the flow of the Qi.

No matter how it works, acupuncture is continuing to gain acceptance in Western medicine. In 1997, the National Institutes of Health published official guidelines for its use. Researchers are optimistic it will become a useful tool for pain management, especially for those who cannot tolerate medication.

Medical Correspondent Dr. Steve Salvatore contributed to this report.

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Giving Chinese Medicine a Shot (CNN Article)

October 7, 1999

By Christina Allen

As it turns out, I've been having headaches and stomach cramps ever since arriving in China. It was easy to volunteer myself as the guinea pig and give Chinese medicine a try.

My first stop was the Beijing Medical Hospital. I sought out Dr. Wan Hui Min who, I had heard, was an acupuncture specialist. She teaches in a classroom full of student desks and charts which indicate age-old points for needle insertion. Not that I ever associated being a human pincushion with feeling good, but I broke into a cold sweat watching Dr. Wang Hui Min unwrap the long needles to insert them in my head, neck, knees, and stomach. To my surprise, it didn't hurt at all! In fact, soon after Dr. Wan Hui Min began inserting the needles I felt a pleasant, warm, and tingly feeling.

Eastern doctors would attribute this tingly, warm feeling to the body's Chi, or vital life force, also called Energy· which runs along lines in the body called Meridians. This network of energy flow doesn't match up in any way to the systems of nerves, muscles, and blood used by Western doctors.

How might a doctor of Eastern and Western Medicine treat the same ailment? Diagnosing a patient with tremors, the Western doctor might examine the brain and spinal cord for nerve and muscle problems or the brain for lesions. Presented with the exact same patient, the Eastern doctor might examine the pulse and condition of the tongue, suspecting the problem to be an internal wind or perhaps an imbalance of the heat in the body.

Many westerners attribute the effects of traditional medicines to the "Placebo effect." That means that your brain believes in something so strongly that your body actually experiences a true physical benefit, even if no medicine was actually given. Tests have confirmed the placebo effect. For instance, when a group of balding people was told they had taken a great new drug to grow hair, a small percentage of them actually grew more, even though they were only given a sugar pill!

Next I tried Chinese healing massage. This is much more vigorous and louder than relaxation massages popular in the U.S. In one technique I particularly liked, a karate chopping motion with the hands made sounds like popping popcorn! This technique increases blood circulation and helps remove toxins from sore muscles.

Later I went to Beijing's People's Park, where people arrive before sunrise to practice all kinds of exercises. They swing on adult-sized jungle gyms and kick karate-style. They also practice the fluid, almost ballet-like meditative dance called Tai Chi and the more vigorous exercises of Chi Gong, which are prescribed for specific health problems. Most of these exercises share the goal of moving Chi, that vital energy, through the body. I've read that Tai Chi can actually help people live longer lives. In addition to increasing general health and well being, one study showed that Tai Chi specifically led to better balance and fewer broken hips in the elderly, a common mishap that contributes to health decline and early death.

I decided to give Tai Chi a try. I simply joined in on one of the many groups of people moving and exercising. We stepped rhythmically in turning patterns, swaying our arms as if we were moving an imaginary beach ball. It was easy to get the basics, and though I stood out like a sore thumb in my red pile jacket, the Chinese elders welcomed me. When I was done, I felt like I not only moved my Chi, I loosened my limbs, got my heart pumping, and made a few new friends.

After two days of trying all sorts of traditional Chinese healing techniques I still don't know if I can explain how it works. All I know is that I'm all psyched up to cycle into the Taklamakan Desert tomorrow. Both my headache and my cramps are gone. Maybe getting my Chi moving swept them right out of my body·

Going with the flow,

Christina Allen

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A Leaf From The Book Of Life

What's behind the drive to bring Chinese herbal medicine into the Mainstream

By Jonathan Sprague

As a baby nears birth, it is supposed to turn over in order to be born head first. If it doesn't do so in the final weeks of pregnancy, doctors have three choices: massage the mother's abdomen to push the baby out of the dangerous "breech" position, get ready for a Caesarian section - or burn some mugroot next to the mother's little toenail. Mugroot? It is a Chinese herb, also called moxa, and right by the nail of the little toe is an acupuncture point. A recent study found that the moxibustion technique worked for 75% of 130 women. In the control group, the baby turned on its own for just half of the expectant mothers. But the amazing thing is not that the technique is effective. Chinese herbalists have known that for centuries. What is striking is that the study was recently published in a bastion of orthodox Western medicine - the Journal of the American Medical Association (JAMA).

Traditional Chinese medicine (TCM) is coming of age. That may seem to be an odd thing to say about a discipline with 2,000 years of recorded history. But the past decade has seen growing confluence of several trends: TCM doctors approaching the tradition on a more scientific basis; Western doctors and researchers recognizing that Chinese herbs offer much that they do not know; and patients becoming more open to non-Western practices. That confluence is now a flood of activity. China is scrambling to modernize its vast TCM infrastructure and grab more of the growing world market for herbal cures. Hong Kong, Singapore and Taiwan are hoping to leverage their Chinese heritage and advanced economies to become TCM centers. Western pharmaceutical giants are stalking the region in search of potentially lucrative TCM partnerships (the world market for herbal medicines is estimated to grow to about $12 billion over the next 10 years). And patients everywhere will (hopefully) benefit from better medicines and better practices based on traditional as well as Western cures.

TCM? Isn't that where an old guy in a funny smelling store lined with drawers full of dried sticks and animal parts takes your pulse and mumbles about excess humidity of the kidneys? Well, yes. Skeptics say that the ancient way of healing is mumbo jumbo, treating vague symptoms that hardly correspond to specific diseases and explaining its effect in terms of qi, a life energy that no instrument can measure. But there is more to it. Science-based research is finding out how TCM works in the body, pinning down which treatments fight which diseases, and gradually winning over Western-oriented doctors and patients. "We can't just say that we've been using a herb for 2,000 years and expect others to use it," says Dr. Kong Yun-cheung, director of the school of Chinese medicine at the Chinese University of Hong Kong (CUHK). Yao Naili, executive vice president of the Chinese Academy of Traditional Chinese Medicine in Beijing, says the ultimate quest is still to find qi. But the academy's 4,000 staff are looking for practical and provable TCM applications. "It's mostly cancers, heart and liver diseases that we're working on," he says.

And new medicines are coming up fast. Last week, researchers from the City University of Hong Kong and the Guangzhou University of Traditional Chinese Medicine said they produced a pill based on phyllanthus, an herb discovered in China's Hainan province, that can reduce the recurrence of hepatitis B. In May, researchers at the University of California, San Francisco, revealed cancer-battling properties in an over-the-counter cure. The compound, made up of eight Chinese herbs, including the saw palmetto, significantly lowers the level of prostate-specific antigen, an indicator of cancer cells, in men with advanced prostate cancer. Swiss pharmaceutical giant Novartis has registered patent rights in 41 countries for a new malaria drug based on a derivative of the Chinese herb artemisinin - the result of a decade-long collaborative effort with China's Institute of Microbiology and Epidemiology and the Kunming Pharmaceutical Corp. In January, the drug won approval to be sold in Switzerland, its first Western market.

In a sense there is nothing surprising about the newfound attention traditional cures are winning. After all, a drug is a drug, and scientists are looking for potential cures in everything from Amazon insects to Pacific sponges, as well as traditions like Indian Ayurvedic medicine. "Drugs are used chemically for the treatment of disease, regardless of whether they come from natural products or are synthesized," says Chen Chieh-fu, director of Taiwan's National Research Institute for Chinese Medicine. But TCM also has a long clinical history that today's scientists can use as a guide. Chen's institute has compiled a database of the possible curative effects of herbs based on traditional texts and is working to identify the active ingredients in the most promising ones. Commercial pharmaceutical companies think the same. "You know from Chinese history what herbs cure a particular disease," says Dr. Zhao Jian, medical director of Beijing Novartis Pharmaceutical. "Therefore you have a direction to follow rather than swim in a sea of chemical compounds."

But the nature of traditional applications makes research according to orthodox scientific standards difficult. Any given herb contains a multitude of chemical compounds, and TCM doctors tailor combinations of herbs to match the symptoms of individual patients. Western medicine demands evidence that an ingredient acts in measurable ways on a specific disease in a large number of patients. "We have to find an active substance or a molecule from the herb before we can study its effects," explains Zhao. "That alone will take you at least a year." But the effort cannot be avoided, not just because the science demands it, but because that is the only route to winning patents, regulatory approval and markets. "What makes developing traditional medicine difficult is that it's hard to identify a single active ingredient necessary for patent rights," says Dr. Helen Chan, managing director of Vita Green Health Products (the Hong Kong company is working to develop products from lingzhi - a highly prized Chinese fungus containing natural antioxidants). "As a result," says Chan, "there's no prospect of breaking even, let alone profits, in sight." Even more daunting is winning regulatory approval for TCM medications. New Jersey-based contract drug developer Covance last year opened an office in Beijing and hopes to shepherd two traditional Chinese medicines used to treat cardiovascular diseases through the approval process of the U.S. Food and Drug Administration. Even though the cures are widely used in China, Covance reckons that getting even one of them approved as a prescription drug in the U.S. could take eight years and $40 million to $60 million. In fact, no traditional Chinese medicine has ever won FDA approval as a drug - TCM products in the U.S. are sold as dietary supplements, like vitamins, which come under much less stringent rules. But such health aids are not easy to develop either, if done right. CUHK's Kong and his team recently began marketing a tea for colds and flus, containing three varieties of a Chinese holly colloquially called dong qing cho. It took 15 scientists three years and $1.3 million to develop.

The search for new drugs that can fit into orthodox practice is not the only challenge for traditional medicine. Perhaps the greater task is upgrading the practice and infrastructure of TCM so that it can stand shoulder to shoulder with orthodox therapy. "With enough studies into the benefits of both Western and Chinese medicine, doctors can switch from one to another or apply both at the same time," says Professor Hu Shilin, of the Hong Kong Baptist University's TCM division. The two traditions have different strengths. Generally, orthodox medicine is regarded as superior in treating acute illnesses. TCM has little surgical tradition. On the other hand, it has been shown to be effective in fighting chronic or slow-developing illnesses and in preventive medicine. Wang Jian, a Beijing-based AIDS specialist, says TCM in combination with Western treatment can help prolong the lives of patients and alleviate some harsh symptoms. "Both disciplines can supplement each other," Wang says.

One problem TCM faces is a lack of standards. Practitioners in China generally are graduates of specialist schools, and many American states require some sort of licensing. That is not the case in Hong Kong, Taiwan and Singapore, where most practitioners learned their craft as apprentices. Often, diagnoses take place in a shop corner or across a counter. But that is starting to change. All three territories are moving to register their practitioners. Hong Kong and Singapore also plan to require licensing exams. Three Hong Kong universities have started offering TCM degrees. In April, medical group Quality Healthcare Asia opened a modern TCM clinic in the SAR in cooperation with the Baptist University, with doctors in private consultation rooms and prescriptions put together by trained pharmacists. "This clinic sets a benchmark for further development," says company adviser John Crawford. "It is not a trial-and-error exercise. There is full quality control." And since Quality Healthcare operates a network of about 100 clinics in Hong Kong, referrals between them can provide patients with the best of both worlds.

In some places, both healing disciplines coexist fairly happily. In much of China, TCM is the main form of therapy, if only because it costs less and can be more easily taught. In Japan, 70% of orthodox doctors will give prescriptions based on kampo - the Japanese offshoot of TCM that literally means the Chinese way - although Western medicine remains dominant. But there clearly is resistance in the medical establishment to Chinese therapies. Some of it is practical. "As TCM develops well in preventive care, you might not go to see doctors when you have some minor symptoms of flu, but most doctors make money from treating minor sicknesses," says CUHK's Kong, who is trained in embryology. But more than livelihood is involved. Despite centuries of clinical use, most TCM treatments have not undergone the controlled studies that Western practices are put through to prove efficacy and safety. Even the study of moxibustion to turn babies in breech position, which then-JAMA editor Dr. George Lundberg said produced very good data, was just one experiment involving a mere 260 subjects over a short time span.

Given the uneven standards for training and licensing, orthodox doctors worry that patients who turn to TCM will not receive the best possible medication. Sometimes that is not such a bad thing. "Maybe 30% of the population have minor psychological disorders," says Dr. Kao Chi-yu, a general practitioner in Taiwan. "Western doctors do not give them enough time, and it's the attention they need." But a health problem could get worse if a patient relying on TCM delays more effective orthodox treatments. Old-style cures can also cause adverse side effects if taken in the wrong combination or dosage. Further, some over-the-counter medications contain dangerous quantities of mercury, steroids and other substances. Growing interest in TCM may put extra pressure on endangered species too. The plight of the tiger and rhinoceros is well known, and there is strong effort within the TCM community to find and use substitutes. But less glamorous plants, for example, wild ginseng, which can command $13,000 for a piece less than 100 grams, already face extinction. "With more people wanting to use TCM, certain endangered plants will be in great demand," worries Judy Mills, East Asia director of TRAFFIC, a non-governmental group devoted to tracking trade in threatened flora and fauna.

The great hope is that as TCM develops, better regulation, improved training and rising investment will cure its shortcomings. China and Taiwan are already starting to clamp down on sloppily made traditional products that contain illegal or harmful compounds. And globally, advocates hope that greater scientific understanding of Chinese medicine, better and more standardized drugs and treatments, and improved training of practitioners will raise the tradition's profile, respectability and usefulness. Hong Kong has mapped out a 10-year plan to turn the territory into a TCM hub, with researchers packing laboratories, certified medicines on shelves and drug makers listed on the stock market. Singapore and Beijing signed an agreement to trade the latter's knowledge of TCM for the former's expertise in healthcare management. Western researchers and pharmaceutical companies are continually expanding their interest in the ancient yet new tradition.

Forward-looking practitioners argue that doctors should eventually be able to use either Western or Easter cures - or both - to best treat the patient. "TCM will absorb more and more of the technical and scientific advantages of Western medicine - that's good," says Yao of the Chinese Academy in Beijing. "Eventually TCM as a different discipline will disappear. It will be integrated into worldwide medical science. But I am looking far, far into the future."

- With reports by Yulanda Chung / Hong Kong, Anne Meijdam / Beijing and Jane Rickards / Taipei

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