Acupuncture in physiotherapy Key concepts and evidence based practice, Acupuncture
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BUTTERWORTH-HEINEMANN
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2004
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First published
2004
ISBN
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Preface
This book is written primarily for physiotherapists who use acupuncture.
It moves beyond the basic theories taught by the Acupuncture Association
of Chartered Physiotherapists (AACP)-approved tutors in the introductory
courses now studied by thousands of UK physiotherapists. It is intended
as both an intermediate text and an encouragement to look further than
simplistic musculoskeletal pain applications for this ancient technique.
Several assumptions are made: first, that all readers will be familiar with
the anatomy of the human body; second, that they will be familiar with
both normal and abnormal manifestations of physiology as taught to med-
ical professionals in the UK; and third, that they will be practising within
the physiotherapy discipline although not necessarily within the National
Health Service of the UK.
Much of the material in this book will serve as an introduction to the
study of acupuncture at a postgraduate level where students are expected
to evolve their own practice, based on a combination of the available sci-
entific evidence, the rich clinical history of Traditional Chinese Medicine
and the basic skills of their profession.
Val Hopwood
Southampton
.
2004
CHAPTER
1
Overview of the main TCM
theories and their place in
modern practice
Introduction
This book is the sum of many hours of reading and researching, mostly of
modern acupuncture texts, looking for a handle or key to the mysteries of
acupuncture. Have I found one? I’m not certain, but I know that I answer
questions with more intelligence than I once might have done because the
information I have gleaned has informed my thoughts. I still feel that there
is a great deal I don’t know, but I also begin to feel that some of what I have
learnt is unnecessary baggage. I am not yet ready to abandon all the origi-
nal ideas of Traditional Chinese Medicine (TCM), even though my profes-
sional background is in so-called scientific medicine; consequently my
practice is, at best, an uneasy balance between the two.
Historically, the acupuncture training available to physiotherapists has
been provided by both TCM and medical trainers, leading to wide variety
in the philosophical underpinnings to practice. As a response, physiother-
apists are using their own form of acupuncture in the conditions that they
understand and in ways that the Chinese probably did not envisage. This
does not make us better, just different.
The teachers and colleagues with whom I work have slowly been mov-
ing to this new form of acupuncture, intuitively filtering the ancient
philosophies when applied to clinical practice and incorporating the
newest research when it seems to offer an explanation.
Most of the work done by physiotherapists can be identified as the relief
of pain and the search for a neurological cure. This is, of course, a sweep-
ing generalization and does not take into account a great deal of work
focused on other fields such as basic movement, the cardiovascular sys-
tem, respiration and child development. However, the majority of physio-
therapists in the UK are still employed in National Health Service (NHS)
outpatient departments dealing with various forms of pain on a daily basis.
This professional interest in alleviating painful problems offers a direct
application for acupuncture, a truly holistic approach. An understanding of
the physiological mechanisms underlying both acupuncture and pain itself
is important. New research information about these mechanisms could,
and indeed should, change the application of acupuncture if it is shown
that the effects can be improved. Equally, if no effects can be demonstrated,
we may need to think again. To quote White and Ernst: ‘If acupuncture
turns out in the end to only be a superior form of placebo then we should
still use it, for we have few active treatments with as few side effects...’
(Ernst & White
1999
). It is perhaps as well that these authors have not
1
acupuncture in physiotherapy
2
spent much time systematically reviewing the evidence for some physio-
therapy modalities. I would venture to suggest that physiotherapists are
very familiar with the placebo effect.
It may be that this book will inform the debate. It will sometimes be
advisable to think of the symptoms and pattern in TCM terms before the
Western diagnostic method. When the signs and symptoms are divorced
from their rigid medical background it is possible actually to see new pat-
terns and logic. A good example is the field of neurology. Essentially, the
problems experienced by the patient include a wide range of changes and
deficits, most of which are common to all the identified conditions although
of differing severity. All of these can be related directly to malfunction of
part of the nervous system, as we currently understand it. Taken in the
broadest possible sense, and in no particular order, the following are symp-
toms that might be expected in a patient with severe multiple sclerosis:
decreased mobility
[
autonomic changes
[
fatigue
[
muscle spasm
[
contractures
[
cognitive damage
[
communication problems
[
emotional lability
[
breathing and coughing problems
[
bladder symptoms
[
visual symptoms.
[
Few patients are unlucky enough to suffer from all these problems, but the
nature of nerve damage implicit in the diagnosis of the condition means
that they are all possible. Neurological conditions are often difficult to dis-
tinguish (with the possible exception of a straightforward stroke), because
they have a great deal in common with one another. Table
1
.
1
shows the
Table
1.1
Neuro-
Symptom
Multiple
Stroke
Parkinson’s
Motor neuron
symptoms
sclerosis
disease
disease
Decreased mobility
✓
✓
✓
✓
Fatigue
✓✓
✓
✓
Respiratory problems
✓
✓
✓✓
Muscle spasm
✓
✓
✓
✓
Contractures
✓
✓
✓
✓
Autonomic changes
✓
✓
✓✓
✓
Cognition or mood
✓
✓
✓
Communication
✓
✓
✓✓
✓
Bladder problems
✓
✓
✓
Visual problems
✓
✓
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