MARSHA NEDNEY didn`t think acupuncture needles would accomplish what allergy shots had not. But after 15 years of sneezing fits, swollen red eyes and pounding headaches, she was ready to try anything.
Several years ago, Nedney, 37, went to Dr. Ping-Cheung Lee, a pediatrician-turned-acupuncturist in San Jose, Calif. He gently inserted small stainless steel needles into selected points on her body: two just below her knees; two above her wrists; two in the cracks of her smile, an inch below the nostrils; one between her eyebrows. When she felt a deep tingling, Lee gave the needles a twirl, then left them in place for about 15 minutes.
Ten sessions changed her life, Nedney says.
”I can now go up to a dog and pet it,” she said recently. ”I can now have cut flowers in the house. I can sit on the patio outside. I can clean the house without sneezing. None of this was possible before. I think acupuncture is the most marvelous thing in the world.”
Most doctors in United States, however, express considerably less enthusiasm. Although many concede that the ancient Chinese technique may relieve pain, few regard it as effective therapy for other medical or psychological problems, including allergies. And although the ranks of acupuncturists have grown in the past decade in California and across the country, few physicians refer patients for the procedure, let alone offer it themselves.
”I don`t think that any of us in medicine can really understand the Oriental explanation for how acupuncture works,” said Dr. Richard Mercer, an orthopedic surgeon and president-elect of the Santa Clara County (Calif.)
Medical Society. ”Most of us would have to say there`s no documented scientific explanation for it.”
That may change. Researchers in the United States and Canada have shown that needle stimulation triggers the release of endorphins, opiate-like chemicals in the brain that play a role in pain control. Through more studies, the investigators hope to come up with a physiological explanation for a phenomenon rooted in Chinese philosophy.
”To most people right now, acupuncture is hocus-pocus,” said Dr. Manochehr Khatami, a clinical psychiatrist at the University of Texas Health Science Center at Dallas who is studying the effects of acupuncture. ”Nobody believes it. It is Chinese medicine. It doesn`t follow the anatomical or physical basis of Western medicine.”
Although many acupuncturists view the research efforts with interest, some believe that Western science will never fully explain how the technique works. Moreover, some say, patients generally don`t care.
”From the patient`s point of view, he says, `Forget how it works. Just get rid of my headache,` ” Lee said.
Chinese philosophy has it that life energy, or chi, circulates through the body along channels called meridians. These meridians are located under the surface of the skin, connected via branches to the vital organs.
Good health depends on a balanced flow of energy, the Chinese say. When the balance is disrupted and energy becomes blocked, pain or illness results. For nearly 4,000 years, Chinese people have stuck needles into one another as a way of restoring the flow of energy–and relieving the symptoms of disease. The technique looks simple. In fact, it`s extraordinarily complex. The body has more than 1,000 points that may be pierced in order to redirect energy. A complex theory guides the practitioner in choosing which points to puncture in any given case. As Lee did in treating Nedney, acupuncturists typically select points both near and far from the site of illness.
Needles are the most popular acupuncture tool. Ranging in length from a half-inch to 5 inches or more, some are as slim as a human hair, others as thick as a straight pin. Modern acupuncturists also use electric needles, lasers and sound waves to stimulate strategic points on the body.
Acupuncture arrived in the United States with the Chinese settlers of the 1800s. Immigrants quietly received treatment for nearly a century in the back shops of scattered Chinatowns across the country. The technique, however, attracted virtually no outside attention until Americans visited China in the early 1970s and brought back stunning tales of what took place in operating rooms.
In Shanghai and Peking, the visitors saw patients lying awake on tables, the tops of their skulls cut off as surgeons plucked through their brains to remove lethal tumors. The Americans found that people underwent acupuncture for everything from hay fever to heart disease. And they discovered a concerted effort by Chinese doctors to document the effects in Western scientific terms.
As acupuncture gained appeal in this country, many states moved to legalize the practice. Fourteen states, including California, now register or certify non-physician acupuncturists, and about that many allow lay acupuncturists to practice but do not license them.
California has one of the most liberal laws. Initially passed in 1974 and amended over the years, the state law established training standards and required would-be acupuncturists to pass a certification exam. But through a grandfather clause, it allowed back-shop healers to stay in business without taking tests or seeking additional training.
About 1,700 lay healers–and an unknown number of physicians–practice acupuncture in California. Some limit their work to pain control while others offer the technique for an array of conditions, including allergies, obesity, smoking, depression and wrinkles.
Unlike some states, California allows acupuncturists to handle patients who have not been referred by physicians, a provision that angers many doctors. ”We`re very lax,” said Dr. Jane Lee, a San Francisco internist who uses acupuncture. ”It`s a pretty sad state of affairs.”
Doctors, including those who, like Lee, practice needle stimulation, advise every patient to get a thorough check-up from a physician before seeing an acupuncturist.
”If you have appendicitis and someone just gets rid of your pain, the treatment can kill you,” said Ping-Cheung Lee, who worked for 10 years in pediatrics before switching to acupuncture for adults in 1981.
”Acupuncture is not a cure,” he added. ”It is a good adjunct therapy.”
Prices vary. The going rate ranges from $30 to $50 per session, with five to 10 sessions the standard course of therapy. Some insurance policies cover acupuncture for certain conditions.
Success rates vary, too, depending on the practitioner and the problem. Several Santa Clara County doctors say they`ve stopped referring patients for acupuncture because so many were disappointed by the results. But acupuncturists say about half of smokers and overeaters kick their habits, 70 percent of allergy suffers show improvement and more than 90 percent of pain victims report at least some relief after needle treatments. Scientific research has given its strongest support for acupuncture as a pain-control technique.
For years, Western scientists have attempted to explain why Chinese patients could have their brains cut apart with acupuncture as the only anesthesia. In the early 1970s, one theory held that acupuncture, like hypnosis, distracted patients from their problems by redirecting their attention. Another had it that impulses from the site of injury clashed with impulses from the acupuncture point to short-circuit the pain.
Today, those notions have been discredited. The popular explanation for acupuncture rests with endorphins, the natural pain-blockers that Western scientists recently discovered and have worked furiously to manipulate through new drugs.
Several researchers have found that needle stimulation alters the activity of nerve cells and prompts the release of endorphins, which halt traveling pain impulses. In experiments with cats, Dr. Bruce Pomeranz, a neurophysiologist at the University of Toronto, found that nerve cells in the spine stopped emitting pain impulses 20 minutes after the animal underwent acupuncture.
Stanford scientists have reported that electrical stimulation of certain parts of rat brains produce pain tolerance and promote the release of endorphins.
And in a study of 20 pain patients, Khatami and his colleagues at the University of Texas showed a marked increase in endorphins after acupuncture treatments. Patients who reported the greatest relief also had the greatest concentration of one type of endorphin circulating through their bodies.
Many U.S. doctors believe that acupuncture works only because people believe it will, not because it has a therapeutic effect on the body. The studies, however, confirm what acupuncturists have said for years.
”You don`t have to believe in acupuncture for it to work,” Jane Lee said.
