Acupuncture and Rheumatoid Arthritis

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Acupuncture and Rheumatoid Arthritis

Summary of a presentation at the Living with RA Workshop at HSS

Y.F. Ngeow, MD

Associate Professor of Anesthesiology, Weill College of Medicine, Cornell

University

Understanding Acupuncture

The underlying principles of acupuncture date to the Stone Ages, when

Neolithic man discovered that hitting the body with sticks or pressing

points on the body with stones could get pain to go away. Over time, certain

points were found to be particularly effective. Based on thousands of years

of practical observation and clinical experience, the Chinese developed this

into acupuncture, which involves stimulating specific points on the body to

treat disease or decrease pain.

Acupuncture may be accomplished by stimulating the points with:

* Pressure - applied with the finger, fruit seeds, stones, or other

methods

* Hitting - gentle tapping

* Insertion of needles, and twirling them with the fingers, applying

electricity, light bloodletting; or heating with moxibustion (burning herbs

attached to the stem of the needle), lamps, or lasers

* Cupping - placing small, heated glass jars, which form a vacuum, over

the points to bring energy to the surface

Traditional Chinese Medicine Theory

The traditional Chinese understanding of how acupuncture works relates to qi

(pronounced chee). Qi is the life energy, contained in every part of the

body. Some qi determines nutrition, helps defenses, or helps the blood and

circulation, for example. Qi must flow around the body harmoniously.

A related concept is yin and yang, the positive and negative aspects or

opposing forces in the body, which must be in balance. Qi conducts the

energy in order to balance the opposing forces throughout the body. A modern

corollary for this concept is the sympathetic and parasympathetic nervous

system - yielding positive and negative feedback. If qi is in deficiency or

excess in any one organ, you get a yin or yang predominant state.

You may have seen drawings showing the meridian lines on the body, depicting

where the acupuncture points fall. Each line has a beginning and end but is

linked to another meridian, with the qi flowing in a definite direction. All

the meridians are ultimately connected. When the flow is interrupted due to

a lack of qi or lack of energy to propel this flow, a pathological condition

occurs.

Each meridian line relates to a particular organ, such as the stomach or

lungs. Stimulating points along that meridian will help to treat diseases of

the organ. The surface acupuncture point on the body is where the internal

organ manifests its function. An example of how meridians flow relates to

heart attacks, which may cause not just chest pain but a radiation of pain

into the left arm; this arm pain falls precisely along the heart meridian

line.

Why does needling at a distant point from the problem help? Traditional

Chinese medicine theorizes that any one part of the body reflects the entire

body. A modern understanding of this might relate to our DNA; every single

cell of our bodies carry the entire set of DNA codes, thus representing our

entire body.

Acupuncture for Rheumatoid Arthritis

Because rheumatoid arthritis is an inflammatory and painful condition, it

falls into the realm of interruption of qi . Inflammatory conditions reflect

an excess of qi ; however, dull pains and stiff joints are indicative of a

deficiency of qi . This probably mirrors the evolution of rheumatoid

arthritis, from an early stage when it is highly inflammatory to a chronic,

late stage where there is more atrophy, stiffness, and dull aching. The

treatment of course has to be appropriate for each stage. So the clinician

must examine you to determine the stage in order to use the appropriate

acupuncture points. However, rheumatoid arthritis can be helped.

Questions and Answers

How long does acupuncture take to work?

Acupuncture effects last 48 to 72 hours in animals, which translates to 2 to

3 days in humans. Thus, for acupuncture to be effective, treatment sessions

should not be more than 2 to 3 days apart. Once a week is not sufficient.

You don't get cumulative benefits. And don't expect to see much benefit

before 5 or 6 treatments.

If you have an acupuncturist working under the supervision of another

doctor, the two have to agree on the cause of your problem and the approach

must be planned out. If the two don't agree, the plan is different and the

effects will be different. When expectations are different, you cannot gauge

the results of the treatment.

Does acupuncture help inflammation?

Yes, it can help control acute inflammation in conditions, such as fever,

laryngitis, and sinusitis. Acupuncture also has an effect on autoimmune

reactivity and chronic inflammation, such as that seen in rheumatoid

arthritis, but the treatment has to be maintained because the condition is

chronic and we cannot totally eliminate the reactivity. However, we can

alleviate it to some extent.

If you have cortisone shots for knee pain, could acupuncture replace those

shots?

Probably. In the clinic here, a primary concern is back pain, often caused

by spinal stenosis, which is an anatomical problem. It cannot be eliminated

without surgery to eliminate the bone. But the pain can be alleviated, such

as with cortisone shots. If the shots do not relieve pain for a specific

time period of several months, acupuncture is offered as an alternative. In

my experience, about 55 to 65% of patients respond to such treatment.

However, a research study is underway to clearly define the level of

benefit.

Can acupuncture replace surgery?

That depends on the reason for the surgery. If it's for pain, acupuncture

may be an alternative. If it's for deformity, acupuncture cannot undo the

deformity. Acupuncture is a symptomatic treatment, not an anatomical

changing modality.

Can ulnar deviation of the hand be treated with acupuncture?

Ulnar deviation is due to joint erosion and, because the joint is damaged

unevenly, the forces on the muscles on either side of the joint are uneven.

Prevention requires relaxation of the muscle. Treatment must be prolonged

and involve an acupuncture technique to relax those muscles. When trying to

achieve relaxation, extra stimulation (such as electricity) should not be

used. But once muscle shortening has become permanent, such as in a bunion,

it is almost impossible to correct without lengthening or cutting loose the

muscle in some way.

What can be done about fainting when the needle is inserted?

This is more common in men than women. Reclining eliminates 90% of fainting

attacks. Be sure to have something to eat and drink beforehand, which also

helps prevent fainting. Further, it helps to get used to the sensation of

the needles in your hands or feet before applying needles to other parts of

the body.

Is acupuncture covered by health insurance?

Some insurers cover it, but Medicare does not.

http://www.hss.edu/Conditions/Rheumatoid-Arthritis/Acupuncture-And-Ra