ACUPUNCTURE IN THE PAIN CLINIC Dr. Kumio Yamashita Conference data in the November 20th Hospital of ISSSTE on 30 of July 1980, Mexico. Mr. Chairman, Ladies and Gentlemen, It is a very great honour for me to have an opportunity to present you a paper concerning acupuncture in the pain clinic, especially on this memorable occasion of the opening day of the pain clinic in this honourable hospital. This is my thrd visit to your country, so I would like to say I come back here to Mexico where the lovely sights and warm friendships are waiting for me everytime. Today I will introduce you ways we are using acupuncture and sometimes moxibustion and herb medicine combined with Western-style techniques in my pain clinic. Slide 1) History of Acupuncture in China. Before I tell about my clinic, I will point out some interesting and yet very important episodes or topics concerning acupuncture history. Here we have a slide about the history of acupuncture in China. Here you can see an acupuncture needle made of stone in the old Stone Age. The first book written about acupuncture-naichen-was published nearly 3, 000 years ago, when some famous philosophers appeared in Europe and here in Mexico the honourable figure of Quetzalcoatl arose. Later many famous and interesting acupuncture books came out. However, I would like to emphasize the fact that there has always been only one meridian line figure until now ; no other figures have been brought out during the long Chinese history or in other Eastern countries. S. 2 Mao figure S. 3 Bronze figure Slide 2) This figure showing acupuncture points, was discovered in Changsha, Hunan province, in the People's Republic of China three years ago. This figure was excavated with the mummy of a woman,s body in Mao-tai-Kan's tomb and it showed 5 meridian lines on the upper extremity lacking the Heart meridian, and 6 meridian lines on the lower extremity. This means that about 2, 000 years ago, the Heart meridian was not described and it is very interesting to compare this with the bronze figure. Slide 3) The famous bronze figure which is said to have been made in 1443 A.D. during the Ming Dynasty shows that the idea of 12 meridians was discovered nearly 1, 500 years ago and the style remains the same until now without any changes or corrections. These meridian lines are now studied as P.S.C. (Propagated Sensation
along Channels) not only in China but also in the whole world including Japan. These facts will be mentioned S. 3 History of Japanese Acupuncture S. 4 Misono's Method of Needling S. 5 Peony later in this paper. Here we have a slide which shows Japanese history of acupuncture. In 563, Chi-so, Go's priest had brought needle and books of acupuncture to Japan from China and then acupuncture reached its zenith until the beginning of Meiji era about 100 years ago, (in 1868), when the Japanese government eliminated Eastern Medicine and then again in 1945, when the American Occupation Headquarters in Japan tried to ban it as a superstition. Some medical doctors educated in Western medicine, for example the teachers of Dr. Nakatani who discovered Ryodoraku, Professor Ishikawa and Sasagawa had to fight against the government to protect the acupuncture system as it was. This fact shows that Ryodoraku serves as a guard to protect Eastern medicine from many obstacles and give many chances to many doctors to understand Eastern medicine. Turning -to the Japanese history of acupuncture, I will point out some interesting facts. In the Taiho era about 1,700 years ago, the training course of acupuncture was described to be 7 years. This is also very interesting when it is compared with the length of the medical course at the present time which is 6 years. Isai Misonou devised an acupuncture method using rather big needles and inserted them by the inertia strength of hitting other parts of the hand. Once he treated a weakened and nearly withered peony in the emperor's garden and revived it by acupuncture. The emperor was so pleased that he awarded him the honorable of Misonou which means the palace garden. S. 6 Benten figure S. 7 Sugiyama's Method of Needling family name Waichi Sugiyama, one of the well-known acupuncturist in the Tokugawa era, who because of blindness was'nt able to learn acupuncture very well, one day visited the Enosima cave shrine to pray for help to be able to do his work. He promised god to continue his prayer for 100 days. On the last day of his promise, there was no sign of help from the god and he fell down and wept. At that time, a sharp pine needle wrapped in a wide leaf pricked his bottom and he discovered the method of using a tube through which a needle could be passed easily for acupuncture. So inspite of his handicap of blindness he became an excellent acupuncturist S. 8 Mexican Indian with Maguey. S. 9 Poem S. 10-14 Indian Lady's Acupuncture using those tubes. In Mexico, the tips of Maguey, it is said, were used as needles for acupuncture your country in olden times, so that makes Mexico the first country continents where acupuncture has been tried. the in in the American Here we have several slides which show an Indian lady using Maguey needles her acupuncture treatment. for
There is a short poem which is called Haiku in Japan, which I wrote : "Acupuncture With Maguey Needles Is the Ancestor Of Mexican Medicine." Here I would like to emphasize that Mexico must become a leader of acupuncture treatment in the North and South American continents because of its history of acupuncture of long duration. And also IMARAC has a very important mission to found a big school for Eastern medicine in this country. S. 15 Western and Eastern Men Shaking Hands When we use Eastern medicine the following problem usually is discussed. It is very difficult to combine Western and Eastern medicine at the same level in the countries where Western medicine previously progressed like in Japan and your country. In the People's Republic of China which was closed for a long time against Western culture, Western medicine has not made comparable progress with other European and American countries. It is very easy to say that Eastern and Western medicine may be combined at the same level using Eastern medicine as a supplemental method or to fill the gap left by Western medicine. In other words, Eastern medicine can de linked with Western medicine and its feature of calmness and composure is worthy to be compared with Western medicine. S. 16 Features of Both Schools of Medicine S. 17 Eastern Medicine Is Individual, Western Medicine Is General The features of Eastern and Western Medicine are as follows Eastern medicine is more philosophical and Western more scientific, Eastern more deductive and Western more analytical, Eastern more subjective and Western more objective, and so on. However, the most important feature of Eastern medicine is that it is more individual, whereas Western medicine is more general. There is a very interesting story related to the prohibition order of Eastern medicine by the Japanese Meiji government in 1868. Cholera infection occurred in some districts of Japan at that time and the Western medicine, phenol, was very useful to prevent the spread of cholera. Eastern medicine had nothing to offer against the infection of cholera. From this fact, the Ministry of Health, Army doctor Ishiguro decided to use Western medicine for basic national medicine in Japan and eliminated the use of Eastern medicine. This means that the feature of individuality of Eastern medicine was completely defeated by the general features of Western medicine at thhat time. However, one close relative of Dr. Ishiguro who suffered from severe Rheumatism was treated by Western medicine but his condition did not improve. Then Dr. Ishiguro asked an Eastern doctor to treat him who got good results by the treatment of Kampo (herbs) and acupuncture. Dr. Ishiguro deeply regretted that he had ordered the ban of Eastern medicine from the national medical system. For its individuality, Eastern medicine could not win over Western medicine but because of that very feature it could help a severe Rheumatism patient. I think that Western medicine is like a dig shop of shoes. It has a large variety of shoes to fill the orders of many users and may be able, in most cases, to answer
the peoples needs. On the contrary, Eastern medicine is like like a small shoemaker's shop. He cannot make many shoes at one time, but he can make a few shoes may precisely fit the user's feet. S. 18 General Treatment In Eastern medicine, there is a strict rule of diagnosis of the patient : It consists of 1) inspection 2) auscultation 3) anamnesis and 4) palpation which And treatment also consists of three steps, 1) general treatment 2) local treatment and 3) specific treatment. Among them, I want to strongly emphasize the importance of general treatment. Of late, in the field of Western medicine, the examination methods have made remarkable progress and the doctors can easily get many data in a short time. And then young doctors sometimes are apt to decide their treatment methods through those data and forget to consult the patient himself and to watch the course of the illness carefully. Once they have interest in Eastern medicine, they will have the custom to visit the patient's bed and watch them carefully before they decide their treatment methods. This is one big reason why I strongly recommend to teach Oriental medicine to medical students and young doctors as pre-medical and post-graduate course of their education. S. 19 Local Treatmnet Local treatment of acupuncture sometimes shows very remarkable effectiveness for the pain patient. Though the mechanism itself is still not clear, you can find that severe stiffness of muscles or acute strains will disappear as soon as the patient has a single acupuncture. This is why gymnastics champions are treated very often by acpuncture in Japan. Many players claimed that they had less pain during their games. So we would also like to recommend you to send several doctors who have good technique in acupuncture to the next Olympic Games. S. 20 Specific Treatment Specific treatment methods are too popular in medical journalism. This fact sometimes leads to misunderstandings concerning acupuncture. For example, the popular magazines very often introduce only several useful specific meridian points for some complaints and many people believe that only these points are enough for these treatments. Before specific treatment, general treatment must be given. This original rule is easily overlooked and acupuncture becomes underrated because of the bad results compared with the overestimated S. 21 Ryodoraku Treatment propaganda. S. 22 Whenever we say that general treatment is very important, we have some questions as follows : 1) What kinds of general treatment are most effective? 2) How do you select the general treatment method and why do you chose certain meridian points or meridian lines rather than others? 3) Why do general treatment methods differ among acupuncturists or doctors who use acupuncture?
4) Is there any objective method of selecting the most accurate useful meridian points for general treatment? The answers to these questions are very difficult and obscure and because of this fact distrust and suspicion against Eastern medicine rises among Western doctors. Here I would like to introduce the general methods used in my clinic. When a new patient comes in our clinic, we usually first examine him as in Western medicine : for example, by blood tests, X-rays, CT-scan etc. Next we use the Eastern diagnosis method, say, Ryodoraku chart, pulse diagnosis and pressure diagnosis. Then we decide what meridian lines and meridian points are most important for his treatment. After 3 to 5 treatments, we decide wether this patient should continue to be treated by Eastern methods or change to Western methods and be sent to the specific departments according to his disease. In my opinion, there are no clear definite diagnostic methods in Eastern medicine, it is necessary to combine the Oriental methods with the Western ones for the sake of the patient, not the illness. S. 23-26 Ryodoraku Method Ryodoraku is one of the acupuncture methods developed in Japan and it is comparatively easy for doctors who are not familiar with Eastern medicine to try. The Ryodoraku chart is a device to determine the excitation and inhibition of all twelve meridians by measuring the electropermeability on the measuring points on the patient's wrists and feet. This slide shows the representative points which most closely coincide with the so-called original points. The excitation and inhibition of meridians are decided by noting whether each of those point levels are above or below the average physiological range which usually has a 1. 4 cm width on the Ryodoraku chart. As for general treatment, the excitation meridians may be regulated by using the sedation point for that meridian, and the inhibition meridian may be treated by using the excitation point. Concerning local therapy, REPP treatment must be used. REPP (Reactive Electro- Permeable Points) mean the points where rather higher electro-permeable values are shown when 12 Volts and 200 micro-amperes S. 27-33 Pressure Diagnosis DC current is applied for measurement. In my clinic, pressure diagnosis on the alarm points by using a specially designed tube is also used. When pressing on the representative alarm points with this tube, the intolerable pain thresholds on the chart especially designed for this purpose are recorded. The standard curve shows an L-type for Yin meridians and horizontal line for Yang meridians. Excitation and inhibition are decided by comparing those with the standard curve. Pulse diagnosis may be tried in the usual way using the three points on the radial artery on both sides. After we compare the results of these three diagnosis methods ; that is to say, Ryodoraku, pressure diagnosis and pulse diagnosis, we ask the patients for their main complaints and then decide the main meridian lines or meridian points which may be used for their treatment.
S. 34 Relation between three diagnosis methods Here perhaps you would like to ask what the relation between these three diagnosis methods is. Usually the results of pulse diagnosis and pressure diagnosis coincide with each other. The relation between pressure diagosis and Ryodoraku sometimes shows the opposite in excitation and inhibition. However, the abnormal meridians are usually rather similar. This phenomenon may be explained by saying that Ryodoraku reveals the excitations of the sympathetic nerve condition and yet pressure diagnosis reveals the excitations of the para-sympathetic nerve condition though we have nothing to prove that fact. Here we have some data which compares the results of the Ryodoraku and the pressure diagnosis. 1000 cases were selected from both groups and arranged according to meridians which had many abnormalities. The liver meridian showed the largest number of abnormalities and the lung the least in both groups. It seems that the objective findings of pulse diagnosis and Ryodoraku diagnosis by and large, show the opposite in excitation and inhibition. However, these approaches seem to show the same value statistically, according to the cumulative bionomical table. S. 36 Indication of Acupuncture The indications for acupuncture in the pain clinic are as follows 1) Those who complain of various and undetermined causes of pain 2) Those with so-called autonomic nerve disturbances 3) Those who need 'diagnosis by exclusion' and 4) Those whose complaints remain after having had proper nerve blocks and adjuvant therapy for other pain relief. Among them I prefer to use acupuncture for diagnosis by exclusion much more than it is usually used. For example, if a headache patient comes to my clinic, we try acupuncture treatment 3 to 5 times at first and if the patient still has a headache, we will send him to a specialist to have more extensive examinations and receive more detailed diagnosis. I would like to call it 'screening therapy' like 'screening test'. S. 37 Some examples of cases I would like to introduce some examples of cases and their standard treatment methods in my clinic : 1) Acute lumbago 1) Roydoraku therapy 2) Acupuncture (Chinese method) 3) Paravertebral or local block 4) Epidural block 5) Continous epidural block 6) Intrathecal or epidural morphine injection 2) Trigeminal Neuralgia 1) Japanese style acupuncture including Ryodoraku 2) Acupuncture (Chinese style) 3) Trigeminal branch nerve block
4) Alcohol nerve block 5) Ganglion Gasseri block 3) Parkinson disease 1) Scalp Acupuncture wth body acupuncture 2) Decrease of the total amount of Western medicine 3) Balanced doses of medicine and acupuncture 4) Decrease in the number of acupuncture 5) Out-patient therapy with medicine and acupuncture S. 38 First Choice of Westen Style Nerve Block : Now I would like to pick up some diseases for which nerve blocks may be used as the first choice. 1) Trigeminal neuralgia we use trigeminal nerve block 2) Facial palsy we use stellate ganglion block 3) Facial spasm we use facial nerve block 4) post herpetic neuralgia (PHN) we use sympathetic nerve block on continuous nerve block as the first choice. S. 39 The Condition of Our Clinic According to a survey made by the medical doctors and cooperating acupuncturists in our clinic, about 72% of the total number of patients are pain patients, 12% are autonomic disturbance patients, 9% are paralysis patients and 7% so-called difficult cases. We are covering these patients with a group of doctors and acupuncture doctors, mainly 4, including 1 resident and 1 part-time doctor and nearly 10 acupuncturists. Among pain clinic patients, nearly 94% have acupunctured and 15% have nerve block. The number of patients to whom only medicaments are given is only 1. 2%. S. 40 WHO Recommendation I have heard that the WHO delegates of the Acupuncture Committee will publish their findings about acupuncture after the National Congress of Acupuncture and Acupuncture Analgesia held in Peking last year. The findings include the following : 1) It is necessary to study the mechanism of acupuncture in the future 2) It is necessary to have education centers in places other than in the People's Republic of China. 3) It is necessary to have centers for the distribution of reports and the exchange of information with study groups around the world. S. 41 Conclusion We must strive to realize these aims with communication from all countries. We all have responsibility to carry out these WHO plans, but you in Mexico especially have responsibility to the American continent because you have a long history of Eastern medicine in your country. So let us clasp hands firmly for the progress of Eastern medicine and to bring health and happiness to the people throughout the world. I would like to close my speech today with one of my own quotations : It is my belief that modern medicine, if it is to be most effective cannot use
Western medicine or Eastern, choosing one at the exclusion of the other, but must accept and use both. Western medicine may be likened to a father's love, strict and at times severe ; and Eastern medicine to a mother's love, gentle and patient. Neither one parent's love nor one school of medicine is complete in itself ; they need to be combined, to become a part of a larger whole. The combination, Western-Eastern medicine, like God's love, is the ideal par excellence.