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This article reviews the physiological basis of acupuncture and evaluates its applications in various neurologic disorders. Acupuncture is most frequently used for the relief of pain. Claims in some other conditions, such as stroke, cannot be confirmed by controlled clinical trials. Although used in practice, acupuncture still needs to be further evaluated by well-controlled clinical trials.
• Of the alternative methods, acupuncture is the one most integrated into conventional medical practice.
• Acupuncture is widely used for the treatment of neurologic disorders, particularly for the management of painful conditions.
• Action of acupuncture in modulating pain pathways has been demonstrated by brain imaging studies.
• Neurologic complications have been reported from the improper insertion of acupuncture needles.
• Further controlled and well-designed studies are needed to evaluate the efficacy of acupuncture for neurologic disorders.
Acupuncture, as the derivation of the word implies (acus meaning needle; puncta meaning puncture), is the insertion of a needle into the skin of the human body. Acupuncture has been practiced in China for several thousand years. The earliest available written record is from 1800 BCE in the Yellow Emperor's Classic of Medicine (48). The ancient Chinese attributed disease to an imbalance between Yin (negative) and Yang (positive) forces. This belief exists for some even today. Acupuncture was supposed to restore the balance between these two forces. The procedure spread to Southeast Asia and Japan and then to Europe in the 1800s. Acupuncture was used for the relief of pain and muscular disability in England more than 125 years ago (44). Osler was familiar with the procedure and considered it to be the most efficient treatment in acute cases of lumbago (33). Osler had occasional failures as indicated by the following episode:
One of these consultations, however, was such an important one that preparations had to be made for it and Ogden (a student of Osler) was requisitioned as an assistant, for the patient was none other than old Peter Redpath, the wealthy Montreal sugar refiner who, being on Montreal General Hospital Board had hopes that the newly appointed physician might be able to cure him of an intractable lumbago. He arrived exhausted after mounting the stairs, in due course they proceeded to treat him by acupuncture. At each jab of a needle, the old gentleman is said to have ripped out a string of oaths, and in the end got up and hobbled out no better off in his pain, to Osler's great distress, for he had expected to give him immediate relief which, as he said, meant millions for McGill University (07).
Wilder Penfield, pioneer Canadian neurosurgeon, visited China in 1962 and was invited by Chinese physicians to try acupuncture on a patient. He gave no definite opinions on this procedure (39). Ten years later, acupuncture as practiced in China was evaluated again, particularly for neurologic applications, and the findings were recorded in a book (16). Acupuncture was effectively used for the relief of pain and even as a substitute for anesthesia during neurosurgical procedures. Penfield agreed with the observations and opinions expressed in the book (Penfield W 1974, personal communication). Although Chinese medicine is now more advanced, with new techniques such cell and gene therapies, acupuncture remains part of the healthcare system and is being further investigated.
During the past few decades, acupuncture has become popular in North America, and practitioners of this art, which include some physicians, are numerous. An estimated 10 million consumers use acupuncture each year in the United States.
A lack of scientific studies to prove or disprove acupuncture's claimed effects led to the initial rejection by many practitioners of Western scientific medicine. Now that the mechanisms can be partly explained in terms of neurophysiology, integration of acupuncture with conventional medicine is possible. Approximately 30% of acupunctures in the United States are done in a multidisciplinary setting and 70% by solo practitioners of acupuncture. Clinical acupuncturists are credentialed through the American Board of Medical Acupuncture and the National Certification Commission for Acupuncture and Oriental Medicine.
The relevance of acupuncture to the neurologist is as follows:
• Several patients referred to neurologists may have undergone acupuncture treatments. Some of these patients may be reluctant to disclose folk medical treatments to Western physicians; therefore, such information may have to be elicited by questioning.
• Some patients may request to be referred to an acupuncturist. The neurologist may have to decide if acupuncture could be useful for the patient in a situation where no relief has been obtained by conventional treatments.
• Neurologists should be familiar with rare neurologic complications of acupuncture.
• Mechanism of effect of acupuncture is a subject of neurophysiological research.
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