Post on 24-Dec-2015
Integrating Chinese Medicine Into Perioperative Care
Barbara Barton, L.Ac., MSTCM, BSN, RN
September 11, 2004
Incidence of CAM in US
25% 1990 42% 1997All socioeconomic groupsHerbal therapy 380%Total CAM visits (629 million) exceeded
total visits to PCP (386 million)
Incidence of CAM in US (cont.)
15 million adults took prescription medications with herbal therapy
$10 billion spent out-of-pocket
Disclosure of CAM therapies remain at 40% or less.
Reasons for CAM use include perceived efficacy, failed conventional therapy, and patients value systems.
2nd International Scientific Conference on Complementary, Alternative and Integrative Medicine Research, April 12-14, 2002, Boston, Massachusetts.
Incidence of CAM in US (cont.)
• One in 4 persons uses complimentary /alternative medicine (CAM)
• Out of pocket costs of CAM rival western medicine (21.2-32.7 billion vs. 29.3 billion)
• Users tend to be well-educated and higher socio-economic group
• Chronic pain, mental health issues, HIV, and cancer are most common reasons
Cauffield JS, The psychosocial aspects of complementary and alternative medicine.
Pharmacotherapy. 2000 Nov:20(11):1289-94.
Incidence of CAM in US (cont.)
Dept. of Anesthesiology Yale University of Medicine surveyed 850 patients pre-operatively:
• 32% used CAM therapies• 15% massage therapy• 9.7% herb therapy• 8.3% relaxation• 6.6% acupuncture• 42% willingness to use acupuncture for preoperative
anxiety• Reluctance to discuss use of CAM with physicians Wang CT, Peloquin C, and Kain ZN . Attitudes of patients undergoing surgery toward
alternative medical treatment. Journal of Alternative and Complementary Medicine 2002 Jun;8 (3):351-6.
Incidence of CAM in US (cont.)
FDA estimates 5 million acupuncture visits/year
$500 million spent for acupuncture treatments/year
NCCAM Information and Resources Package, NIH, National Center for Complementary and Alternative Medicine (NCCAM).
History of TCM
• 5000+ years old• 1st Chinese herbology
text published 3494 BC• Yellow Emperor’s Inner
Classic 200-100 BC, text in use today
• Cultural revolution • TCM in China today
www.chinatown-online.co.uk
What is Chinese Medicine?
• Ancient healing art
• Holistic
• Mind-Body-Spirit
• Health & Illness
• Emotion
• Goals
• Approaches to treatment and diagnosis
TCM & 5 Element Theories8 Principles
• YIN
• INTERIOR
• COLD
• DEFICIENCY
• YANG
• EXTERIOR
• HOT
• EXCESS
TCM & 5 Element TheoriesZANG-FU ORGANS
ZANG or YIN• LUNG (LU)
FU or YANG• LARGE INTESTINE (LI)
www.acuxo.com
TCM & 5 Element TheoriesZANG-FU ORGANS
FU or YANG
STOMACH (ST)ZANG or YIN
SPLEEN (SP)
www.acuxo.com
TCM & 5 Element TheoriesZANG-FU ORGANS
ZANG or YIN
HEART (HT)
FU or YANG
SMALL INTESTINE (SI)
www.acuxo.com
TCM & 5 Element TheoriesZANG-FU ORGANS
FU or YANG
URINARY BLADDER (UB)
ZANG or YIN
KIDNEY (K)
www.acuxo.com
TCM & 5 Element TheoriesZANG-FU ORGANS
ZANG or YIN
PERICARDIUM (P)
FU or YANG
SAN JIAO (SJ)
www.acuxo.com
TCM & 5 Element TheoriesZANG-FU ORGANS
FU or YANG
GALLBLADDER (GB)
ZANG or YIN
LIVER (LIV)
www.acuxo.com
TCM & 5 Element TheoriesMERIDIAN THEORY
Oldest Superficial energetic layers12 primary meridians of Zang-Fu
organs/meridians and 5 Element309 acupointsYin- anterior and medialYang- posterior and lateralHorary clock
5 Element Theory
Water
K-UB
Blue
Black
Groan
Putrid
Fear
P
H
I
L
O
S
O
P
H
E
R
Element Color Sound Odor Emotion Archetype
5 Element Theory
Wood
LIV-GB
Green
Shout
Rancid
Anger
Lack of
Anger
P
I
O
N
E
E
R
Element Color Sound Odor Emotion Archetype
5 Element Theory
Fire
HT-SI
PC- SJ
Red
Laugh
Scorch
Joy
Lack of Joy
W
I
Z
A
R
D
Element Color Sound Odor Emotion Archetype
5 Element Theory
Earth
SP-ST
Yellow
Singing
Sweet
Worry
P
E
A
C M
E A
K
E
R
Element Color Sound Odor Emotion Archetype
5 Element Theory
Metal
LU-LI
White
Weep
Spicy
Grief
A
L
C
H
E
M
I
S
T
Element Color Sound Odor Emotion Archetype
TCM DIAGNOSIS
Look, listen, ask, smell, palpatePulse DiagnosisTongue DiagnosisIn-depth HistoryAnalysis
TCM TREATMENT
Root and branch
Collaboration with client on plan
Acupuncture & Chinese Herbology
ACUPUNCTURE
32-40 gauge sterile, disposable needles
Regulate flow of Qi & Blood
Restore harmonious energetic balance to body-mind-spirit
Acupuncture Points
Vortexes of energy at specific sitesPathways for circulation of Qi & BloodAccess to regulate body functionsStrengthen immune SystemPrevent and treat disease Bring body into balanceOver 600 acupoints
TOP 10 Acupuncture Points
ST 36
Zusanli/
Leg 3 miles
ST, abdominal region, immune
system
www.hoptechno.com
Zusanli ST 36
TOP 10 Acupuncture Points
UB 40
Weizhong/
Supporting Middle
Low Back
www.hoptechno.com
Weizhong UB 40
TOP 10 Acupuncture Points
LU 7
Lieque/
Narrow Defile
Head & Neck
www.hoptechno.com
Lieque LU 7
TOP 10 Acupuncture Points
LI 4
Hegu/
Joining Valleys
Face, Mouth,
Head
www.hoptechno.com
Hegu LI 4
TOP 10 Acupuncture PointsGB 34
Yanglingquan/ Yang Hill Spring
SJ 6
Zhigou/
Branch Ditch
Hypochondriac region, Legs
www.hoptechno.com
Yanglingquan GB 34
Zhigou SJ 6
TOP 10 Acupuncture PointsPC 6
Neiguan/
Inner Frontier Gate
Heart, Chest
www.hoptechno.com
Neiguan PC 6
TOP 10 Acupuncture Points
LI 11
Quchi/
Crooked Pond
Arms
www.hoptechno.com
Quchi LI 11
TOP 10 Acupuncture Points
HT 7
Shenmen/
Spirit Gate
Calming, Heart
www.hoptechno.com
Shenmen HT 7
TOP 10 Acupuncture Points
GB 30
Huantiao/ Jumping Circle
Hips
www.hoptechno.com
Huantiao GB 30
CHINESE HERBOLOGY
• Individualized formulas for TCM Dx.
• Based on ancient prescriptions
• Contain between 2-18 herbs
• Tablets, teapills, powder concentrations, extracts or raw herbs cooked & taken as tea
Indications for AcupunctureNIH
• Low back pain
• Nausea postop, chemo
• Stroke rehab
• Headache
• Asthma
• Menstrual cycle
• Tennis elbow
• Carpal tunnel syndrome
• Fibromyalgia
• Addiction
Indications for AcupunctureWORLD HEALTH ORGANIZATION
Digestive
Emotional
Eye, Ear, Nose, Mouth, Throat
Gynecological
Miscellaneous
Musculoskeletal
Neurological
Respiratory
TCM INDICATIONS
Over 200 disorders
Other categories in addition to WHO: Circulatory, Urological, Other
See handouts for indications
Common indications for acupuncture perioperatively
• Pre or postoperative pain
• Boost immune system
• Speed recovery• To avoid surgery• Increase mobility
and healing• Balance energy
• Health maintenance
• Increase strength
• Treat underlying disease
• Allay anxiety, calm fear
• Reduce stress
• Lift depression
Harvard Researchers
• Blood flow to the key areas of brain are with pain-relief acupuncture via MRI
• Affects mood, pain, and cravings
• Could explain why acupuncture helps in treating depression, eating disorders, addictions, and pain
Elias, Marilyn, “Acupuncture’s secret: Blood flow to the brain” USA TODAY, 03/03/04,
European Postoperative Acupuncture Studies
As effective as antiemetics for prevention of nausea and vomiting
Electroacupuncture opioid requirement
Treats spinal headache after C-section
Superior to placebo for dental pain
pain 20% for total knee replacement
European Postoperative Acupuncture Studies
severity of complications
catecholamine responses vs. placebo
hypotensive effects after anesthesia induction
Spacek, Anna, “Acupuncture – postoperative and posttraumatic”. Department of Anesthesia, General Hospital, Vienna, Austria. 2000 International Medical Acupuncture Congress.
Acupuncture CredentialingTraditional Chinese Medicine Master of
Science (MSTCM)
• 3-4 years
• Acupuncture
• Chinese herbology
• Tui Na
• Qi Gong
• Western medicine
Acupuncture Credentialing
5 Element Acupuncture
• 3 years
• Emphasis on acupuncture
• Apprenticeship
Acupuncture Credentialing
• Both require passing NCCAOM national board exams to be licensed in acupuncture
• CA requires own state exam
• separate optional exam for Chinese herbology
• Over 10K licensed acupuncturists in US
Acupuncture Credentialing
MD Programs
• 200-300 hours of post-graduate training
• National credentialing exam
• No specialty in medical acupuncture yet
Acupuncture Credentialing
Chiropractors
• 100 hours of post-graduate training