Transcript Integrating Chinese Medicine into Perioperative Care

Integrating Chinese Medicine
Into Perioperative Care
Barbara Barton, L.Ac., MSTCM, BSN, RN
September 11, 2004
Incidence of CAM in US
25% 1990
42% 1997
All socioeconomic groups
Herbal 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 socioeconomic 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:
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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 Theories
8 Principles
• YIN
• YANG
• INTERIOR
• EXTERIOR
• COLD
• HOT
• DEFICIENCY
• EXCESS
TCM & 5 Element Theories
ZANG-FU ORGANS
ZANG or YIN
• LUNG (LU)
FU or YANG
• LARGE INTESTINE (LI)
www.acuxo.com
TCM & 5 Element Theories
ZANG-FU ORGANS
FU or YANG
STOMACH (ST)
ZANG or YIN
SPLEEN (SP)
www.acuxo.com
TCM & 5 Element Theories
ZANG-FU ORGANS
ZANG or YIN
HEART (HT)
FU or YANG
SMALL INTESTINE (SI)
www.acuxo.com
TCM & 5 Element Theories
ZANG-FU ORGANS
FU or YANG
URINARY BLADDER (UB)
ZANG or YIN
KIDNEY (K)
www.acuxo.com
TCM & 5 Element Theories
ZANG-FU ORGANS
ZANG or YIN
PERICARDIUM (P)
FU or YANG
SAN JIAO (SJ)
www.acuxo.com
TCM & 5 Element Theories
ZANG-FU ORGANS
FU or YANG
GALLBLADDER (GB)
ZANG or YIN
LIVER (LIV)
www.acuxo.com
TCM & 5 Element Theories
MERIDIAN THEORY
Oldest
Superficial energetic layers
12 primary meridians of Zang-Fu
organs/meridians and 5 Element
309 acupoints
Yin- anterior and medial
Yang- posterior and lateral
Horary clock
5 Element Theory
Element Color Sound Odor
Emotion Archetype
Water
Groan
Fear
K-UB
Blue
Black
Putrid
P
H
I
L
O
S
O
P
H
E
R
5 Element Theory
Element Color
Sound
Odor
Emotion Archetype
Wood
Shout
LIVGB
Anger
Rancid
Green
Lack of
Anger
P
I
O
N
E
E
R
5 Element Theory
Element Color
Sound
Fire
HT-SI
Odor
Emotion Archetype
Scorch
Red
Joy
PC- SJ
Laugh
Lack of
Joy
W
I
Z
A
R
D
5 Element Theory
Element
Color
Sound
Odor Emotion Archetype
Earth
Singing
SP-ST
Worry
Yellow
Sweet
P
E
A
C M
E A
K
E
R
5 Element Theory
Element Color
Sound Odor
Emotion Archetype
Metal
Weep
LU-LI
Grief
White
Spicy
A
L
C
H
E
M
I
S
T
TCM DIAGNOSIS
Look, listen, ask, smell, palpate
Pulse Diagnosis
Tongue Diagnosis
In-depth History
Analysis
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 sites
Pathways for circulation of Qi & Blood
Access to regulate body functions
Strengthen immune System
Prevent and treat disease
Bring body into balance
Over 600 acupoints
TOP 10 Acupuncture Points
ST 36
Zusanli/
Zusanli ST 36
Leg 3 miles
ST, abdominal
region, immune
system
www.hoptechno.com
TOP 10 Acupuncture Points
UB 40
Weizhong UB 40
Weizhong/
Supporting Middle
Low Back
www.hoptechno.com
TOP 10 Acupuncture Points
LU 7
Lieque/
Narrow Defile
Head & Neck
Lieque LU 7
www.hoptechno.com
TOP 10 Acupuncture Points
LI 4
Hegu LI 4
Hegu/
Joining Valleys
Face, Mouth,
Head
www.hoptechno.com
TOP 10 Acupuncture Points
GB 34
Yanglingquan/
Yang Hill Spring
Yanglingquan GB 34
SJ 6
Zhigou/
Branch Ditch
Hypochondriac
region, Legs
Zhigou SJ 6
www.hoptechno.com
TOP 10 Acupuncture Points
PC 6
Neiguan/
Inner Frontier
Gate
Heart, Chest
Neiguan PC 6
www.hoptechno.com
TOP 10 Acupuncture Points
LI 11
Quchi/
Crooked Pond
Arms
Quchi LI 11
www.hoptechno.com
TOP 10 Acupuncture Points
HT 7
Shenmen HT 7
Shenmen/
Spirit Gate
Calming, Heart
www.hoptechno.com
TOP 10 Acupuncture Points
GB 30
Huantiao/
Jumping Circle
Huantiao GB 30
Hips
www.hoptechno.com
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 Acupuncture
NIH
• Low back pain
• Nausea postop,
chemo
• Stroke rehab
• Headache
• Asthma
• Menstrual cycle
• Tennis elbow
• Carpal tunnel
syndrome
• Fibromyalgia
• Addiction
Indications for Acupuncture
WORLD 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 Credentialing
Traditional 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