Mr COCUDE
We continue the agenda with Mrs WANG who has made an Internet study
of Chinese articles of the past ten years; your dossier includes a short
note stating the results of her research. We will refer back to it at
the end of the meeting. For the moment we will confme ourselves to what
Mrs WANG is going to tell us about 'Acupuncture and Pneumoconiosis,
recent work in China'.
Mrs WANG
I have searched the bibliography on Internet. In fact there is little
use of acupuncture in internal. diseases. There are few publications
on acupuncture in the treatinent of pneumoconioses. Acupuncture is used
above all in combination with phytotherapy depending on the symptoms.
Research is being conducted in cooperation with the Japanese. Certain
acupoints have been tested to determine the efficacy of a given point
with respect to others and five to six acupoints have been selected.
Three of these have quite a powerful result.
A first point is on the throat in the region of the lung. There is
also the lung meridian: from the terminal point the meridian rises,
then descends, then rises again. This is the internai. line; beyond,
the line is subcutaneous. This line is connected with the meridians
of other organs such as the large intestine.
When certain points are needled both organs can be made to react. This
is the case with point no. 17 on the conception vessel. Another point
is no. 22 of the conception vessel and it is more effective than the
other two. Japanese research above all (conducted in collieries) has
determined this on the basis of 400 cases. In China there are no studies
exclusively on acupuncture, but only in combination with certain drugs.
Mr SAUTREUIL
It should be noted that only now do we have the means to justify what
the Chinese have proposed for thousands of years. For example it was
a Frenchman, NIBOYET, who was the first to demonstrate that acupoints
have an electric singularity. We do not know exactly how an acupoint
is constituted. We know that the histologic structure of the skin is
not, on the face of it, différent between the acupoint and its
environment. It appears that the acupuncture signal is mediated by a
density of receptors described by the Japanese as polymodal receptors,
in other words capable of accepting a mechanical signal and a thermal
signal.
Similarly, thanks to the development of the neurosciences, it has been
evidenced that opiates or morphines mediate one of the mechanisms, only
one of the mechanisms among others, which explain the analgesic role
of acupuncture. There are indeed other mechanisms such as the gate control
mechanisin used during the repeated stimulation of specific points chosen
in accordance with the rules of traditional medicine. By making this
stimulation on the spinal chord a jam' is created which renders non
receptive the nociceptive stimulus of surgery. We have made a really
interesting video on this topic in Vietnam.
This technique is also used in TENS (Transcutancous Electro-Neuro Stimulations)
in western medicine. TENS are the transcutancous stimulations used on
chronic pain. An electric stimulation is made on the skin which saturates
locally the sensitive receptors and allows patients in chronic pain
to live with a far less intense pain. Japanese work also demonstrates
the convergence between TENS and certain forms of acupuncture with electric
stimulation.
We therefore have the prospect of explanations at present. One of the
main questions of Chinese medicine concerns energy, Qi. It is perhaps
quite simply the electromagnetic manifestation of metabolism which would
explain why it varies, and why there are lines (meridians), because
the anatomic axes formed by the bones and the vascular nervous systems
are themselves expressed by electromagnetic lines. This is a personal
explanation.
Mr COCUDE
1 wish to, return to what you said. To prepare today's work 1 asked
the people to whom 1 spoke, including several acupuncturists, to bring
information on this issue, in other words the scientific demonstration
of the existence of acupoints.
Mr SAUTREUIL
I'll answer if you like. First of all it is not my speciality to manage
the scientific aspects of acupuncture; we could say there are many elements
converging progressively towards scientific explanations. These explanations
head in the direction of my profession (physiotherapy). In traditional
acupuncture we can proceed only by means of very hard to make assessments.
The Americans have documented these difficulties and obtained contradictory
results. However 1 have with me Japanese documents translated into English
which demonstrate that we are heading towards a scientific explanation-not
of all the mechanisms but of some of them. The Japanese are very specialised
in this respect. We dowt possess the full picture but it's getting clearer.
Mr OBRINGER
Two or threc little remarks on the documents would in a way sura up
the work. There is a book which is already quite old, I think it was
published in 1980 in Cambridge, by a great historian of the sciences
Joseph NEEDHAM and his collaborator LU GWEIDJEN, entitled 'Celestial
Lancets. A History and Rationale of Acupuncture and Moxa'. This book
addresses all the western theories that have tried to explaîn.
the efficacy of acupuncture or at least how it works. Although this
is a slight digression from our pneurnoconiotics-it's a remark by a
historian of the sciences -1 wish to recall that one of the first doctors
to, take an interest in acupuncture and to, have incorporated it in
his therapeutic arsenal was the father of Hector BERLIOZ, at the beginning
of the 19th century. Acupuncture was then very fashionable for several
years in France around 1825, ofien in combination with an electric stimulation.
What can also be noted is that acupuncture is a kind of extraordinary
marker of biochemistry innovations. Twenty or so years ago, for instance,
it was proposed to explain the efficacy of acupuncture by referring
to endorphins which had just been discovered. If in five or ten years
a truly decisive innovation appears in the neurosciences, an attempt
will probably be made to explain it by the mechanisms of acupuncture.
Mr COCUDE
What you have said is very interesting and gives me the opportunity
to observe that the interest of a meeting like today's is to bring Chinese
medicine out of the narrow circle of a small number of specialists.
Mrs MINGAM
In 1975 an experiment was carried out by J. RABISCHONG, I think, in
Montpellier, on the transfer of cephalorachidian liquid from a rabbit
with an anaesthetised right leg to another rabbit which also became
anaesthetised in the saine leg. Experiments which have perhaps not been
renewed sufficiently have proved that Chinese medicine is more than
just a passing fashion. A compilation of this scattered work can be
found in my thesis on Chinese medicine which I presented at the Université
de Bretagne Occidentale, Faculté de Médecine, in Brest
on 14 November 1975.
Mr DUHAMEL
It is nevertheless interesting to know that the Americans have found
a certain number of pathologies that can be treated effectively by acupuncture
since they have decided to conduct research and voted several thousand
million dollars of appropriations. We don't have enough documents on
the topic because in France the appropriations for official research
on acupuncture are non-existent. However studies have been made in China
and can be reproduced quite easily in France, for example propagation
phenomena. When you insert a needle, in a certain number of cases (one
in a hundred) a wave propagation is obtained, in other words the person
needled says that he feels a more or less long line in his body.
Stimulation techniques exist which allow these lines to be observed
more often (one in fifty or one in thirty cases) and a line is sometimes
felt on a set of meridians. Remember that meridians have nothing to
with nerves; they are not nerve lines and we still cannot explain the
phenomenon scientifically. People who know nothing about acupuncture
are capable of feeling them in their own body.
I wish to point out that MAXWELL described electromagnetic waves fifty
years before HERTZ proved their existence by technical means. When we
have the technical means we will perhaps be able to effectively prove
the reality of acupuncture. Chinese studies exist and we have cassettes
which for want of time we cannot show. In any case acupuncture is also
used on animals and indisputable results are obtained.
Mr COCUDE
Referring to the American studies you have just mentioned, 1 would
like to know if a length of time has been fixed for them. Because, as
I said in my introduction, the European Parliament in 1993 - 1994 voted
several million ECUs to study alternative and complementary medicines.
However, to date, little has been dont.
Mr DUHAMEL
1 have an American document on the subject, which states that the bureau
of alternative medicines created at the NIH in Washington has an annual
budget of 50 million dollars, perhaps 70 now.
Mr LAFOREST
A little practical question: when acupoints are spoken about, what
do they represent in surface terms ? Can their surface be estimated
and over what surface area can the insertion be made?
Mr SAUTREUIL
From. 0. 1 sq. mm for acupoints on the ends of the flingers to 1, 2,
or 3 sq. cm for the largest.
Mr LAFOREST
In other words; you need a good technique for phenomena to be reproducible
and you can't insert the needle anyhow or anywhere; that could explain
why some experiments cannot easily be reproduced.
Mr SAUTREUIL
Thaf s a difficulty of this therapy especially as palpation does not
always allow you to understand what's going on deep down.
There are two visions of the acupoint: a three dimensional. vision
with a depth that can reach 10 cm and a more restricted vision, reduced
to the epidermis. Only the epidermis is then stimulated and not all
of the tissues down to the periosteum.
Mr MARQUET
1 would like to raise a rather naive question: I would like to know
if there are any hazards in acupuncture. Since we have a relatively
precise defmition of meridians and acupoints, isn't there a risk of
seeing secondary effects or of awakening unwanted pains with bad practice
?
Mr SAUTREUIL
When a nerve is touched, the patient feels that and says so immediately.
But when the needle is removed, the pain disappears immediately. The
hazard could consist in touching a large vein or an artery; but that
risk is minimal because if the needle is inserted softly it will slide
against the artery. There is a hazard only with very small superficial.
vessels.
To my knowledge the hazard could exist for an acupoint on the lung-with
a long needle a pneumothorax could be caused. But that risk is very
theoretical because the hole is really very little.
As for the AIDS hazard, the doctor is more exposed. The risk of being
contaminated by hepatitis and AIDS has led to the generalised use of
throwaway needles.
Mr MARQUET
You have just spoken of the local hazard. But can pain be triggered
in another territory ?
Mr SAUTREUIL
That is perhaps a hazard but it has never happened to me. In any case
the action of the needles is felt by the patient and by the practitioner.
1 think the NIH has observed that the secondary effects of acupuncture
are far less dangerous than those of western treatments.
1 have already experienced a worsening of pain with an electric stimulation,
but only once in 15 or 20 years.
A slight digression to return back to the history of acupuncture; it
appears to have originated in Neolithic times since, at the beginning,
little stone awls were used, and it can be understood that it is dangerous
to use that type of equipment, far less sophisticated than the Japanese
needles with a 0.15 or 0.20 mm diameter. But it should be borne in mind
that equivalent instruments were developed elsewhere in the world as
evidenced by the body that was found at the border between Austiia and
Italy-marks were found on 'Hibematus' that correspond to acupoints.
A body or a mummy, 1 cWt rernember exactly, also with traces of acupuncture,
was found in the 1950s in Columnata situated in Tiaret in Algeria.
That proves that in the Neolithic Age an attempt was made at treating
pain, inflammation or infection with the means of the times. No more
progress was made in Europe and in Africa. However, building on the
basis of that age, the Chinese developed a highly structured medicine
over the centuries. Yin-Yang dates back to the ancient Taoist culture,
whereas the five movements correspond to a more recent period (approximately
the Christian era).
Mr OBRINGER
Firstly, we have the impression that, in the beginning, acupoints were
blood-letting points and this is still the cause with veterinary acupuncture,
for example on horses. Secondly, it is believed that the stone awls
were mainly instruments for minor surgery to erapty abscesses. Also
there are very ancient, divinatory texts that lead to the belief that
needling is of shamanic origin: an attempt was thus made to expel evil,
like a devil, from. inside the body.
Yet another reason explains why acupuncture developed in China. It
is a country where work on canals and controlling rivers has always
been extremely important and 1 like to think that it was understood
that, if you act on given point, you have action much fialher down the
river. That predisposes you to see the body différently.
Mr BONNEVIALE
1 wanted to know if the history of the development of acupuncture in
China has been charted. 1 suppose that acupuncture did not arrive accidentally
and that it developed progressively. Do we have an idea of how this
technique developed in China?
Mr OBRINGER
Yes we know quite well about the beginnings and the development of
acupuncture. In the West we tend to exaggerate the ancientness of acupuncture
because we feel that, in certain fields, the older the more effective....
We have established, using the texts found in tombs and thanks to archaeologists,
that acupuncture, as we know it today, dates back roughly speaking to
the second or first century BC and it was preceded by moxibustion.
Continuing with the history of acupuncture in China, 1 wish to emphasise-perhaps
to give rise to debate-that during certain periods under certain dynasties,
acupuncture was considered dangerous; for instance at the beginning
of the XIXth century an emperor completely advised against it. Ten or
so years ago 1 worked on a very large volume, a medical work dating
back to the VIIIth century and devoted solely to the pharmacopoeia because
the author said: 'I don't want to speak about acupuncture insofar as
1 consider it has a far greater tendency to kill the living than to
resuscitate the dead'.
Mr HOR
1 have noticed that our discussion focuses on the justification of
acupuncture. Unsurpisingly, we are calling for scientific proof in this
respect. This justification can be sought by answering the following
two questions. Do the principles of acupuncture have a real basis? Is
acupuncture treatment effective?
Despite the efforts and encouraging results, the existence of meridians
and of Qi, or the reasoning contained in a theory like that of the five
movements, are far from being established scientifically. The question
remains: If the system of acupuncture does not have a scientific foundation,
does it nevertheless have its value in clinical practice? In effect
the aim of medicine is différent from that of science.
It is more relevant in this respect to conduct scientific research
to justify and clarify the efficacy of acupuncture in the treatinent,
here, of pneumoconiosis.
Mr COCUDE
Personally 1 don't think it is absolutely necessary to demonstrate
the existence of meridians to believe that acupuncture can be effective.
Nevertheless, any progress in knowledge on its mechanisms of action
is of course welcome because of the contribution made towards understanding
the makeup of the human being.
Mrs WANG
Just a little remark to answer that by Mr OBRINGER: he mentioned that
under certain Chinese dynasties acupuncture was not practised. This
mistrust is far less pronounced regarding phytotherapy because it suits
the Chinese mentality much more.
China is a country where literature, poetry, and calligraphy are of
great importance; in China literature and medicine are not separated.
And phytotherapy is based on all plants and all animals.
On the other hand, acupuncture involves manipulation, it's a manual
discipline, physical work. That could hinder some emperors who found
it more advantageous to support the 'literary sort' than acupuncturists.
And still today in the field of medicine there are 70% phytotherapists
in China as against 30% acupuncturists. For phytotherapists, acupuncture
is external medicine.
Mr COCUDE
I turn to Mr KOCH who cannot be accused of being biased because of
support for a given systera and ask him to conclude our debate.
