Acupuncture is a form of therapy dating back to 2000 BC in its earliest forms. It has been widely refined over the years and involves the application of fine needles to specific points over the body to manipulate the body?s ?qi? or ? energy? to restore harmony and balance to the organs of the body (Giovanni? Maciocia, 2015). Illness and disease is a result, according to Traditional Chinese Medicine (TCM), of imbalances between the bodily organs. These imbalances can be due to environmental factors ( e.g. heat, cold damp), emotional disturbances, inappropriate diet, lifestyle factors ( e.g. smoking, excessive alcohol, poor sleep etc) and underlying constitutional (e.g. genetic factors). One can see that addressing the causative factors for ill health cannot rely on a simple remedy alone, but necessitates a change in lifestyle, diet and environment which enables the patient to have some control over their own health (Kaptchuk, Caudill, & Weil, 2000).
The use of acupuncture in the setting of TCM to treat women?s health disorders has been gaining increasing popularity in recent years. Numerous aspects of women?s reproductive health has been considered to be responsive to Acupuncture and TCM (Cochrane, Smith, Possamai-Inesedy, & Bensoussan, 2014). Despite its increasing use, TCM needs to be evaluated according to Evidence Based Medicine (EBM). EBM evaluates available evidence that supports the use of any treatment modality e.g. a prescribed medication for blood pressure control or the use of Acupuncture for Polycystic Ovarian Syndrome. The ?Gold Standard? of EBM is considered to be systematic reviews of double blinded randomised controlled trials (which is a rigorous standardised academic evaluation of the information published from such trials). EBM also icludes information from case reports, historical observations as well as anecdotal information and observations, although this is not rated as highly as systematic reviews (Titler, 2008). The use of the latter types of evidence has nevertheless has led to significant advances in health care. The development of the smallpox vaccination was based on Edward Jenner?s observation that women who milked cows were commonly afflicted by a blistering disorder known as ?cowpox? and this was observed to protect them against developing smallpox. Similarly, the development of Aspirin was based on the Native American use of willow bark (salicylic acid being the active ingredient) to treat fevers and pain. Acupuncture poses significant hurdles in designing double blind controlled trials (Vase et al., 2015), TCM and acupuncture is not subject to patents and as such does not attract the vast reserves of funding that multinational pharmaceutical companies have at their disposal for conducting sophisticated trials. While Acupuncture may not have the large volumes of sytematic reviews and double blinded controlled studies it does have over 2000 years of case reports and epidemiological ( i.e. distribution, incidence and control of disease) evidence to support its use in a variety of conditions related to Women?s Health (Giovanni Maciocia, 2011).
The natural process of menopause can be a smooth transition for many women. Other women may present with a variety of conditions including mood disturbance, hot flushes, and headaches just to name a few. It is important to exclude other causes of symptoms before attributing these to ?menopause?. The use of acupuncture to alleviate hot flushes has been shown to be effective with minimal side effects; despite the fact that the trials included only a small number of participants, and demonstrated flawed study designs an inherent problem for trials involving acupuncture. Further research is being undertaken in this field (Smith & Carmady, 2014).
The management of pain associated with menstruation and premenstrual syndrome is another area where historical evidence from Classic Chinese literature supports its use (Giovanni Maciocia, 2011) . While the initial results of modern trials have shown that the use of acupuncture for these problems is promising, there remains a need for larger studies to support its inclusion as a first line therapy alone or in combination with other treatment modalities. (Kang, Jeong D Fau – Kim, Kim Di Fau – Lee, & Lee).
Infertility is a complex issue that can benefit from a collaborative approach using western medicine and TCM. Acupuncture has been advocated as a useful method in the regulation of the menstrual cycle especially ovulation by the WHO (Balen et al., 2016). It is acknowledged that while the exact mechanism of the effects of acupuncture may not be fully understood it can provide yet another way of managing problems of reproduction (Cochrane et al., 2014).
Ongoing research into Acupuncture and TCM as a treatment for many problems in the fields of Women?s Health is a challenging and exciting field to be working in. I am eager to apply this knowledge into every day medical practice to deliver a uniquely integrated medical service.
Reference List
Balen, A. H., Morley, L. C., Misso, M., Franks, S., Legro, R. S., Wijeyaratne, C. N., . . . Teede, H. (2016). The management of anovulatory infertility in women with polycystic ovary syndrome: an analysis of the evidence to support the development of global WHO guidance. Human Reproduction Update, 22(6), 687-708. doi:10.1093/humupd/dmw025
Cochrane, S., Smith, C. A., Possamai-Inesedy, A., & Bensoussan, A. (2014). Acupuncture and women’s health: an overview of the role of acupuncture and its clinical management in women’s reproductive health. Int J Womens Health, 6, 313. doi:10.2147/IJWH.S38969
Kang, H. S., Jeong D Fau – Kim, D.-I., Kim Di Fau – Lee, M. S., & Lee, M. S. The use of acupuncture for managing gynaecologic conditions: An overview of systematic reviews. (1873-4111 (Electronic)).
Kaptchuk, T. J. a., Caudill, M., & Weil, A. (2000). The web that has no weaver : understanding Chinese medicine (Second edition. ed.). Chicago: Contemporary Books.
Maciocia, G. (2011). Obstetrics and gynecology in Chinese medicine (2nd ed. ed.). Edinburgh: Elsevier.
Maciocia, G. (2015). The foundations of Chinese medicine : a comprehensive text (Third edition. 25th anniversary edition. ed.). Edinburgh: Elsevier.
Smith, C. A., & Carmady, B. (2014). Acupuncture to treat common reproductive health complaints: An overview of the evidence. (1872-7484 (Electronic)).
Titler, M. (2008). The Evidence for Evidence-Based Practice Implementation. (R. Hughes Ed. Vol. Chapter 7): Agency for HealthCare and Quality.
Vase, L., Baram, S., Takakura, N., Takayama, M., Yajima, H., Kawase, A., . . . Svensson, P. (2015). Can Acupuncture Treatment Be Double-Blinded? An Evaluation of Double-Blind Acupuncture Treatment of Postoperative Pain. PLoS One, 10(3), e0119612. doi:10.1371/journal.pone.0119612