Holism is a concept that incorporates the idea that systems change and fluctuate to adjust to a changing environment. Holistic practitioners embrace the Eastern perspective of health, which accepts the premise that there is a dynamic interrelationship between the body, mind, and spirit. For example, changes in one's physical well-being will cause adjustments in the mental and spiritual components of the individual. Consequently, changes in the mind and spirit will produce physical adjustments in the body. These continual adjustments form the basic explanation of the Eastern perspective of many alternative therapies.
Many alternative therapies are becoming more popular with clients and seem to have gained acceptance by some physicians. In 1990, it was estimated that there were more than 425 million client visits to unconventional or nontraditional medical practitioners, exceeding the number made to primary care physicians. Clients spent an estimated $14 billion for visits to alternative or unconventional therapists (Fontanarosa & Lundberg, 1997).
One of the more popular and widely publicized alternative treatment modalities is acupuncture. Approximately one million Americans have paid the estimated out-of-pocket cost of more than $500 million to receive acupuncture treatments for such ailments as lower back pain, migraines, and a number of other illnesses. The purpose of this article is to present information about acupuncture so that gerontological nurses can consider the appropriateness and applicability of this complementary and alternative treatment for their clients.
Acupuncture has been practiced as part of Chinese medicine for more than 2,500 years. However, it was only after the report of an incident in China that this treatment modality acquired initial acceptance and legitimacy in the United States. In 1971, James Reston, a New York Times reporter, required an emergency appendectomy while covering Henry Kissinger's diplomatic visit to China. After the routine operation, a Chinese doctor inserted several long needles into Mr. Reston's right elbow and just below his knee. The needles were twirled, and the pain disappeared without returning. Mr. Reston related his experience with this strange treatment called "acupuncture" in a front page story of the New York Times (Holzman, 1997). This single report began the public debate about the usefulness and legitimacy of acupuncture.
Although the debate about acupuncture continues, its legitimacy was enhanced when, in November 1997, the National Institutes of Health (NIH) assembled a panel of experts to examine this treatment modality. At the end of the 3-day conference, the NIH panel concluded there was "clear evidence" that acupuncture alleviates postoperative-induced and chemotherapy-induced nausea and vomiting, and postoperative dental pain (Marwick, 1997). In addition, the panel indicated that "reasonable" studies demonstrated the use of acupuncture either alone or in combination with other therapies resulted in the satisfactory treatment of various conditions. Thus, acupuncture received a "qualified" endorsement as a supplemental therapy for drug and alcohol addiction, carpal tunnel syndrome, stroke rehabilitation, headache, general muscle pain, and low-back pain (Marwick, 1997). One of the major advantages of using acupuncture in treating older adults is that the incidence of side effects is substantially lower than that associated with western medical practices, such as drugs or surgery. In fact, the NIH panel reported that when traditional medical therapy is ineffective in treating a chronic condition, the existing evidence supports acupuncture as a treatment consideration (Marwick, 1997).
In this article, both the Eastern (i.e., holistic) and Western (i.e., scientific) explanations of acupuncture will be briefly described. The Eastern perspective was explained by Taoists in China who believe a balance of the life forces, called Yin and Yang, is responsible for health. Yin and Yang forces combine to produce a vital life energy called chi or qi (pronounced "chee"). Chi flows through the body along a system of channels called meridians, which contain numerous acupuncture points. When illness occurs, it is thought that an obstruction within the channels has occurred. The obstruction causes an imbalance of chi between the yin and yang forces. The balance of chi must be restored to treat the illness. Acupuncture needles are inserted into the appropriate points on the meridians to open the blockage in the channels so that the flow of chi between the yin and yang forces (i.e., balance or homeostasis) can be reestablished. Thus, acupuncture is perceived as compelling the resumption of the normal flow of chi and allowing the yin and yang to become balanced.
A Western scientific theory explaining the effects of acupuncture has been proposed by Pomeranz (1996). It is theorized that the insertion of acupuncture needles initiates a reaction from the sensory nerves and triggers electrical impulses to a spinal cord nerve. The stimulated nerve cells release endorphins which mute pain. Simultaneously, the midbrain/hypothalamus releases neurotransmitters which block pain pathways, while the pituitary gland is stimulated to release endorphins and other anti-inflammatory chemicals into the bloodstream.
Other more general explanations about the mechanisms of acupuncture have included the discussion of the halo and placebo effects. As most nurses know, a demonstrable psychological response may occur when clients perceive they are receiving special treatment from health care providers. This response is demonstrated whether the client receives the actual regimen or a placebo protocol. The placebo effect explanation of the result of acupuncture treatments has been dismissed after finding that animals that experienced this treatment produced an increase in their endorphin levels and, therefore, experienced less pain.
One minor criticism of the acupuncture treatment protocols is related to the safety of the needles. This concern was virtually dismissed when the United States Food and Drug Administration began to regulate the solid stainless steel acupuncture needles, which are about the width of a human hair, in the same way as syringes and scalpels. By law, acupuncture needles must be used only once and encased in clear plastic sleeves, sometimes called guide tubes. Sleeve guides are used to position the needle over the acupuncture points.
The professional and popular literature document that the practice of acupuncture is becoming more widely accepted by both consumers and members of the holistic health practitioner community (Holzman, 1997; Malmgren, 1997a, 1997b; Podolsky, 1996; Thompson, 1997). At least 34 medical schools, including Harvard, Stanford, and the University of Miami, are reported to have started or to be developing courses in alternative medical therapies and interventions. The American Academy of Medical Acupuncture (AAMA) is a 10-year-old organization with more than 1,000 physician members. Members of this organization believe in incorporating acupuncture into their medical practice. At least 10,000 individual nonphysician acupuncture practitioners are licensed by thenstates or are certified by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM). The national certification activity of the NCCAOM is recognized by some major professional organizations. However, as the popularity and legitimacy of acupuncture increases, guidelines for training and credentialing programs need to be developed, accepted, implemented, and evaluated.
It is becoming apparent that nurses, especially those working primarily with older adults, must become more engaged in identifying, evaluating, and in some cases, accepting appropriate alternative or unconventional therapies. Critically evaluating alternative or unconventional therapies will allow holistic nurses to continually expand the treatment regimens available to clients. Gerontological nurses must recognize that some alternative therapies, like acupuncture, may be or may become appropriate treatments for older adults who are more sensitive to drug or surgical treatments than younger individuals. Multiple clinical research studies will be conducted, and more detailed scientific explanations of the treatment will emerge. As professional health care providers, nurses need to become knowledgeable about these legitimate alternative therapies which could benefit the older adult client population.
- Fontanarosa, RB., & Lundberg, G.D. (1997, December 17). Complementary, alternative, unconventional and integrative medicine. Journal of the American Medical Association, 287, 2111-2112.
- Holzman, D. (1997). Acupuncture enters the mainstream. Alternative & Complementary Therapies, 3(5), 341-343.
- Malmgren, J. (1997a, December 30). Ancient healing meets modern medicine. The St. Petersburg Times, pp. Dl, D3.
- Malmgren, J. (1997b, December 30). Taking a stab at acupuncture. The St. Petersburg Times, pp. Dl, D3.
- Marwick, C. (1997, December 3). Acceptance of some acupuncture applications. Journal of the American Medical Association, 278, 1725-1727.
- Podolsky, D. (1996, May 13). Nod to an ancient art. U.S. News & World Report, 122, 78, 80.
- Pomeranz, B. (1996). Acupuncture and the raison d'être for alternative medicine. Alternative Therapies in Health and Medicine, 2(6), 85-91.
- Thompson, D. (1997, November 17). Acupuncture works. Time, 150, 84.