The Pediatric Page
Acupuncture for the Pediatrician
“The sages of antiquity did not treat those who were already sick, but those who were not sick... When a disease has already broken out and is only then treated, would that not be just as late as to wait for thirst before digging a well, or to wait to go into battle before casting weapons?”
- Nei Jing: “ Yellow Emperor’s Classic of Internal Diseases” ~1st century B. C.
The Taoist concept of health is to attempt to attain perfect harmony between the opposing yet unified forces of the natural world, between Yin and Yang. Disharmony brings disease and death.
When there is imbalance, external agents can invade the body and cause disease. The essential principle of Traditional Chinese Medicine (TCM) is to decide on the exact nature of the imbalance between Yin and Yang and the nature of the external agent. The basis of treatment is to correct these pathological processes and return the body to a normal balance.
Acupuncture: The channels (Meridians) are a system of conduits that carry and distribute Qi (pronounced chee) — or vital energy—throughout the body. Each of the body’s organs (TCM organs are functional rather then anatomical) is represented by a channel. Using acupuncture on a specific area of the corresponding channel can treat diseases of a particular organ. By correcting the imbalance within the body/meridian/organ (in TCM), the practitioner is thus healing the disease. Acupuncture is rarely used alone, but rather as part of a comprehensive program. Other modalities include: herbs, cupping, moxibustion (heat) as well as massage (Tui Na), nutrition and exercise.
Indications: In 1997, the NIH concluded that there is “clear evidence” of acupuncture’s efficacy in various clinical conditions and deemed the practice appropriate as “part of comprehensive care for others.” The World Health Organization also came up with specific indications:
Conditions Appropriate for Acupuncture Therapy (good to strong evidence)
Digestive
- Abdominal pain
- Constipation
- Diarrhea
- Hyperacidity
- Indigestion
- Anxiety
- Depression
- Insomnia
- Nervousness
- Neurosis
- Cataracts
- Gingivitis
- Poor vision
- Tinnitis
- Toothache
- Infertility
- Menopausal symptoms
- Premenstrual syndrome
- Addiction control
- Athletic performance
- Blood pressure regulation
- Chronic fatigue
- Immune system tonification
- Stress reduction
- Arthritis
- Back pain
- Muscle cramping
- Muscle pain/weakness
- Neck pain
- Sciatica
- Headaches
- Migraines
- Neurogenic
- Bladder dysfunction
- Parkinson's disease
- Postoperative pain
- Stroke
- Asthma
- Bronchitis
- Common cold
- Sinusitis
- Smoking cessation
- Tonsillitis
The theory of how acupuncture works is under study and debate. Current thought focuses on neurohumoral modulation via the CNS. The stimulation from acupuncture needles is transmitted to the brain (via pain fibers) and results in effects involving midbrain, raphe nucleus, pituitary/hypothalamic axis and more. Studies have also demonstrated release of several chemical modulators including: enkephalins, neuropeptides and endorphins. These effects have been demonstrated in animal models as well as human studies using functional MRI (fMRI). Of note, acupuncture effects can be reversed using Narcan.
Side effects are rare in competent hands (less then 5%) and mostly include bleeding and bruising at the needling site. More rare side effects may include: infections, broken needles and syncope. Most of today’s practitioners use sterile, disposable needles.
Pediatrics in TCM: In traditional texts, children are considered deficient in:
- Spleen Qi—susceptible to GI illness and nutritional problems;
- Lung Qi—susceptible to exterior insult (cold, dampness, etc) and frequent lung problems (URI’s, etc.)
Pediatric Acupuncture: In general, acupuncture is of limited use in children due to needle phobia and pain. Interestingly, a recent study3 showed that after first session most children (ages 6-18 yrs) described their acupuncture experience as “weird” but not uncomfortable.
When compared to acupuncture in adults, pediatric practitioners use small, solid needles (36-40 Gauge), fewer needles per session, an in-and-out technique (vs. keeping needles in place). Non-invasive stimulation techniques such as acupressure, massage and various blunt instruments (brushes, scrapers) may be used as alternatives to needles on the same points. Many techniques can be taught to parents for home use. Emphasis is also placed on diet and herbal therapies.
What to look for in a practitioner: A licensed acupuncturist with at least one year experience in pediatrics who treats at least three children a week. Credentialing and licensure can be verified online at http://www.acupuncture.ca.gov.
Internet Sites:
http://www.internalhealers.com
http://nccam.nih.gov/health/acupuncture/index.htm
http://www.medicalacupuncture.org
Articles:
- Ernst E, White A: Prospective studies of the safety of acupuncture: A systematic review. The American Journal of Medicine 2001; 110(6):481-485
- Lin Y-C, Lee A, Kemper K, Berde C. Integrating complementary and alternative medicine in pediatric pain management. Anesthesiology. 1999;91:939.
- Lin Y-C.: Acupuncture And Needlephobia: The Pediatric Patient’s Perspective. Medical Acupuncture. 2003;14(3).