Integrating Chinese Medicine Into Perioperative Care

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Integrating Chinese Medicine Into Perioperative
Care

• Barbara Barton, L.Ac., MSTCM, BSN, RN
• September 11, 2004

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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)

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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.

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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
  socio-economic 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 Nov20(11)1289-94.

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Incidence of CAM in US (cont.)

•  Dept. of Anesthesiology Yale University of
  Medicine surveyed 850 patients pre-operatively
• 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 Jun8 (3)351-6.

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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).

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History of TCM

• 5000 years old
• 1st Chinese herbology text published 3494 BC
• Yellow Emperors Inner Classic 200-100 BC, text
  in use today
• Cultural revolution
• TCM in China today

www.chinatown-online.co.uk
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What is Chinese Medicine?

• Ancient healing art
• Holistic
• Mind-Body-Spirit
• Health Illness
• Emotion
• Goals
• Approaches to treatment and diagnosis
•  
•  

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TCM 5 Element Theories8 Principles

• YIN
• INTERIOR
• COLD
• DEFICIENCY

• YANG
• EXTERIOR
• HOT
• EXCESS

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TCM 5 Element TheoriesZANG-FU ORGANS

• ZANG or YIN
• LUNG (LU)

• FU or YANG
• LARGE INTESTINE (LI)

www.acuxo.com
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TCM 5 Element TheoriesZANG-FU ORGANS

• FU or YANG
• STOMACH (ST)

• ZANG or YIN
• SPLEEN (SP)

www.acuxo.com
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TCM 5 Element TheoriesZANG-FU ORGANS

• ZANG or YIN
• HEART (HT)

• FU or YANG
• SMALL INTESTINE (SI)

www.acuxo.com
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TCM 5 Element TheoriesZANG-FU ORGANS

• FU or YANG
• URINARY BLADDER (UB)

• ZANG or YIN
• KIDNEY (K)

www.acuxo.com
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TCM 5 Element TheoriesZANG-FU ORGANS

• ZANG or YIN
• PERICARDIUM (P)

• FU or YANG
• SAN JIAO (SJ)

www.acuxo.com
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TCM 5 Element TheoriesZANG-FU ORGANS

• FU or YANG
• GALLBLADDER (GB)

• ZANG or YIN
• LIVER (LIV)

www.acuxo.com
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TCM 5 Element TheoriesMERIDIAN 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

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5 Element Theory
Element Color Sound Odor Emotion
Archetype
Water K-UB Blue Black Groan Putrid Fear P H I L O S O P H E R
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5 Element Theory
Element Color Sound Odor Emotion
Archetype
Wood LIV-GB Green Shout Rancid Anger Lack of Anger P I O N E E R
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5 Element Theory
Element Color Sound Odor Emotion
Archetype
Fire HT-SI PC- SJ Red Laugh Scorch Joy Lack of Joy W I Z A R D
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5 Element Theory
Element Color Sound Odor Emotion
Archetype
Earth SP-ST Yellow Singing Sweet Worry P E A C M E A K E R
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5 Element Theory
Element Color Sound Odor Emotion
Archetype
Metal LU-LI White Weep Spicy Grief A L C H E M I S T
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TCM DIAGNOSIS

• Look, listen, ask, smell, palpate
• Pulse Diagnosis
• Tongue Diagnosis
• In-depth History
• Analysis

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TCM TREATMENT

• Root and branch
• Collaboration with client on plan
• Acupuncture Chinese Herbology

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ACUPUNCTURE

• 32-40 gauge sterile, disposable needles
• Regulate flow of Qi Blood
• Restore harmonious energetic balance to
  body-mind-spirit

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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

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TOP 10 Acupuncture Points
ST 36 Zusanli/ Leg 3 miles ST, abdominal region, immune system
Zusanli ST 36
www.hoptechno.com
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TOP 10 Acupuncture Points
UB 40 Weizhong/ Supporting Middle Low Back
Weizhong UB 40
www.hoptechno.com
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TOP 10 Acupuncture Points
LU 7 Lieque/ Narrow Defile Head Neck
Lieque LU 7
www.hoptechno.com
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TOP 10 Acupuncture Points
LI 4 Hegu/ Joining Valleys Face, Mouth, Head
Hegu LI 4
www.hoptechno.com
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TOP 10 Acupuncture Points
GB 34 Yanglingquan/ Yang Hill Spring SJ 6 Zhigou/ Branch Ditch Hypochondriac region, Legs
Yanglingquan GB 34
Zhigou SJ 6
www.hoptechno.com
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TOP 10 Acupuncture Points
PC 6 Neiguan/ Inner Frontier Gate Heart, Chest
Neiguan PC 6
www.hoptechno.com
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TOP 10 Acupuncture Points
LI 11 Quchi/ Crooked Pond Arms
Quchi LI 11
www.hoptechno.com
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TOP 10 Acupuncture Points
HT 7 Shenmen/ Spirit Gate Calming, Heart
Shenmen HT 7
www.hoptechno.com
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TOP 10 Acupuncture Points
GB 30 Huantiao/ Jumping Circle Hips
Huantiao GB 30
www.hoptechno.com
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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

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Indications for AcupunctureNIH

• Low back pain
• Nausea postop, chemo
• Stroke rehab
• Headache
• Asthma

• Menstrual cycle
• Tennis elbow
• Carpal tunnel syndrome
• Fibromyalgia
• Addiction

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Indications for AcupunctureWORLD HEALTH
ORGANIZATION
Digestive
Emotional
Eye, Ear, Nose, Mouth, Throat
Gynecological
Miscellaneous
Musculoskeletal
Neurological
Respiratory
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TCM INDICATIONS

• Over 200 disorders
• Other categories in addition to WHO
• Circulatory, Urological, Other
• See handouts for indications

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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

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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, Acupunctures secret
  Blood flow to the brain USA TODAY, 03/03/04,

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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

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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.

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Acupuncture Credentialing

• Traditional Chinese Medicine Master of Science
  (MSTCM)
• 3-4 years
• Acupuncture
• Chinese herbology
• Tui Na
• Qi Gong
• Western medicine

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Acupuncture Credentialing

• 5 Element Acupuncture
• 3 years
• Emphasis on acupuncture
• Apprenticeship

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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

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Acupuncture Credentialing

• MD Programs
• 200-300 hours of post-graduate training
• National credentialing exam
• No specialty in medical acupuncture yet

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Acupuncture Credentialing

• Chiropractors
• 100 hours of post-graduate training

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