Pains and needles
When Kenny Kon, 43, suffered sciatica in his left leg, he first turned to non-steroidal anti-inflammatory drugs and then to chiropractic treatments to relieve the pain, but neither helped.
The pain lingered and made it especially uncomfortable to sit through his MBA classes. At a relative's suggestion, Kon turned to traditional Chinese medicine for help. The TCM practitioner recommended acupuncture and inserted needles in Kon's calf and at other points along his leg.
'Once he took the needles out, I felt wonderful,' Kon says.
'After that one session, the pain has never come back.'
Kon's experience is one shared by a growing number of users of acupuncture worldwide despite controversial - and conflicting - scientific evidence about its efficacy.
In the United States alone, a survey in 2007 found, 3.1 million adults reported using acupuncture in the previous 12 months, compared with 2.1 million in 2002.
In Europe in the 1990s, between 12 per cent and 21 per cent of the population in various countries reported using acupuncture.
Acupuncture - or needling - is one of the best-known components of TCM. This ancient medical system teaches that one's qi, or life force, needs to flow freely to all parts of the body to sustain health. If qi stagnates at a particular point, illness or pain occurs.
To unblock qi and restore health, acupuncture uses fine needles to stimulate specific locations - called acupoints - on the body. There are more than 1,000 acupoints that acupuncturists use to treat a wide range of ailments, including bone- and muscle-related pain, allergies, fatigue, depression, digestive disorders, infertility and insomnia.
There are different methods of acupuncture - some use only needles, some run a small electric current through the needles, and others concentrate on the acupoints in the ear or the hand.
In addition to the Chinese system of acupuncture, the Koreans and Japanese have their variations of the therapy. In Chinese medicine, acupuncture is often used with moxibustion, in which a tight bundle of herbs is burned over the needles or acupoints.
It is widely believed that American interest in acupuncture took off after a journalist from The New York Times, James Reston, wrote about how acupuncture eased his discomfort after an appendectomy in 1971. Europe's history with acupuncture, however, dates back to the 1600s.
In recent decades, the Western medical community has conducted reams of research into this ancient therapy. But the research findings are as mixed as the types of reactions that acupuncture seems to elicit.
Advocates hail acupuncture as a safe, gentle and effective alternative to drugs or surgery, producing results where allopathic medicine fails. Detractors slam it as a sham remedy built on astrology or superstition. On one hand, the World Health Organisation recognises acupuncture as an effective treatment for a list of 44 conditions - including sciatica, headaches, lower back pain, knee pain, depression and allergic rhinitis - and to relieve side effects of chemotherapy and radiotherapy.
Yet a review in the New England Journal of Medicine last year of acupuncture research concluded that 'real acupuncture treatments were no more effective than sham acupuncture treatments'.
Recently, however, a Hong Kong-based study by researchers from Columbia University in New York and the University of Hong Kong explained scientifically - for the first time - the therapeutic effects of acupuncture.
From tests first done on rats and rabbits, and then on 30 HKU student volunteers, the team found that acupuncture worked most effectively when the needle was on the acupoint, but was still effective, to a slighter degree, if it was off the acupoint.
They said that when a needle, oscillating mildly, pierced tissue, it sent slow-moving acoustic waves into the muscles that triggered calcium flow. When the calcium interacted with white blood cells, it produced endorphins, which mitigated pain, migraines, hot flushes, nausea and other illnesses.
The study was published in the European Journal of Physiology in June after eight years of research.
Associate professor Zhang Shiping, of Baptist University's School of Chinese Medicine, says there are generally two types of research - benchtop research and clinical trials. Bench-top research looks at how acupuncture works and the biological effects that needling elicits in the body.
For example, US researchers from the University of Rochester Medical Centre, Boston University School of Medicine and the National Institutes of Health found that acupuncture increases the body's production of a natural painkiller called adenosine by 24 times, and the levels remained high for an hour after treatment. Mice with both inflammatory and neuropathic pain experienced relief after acupuncture raised their adenosine levels.
Clinical research, on the other hand, investigates how effective acupuncture is in treating conditions such as migraine, fibromyalgia, lower back pain and so on. While bench-top research shows that acupuncture does stimulate a biological response in the body, it is in the clinical trials that controversial findings often result.
Clinical trials investigating the efficacy of acupuncture now use the same high standards of evaluation as those used in drug testing. These single- or double-blind, randomised, controlled trials are designed such that the administrators and/or the randomly assigned subjects are unaware of whether they are in the experimental, or the placebo, or alternative treatment group.
Under these trial conditions, acupuncture does not appear to produce consistent results. The problem, however, Zhang says, may lie not with acupuncture but with the design of the clinical trials.
The allopathic medical community expects investigative clinical trials to administer the medical drug or therapy in a standardised manner to all subjects for a proper evaluation of the therapy's efficacy.
Hence, researchers will usually pick several acupuncture points that relate to the condition being treated, apply needles and then observe the effects, Zhang says.
But these findings are not necessarily meaningful beyond the trials, because the conditions of the trial are not true to clinical practice.
In practice, TCM practitioners are likely to use a combination of therapy modalities. For instance, TCM holds that a frozen shoulder is caused by a cold pathogen, which must be expelled using heat. Infrared heat or moxibustion is often used to do so, in addition to acupuncture. Hence, if acupuncture is used in isolation during a clinical trial, then the healing effect may be diminished.
However, in a clinical trial, other treatment modalities are excluded, because the researchers want to focus on the effects of acupuncture alone, and standardisation requires that variables presented by other modalities be excluded.
Moreover, such strict standardisations fail to recognise TCM's individualistic approach to therapy, says Chew Say Yeow, president of the Singapore Acupuncture Association.
In TCM, two people presenting with the same set of symptoms may actually have different root problems, which must be treated differently, Chew says. In addition, he questions the skill of the acupuncturists who administer the therapy in the trials.
'Acupuncture is a form of manipulation, a skill,' Chew says. 'Much like how you have different skill levels of doctors and surgeons in Western medicine, the chance of success with acupuncture also increases when you are treated by a skilled acupuncturist.'
Chew explains that acupuncture is more complex than merely pressing a standard set of acupoints for standard results.
'Administering acupuncture is similar to prescribing herbal medications - you need to know which groups of acupoints work well together to treat individual conditions. Some ailments can be treated by stimulating a single acupoint; others need specific combinations of acupoints,' he says.
'In addition, you must look at the individual patient's unique combination of body constitution and symptoms and be able to address them holistically.'
Moreover, he says, the duration and strength of the stimulation by the needles can create varying effects - strong and continuous stimulation with needles will have a purging effect, whereas mild stimulation helps to strengthen and tonify the body.
Zhang suggests that it may be more effective to evaluate acupuncture's efficacy using pragmatic clinical research, which looks at how effective a therapy is when compared to no therapy or another type of treatment. In such trials, acupuncture is generally shown to create consistently favourable results.
But some researchers take issue with pragmatic trials because they show practical success but do not actually determine efficacy.
Users, however, are not waiting for Western science's validation of acupuncture. Finding the therapy generally safe and with few side effects, people such as Kon are willing to brave the needles for a shot at relief.