integrating chinese medicine into perioperative care barbara barton, l.ac., mstcm, bsn, rn september...

Integrating Chinese Medicine Into Perioperative Care

Barbara Barton, L.Ac., MSTCM, BSN, RN

September 11, 2004

Incidence of CAM in US

25% 1990 42% 1997All socioeconomic groupsHerbal therapy 380%Total CAM visits (629 million) exceeded

total visits to PCP (386 million)

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.

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 Nov:20(11):1289-94.

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 Jun;8 (3):351-6.

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).

History of TCM

• 5000+ years old• 1st Chinese herbology

text published 3494 BC• Yellow Emperor’s Inner

Classic 200-100 BC, text in use today

• Cultural revolution • TCM in China today

www.chinatown-online.co.uk

What is Chinese Medicine?

• Ancient healing art

• Holistic

• Mind-Body-Spirit

• Health & Illness

• Emotion

• Goals

• Approaches to treatment and diagnosis  

TCM & 5 Element Theories8 Principles

• YIN

• INTERIOR

• COLD

• DEFICIENCY

• YANG

• EXTERIOR

• HOT

• EXCESS

TCM & 5 Element TheoriesZANG-FU ORGANS

ZANG or YIN• LUNG (LU)

FU or YANG• LARGE INTESTINE (LI)

www.acuxo.com

TCM & 5 Element TheoriesZANG-FU ORGANS

FU or YANG

STOMACH (ST)ZANG or YIN

SPLEEN (SP)

www.acuxo.com

TCM & 5 Element TheoriesZANG-FU ORGANS

ZANG or YIN

HEART (HT)

FU or YANG

SMALL INTESTINE (SI)

www.acuxo.com

TCM & 5 Element TheoriesZANG-FU ORGANS

FU or YANG

URINARY BLADDER (UB)

ZANG or YIN

KIDNEY (K)

www.acuxo.com

TCM & 5 Element TheoriesZANG-FU ORGANS

ZANG or YIN

PERICARDIUM (P)

FU or YANG

SAN JIAO (SJ)

www.acuxo.com

TCM & 5 Element TheoriesZANG-FU ORGANS

FU or YANG

GALLBLADDER (GB)

ZANG or YIN

LIVER (LIV)

www.acuxo.com

TCM & 5 Element TheoriesMERIDIAN THEORY

Oldest Superficial energetic layers12 primary meridians of Zang-Fu

organs/meridians and 5 Element309 acupointsYin- anterior and medialYang- posterior and lateralHorary clock

5 Element Theory

Water

K-UB

Blue

Black

Groan

Putrid

Fear

P

H

I

L

O

S

O

P

H

E

R

Element Color Sound Odor Emotion Archetype

5 Element Theory

Wood

LIV-GB

Green

Shout

Rancid

Anger

Lack of

Anger

P

I

O

N

E

E

R

Element Color Sound Odor Emotion Archetype

5 Element Theory

Fire

HT-SI

PC- SJ

Red

Laugh

Scorch

Joy

Lack of Joy

W

I

Z

A

R

D

Element Color Sound Odor Emotion Archetype

5 Element Theory

Earth

SP-ST

Yellow

Singing

Sweet

Worry

P

E

A

C M

E A

K

E

R

Element Color Sound Odor Emotion Archetype

5 Element Theory

Metal

LU-LI

White

Weep

Spicy

Grief

A

L

C

H

E

M

I

S

T

Element Color Sound Odor Emotion Archetype

TCM DIAGNOSIS

Look, listen, ask, smell, palpatePulse DiagnosisTongue DiagnosisIn-depth HistoryAnalysis

TCM TREATMENT

Root and branch

Collaboration with client on plan

Acupuncture & Chinese Herbology

ACUPUNCTURE

32-40 gauge sterile, disposable needles

Regulate flow of Qi & Blood

Restore harmonious energetic balance to body-mind-spirit

Acupuncture Points

Vortexes of energy at specific sitesPathways for circulation of Qi & BloodAccess to regulate body functionsStrengthen immune SystemPrevent and treat disease Bring body into balanceOver 600 acupoints

TOP 10 Acupuncture Points

ST 36

Zusanli/

Leg 3 miles

ST, abdominal region, immune

system

www.hoptechno.com

Zusanli ST 36

TOP 10 Acupuncture Points

UB 40

Weizhong/

Supporting Middle

Low Back

www.hoptechno.com

Weizhong UB 40

TOP 10 Acupuncture Points

LU 7

Lieque/

Narrow Defile

Head & Neck

www.hoptechno.com

Lieque LU 7

TOP 10 Acupuncture Points

LI 4

Hegu/

Joining Valleys

Face, Mouth,

Head

www.hoptechno.com

Hegu LI 4

TOP 10 Acupuncture PointsGB 34

Yanglingquan/ Yang Hill Spring

SJ 6

Zhigou/

Branch Ditch

Hypochondriac region, Legs

www.hoptechno.com

Yanglingquan GB 34

Zhigou SJ 6

TOP 10 Acupuncture PointsPC 6

Neiguan/

Inner Frontier Gate

Heart, Chest

www.hoptechno.com

Neiguan PC 6

TOP 10 Acupuncture Points

LI 11

Quchi/

Crooked Pond

Arms

www.hoptechno.com

Quchi LI 11

TOP 10 Acupuncture Points

HT 7

Shenmen/

Spirit Gate

Calming, Heart

www.hoptechno.com

Shenmen HT 7

TOP 10 Acupuncture Points

GB 30

Huantiao/ Jumping Circle

Hips

www.hoptechno.com

Huantiao GB 30

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

Indications for AcupunctureNIH

• Low back pain

• Nausea postop, chemo

• Stroke rehab

• Headache

• Asthma

• Menstrual cycle

• Tennis elbow

• Carpal tunnel syndrome

• Fibromyalgia

• Addiction

Indications for AcupunctureWORLD HEALTH ORGANIZATION

Digestive

Emotional

Eye, Ear, Nose, Mouth, Throat

Gynecological

Miscellaneous

Musculoskeletal

Neurological

Respiratory

TCM INDICATIONS

Over 200 disorders

Other categories in addition to WHO: Circulatory, Urological, Other

See handouts for indications

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

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, “Acupuncture’s secret: Blood flow to the brain” USA TODAY, 03/03/04,

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

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.

Acupuncture CredentialingTraditional Chinese Medicine Master of

Science (MSTCM)

• 3-4 years

• Acupuncture

• Chinese herbology

• Tui Na

• Qi Gong

• Western medicine

Acupuncture Credentialing

5 Element Acupuncture

• 3 years

• Emphasis on acupuncture

• Apprenticeship

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

Acupuncture Credentialing

MD Programs

• 200-300 hours of post-graduate training

• National credentialing exam

• No specialty in medical acupuncture yet

Acupuncture Credentialing

Chiropractors

• 100 hours of post-graduate training