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Vol. LXI, No. 7
April 3, 2009
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Nuland Speaks on Chinese Medicine, Western Science, Acupuncture


Dr. Sherwin Nuland

Dr. Sherwin Nuland

Dr. Sherwin Nuland, clinical professor of surgery at Yale University and author of How We Die and The Uncertain Art: Thoughts on a Life in Medicine, recently spoke to a packed house in Masur Auditorium on “Chinese Medicine, Western Science, and Acupuncture.” His talk, sponsored by NCCAM, was the inaugural Stephen E. Straus Distinguished Lecture in the Science of Complementary and Alternative Medicine and marked NCCAM’s 10th anniversary.

NCCAM director Dr. Josephine Briggs and NIAMS director Dr. Stephen Katz opened with tributes to Straus, NCCAM’s founding director and an internationally recognized clinician-scientist. Straus died in 2007.

Nuland first witnessed acupuncture back in the late 1980s, when, as a member of the Yale-China Association medical committee, he frequented China’s Hunan Medical University. There he observed major surgery using acupuncture for anesthesia (coaching in relaxation breathing and light preoperative sedation were used, but no general, regional or local anesthesia).

Patients tolerated the procedures well, reporting only slight discomfort. Moreover, they required little to no post-operative pain medication.

Why, when China already had Western-trained physicians, was acupuncture still in standard use? In the 50 years prior to his visits, Nuland said, the field of anesthesiology had greatly expanded in the West, but “the large armamentarium available here was not available in China.”

In 1958, Chairman Mao had directed that Western methods be used if available, yet he also insisted that traditional Chinese methods were not to be abandoned.

“[The Chinese] are not waiting for theoretical justification,” wrote New York Times columnist James Reston of his own experience as a surgical patient in China in 1971, when he received acupuncture for post-appendectomy pain. “They have enough pragmatic evidence.”

Nuland confers with NCCAM director Dr. Josephine Briggs at the inaugural Straus Lecture.
Nuland confers with NCCAM director Dr. Josephine Briggs at the inaugural Straus Lecture. Eleventh-century anatomical model used to teach physicians location of acupuncture points

Almost 40 years later, Western biomedical science has yet to explain acupuncture’s success in the operating room, Nuland said.

China has its own explanation of how the body works and how human beings fit into the cosmos. As far back as the 10th century B.C., Chinese texts show the therapeutic use of needles to influence chi, roughly translated as “vital energy, life force.”

“Chi is responsible for the harmonious function of the body…or homeostasis,” said Nuland.

In the West, science is based on a separation of phenomena into component parts; researchers propose hypotheses to explain them and design experimental studies to test them.

Dr. Sherwin Nuland
Nuland times two, at the lectern and (back row, 4th from left) as a member of the Yale-China Association medical committee, Hunan Medical University, late 1980s.
Meanwhile, the Chinese world view is based on how we function in harmony and the interdependent balance of yin and yang. We fit into the world’s natural function not by subjugating nature but rather by understanding its laws, since “man is an integral part of the natural world,” said Nuland. Over centuries, he said, these ideas barely changed at all.

Acupuncture uses fine-gauge sterile, disposable needles inserted at points along meridians—vast energy channels in the body. Held between thumb and forefinger, the needles can be gently rotated in place or attached to a mild electric current.

The meridians are part of traditional Chinese medical knowledge and aren’t analogous to any Western element of anatomy or physiology. Needles are used to change the flow of energy through meridians and the organs through which that energy flows.

During Nuland’s visits to China, western observers were becoming increasingly aware of acupuncture’s practical applications. In surgical cases using acupuncture anesthesia exclusively, he observed firsthand an 80 percent success rate: “The only sensation [reported by patients] was that someone was working [on the surgical site], but no pain.

With Nuland (r) at a poster session following the Straus lecture is Dr. Weidong Lu, currently on the acupuncture service at Dana-Farber Cancer Institute.
With Nuland (r) at a poster session following the Straus lecture is Dr. Weidong Lu, currently on the acupuncture service at Dana-Farber Cancer Institute.

“In spite of what I was seeing,” he said, “I remained in disbelief…We tried to fit it in with science we understood.” Was it a hoax? Autosuggestion, indoctrination, placebo effect?

He cited studies showing that, in surgical patients, acupuncture increases endorphin receptors in the caudate nucleus in the brain and raises endorphin levels both there and in the blood.

Endorphins are naturally occurring hormones that act as the body’s own painkillers. The caudate nucleus, periaqueductal gray matter located deep in each hemisphere of the brain, is involved with body movement and coordination, learning and memory, and (as some non-acupuncture studies show) feelings of affection and trust.

We in the West need a new paradigm, Nuland said, because “there are phenomena that cannot be fully explained by the scientific method. Perhaps a new paradigm will have room for yin and yang and chi channels.”

During a lively Q & A, Nuland noted that acupuncture’s primary function at this time in the U.S. is for treating chronic ailments, such as back pain, with “excellent or good” results.

As for the ongoing studies, indications are that, with acupuncture, “endorphin levels go up, receptors increase, and they stay up.”

In closing, he circled back to honor NCCAM’s founder: “The reason I’m discussing acupuncture,” he said, “is because I think Dr. Straus would have gotten a huge kick out of this discussion.”

Following the talk was a poster session including the work of two young scientists who’ve received the Bernard Osher Foundation/NCCAM CAM Practitioner Research Career Development Award: Harvard Medical School’s Dr. Weidong Lu, currently on the acupuncture service at Dana-Farber Cancer Institute, and Oregon Health and Science University’s Dr. Helané Wahbeh, who is studying meditation and PTSD. NIHRecord Icon

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