"Cardio-acupuncture" - My introduction to this term was at the Autumn Scientific Meeting hosted by the British Medical Acupuncture Society at the Royal College of Physicians in London last month.
Dr. Fokke Jonkman, a cardiologist, gave a very interesting account as to how he uses medical acupuncture to complement his cardiology practice. Being more well versed with the role of acupuncture in pain management, most of what he had to say took me into less familiar territory in terms of my understanding of a wider application of acupuncture in medicine.
Broadly speaking, the cardiovascular system i.e the heart, lungs and the vessels which circulate blood around the body is controlled by the autonomic nervous system which in turn is divided into a sympathetic (excitatory) and parasympathetic (more inhibitory) portion.
When we are running from a wild bear our sympathetic nervous system increases our heart rate, constricts our blood vessels, increased blood pressure and shunts blood away from our organs and skin towards the brain and muscles where it is needed at a time of fight or flight.
By contrast, when we are sitting on the loo, doing our business, the parasympathetic nervous system is more active allowing our blood pressure to ease, heart rate to slow down, smooth muscle contraction allows for peristalsis, our sphincters relax and blood flow is directed towards the gut as well as other organs. When in this state we are generally more calm and relaxed.
It’s okay, some would argue healthy to enter a fight or flight state from time to time. When we develop health problems, including cardiovascular disease, is when we remain in a fight or flight state for too long such that our nervous system and neuro-endocrine system becomes overly stressed.
Enter, medical acupuncture...
In Chinese Medicine, the term Yin may refer to the functioning of the parsympathetic nervous system, and Yang the sympathetic. The concept of ‘balance between Yin and Yang’ therefore makes sense physiologically when considered in this way.
When someone suffers a cardiac event, such as a heart attack or a severe case of angina, the autonmic nervous system becomes more labile or in other words prone to spikes in autonomic sympathetic activity. This may last for three to six months and in some cases up to a year after the event. Most pharmacotherapy would involve the use of medications to block the adrenergic receptors involved in the sympathetic response however patients often don’t like the side effects and may complain of a reduced enjoyment of life.
Could medical acupuncture help ‘reset’ the autonomic nervous system as an alternative form of treatment to drug therapy after a cardiac event? Or possibly during a cardiac event alongside appropriate medical treatment? We also know that medical acupuncture helps reduce feelings of anxiety due to it’s effects within the limbic system, as well as anti-inflammatory effects. As such, medical acupuncture may reduce sympathetic tone without the unwanted hypotensive effects whereby blood pressure drops too low.
Medical acupuncture may also have a role to play in the treatment of non cardiac chest pain (NCCP). NCCP is defined as recurring angina-like substernal chest pain of noncardiac origin. The prevalence of NCCP varies from 14–33% in different population-based studies. Due to the nature of the symptoms, which are indistinguishable from those of ischaemic heart disease, a thorough evaluation by a cardiologist is often necessary. NCCP is may be caused by gastroesophageal reflux or be related to ‘functional chest pain syndrome’ both of which are likely to involve autonomic nervous system dysfunction associated with stress and anxiety and so medical acupuncture may also have a role to play in this condition.
Fokke Jonkmann decribes a treatment approach lasting up to 6 weeks with a sessions lasting 30-40 mins using up to 20 needles applied at a low dose with no added stimulation, shorter sessions would be used if the patient is low on energy so as not to fatigue.
Michael Greenwood’s approach was also described where each patient embarks on an inner journey. The needles must be allowed to do the job with minimal interference for up to 40 minutes. The practitioner should say little as words bring patients into their heads. Often patients will report an ‘energy’ dip or low dive which they pull out by 40 minutes feeling refreshed and invigorated. It is important not to remove the needles too early when the patient is still in low state. This approach may the considered in terms layers of arousal which challenges the mind - body cartesian split. Needles open the doors to patients own self discovery.
Such an approach may, according to Fokke Jonkman help stop vicious cycles of visits to the GP, cardiologist and result in decreased hospital admissions. Such simple but potentially effective complementary treatment for cardiac patients.