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下記は、「米大統領の訪中」と「鍼麻酔」で話題となった’７０年代に、ＷＨＯ発行の「ＷＨＯ THE MAGAZINE OF THE WORLD HEALTH ORGANIZATION」誌に、「ａｃｕｐｕｃｔｕｒｅ」 という題名で中国鍼灸を特集した７項目の内の２項目です。 （THE MAGAZINE OF THE WORLD HEALTH ORGANIZATION DEC.1979 ）。
THE MAGAZINE OF THE WORLD HEALTH ORGANIZATION DECEMBER 1979 The practice of healing through acupuncture which has been years in China offers a relatively number of illnesses. Using no more complex instruments than a few metal needles, mostly of steel, and triangular probes, some rolled leaves of the plantaritemisia (for moxibustion), and cupping glasses, the practitioner is able to regulate the energy of the human body. In ancient times the Chinese considered the body as a kind of field of energy which was channelled through certain lines of force call "currents". From birth to death, this energy followed quite precise routes along a network of socalled meridians. Distributed along this network, at certain very specific localities, were the controlling energy centers, the acupuncture " points", of which more than 800 were recognized. It is at these points that the practitioner operates by needling, or sometimes by cauterization (the technique known as moxibustion),either in order to tone up or to disperse the energy. The latter flows along well-codified routes, and the "currents" stemming generally from a higher center of the body, serve to compensate for any weaknesses. Toning up involves summoning energy into a zone of deficiency from other areas where there is an excess. Dispersing the energy, on the other hand, means driving energy away from areas where it is in excess towards the areas of deficiency. To put it another way, what is required is to tone up a vacuum and to disperse an over-surplus, thus resorting the state of balance in the forces which animate each individual human being and putting him (or her) in harmony with himself and with his environment. This balance, which allows the free circulation of energy within the body, is what the Chinese call health-a state which is as much mental as physical,since according to Chinese philosophy the difference between these two concepts is a matter of nuance rather than of nature. The physical is a coarser aspect of the mental, and the mental is a more subtle aspect of the physical. The distinctions drawn between that which is mental and that which is physical, like those between body and spirit or between the spiritual and the material-these are "Western" concepts and quite contrary to Chinese thinking. Acupuncture and with it the whole of Chinese medicine, including the pharmacopoeia such manual treatments as massage, and physical exercises like Taigichuan (called in the West Tai Chi), are clearly an entirely original form of medicine, differing from the Western science in the way it explains the functioning of the organism and in its therapeutic method. The daily practice of acupuncture enables the practitioner to recognize that this technique responds to the authentic functioning of the body even more closely than Western medicine. And in turn this explains the success it enjoys in curing certain ailments and also in acting as an effective analgesia during surgical operations. Analgesia is one of the big success stories of acupuncture. It serves to reduce the pain felt by a patient while allowing him to retain full consciousness and tactile sensation. It is triggered off by the stimulation. It is triggered off by the stimulation of certain specific points selected according to which part of the body is to be rendered insensitive and in keeping with the logic of Chinese physiology. This method of overcoming pain was discovered in China in 1958, and since then has won great prestige and popularity. Now it is practised in other countries and in 1971 by Nguyen Van Nghi. The analgesic effect can be explained just as well by the Western one. The method used is said to act by liberating encephalines and endorphins at different levels of the nervous system. In other areas the selected acupuncture points appear to stimulate the fundamental system of meridians. The importance given to maintaining stimulation throughout the operation and to keeping a conversation going with the patient suggests that these activities help to keep the energy circulating. Thus it is circulation, that causes pain, and what is needed is to "stir up" the organism in order to prevent this effect. In this way the two canons of medicine can set up house together and peacefully coexist. In other words, the medicine of our times is being adapted and illuminated by the principles of universal energy given to the world more than 2000 years ago in the book called the Nei Jing, which is the true "Bible" of the acupuncturist. In order to transcribe transcribe traditional medicine in modern medical terms, the acupuncturist has to stick to a very strict methodology. For instance, he must be capable of translating the ideograms of the ancient texts ; this means that Western acupuncturists have to address themselves in this case to specialists in Chinese culture. In the Far East, efforts are being made to understand Western medicine through the inspiration of the principles of acupuncture. First place is naturally given to the latter in explaining clinical phenomena because it is regarded as more authentic. Thus the causes of disease are attributed to variations in the energy pattern of the body rather than to changes in the balance of the nervous system. The books published today in Beijing on the subject may express the energy changes in their equivalent neurological terms, just as in other contexts the functional phenomena occurring in the major systems of Western medicine have been described, such as the cardiovascular and endocrine systems. But the study of the "currents" remains what it always was in these works, and the terminology used is that of the ancient treatises. In these countries of the Far East, traditional Chinese and Western medicine are taught in proportions which vary according to whether the student is destined for a doctorate in Western medicine or for a career in acupuncture. In the former case, the course of studies will consist one-third of traditional medicine, that is, acupuncture, the pharmacopoeia, dietetics and physical medicine. In the second case, the proportion will be the other way round : one-third of the time will be devoted to such subjects as physiology, clinical medicine and Western therapeutic methods. In other countries, there are quite different problems in the teaching of acupuncture. In the first instance, some 50 years ago, it was the doctors of Western medicine, and particularly specialists in homeopathy, who practised acupuncture. Even though it was a non-physician, Georges Soulie' de Morant, who first introduced the practice to Europe, it was a French doctor, Roger de la Fuye, and his followers who spread it through such counties as Belgium, Germany, Italy, Spain and United States. After Soulie' de Morant another doctor, Nguyen Van Nghi, contributed to the fame of acupuncture in the West. His great merit is to have awakened the scientific conscience of practitioners by recalling in his teaching that it is an original technique and not some speciality of Western medicine. Until he appeared on the scene, and despite the teaching of Soulie' de Morant, acupuncture in the reflexotherapy (treatment involving the deliberate irritation of part of the body). In used Chinese terms but could only explain the mechanisms involved by reference to Western medicine. Thus in order to account for a specific pain, it was necessary to refer to the never distribution in the affected region. Acupuncture was viewed as a department of general medicine, with the same status as neurology or rheumatology, and indeed was considered as simply a kind of stimulotherapy. The teaching of acupuncture in the West is to a large degree veiled in considerable ambiguity. The traditional date are presented in varying proportions, either in a highly simplified form or else in subsidiary courses at the end of the studies. This instruction is generally offered over a three-year period in one or two lectures or practical exercises a week, and usually relates to the standard texts on traditional medicine. So the student may learn the system of principal and secondary meridians and their related points, the n the elementary rules of controlling the vital energy according to Chinese teaching, and finally the choice of points and the way of using them to treat diseases-but diseases as described in Western textbooks rather than as presented in the Chinese literature. Thus the treatment of sinusitis (a Western term) is tackled under the headings "running nose", "lung cough" and "abyssal waters of the nose", which require action bearing on the clarification of the lungs, the obstruction of the stomach and displacement of heat from the gall bladder to the brain-yet all these terms will be incomprehensible to the student who has not followed a traditional acupuncture training course. In Europe, the teaching of acupuncture follows a variety of different patterns. Broadly speaking, the Soviet Union and the countries of Eastern Europe as well as Austria still regard acupuncture as stimulotherapy. Teaching in France tends to be Westernized, except in the schools that have followed the teachings of Nguyen Van Nghi. But Belgium, the Federal republic of Germany, Italy and the Netherlands, to name but a few, do follow Nguyen, and for some years past the European school of Acupuncture has offered opportunities for refresher courses at which traditional and modern Chinese texts, in good translations, are presented and commented on. As for acupuncture analgesia, this is more generally taught and practised in Austria, Greece, Italy and Eastern Europe, and also in Argentina. Thus its teaching is tending to spread in the West and generally throughout the world. Let us hope that the teaching and practice of acupuncture will continue to gain ground, and will always be undertaken in an essentially Chinese spirit. END (2) Acupuncture: the WHO view (by R.H.Barnnerman) THE MAGAZINE OF THE WORLD HEALTH ORGANIZATION DECEMBER 1979 The WHO interregional Seminar drew up the following provisional list of the diseases that lend themselves to acupuncture treatment. The list is based on clinical experience, and not necessarily on controlled clinical research ; furthermore, the inclusion of specific diseases is not meant to indicate the extent of acupuncture's efficacy in treating them: UPPER RESPIRATORY TRACT（上気道疾患） Acute sinusitis(急性上顎ﾄﾞｳ炎） Acute rhinitis（急性鼻炎） Common cold（感冒） Acute tonsillitis(急性扁桃炎） RESPIRATORY SYSTEM（呼吸器系疾患） Acute bronchitis（急性気管支炎） Bronchial asthma (most effective in children and in patients without complicating diseases)（気管支喘息 ［小児に最も効果的。悪性を除く。］） DISORDER OF THE EYE（眼疾患） Acute conjunctivitis（急性結膜炎） Central retinitis（中心性網膜炎） Myopia (in children)（小児近視） Cataract (without complications)（白内障 ［悪性を除く］） DISORDER OF THE MOUTH（口腔疾患） Toothache（歯痛） Post-extraction pain（抜歯後の疼痛） Gingivitis（歯肉炎） Acute and chronic pharyngitis（急性咽頭炎） GASTRO-INTESTINAL DISORDERS（胃腸疾患） Spasms of oesophagus and cardia（食道と噴門の痙攣） Hiccough（しゃくり） Gastroptosis（胃下垂） Acute and chronic gastritis（急性と慢性胃炎） Gastric hyperacidity（胃酸過多症） Chronic duodenal ulcer (pain relief)（慢性十二指腸潰瘍 ［止痛］） Acute duodenal ulcer (without complications）（急性十二指腸潰瘍 ［悪性を除く］） Acute and chronic colitis（急性と慢性大腸炎） Acute bacillary dysentery（急性細菌性下痢） Constipation（便秘） Diarrhoea（下痢） Paralytic ileus（麻痺性イレウス） NEUROLOGICAL AND MUSCULO-SKELETAL DISORDERS（神経学系・筋骨格系疾患） Headache（頭痛） Migraine（片頭痛） Trigeminal neuralgia（三叉神経痛） Facial palsy (early stage, i.e. within three to six months)（顔面神経麻痺［３～６ヶ月以内で初期症状のもの］） Pareses following a stroke（打撲による麻痺） Peripheral neuropathies（末梢神経系疾患） Sequelae of poliomyelitis (early stage, i.e. within six months)（多発性筋炎［３～６ヶ月以内で初期症状のもの］） Me'nie're's disease（メニエル病） Neurogenic bladder dysfunction（神経性膀胱障害） Nocturnal enuresis（夜尿症） Intercostal neuralgia（肋間神経痛） Cervicobrachial syndrome（頚腕症症候群） "Frozen shoulder"（五十肩） "Tennis elbow"（テニス肘） Sciatica（座骨神経痛) Low back pain（腰痛） Osteoarthritis（関節炎） Acupuncture has been applied as a therapeutic medical technique in China since at least two thousand years ago, when stone knives and other sharp instruments were used. The term itself is derived from the Latin word "acus"-needle, and "punctura"-puncture. Only two generations ago the practice of this technique was still confined to those who inherited it, and was handed down from one generation to the other together with the "golden" needles which were then in use. Thin filiform needles which were then in use. Thin filiform needles are inserted into various parts of the body to treat a variety of diseases and, since 1958, acupuncture has been used as analgesia for surgical procedures. Needles are typically left in position for anything from fifteen to thirty minutes during treatment, and for much longer periods during surgical operations. They are manipulated in twirling or push/pull movements, or they may be activated by pulsed electrical stimulation. An acupuncture-like effect can also be obtained by deep finger pressure, so-called acupressure. Other more recent approaches to the stimulation of the recognized acupuncture " points" include the use of ultrasound and lasers. Moxibustion represents a special form of point stimulation, and involves burning pieces of drug plants, generally the moxa leaf, either on the head of the acupuncture needle, so as to conduct heat into the body, or in some cases actually on the surface of the skin. The medical procedure of acupuncture therapy is today being accorded greater attention in several Asian and European countries and also by WHO under its Traditional Medicine Programme. This practice requires knowledge of the system of anatomy and pathophysiology which is inherent in Chinese traditional medicine. The body is thought to be pervaded by a system of energy channels in which circulates vital energy or farce, termed "shi"(qi). Most of the acupuncture points are located on these channels or meridians, although some are also located on the human ear. Acupuncture is an important therapeutic method within the Chinese traditional system of medical theory and practice. It is often used in combination with other therapeutic measures, but some practitioners adhere strictly to traditional theory, while others use the technique empirically and in accordance with Western-style diagnosis and concepts of pathophysiology. A WHO Interregional Seminar on Acupuncture, Moxibustion and Acupuncture Anaesthesia was held in Beijing(Peking) in June 1979, attended by 15 participants from 12 countries. Its purpose was to discuss ways in which priorities and standards could be determined in the areas of acupuncture, clinical work, research, training and technology transfer. The group watched clinical acupuncture being used for a variety of purposes, including analgesia for major surgery, radiographic diagnosis of gastrointestinal disorder, and a variety of medical conditions. They also visited leading institutions where research is being carried out into the mechanisms of acupuncture and acupuncture analgesia. Such investigations may contribute to the general understanding of pain and pathophysiology. As part of traditional medicine, acupuncture was developed over many centuries by empirical research and field testing. That its scientific elucidation according to international scientific standards is a relatively recent enterprise serves to add to its general scientific interest. However, such scientific investigation must be closely correlated with demonstrations of its clinical efficacy. Many claims have been made for its usefulness; apart from its uses mentioned above, it has been applied as a treatment for drug abuse, and more recently, it has been employed as a diagnostic aid and in conjunction with fluoroscopy in gastrointestinal diseases. Clearly, it is not a panacea for all ills, and is certainly not without risk, but the sheer weight of evidence demands that acupuncture must be taken seriously as a clinical procedure of considerable value. WHAT IS AN ACUPUNCTURIST? The question of acupuncture's clinical application cannot be considered separately from that of training health personnel in its use. What is an acupuncturist? How much need one know to practice acupuncture responsibly? What would an optimal training programmer consist of for acupuncture practice in primary health care, in surgery, and in research? What effect will international differences in nomenclature and terms have on future initiatives in acupuncture training? How can China's experience held in this field? What are the legal and administrative obstacles to acupuncture training and practice in various countries? What standards of professional ethics are relevant in the practice of acupuncture to assure a high quality of care to the people and to protect them from unscrupulous practitioners or inexpert treatment? Answers to these questions require serious thought now that this technique is being undertaken in many parts of the world by practitioners of different training, expertise, or professional and academic backgrounds. Acupuncture requires further scrutiny in the context of scion-economic, cultural and health care policy. Its technical simplicity and successful application to primary health care and the work of "barefoot doctors" and other health workers, particularly in the rural area in China, provides a model for adaptation and ready transfer to the developing countries. Any surgeon with clinical experience of work in tropical countries will readily appreciate the potential benefits that could be derived from acupuncture analgesia for both major and minor surgical procedures. between fifteen and twenty percent of all surgical operations are now said to be performed with acupuncture Anaesthesia in China, and with an overall success rate of between seventy and eighty percent. The history of acupuncture in neighboring Japan dates back more than one thousand years when it was disseminated from China. During the last century it was nearly abandoned, but the present decade has seen considerable revival of interest with the establishment of well organized training courses and research activities. Today, an estimated 6,000 doctors out of a total of 120,000 are said to practise acupuncture. The practice was introduced to Europe during the eighteenth and early nineteenth centuries, but modern acupuncture therapy has only been developed seriously and scientifically since the end of the Second World War. Efforts have been made to explain its mechanisms and effects in modern scientific terms, and surgical operations are now being performed using acupuncture in combination with Western analgesic techniques. It has long been practised in the United States, but widespread interest in this and other aspects of Chinese traditional medicine awaited the reopening of significant communications between China and United States. Considerable controversy has surrounded acupuncture ; on the one hand, extravagant claims have been made for its efficacy while, on the other, it has been criticized for its lack of scientific standing. It has now been introduced into several developing countries and, since 1979, WHO has organized training courses in China. Quite a number of Western-trained doctor practise it and there is official interest and enthusiasm, particularly from the point of view of its potential usefulness as a tool in primary health care delivery. However , there is some resistance to its acceptance by physicians. So far, it has been used with considerable success for the treatment of musculo-skeletal diseases, for example, low back pain, frozen shoulder or neck pain, and surgical procedures under acupuncture anaesthesia are slowly gaining popularity. With adequate logistic support, training and research facilities, acupuncture will be fully accepted in these territories in the foreseeable future. BEWILDERING VARIETY From the outset of the WHO Interregional Seminar, it was clear that an almost bewildering variety of indications existed for the clinical application of acupuncture therapy,while opinions varied from one country to another about the disorders for which it was most recommended. It was agreed that specific contra-indications to the use of acupuncture include pregnancy, needling of tumour sites, skin infections, and the presence of a cardiac pacemaker. There are obvious risks attendant on any kind of needle insertion into the body, particularly where vital structures might be punctured. During the past decade, there has been a growing convergence between the most advanced research knowledge from physiology, biochemistry and pharmacology, and knowledge obtained by research in the field of acupuncture ; that is to say, a convergence of modern international science with traditional Chinese medicine. for example, in more than 600 cases of coronary heart disease, the effectiveness of acupuncture in relieving the symptoms was over 80 per cent. In 645 cases of acute bacillary dysentery, 90 per cent of the patients were cured within ten days, as judged by clinical symptoms and signs and the results of stool culture. The technique is also comparatively effective in controlling fever, inflammation and pain. From the viewpoint of modern medicine, the principal action of acupuncture (and of Moxibustion) is to regulate the function of the human body and to increase its resistance by enhancing the immune system and the antiphlogistic, analgesic, antispastic, antishock and antiparalytic abilities of the body. Acupuncture analgesia has been tried in over 100 different types of operations, and its effects have been found to be comparatively stale in 20 to 30 kinds of common operations. Generally, it is thought to be more effective in head, neck and chest surgery, but it has also been used with satisfactory results in subtotal gastrectomies, splenectomies, total laryngectomies, and open heart surgery under extracorporeal circulation. with the extensive practice of family planning in China, large numbers of abdominal tubal ligations are done under acupuncture analgesia ; more than 80 per cent were rated as excellent and good. Already more than two million surgical cases have been operated on in China under acupuncture analgesia. Large numbers of animal experiments and clinical studies have been performed on the mechanisms of acupuncture analgesia. In the past two to three years, Chinese scientists have succeeded in developing techniques for the isolation, extraction and determination of endogenous morphine-like substances, as well as for artificially synthesizing the highly active encephaline and its derivatives. The WHO Seminar felt that acupuncture analgesia was a valuable addition to the therapeutic armoury of the qualified anaesthetist. It is clear that further exploration, application and research on acupuncture will be not only significant for the health and welfare of the people but also important for the progress of medical science. However, many problems concerning the mechanism of these techniques remain to be elucidated. HIGH STANDARDS OF TRAINING Since acupuncture may be considered part of the practice of medicine, it is necessary to define high standards for training, and this training must be addressed to the different needs of basic scientists, primary care physicians, medical specialists, and other health professionals including auxiliary health workers. Thus a no more than three months' training to learn the technique in theory and practice. Graduates from China's three month courses in acupuncture generally study the identification and use of the 300-old basic points. They also cover the treatment of common diseases both in theory and practice as well as traditional Chinese medical theory , including the theory of channels and vital energy. China's medical educational system is under review by the Chinese authorities, but basically follows a dual track system which ensures integration of traditional Chinese with Western medicine. Doctors trained in traditional medicine work throughout the health care system, in hospitals, clinics, specialty areas and in primary health care. Health workers, called" barefoot doctors" in rural areas and "red medics" in urban areas, are also taught acupuncture for the treatment of a limited number of disorders such as the common cold and influenza, common skin diseases, neuralgias and sciatica. The WHO Seminar agreed that,during training, traditional Chinese techniques and theories must be combined with established Western approaches to the diagnosis and treatment of disease. The development of acupuncture as a safe and clinically useful method depends very much on the international transfer and exchange of information. At present, numerous obstacles exist. For example, there are only limited means for the dissemination of information, and acupuncture literature is only sporadically represented in standard computerized medical information systems such as Medline. There is, as yet, no centre where information from international sources is stored and compiled for use by interested investigators. Another significant problem concerns nomenclature. In most medical fields, terminology units have been standardized on an international basis. In acupuncture, numerous systems are used in different countries for designation of the points, and other technical terms are translated in various ways. Most research in this field has taken place in China, yet access to the literature is limited by its relative unavailability in languages other than Chinese. No concerted effort has yet been made to translate the bulk of this material into other major Western languages. Another serious obstacle to the transfer of acupuncture is the antagonistic attitude of many medical colleagues and allied health professionals toward accepting this therapy as a valid practice. This scepticism is paralleled by a general ignorance on the part of the general public, which makes patients in search of treatment easy prey for unscrupulous or uninformed practitioners. The elimination of such quacks, so as to assure a high level of clinical ethics and practice, would do much to make acupuncture respectable and encourage its transfer to other countries. The WHO Seminar concluded that educational programmes for collecting and disseminating available knowledge and research data will be of great importance. It recommended that special programmes might be organized to reverse the unfavourable attitudes of medical professionals and to educate the public about the safety of the procedure, its indications and its limitations. It also recorded the need in many parts of the world for more careful formulation of policies concerning the regulation of acupuncture, and suggested that the established international agencies could play an important consultative role in such efforts. END "WORLD HEALTH" 1979 Dec. WHO Av.Appia,1211 Geneva 27, Switzerland.
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