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Crohn’s Disease – An Acupuncture Review

digestiveblog3-672x340In discussing the acupuncture treatment of Crohn’s disease, lets first have a brief review of this illness. Of prime importance- it has to be diagnosed, treated and followed up by tests on a regular basis, by the patient’s medical family doctor and by a consultant specialist hospital doctor.

The illness was initially described by Crohn and colleagues in 1932.

An acupuncturist may have an important supportive role by helping to lessen the severity of the illness, using another approach and give more time to the patient in discussing their illness.

Acupuncture Treatments of Crohn’s disease. The role of acupuncture is to help to treat

1. the causes and possible contributing factors of the illness, such as stress, unhealthy food intake, alcohol , cigarette smoking and lack of exercise.

2. To decrease the symptoms of the disease, by helping the person to stay in remission and to decrease the severity and frequency of relapses reoccurring.

3. To decrease the risks of complications occurring-complications of both the illness and of the treatments and

4. To help the patient to cope and function better, in family life, at work, and socially.
It helps the patient to improve their own inner healing, it helps to lessen the disease in many cases, and is not very expensive. Western scientific research is being researched more and one study shows that acupuncture is effective in decreasing disease activity and in improving disease related symptoms (1).

Western Medical Review.
Description. Crohn’s disease is usually an ongoing, reoccurring illness, with inflammation and thickening of the wall of the intestine that usually occurs in the distal part of the small intestine, but may occur anywhere between the stomach and the anal area. It usually affects young adults, with a prevalence of 0.5-24.5/100,000 persons (8).

Causes. Not known, but related to family history, imbalance of the immune system, and stress, and other possible predisposing factors as discussed above.

Symptoms. May be mild to moderate to severe—with remissions and relapses—usually loose stool which may be accompanied by the passage of mucus and blood in the stool, may also get constipation, colic, intermittent fever, loss of appetite, weight loss, feeling unwell, with loss of energy. Patients may also present with complications of Crohn’s disease such as the formation of fistulae—which is a connection between the intestine and other body organs, also intestinal obstruction, anaemia, need ongoing regular bowel tests to out-rule bowel tumour development, and other conditions. They may also present with illnesses not related to the intestine such as arthritis and inflammation of the eyes. The doctor will also note if the patient is presenting with a side effect of medical and/or surgical treatment.

Diagnosis. Diagnosis is based on the doctor taking a history from the patient of their symptoms, and on examining the patient. Some of the investigations include blood tests, x-ray of the intestines using barium, colonoscopy-a view of the inside of most of the large intestine, taking a biopsy, scans, and maybe other tests. These tests are needed to out rule other conditions such as ulcerative colitis, tumour of the bowel, diverticulosis, bowel infection, irritable bowel syndrome and other conditions.

Treatment. Treatments include medication to decrease the bowel inflammation, anti-inflammatory medication, and medication to decrease the body’s own immune system from attacking itself—this includes using steroids and immunosuppressant agents, antibiotics, and may need to consider biologic therapy such as infliximab. Also medication to decrease pain, anti-diarrhoeal agents, and possible re-hydration. May also be advised high calorie intake, decreased residue diet, with vitamin and mineral supplements due to some malabsorption conditions, especially vitamin B12.

Treatments may also include surgical treatment, and treatment of complications of Crohn’s disease.

Prognosis. Patients with Crohn’s disease usually experience periods of remission, the majority live normal lives, have families, and hold down jobs successfully.

Chinese Medical Review
Acupuncture- the insertion of needles at specific points in the body, has been in practice in China for thousands of years and has stood the test of time where it is the result of a continuous process of clinical analysis and testing based on a system that, if beneficial results keep reoccurring, then you know that it works – a different approach to ours in the west which is based more on a scientific basis,– and in recent years is more verifiable by medical research and controlled clinical trials (2,3).

An acupuncturist using Chinese acupuncture, takes a holistic approach to the patient from a physical, emotional and psychological point of view. He will work on the flow of energy within the body called ‘Chi’ which is affected by illness, balances any excess or deficiency of the energy and the flow of energy within the body. An acupuncturist has a knowledge of what is known as the five elements, the five fundamental substances, the external and internal eastern causes of disease, and of the Zang-Fu organs within the body and other features which are woven into a pattern of diagnosis, for example, damp-heat, chi deficiency, chi stagnation, yin deficiency and/or other syndromes as diagnosed from the patient by the acupuncturist. An acupuncturist has to read the disharmony within the body, read how the body is trying to heal itself, and accelerate that healing processes within the body. Working with the different five element cycles to re- balance the internal environment of the body in this illness, has a relationship with western scientific medicine, where balancing its internal environment is related to many systems such as the endocrine system and the autonomic nervous system. An acupuncturist takes a detailed history –much of which is different from the questions asked in western medicine. Much information is also obtained from looking at the person’s tongue, and from examining the right and left hand pulses, to help to interpret the internal environment of the body. The tongue is an internal organ, so by looking at the disorders in the tongue you are also looking at the disorders of the other organs of the body-for example when a doctor looks at the person’s skin he can say the person is anaemic if the skin is pale .

There are more than three hundred acupuncture points on the surface of the body, and an acupuncturist may use between ten and twenty sterile disposable acupuncture needles in a session which may take nearly one hour. Usually one treatment a week is needed for four to six weeks and then usually less often after that to reinforce the healing processes .Acupuncture is not supposed to be painful-the patient usually feels a pinch like sensation, with a fullness, aching sensation.

Some acupuncturists use more a western approach called Trigger Point Acupuncture, or dry needling acupuncture, which has mainly a western medical approach, where they would focus on factors such as the same nerve segment on the surface of the body as that of the internal organ affected, and also focus on other factors such as the body’s own internal opioid peptides and own steroid production ,serotonin and noradrenaline balance in the brain system, the autonomic nervous system, reciprocal connections to the limbic system, and many other physiological processes.

So an acupuncturist takes a history, examines the person, and formulates a treatment plan for to use the acupuncture needles. Patients often say that stress makes their symptoms worse, so the practitioner may discuss some relaxation techniques with the patient (7).

Acupuncture helps to decrease the inflammation of the intestine (4, 6), and to work on the immune system (5).

An acupuncturist may also use an electrical instrument called Electro-Acupuncture, which stimulates the acupuncture needles as in manual needling acupuncture, to many different features such as intensity and frequency of stimulation, so as to optimise the acupuncture treatment .
As can be seen there are different types of acupuncture, and each type have features In common, and which overlap.

An acupuncturist must be always aware of contraindications and precautions to acupuncture.

Acupuncture must be used only to complement the patient’s family doctor’s treatment.

Research
More and more research and clinical trials are being done to show the benefits of acupuncture in treating illnesses. This is a relatively new science that is developing over the last forty to fifty years. However Eastern acupuncture is at least five thousand years old, and has stood the test of time. Rather than being based on scientific evidence that it works, it is based on reading and thinking out the disorder and the healing process , clinical observation, and testing, and if beneficial results keep reoccurring, then you know that it works.

Acupuncture treatment has a role in treating Crohn’s disease, and more study, research, and clinical trials are now taking place on this.

References
1.Acupuncture and moxibustion in the treatment of active Crohn’s disease-a randomized controlled study.
www.ncbi.nlm.nih.gov/pubmed/15114043

2. Acupuncture Review and Analysis of Reports on Controlled Clinical Trials
whqlibdoc.who.int/publications/2002/9241545437.pdf

3 Acupuncture; Which Diseases can be helped by Acupuncture?
www.healthy.net/scr/Article.aspx?Id=1980

4 Anti-inflammatory actions of Acupuncture.
www.hindawi.com/journals/mi/2003/807126
www.ncbi.nlm.nih.gov/pmc/articles/PMC 1781596

5. The Neuroimmune basis of Anti-inflammatory Acupuncture
www.chiro.org/acupuncture/ABSTRACTS/Neuroimmune_Basis.shtml

6 The Mechanism of Acupuncture and Clinical Applications.
www.hawaii.edu/hivandaids/The_Mechanism_of_Acupuncture_and Clinical Applications

7 Psychoneuroimmunology-Wikipedia, the free encyclopaedia.
En.wikipedia.org/wiki/psychoneuroimmunology

8. Centres for Disease Control and Prevention: Inflammatory Bowel Disease.
http://www.cdc.gov/ibd/

By Dr. Anthony J Walsh, Robertstown, Carrigaline, Co Cork. Member of the Acupuncture Council of Ireland.
Mr.David Hennessy, Glanmire, Co. Cork. Member of the Acupuncture Council of Ireland.

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