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10 SCIENCE & PRACTICE Dental Tribune Asia Pacifi c Edition | 4/2017 Acupuncture: Probing its way into dentistry—Part I An introduction to acupuncture and its practical applications in contemporary dental practice By Dr Wong Li Beng, Singapore m o c . k c o t s r e t t u h S / a k s w e i n s i W a k i n o M © The history of traditional Chinese medicine (TCM) can be traced back to the Warring States and the Qin and Han dynasties more than 2,000 years ago. The Huang- di’s Inner Classic of Medicine , of comparable importance to the Hippocratic corpus in Greek med- icine, is a scholastic collection of medicinal doctrines and philoso- phies accumulated over the years. To date, it still provides a theoret- ical guide and basis for the devel- opment of contemporary TCM. It consists of two parts, Suwen [plain questions], which mainly addresses the theoretical aspects and diagnostic methods, and Lingshu [spiritual pivot], which covers the practice of acupunc- ture. Acupuncture, according to the dei nition of the TCM Practi- tioners Act in Singapore,1 means “the stimulation of a certain point or points on or near the surface of the human body through any technique of point stimulation (with or without the insertion of needles), including through the use of electrical, magnetic, light and sound en- ergy, cupping and moxibustion, to normalise physiological func- tions or to treat ailments or con- ditions of the human body”. In order to understand the role of acupuncture therapy in TCM, we must i rst appreciate the funda- mental treatment philosophies in TCM. TCM is premised on the con- cept of holism, according to which the human body is seen as an or- ganic whole; all the constituent parts are interconnected and they coordinate and interact with one another functionally. There is also recognition of humans’ interac- tion with the external environ- ment and its effect on the human body. The state of the constitution of the human body, at the point of challenge by pathogenic factors (both internal and external), will Endogenous pathogens | 7 emotions | improper diet | maladjustment of work and leisure Fig. 1: Pathogenesis of disease based on TCM philosophy.2 Exogenous pathogens Constitution of patient | wind | cold | summer heat | dampness | i re heat | pestilent pathogens | yin–yang balance | qi–blood balance | status of vital qi | qi l ow in the meridian ConClinical presentation of disease based on 8 principles for syndrome differentiation | exterior and interior | cold and hot | dei ciency and excess | yin and yang Secondary pathogenic factors | phlegm | stagnant l uid | stagnant blood determine the occurrence and progression of disease. The consti- tution of the body can be regu- lated by maintaining the yin– yang and qi–blood balance. The vital qi, or life force, is viewed as keeping the entire body system going. It circulates all over the body along designated pathways called “meridians”. To put it sim- ply, acupuncture therapy involves the stimulation of certain points along the meridians to allow the free l ow of qi to maintain yin– yang and qi–blood balance. The pathogenesis of disease based on TCM philosophy is summarised in Figure 1.2 This concept of host–pathogen interaction, according to which the manifestation of disease pres- entation depends on both the vir- ulence of the invading pathogens and the host response, has paral- lels with some of the modern con- cepts of disease progression in Western medicine, for example the pathogenesis of periodontitis (Fig. 2)—an inl ammatory disease initiated by oral micro-organisms, resulting in the loss of the sup- porting structures around the dentition.3 The story of New York Times editor James Reston, whose post-appendicectomy pain was re- lieved by acupuncture, and the visit of US President Richard Nixon to China in 1971 brought ac- upuncture into the limelight and created much interest in the West- ern medical i eld. In 1979, the World Health Organization (WHO) endorsed the use of acupuncture for treatment of 43 symptoms. In 1996, WHO’s endorsement of acu- puncture was extended to 64 indi- cations. In the Geneva 2003 WHO report, pain in dentistry (includ- ing dental pain and temporoman- dibular joint dysfunction syn- drome), facial pain and postopera- tive pain were listed among the conditions for which acupuncture had been proven, through con- trolled trials, to be an effective treatment.4 Scientii c basis of acupuncture Acupuncture treatment in- volves the excitation of qi or “de qi”, which is the transmission of needling sensation along the me- ridians, often described by pa- tients as soreness, numbness, ache, fullness or a warm sensation as a result of needle manipulation. This is also perceived by the acu- puncturist as a needle grasp sen- sation, which is key in achieving