Dental Tribune United Kingdom Edition No.3, 2017

16 TRENDS & APPLICATIONS Dental Tribune United Kingdom Edition | 3/2017 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 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 Huangdi’s Inner Classic of Medicine , of comparable importance to the Hippocratic corpus in Greek medicine, is a scholastic collection of medicinal doctrines and philosophies accumulated over the years. To date, it still provides a theoretical guide and basis for the development of con- temporary TCM. It consists of two parts, Suwen [plain questions], which mainly addresses the theoretical as- pects and diagnostic methods, and Lingshu [spiritual pivot], which covers the practice of acupuncture. Acupuncture, according to the deﬁ nition of the TCM Practitioners Act in Singapore,1 means “the stim- ulation of a certain point or points on or near the surface of the hu- man body through any technique of point stimulation (with or with- out the insertion of needles), in- cluding through the use of electri- cal, magnetic, light and sound en- ergy, cupping and moxibustion, to normalise physiological functions or to treat ailments or conditions of the human body”. In order to un- derstand the role of acupuncture therapy in TCM, we must ﬁ rst ap- preciate the fundamental treat- ment 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 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 “me- ridians”. To put it simply, acupunc- ture therapy involves the stimula- tion of certain points along the meridians to allow the free ﬂ ow of qi to maintain yin–yang and qi– blood balance. The pathogenesis of disease based on TCM philoso- phy is summarised in Figure 1.2 This concept of host–pathogen interaction, according to which the manifestation of disease presenta- tion depends on both the virulence of the invading pathogens and the host response, has parallels with some of the modern concepts of disease progression in Western medicine, for example the patho- genesis of periodontitis (Fig. 2)—an inﬂ ammatory disease initiated by oral micro-organisms, resulting in the loss of the supporting struc- tures around the dentition.3 The story of New York Times editor James Reston, whose post- appendicectomy pain was relieved by acupuncture, and the visit of US President Richard Nixon to China in 1971 brought acupuncture into the limelight and created much in- terest in the Western medical ﬁ eld. In 1979, the World Health Organi- zation (WHO) endorsed the use of acupuncture for treatment of 43 symptoms. In 1996, WHO’s en- dorsement of acupuncture was ex- tended to 64 indications. In the Geneva 2003 WHO report, pain in dentistry (including dental pain joint and dysfunction facial pain and postoperative pain were listed among the conditions for which acupuncture had been proven, through controlled trials, to be an effective treatment.4 temporomandibular syndrome), Scientiﬁ c basis of acupuncture Acupuncture in- volves the excitation of qi or “de treatment 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 sensa- tion, which is key in achieving therapeutic efﬁ cacy. Recent histo- logical evidence using rat models suggests that this needle grasp sensation is the result of collagen and elastic ﬁ bres tightening around the needle during needle manipulation.5 The authors went further to postulate that this me- chanical coupling between the needle and soft tissue is responsi- ble for transducing mechanical signals to ﬁ broblasts and other cells, with resultant therapeutic downstream effects. How acupuncture can relieve pain can be explained by the gate control theory of pain. It proposes that the activation of alpha delta and C afferent nerve ﬁ bres through acupuncture point stimulation sends signals to the spinal cord, with local release of dynorphins and enkephalins.6 Upon reaching the midbrain, both excitatory and inhibitory mediators are activated in the spinal cord. Neurotransmit- ters, like serotonin, dopamine and norepinephrine, are produced, causing pre- and postsynaptic inhibition of pain transmission. Endogenous pathogens | 7 emotions | improper diet | maladjustment of work and leisure (cid:25) Fig. 1: Pathogenesis of disease based on TCM philosophy.2 Exogenous pathogens Constitution of patient | wind | cold | summer heat | dampness | ﬁ re heat | pestilent pathogens (cid:25) | yin–yang balance | qi–blood balance | status of vital qi | qi ﬂ ow in the meridian (cid:25) ConClinical presentation of disease based on 8 principles for syndrome differentiation | exterior and interior | cold and hot | deﬁ ciency and excess | yin and yang (cid:25) Secondary pathogenic factors | phlegm | stagnant ﬂ uid | stagnant blood

Dental Tribune United Kingdom Edition No.3, 2017

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