Until recently, life for Rahela Begum, a 46-year-old housewife and mother of two, was pure misery. For the last one and a half years Rahela was plagued by acute pain from her hips to her feet. She would wake up with pain, do her household chores with pain and even sleep with pain. To get relief she tried everything -- allopathic treatment, homeopathic medicine, even ayurvedic concoctions, all in vain. Tests revealed that she had sciatica triggered by a deterioration of bone in her spine. Taking high doses of painkillers became routine. Going out was an excruciating experience. “I was always irritable, depressed. I would cook sitting on a chair because standing was so painful. I couldn't move from side to side in bed and would often lie awake with pain at night. Even during my labour pains I never shed a tear but this pain made me cry.” It was an advertisement in a Bangla daily of an ancient Chinese method called acupuncture being offered at a clinic, that caught Rahela's attention. At that point she was willing to try anything to get relief and acupuncture offered a ray of hope. Rahela and her husband went to the TCM (Traditional Chinese Medicine) clinic in Gulshan taking her X rays and MRI reports. A Chinese doctor examined her, studied the reports and listened to all her complaints. On that very day Rahela insisted on starting her treatment and to her surprise the very first sitting brought remarkable relief. By the 11th sitting the pain was completely gone. “I still am paranoid that the pain will come back but God willing, it hasn't,” says Rahela who keeps a hot water bottle beside her bed and tries to avoid steps -- advice from her doctor.

The Clinic, a Bangladeshi and Chinese joint venture, receives around 30 to 32 patients a day. A large number of patients are expatriates, familiar with acupuncture but Bangladeshis like Rahela are also becoming interested in this ancient treatment that has worked wonders on many people suffering from acute pain. The clinic, a Quasem Group venture with Chinese collaboration, has four Chinese doctors who have trained and practiced in China. Located on Road 114, Gulshan 2, the clinic is open every day from 9 a.m. to 1 p.m., 3 p.m. to 5 p.m. and 6:30 p.m. to 8 p.m.

When a patient first arrives at the Clinic he/she has a consultation with the Chinese doctors on duty, explains the Clinic's director Anwarul Ghani. “Usually a patient requires 4-5 sittings lasting 20 minutes to 40 minutes,” says Ghani. “Treatment requires at least five sittings but usually not more than 10.”

Dr. Yang Jinhong, a professor from China of Acupuncture at TCM clinic using moxibustion on a patient.

Since using needles brings with it risk of contamination, the Clinic uses only disposable ones. “Once a needle is used we break it in the breaking machine and then bury it in our own grounds. We do not give or sell needles.”

But just how painful is it? “It's like a pin prick at first when the needle is inserted but then it goes away,” says a middle aged woman who has just completed her third session to treat her arthritis and will probably need another sitting to get complete relief says her doctor, Dr. Yang Jinhong, a Professor of Acupuncture. Most of Dr. Yang's patients come to the Clinic with extreme pain from various ailments such as migraine, spondalitis, lumbago, frozen shoulder, facial palsy and of course arthritis. Acupuncture, however, is used in innumerable treatments, reveals Dr. Yang who has 20 years experience in this form of medicine. These include from treating muscle atrophy to painful post-operative flatulence to epilepsy. One of Dr. Yang's patients was an eight-year old mentally disabled boy with severe epilepsy. The child could not talk, was always irritable and would get seizures every day. After acupuncture treatment the seizures were reduced to once a month, the boy started talking and became much more cheerful than before.
A quick tour of the clinic reveals that it's not just about sticking needles into the body. Acupuncture treatment also includes a few other rather unusual techniques. Moxibustian, for example, involves burning a pinch of a Chinese herb concoction over slices of ginger which are placed on the patient's body. As the herbs get 'cooked' the ginger juice combined with all the herbal goodness seeps out and into the skin. This is a very effective treatment for colds and asthma says Dr. Yang.

Cupping is another curious method which uses dozens of round glass cups which are heated first then stuck on the body. The cups are kept there for sometime to relieve pain, associated with colds, fever or muscle pulls. The surprising part of these methods as our visit to the clinic revealed is that a patient may sleep through the entire session with scores of spindly needles inserted all over his body or a dozen glass cups stuck on his back! In order for acupuncture to work, however, the patient must complete all the scheduled sessions.

In the cupping method, round glass cups are heated and kept on the body for a while to relieve pain.

For 68 year old Shamsunnahar Musa acupuncture has enabled her to start walking again. Osteoathritis, a common ailment in women, caused extreme pain in her knee joints which made walking impossible for over a year. Shamsun-nahar has had about 14 or 15 sessions of acupuncture at the clinic. The pain has significantly been reduced and she is able to walk again.

Although Bangladeshi patients are just beginning to explore this kind of treatment and are still somewhat ambivalent about it, doctors here are very keen to train in acupuncture and include it in their practice of medicine. The clinic's founders are already planning to give extensive courses to young doctors. At the end of the course the doctors will receive a certificate from the Acupuncture Institute of China Academy of Traditional Chinese Medicine, Beijing. A long-term goal is to build a full-fledged institute that will offer training and education.
Acupuncture, in fact, is becoming increasingly accepted in medical circles around the world, as an effective treatment of pain. In China, its birthplace, it is not considered an alternative medicine but as part of mainstream health care with a scientific basis. Doctors like Dr. Yang have had to take a six year course plus a year's internship before practicing.

In Europe acupuncture has been a big hit. In Germany 50,000 physicians practice acupuncture and more than 2,000 acupuncturists are licensed in France. (TIME, May 19, 2003) One of the reasons for its popularity is that acupuncture has significantly reduced health care costs. The method may extend over weeks but it greatly reduces the use of expensive drugs. In Bangladesh the cost-benefit analysis is not so clear as acupuncture is still a very new and mysterious concept that is yet to gain the widespread popularity of China or Europe. At the TCM clinic in Dhaka consultation fee is Tk. 400 and each sitting costs about Tk. 400, which is still quite expensive even for middle class patients. Public hospitals especially, that cater to poor patients, could do wonders in lessening their financial burden, by incorporating acupuncture in their normal regime.

The biggest plus point in favour of acupuncture however, is that it has no side effects. So at least you know the little pin pricks will not damage your kidney or liver or mess up your digestive system -- side effects of many allopathic drugs.

Acupuncture, of course, is not a miracle worker for many serious illnesses such as cancer or AIDS. It is a method that seems to work best at relieving pain or curing many pain-related ailments. Acupuncture points are very precise so it is also crucial that the acupuncturist is properly trained and knows what he/she is doing before popping the needles into the patient's body.

At 75, Towfiqul Islam, a retired secretary, has tried all sorts of treatments in many countries for his thirty-year old backache. But even numerous chiropractic sessions in the US and heavy doses of medication prescribed by an American spine specialist did not provide the satisfactory relief he was searching for. “I was taking 500mg pain relievers 3 times a day when I noticed that my feet were beginning to swell,” says Islam who finally decided on acupuncture which did not have any side effects. Over the years Islam has tried acupuncture off and on at other clinics. “I got some relief but not much. Now over time acupuncture has become more advanced.”

He refers to the TCM clinic in Gulshan where he now goes to and seems to be satisfied with the treatment. Islam has taken seven sessions and so far the pain has noticeably reduced. “I just hope the relief lasts,” he says.

Keeping the Yin and Yang in Order

Traditional Chinese Medicine, commonly known as TCM, is one of the oldest systems of medicine in history, with recorded examples dating as far back as two thousand years before the birth of Christ. Chinese medicine is quite complex and is usually difficult for people to comprehend. This is because TCM is based, in part, on the belief that we live in a universe in which everything is interconnected. What happens to one part of the body affects every other part of the body. The mind and body are not viewed separately, but as part of an energetic system. Similarly, organs and organ systems are viewed as interconnected structures that work together to keep the body functioning. Many of the concepts found and emphasised in Chinese medicine are unique. Take for instance the concept of qi (pronounced chi). Qi is considered a vital force or energy responsible for controlling the functions of the human mind and body. It flows through the body via channels, or pathways, which are called meridians. There are a total of 20 meridians: 12 primary meridians, which connect to specific organs or organ systems and eight secondary meridians. Imbalances in the flow of qi are the reasons behind different ailments. Therefore, the correction of this flow can restore the body's balance.

Traditional Chinese medicine encompasses several methods designed to heal. When people think of TCM, they automatically associate it with acupuncture alone. But acupuncture is only a component of the whole procedure. While it is true acupuncture is the major and the most integral part of TCM, the system also includes therapeutic techniques like acu pressure, moxibustion, tuina and gua sha massages, cupping, herbal medicine, meditation, diet, exercise (often in the form of qigong and tai chi) and also lifestyle changes.

To get a better idea of TCM, one needs to understand the 'Yin and Yang' Theory. The theory of yin and yang is the most fundamental concept of ancient Chinese medicine. One of the major beliefs of TCM is that all things in the universe are either yin or yang. However, there are no absolutes, nothing is ever all yin or all yang but a balance between the two forces. For instance, when day changes into night, it is an example of a yang object changing into a yin object; when winter turns into spring;

it is considered a changing from yin to yang. These forces are opposite yet complementary. They share an interdependent relationship, without yin, there would be no yang, and without yang, no yin.
Yang is generally associated with items or concepts that are bright, warm, and in motion. Yin is generally associated with objects or ideas that are dark, still and cold. Any given frame of reference can be divided into opposite factors, i.e. a yin side and a yang side. For instance, a human body can be divided into exterior and interior sections; the temperature can be divided into hot or cold; time can be divided into day or night; animals can divided into hot-blooded or cold-blooded, and so on.

How can Yin and Yang theory be applied to Chinese Medicine?

Each organ in the body has an element of yin and yang within it. Some organs, such as the liver, are predominantly yang; others, such as the kidneys, are yin. Even though an organ may be predominantly yin or yang in nature, the balance of yin and yang is maintained throughout the body, because the sum total of yin and yang will be in balance. According to the theory, the body is not always in an exact balance of yin and yang. Even when the body is healthy, there may be subtle shifts from one state to the other. When a person gets angry, for instance, the yang state may dominate and when that person has calmed down and resumed to a peaceful state, yin may become dominant. It is perceived in TCM that illness is caused by an imbalance of yin and yang in the body. Basic treatment of diseases caused by the imbalance aims at replenishing depleted yin or yang, and it is through this process that the balance of yin and yang is restored. Traditional Chinese medicine practitioners attempt to determine the exact nature of the imbalance, then fix it through a variety of approaches, including acupuncture, herbal remedies, exercise, and changes in diet and lifestyle. Once the balance is restored in a person's body, s/he regains her/his health.

Although people may find it difficult to accept how traditional Chinese medicine works, the results show that TCM is indeed, very effective. Several studies have reported on traditional Chinese medicine's success in treating a wide range of conditions, from nausea and vomiting to skin disorders, tennis elbow and back pain. Many Western-trained physicians have begun to see the benefits traditional Chinese medicine has to offer to patients. More people around the world are showing faith in alternative, herbal treatments and turning to acupuncture and other components of traditional Chinese medicine than ever before. The reasons for this may vary, but researchers believe that the increasing interest in TCM is due largely to its effectiveness, affordability and lack of adverse side-effects compared to Western medicine.

How Acupuncture Works

Acupuncture is an ancient Chinese method of treating a disease or relieving pain by inserting one or more metal needles at a certain point or certain points on the human body. It has been practiced in China and the Orient for at least 5000 years. Acupuncture is practiced based on discerning a pattern of imbalance in the body and treating accordingly. The imbalance can be caused by physical or emotional difficulties. Acupuncture is the process of encouraging the body to promote natural healing. Traditional Chinese medicine holds that there are as many as 2,000 acupuncture points on the human body, which are connected by 20 pathways (12 main, 8 secondary) called meridians. These meridians conduct energy or qi, between the surface of the body and its internal organs. Each point has a different effect on the qi that passes through it. Acupuncture is done by inserting needles and applying heat or electrical stimulation at very precise acupuncture points. Acupuncture stimulates a regulatory system which affects the body separately from the nervous, hormonal and biochemical systems. This regulatory system is comprised of meridians and points, which have a higher electrical conductivity than the surrounding tissues. When these points are stimulated, they send an electrical signal through the meridians which intensifies the healing process and decreases pain.

A skilled acupuncturist carefully notes down the patient's problems and observes him carefully to make the correct diagnosis. The treatment procedure may include any or a combination of TCM components such as acupuncture, acu pressure, moxibustion, herbal medicines, diet and lifestyle changes.
Acupuncture is considered highly effective not only as a preventive medicine, but as a drug free treatment of signs and symptoms. Tests reveal that the process releases endorphins from the brain, which makes acupuncture particularly effective in pain control. It also affects sugar and cholesterol levels in the blood, the functioning of the gastrointestinal system and the activity of the endocrine system.

There are several theories as to how exactly acupuncture works. One theory suggests that pain impulses are blocked from reaching the spinal cord or brain at various "gates" to these areas. This theory is often known as the 'Gate control theory of pain'. According to this theory, pain signals must pass through a number of high traffic 'gates', as they move from the area of injury to upward through the spinal cord to the brain. Since a majority of acupuncture points are either connected to or are located near neural structures, this suggests that acupuncture stimulates the nervous system.

Another theory known as the 'Electrical Theory' points out that the body generates tiny but detectable discharges. The electrical field influences the growth and functioning of some types of cells. Acupuncture points are concentrated in regions of low electrical resistance. Studies have shown that there is a correlation between the electromagnetic fields in the body and the channels of meridians. The Electric Theory of Acupuncture suggests that acupuncture works by influencing the body's electromagnetic fields. Another theory has it that acupuncture stimulates the body to produce narcotic-like substances called endorphins, which reduce pain.

Prof. Yang explains the healing process of acupuncture as well as other traditional Chinese medicine techniques.

Does acupuncture hurt?

Unlike hypodermic needles, acupuncture needles are solid and hair-thin, and they are not designed to cut the skin. They are also inserted into much more shallow levels than hypodermic needles, generally no more than a half-inch to an inch depending on the type of treatment being delivered.

While the acupuncture experience of each person is different, most people feel only a minimal amount of pain as the needles are inserted. Some people feel a tingling sensation, while others feel relaxed. In fact, one of the greatest advantages of acupuncture is the rare occurrence of serious side effects. The trained acupuncturist can adjust treatment any time after noticing changes in an individual's condition.

When practiced by a licensed, trained acupuncturist, acupuncture is believed to be very safe. Acupuncture already has some inherent safeguards as a healing technique. Because the treatment is drug-free, patients do not have to worry about taking several doses of a medication and suffering a possible adverse reaction.

However, there are certain health conditions that an acupuncturist needs to know before someone decides to undergo treatment. For instance, if one has a pacemaker, one should not receive electro-acupuncture due to the possibility of electromagnetic interference with the pacemaker. Similarly, acupuncture is not recommended for people who have high blood pressure and who are prone to bleeding or bruising easily. Also people taking anticoagulant drugs may bleed easily, so they should consult their physicians before doing acupuncture.

What conditions does it treat?

In the late 1970s, the World Health Organization recognised the ability of acupuncture and Oriental medicine to treat nearly four dozen common ailments, including neuromusculoskeletal conditions (such as arthritis, neuralgia, insomnia, dizziness, and neck/shoulder pain); emotional and psychological disorders (such as depression and anxiety); circulatory disorders (such as hypertension, angina pectoris, arteriosclerosis and anemia); addictions to alcohol, nicotine and other drugs; respiratory disorders (such as emphysema, sinusitis, allergies and bronchitis); and gastrointestinal conditions (such as food allergies, ulcers, chronic diarrhea, constipation, indigestion, intestinal weakness, anorexia and gastritis).

In 1997, a consensus statement released by the National Institutes of Health in the US found that acupuncture could be useful by itself or in combination with other therapies to treat addiction, headaches, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, lower back pain, carpal tunnel syndrome and asthma.

Other studies have demonstrated that acupuncture may help in the rehabilitation of stroke patients and can relieve nausea in patients recovering from surgery.

A patient undergoing moxibustion therapy.

Moxibustion

Moxibustion is a traditional Chinese medicine technique that involves the burning of a small, spongy herb to facilitate healing. The material used is mainly 'moxa-wool (a combination of herbs) in the form of cone or stick. For centuries Moxibustion and acupuncture have been combined in clinical practice. Moxibustion treats and prevents diseases by applying heat to points of certain locations of the human body. The purpose of moxibustion, as with most forms of traditional Chinese medicine, is to strengthen the blood, stimulate the flow of qi, and maintain general health.

There are two types of moxibustion: direct and indirect. In direct moxibustion, a small, cone-shaped amount of moxa is placed on top of an acupuncture point and burned. Indirect moxibustion is currently the more popular form of healing because there is a much lower risk of pain or burning. In indirect moxibustion, a practitioner lights one end of a moxa stick, roughly the shape and size of a cigar, and holds it close to the area being treated for several minutes until the area turns red. Another form of indirect moxibustion uses both acupuncture needles and moxa. A needle is inserted into an acupoint and retained. The tip of the needle is then wrapped in moxa and ignited, generating heat to the point and the surrounding area. After the desired effect is achieved, the moxa is extinguished and the needle(s) removed.

Dr. Liu Yutang, attending physician of TCM Clinic applying acupuncture technique on a patient.

Cupping

Cupping is a therapy in which a jar is attached to the skin surface to cause local congestion through the negative pressure created by introducing heat in the form of an ignited material. In ancient China, cupping method was known as the “Horn method”, because the animal horn was used at the time. The materials for making glass cups and the methods too, have greatly improved with time. Cupping is also used along with acupuncture and moxibustion as part of an integrated therapy.

Tuina massage

Tuina is a form of Oriental massage that has been used in China for centuries. A combination of massage, acupressure and other forms of body manipulation, tuina works by applying pressure to acu points, meridians and groups of muscles or nerves to remove blockages that prevent the free flow of qi. Removing these blockages restores the balance of qi in the body, leading to improved health and vitality. The details of tuina's techniques and uses were originally documented in The Yellow Emperor's Classics of Internal Medicine, which was written about 2,500 years ago. Its popularity and recognition grew steadily to the point that by the sixth century, many traditional Chinese medical schools had incorporated tuina into their programmes as a separate department. In China, tuina is currently taught as a separate but equal field of study, with practitioners receiving the same level of training and enjoying the same professional respect as acupuncturists and herbalists.