Page 320 Guide to Pain Management in Low-Resource Settings

308 Natalia Samoilova and Andreas Kopf

is that acupuncture can be simply applied without tech- knowledge about (patho)physiology. It should therefore
nical support or devices. Th e only preconditions are the not be regarded as detracting from the Western tradi-
presence of a skilled acupuncturist and a supply of ster- tion if we promote the use of acupuncture in this chap-
ile acupuncture needles. ter, possibly outside the concepts of TCM. Th e essence
should be that TCM promotes the subjectivity of the
What are we trying to manage: pain or disease? patient and the therapist, which is an important aspect,
As globalization accelerates, diff erent cultures and phi- sometimes lost in Western technical medicine, which
losophies of medicine have started to spread worldwide. tries to fragment the patient into symptoms. Due to
It is very tempting to adapt to a new idea quickly, and the subjective approach, acupuncture remains a unique
TCM (including acupuncture)—because of its holistic therapeutic exchange between patient and doctor. It
approach—has a very positive image. Very busy week- must be noted, though, that the transfer of acupunc-
end acupuncture courses in Europe and the English- ture into Western medicine has caused some confusion.
speaking countries show that we are only too willing to Th erefore today’s practice of acupuncture does not nec-
incorporate new ideas. While it always makes sense to essarily refl ect traditional acupuncture but a Western
extend one’s own horizon, it has to be doubted whether interpretation of Chinese texts, which are full of misun-
the cross-cultural transfer of TCM, including acupunc- derstandings and misinterpretations. Putting acupunc-
ture, is that easy. ture into an explanatory context of “counterirritation,”
To give an example, TCM uses acupuncture not “gate-controlling,” and “endogenous pain inhibition”
as an isolated single therapy, but as part of a diagnostic might on the one hand, save acupuncture from “quack-
and treatment concept including pulse diagnosis, phys- ery” and on the other hand may help acupuncture fi nd
iotherapy, and dietary treatments. Pulse diagnosis is its place as an accepted complimentary therapy. Since
one of the original set of four diagnostic methods that learning acupuncture might this way become much eas-
are described as an essential part of TCM practice. Th e ier, it would also make it possible to spread knowledge
Chinese term indicating a blood vessel or a meridian is and practice of acupuncture in low-resource countries.
Mai, and the same term is used to describe the pulse. It will be interesting to see whether and how the new
Pulse feeling is called Qiemai, which is part of the gen- initiative, the “Pan-African Acupuncture Project” in Ke-
eral diagnostic method of palpating or feeling the body. nya and Uganda, will be successful integrating acupunc-
Pulse diagnosis was mentioned in ancient Chinese ture into routine medical care.
medical textbooks. A pulse too strong or too weak de-
notes illness. Th e aim of pulse diagnosis, like the other What is the diff erence between oriental
and Western concepts of medicine?
methods of diagnosis, has always been to obtain useful
information about what goes on inside the body, what Acupuncture has been a major part of primary health
has caused disease, what might be done to rectify the care in China for the last 5,000 years. It is used exten-
problem, and what the chances are for success. “Hot- sively for a variety of medical purposes, ranging from
ness” and “coldness,” or “excess” or “defi ciencies,” are the prevention and treatment of disease to relieving
typical categories used to make a diagnosis in this ap- pain and even anesthetizing patients for surgery. But
proach. Th e physician must feel the pulse under proper as in many oriental medicine practices, the emphasis of
conditions—following established procedures—and acupuncture is on prevention. In TCM, the acupunctur-
must then translate the unique pulse that is felt into one ist was regarded very highly for enabling his patient to
or more of the categories of pulse form. Th e most stan- live a long and healthy life (and in case a patient became
dard iconography involves 24–28 diff erent pulse forms! sick, the doctor had to treat him or her for free!).
In essence, there are nine pulse takings on each wrist: In oriental theory, the understanding of the hu-
one for each of the three pulse-taking fi ngers at each of man body is based on the holistic understanding of the
three levels of pressure. Th is example gives the reader universe as described in Daoism, and the treatment of
the possibility to understand on the one hand the com- illness is based primarily on the diagnosis and diff erenti-
plexity of TCM and on the other hand its fundamental ation of syndromes. Th e oriental approach treats Zang-
diff erences to the Western medical approach. Fu organs as the core of the human body. Tissue and
It has to be remembered that TCM was devel- organs are believed to be connected through a network
oped a long time ago when there was only rudimentary of channels and blood vessels inside the human body.