O. DUHAMEL

I have been an acupuncturist physician for twenty-five years. I have a private surgery and am also a consulting physician in acupuncture at the CHU Pitié-Salpêtrière (centre hospitalier universitaire-university hospital centre). How is an acupuncture session seen in France today? That will be the topic of my five to ten minute speech.

This morning you heard about diagnosis in Chinese medicine, which I will not go into again because, although Chinese diagnosis is perhaps not based on the same criteria as western medicine, it nevertheless includes a certain number of objective elements. These allow an etiologic diagnosis to be reached, in other words a syndrome can be defined. The patient is questioned, his tongue studied, pulse taken, and his face, nails, skin and general aspect observed for anything unusual. Then one of the syndromes of Chinese medicine is pronounced. Of course, the diagnosis is never exactly what the books tell you or teach you, but the same applies in western medicine. The practitioner therefore tries to draw a parallelism. with something he already knows or has studied, using the principles of Chinese medicine.

Use of needles

Once the syndrome has been defined a certain number of points on the acupuncture meridians are selected. Remember, there are twelve acupuncture meridians; fourteen, with the anterior and posterior meridians known respectively as the governing vessel and the conception vessel, and there are approximately 365 acupoints. Out of these 365 points there are roughly 170 important control points which are used.

Différent size needles are used-small, medium and large. Use can also be made of electric stimulators which are connected directly to the needles, or of moxas (remember what was said this morning) which are burning sticks of artemesia used to heat certain acupoints.

Once the points to be treated have been selected, the needles may be manipulated to obtain what is called the de chi sensation, a sensation of energy arriving on certain points. Other points are left as they are. The direction and depth of needle insertion may also play a role. The needles remain in place for a variable time, on average 15 to 20 minutes, sometimes for much less or for much longer depending on the case.

Main. indications ofacupuncture

1 will now speak to you about the main indications of acupuncture, at least in the West. Obviously acupuncture in France is not exactly the same as in China, for various reasons.

But, firstly, why is acupuncture used in France without the other components of Chinese medicine?

The answer is mainly because of historie and practical reasons. In the 1920s, when acupuncture began in France, it was much easier to import Chinese needles rather than Chinese drugs. We therefore took a greater interest in acupuncture because it was out of the question importing all the Chinese drugs. Nowadays the issue is less clear and moreover doctors practising Chinese medicine are beginning to feel that acupuncture is not the only component. Chinese medicine is 70% pharmacopoeia, 30% acupuncture. They both of course follow the same basic principles of Yin-Yang, rebalancing, the five movements, etc.

What is treated with acupuncture?

• In France anaesthesia by acupuncture is barely used because that would require specialised departments that do not exist here. In China it is used for that purpose and there are also whole departments treating serious pathologies that cannot be treated in France either, because we don't have the necessary departments and wards. In China patients sometimes have one or several acupuncture sessions a day, which is impossible in France today.
• The treatment field includes all functional pathology, but not only that, because organic pathology is also concerned, in relation with the nervous system: insomnias, anxieties, some types of depressions, and physical, psychic and sexual asthenias. In rheumatology of course the field is very broad, because there is the whole rage of rheumatology pains, particularly slight pains, inflammatory pains, spasms, and cramps.

• If you speak to someone in France who doesn't know about acupuncture, they'll tell you: 'Yes, its to treat pains and help people give up tobacco. It may also be used in slimming.' Digestive pathology is also a large purveyor of acupuncture surgeries because acupuncture has definite efficacy in this field. Of course many patients are received with the range of pathologies met by general practitioners--constipation problems, diarrohea, gastric pains, etc.

• The efficacy of acupuncture was referred to above with refèrence to organic pathologies: this is the case with psychosomatic diseases. Tuming to infectious pathologies-an attack of acute sinusitis or recurring sinusites-we sometimes manage to treat thern definitively with acupuncture needles. When youve sufféred it yourself you know that it's perhaps psychosomatic but that the patient is very pleased to be rid of it. I would tend to believe that we have treated the underlying condition. We often see recurring sinusites or colds, particularly in children: these can be treated by acupuncture, generally from age three on. Previously the acupoints can be massaged and the parents can perhaps be taught how to massage their children. This is a highly used technique in China and can easily be used in France.

• I also wish to mention the problems of cystites, recurring cystalgias, and zonae. Acupuncture is highly indicated in zonae. If practised in the first days of appearance, very interesting results are obtained. So'me say zonae cure on their own; that remains to be seen, and in any case pain is avoided.

• At cardiovascular level, mention can be made of palpitations and of some vertigo syndromes. Can migraines and tinnitus be likened to them? Tinnitus is a problem though. Approximately half such cases can be successfully treated, which isn't bad.

• Dermatology is also one of the important aspects of the application of acupuncture. In the theory of Chinese medicine, which I cannot go into now, the skin merely expresses what is going on inside the body. In treating various organs for which a precise pathology is found, dermatological problems will obviously be able to be treated, and not from the sole symptomologic viewpoint.

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