ЕТ “Painkiller”

Dr. Bogdan Rouytchev

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53-1 Mladost 1, 1784 Sofia, Bulgaria

The future belongs to the Third Medicine—the one which unites the Contemporary Western and the Traditional Eastern medicines. This integration begins in the pain treatment clinics.

Pain and analgesia according to traditional Chinese medicine

Dr.B. Rouytchev,MD

Historically the Western world became aware of Traditional Chinese Medicine (TCM) after President Nixon’s visit to China in 1972, when an accompanying American journalist developed acute appendicitis, to the amazement of Nixon and his delegation, necessitated an urgent operation under “needle anesthesia”. This is how acupuncture gained fame in the US. Unfortunately this event gave rise to two pri­mitive misconceptions in Western medicine:

  1. Eastern medicine is all about needle puncturing in specific points;
  2. Its’ underlying mechanism is merely reflex therapy, all other possible mechanisms are simply “mystification”.

In fact acupuncture is only a method, much like the use of injections in Western Medicine. Evidently both methods are effective and have a strong impact on medical practice. But if a person has mastered the technical skills required to perform injections does that imply that they have mastered the skills of medicine? Will they be able to select the appropriate drug for a given disease, its’ dosage and application scheme, consider the side effects, etc.? Will they be able to act as licensed practitioners? One would suggest not. Many “acupunctu­rists” in the East and the West are in essence paramedics or nurses, but not Doctors of Oriental Medicine. TCM is a broad and complicated theoretical system that integrates medical concepts and principles which are entirely unrelated to nerve refle­xes or mystics. A clear understanding of pain and analgesia from the standpoint of TCM may be gained by comparing and differentiating between the two systems:

  1. Western medical logic is based on Aristotle’s concept that something may be true only if it is A or not-A. This key paradigm was the supreme rule of Western science up until it was questioned by Albert Einstein, who first allowed for the simultaneous existence of two principally different manifestations of the same phenomenon, considered once as energy and once as matter. On the other hand, six centuries B.C. Lao Tzu postulated that Yin and Yang (A and not-A) may exist only through the constant interchange and mutual transformation of the one into the other, they are inseparable!1 In this sense pain may exist only through the medium of not-pain and vice versa.
  2. The most common Western definition of health is “absence of disease”. The Eastern definition of disease implies “dis­harmony in the homeostasis of the individual’s body, psyche and soul”. Hence health incorporates homeostatic harmony of these three components. It was only at the end of the last century, after already having an extensive flow of information form the East, that the World Health Organization defined health as the “total physical, mental and social wellbeing of the individual”.
  3. The very fact that TCM postulates a three dimensional position of meridians (more accurately, channels) with interrelations such as “ex­trinsic—intrinsic”, “superior—inferior”, “plus—minus”, “ascent—des­cent” etc. implies a volumetric, but not a morphological approach. This approach is primarily functional and takes into account the simultaneous occurrence of events in the entire body, rather than in isolated “morpholo­gically frozen” areas. Unlike TCM, Western microscopic morphology underestimates the third dimension, the time vector is practically absent. It is not by mere coincidence that, according to TCM, the theoretical understanding of “pain” phenomena and the concepts of human body and life are necessarily based on the three dimensions of space. This implies not only three dimensionality in the anatomical sense, conducted by a system of sensory, motor and vegetative neurons, but also on the level of the organism, which in it’s entirety and in each individual component cell functions simultaneously and constantly in three dimensions….

One should strongly underline the fact that the fundamentals of Eastern medicine rest on physics, whereas those of Western medicine rest mainly on chemistry. It is well recognized that, strictly speaking, physics is the mother of chemistry.

Medical scientists and specialists who find these observations too abstract and unrelated to chronic pain should be cau­tioned that the fundamental physical approach is as scientific and objective as routine double blind randomized clinical tests. In addi­tion, this approach is based on preliminary hypotheses, which leads to highly significant results.

Let us consider for a moment the main TCM hypothesis:

“An intrinsic or extrinsic pathogenic factor may block CHI, blood and other fluids in any body compartment which generates pain. The timely needle puncture of the corresponding points of the affected channel, function or organ eliminates congestion and pain.”

If this hypothesis is true, what are its underlying mechanisms? The accumulating evidence that acupuncture helps to cure pain, gives this statement significant credibility. This forces us to explore where the hypothetical and the known converge. The following questions arise:

Where are the famous channels of Chinese medicine? What is the essence of the famous energy Chi, which flows through them? Is it possible for one organism to host two different physio­logies, established separately by both medical teachings?

Let us look at EBM – evidence based medicine – it offers a perfect model for exploration. However, one should bear in mind that the concept “evidence” covers only the phenomena you can see. By tradition man sees what he knows. It is possible that we are constantly seeing the channels without actually recognizing them, simply because we do NOT KNOW that they are the object of our search. Just as for centuries people have been seeing apples fall, before Sir Isaac Newton SAW gravity in one of them .

I have already had 25 years of experience as an anesthesiologist and more than 10 years of studying TCM. I had witnessed many times the decoulement phenomenon with subcutaneous emphysema, during gynecologic laparoscopy. But in one case my attention was caught by something simple – the emphysema progressed centripetally and thinned out towards the periphery, just like the meridians. I could easily follow how the pericardial meridian reached the apex of the middle finger…

Why shouldn’t we allow for the possibility that the meridians are interstitial spaces between the separate layers, organs, tissues and even cells? The microscopic slits, which even when we recognize them, are not interesting to us because they can not be visualized with an unequipped eye. The­se are cavities, defined as interfacial spaces, synovias, etc. Their channels and micro channels are filled by fluids referred to as lymph, in­terstitial liquor, cerebral-spinal fluid, (c.s.f), etc., that exchange substances with the surrounding tissues and transport them in parallel to the vascular system. To a large extent they are involved in the transport of ions and other low molecular substances (cytokines, lymphokines and other mediators). The conventional observation discloses the move­ment of these liquids and their components only within the frame­work of a region, like the muscle or fascia. But is this really true? Are there any scientists left to believe that the lymph as­cends from the ankle to vena cava only owing to the pumping force of the heart? If we look at it from another perspective our body is a gi­gantic network of extra vascular channels and micro channels, that are very difficult to be explored by macro- and microscopic means, but whose functional ordering becomes available to micro current tests or to Kirlian’s effect of bioelectrography.2

If the model of the tendon-periosteal meridians is easily acc­essible to studying, how could one demonstrate the deeper links bet­ween the index finger and the colon? More or less on the same principle – alongside the major vessels, leading from the extremity to the major cavities, run membrane muffs. These membranes coalesce with the ones of the viscera or upholster the thoracic and abdominal cavities. Thus, the inter-muscular liquor may be connected with any internal organ but the connection with some of them is especially easy. Our body is literally weaved by a network of layers and channels. Hence, the appearance of an electrical micro current will not result into its’ direct expansion through the layers, which are relative insulators, but alongside the channel, up to its’ final destination. In each part of the channel the electrolyte possesses a micro poten­tial, which is protected from the sur­rounding milieu by the skin insulator. However, if a metal needle pierces the insulator this will cause an abrupt change of the potential, resulting in a glow of electric signals. If the needle is inserted in a random point of the skin the potential difference will be insignificant, but if it is in an acupuncture point then a tangible current shall be evoked. The electric micro-currents produced by the acupuncture needle3 have been experimentally demonstrated by Mussat in the 1970’s and since then have been confirmed on nu­merous occasions. Surprising experiments, based on color punc­ture with visible light, have been performed by the German au­thors F. Popp and P. Mandel in “Data on the non classical light in biological systems” and “Consciousness and evolution process based on coherence” published by the International Biophysics Institute45.

If we accept that the network of these interstitial spaces is the anatomic equivalent of the hypothetical channels we might also postulate that the Chi is flowing within them. In Chinese Chi simultaneously means “power, energy and matter” etc. Per­haps it also carries the meaning of merely “something”. The first time that Chi sounded like a meaningful term to me, deprived of mysticism, was the phrase “The Chi of cold damaged…” This sounded intelligible to me because we do know that cold is really damaging to the tissues, without being able to define the exact damaging agent. Whether we will use the terms “low temperatures” or “Chi” will be equal­ly conventional, having in mind the properties of cold to inflict dama­ge, depending on its size (power). The Chi of the body flowing through the channels may reside in the above mentioned mixture of fluids, lymph, electrolytes and other micro molecules which determine the “power” of this current. An interesting TCM postulate is that in this movement “Chi is the object and the blood – its’ shadow”. To me, as anesthesiologist, the links between the meridians and the vascular systems are those functional “micro-channels” known to us as “arteriole-venous capillaries”. Both ty­pes of physiology agree that these are the checkpoints between intra vascular and extra vascular tissues. However, whereas Western medicine is oriented more towards the capillary effects on the vascular side (predominantly chemical), Eastern medicine is oriented mainly towards the interstitial (the “channels”). Therefore it is simply based more on physical phenomena and effects [6].

As this is the area where both teachings converge and cross each other, we obtain a scientific answer to the ENIGMA of acupuncture. Here we face a classical illustration in which dialectics and human physiology become integrated back into a whole! The confirmation of this discovery may open up new possibilities to basic research and therapy. For example, one should have in mind that various disciplines, like allergology, rheumatology, neurology etc. base their therapeutic achievements predominantly on the stabilizing effect of the capillary membrane by corticosteroids. Let us just imagine how much easier this balance could be achieved without the side effects of those agents, by restoring the homeostasis of the organism in the corresponding order and local targeting. This, though, necessitates the better understanding of the principles of acupuncture and their applica­tion.

Let us now return to chronic pain, having in mind that the latter is quite unlike acute pain, following trauma and tissue tears. The presence of channels and the possibilities to induce the fluids inside them are the keys to acupunc­ture induced analgesia. According to TCM, this therapy eliminates the congestion of blood and Chi and restores the circulation of fluid inside the vessels and channels. What would result from this?

Let’s consider for a moment our routine observations in surgery, rheumatology or any chronic pathological process, which induces an inflammatory reaction of the body. We are all well familiar with the main symptoms of edema, rub, cal, etc., which are the result of the organism’s attempt to limit the invasion of the pathogenic agent that ends up in fibrosis and adhesions. In surgery we often come across such adhesions and keep on asking ourselves how much pain they have caused to our pa­tients! Now let us pose the question in a different way: why is it that only the process of adhesion is painful? In all probability we will be surprised by the answer that the structures involved in adhe­sion are predominantly the membranes. That means that the channels are blocked. As a result the circulation in them, as well as in the vessels becomes stagnated, which causes PAIN. Thus the change in micro-circulation is the common ground between the two types of medicine, where the one is focused on the “stasis” and channel obstruction and the other – on the “production of bradykinins, cytokines and other toxic products”.

How, though, could TCM be able to prevent the occurrence of such events? The answer is simple – by resto­ring normal intra and extra vascular microcirculation by means of micro currents, ionic, laser or other as yet unknown currents. Generally speaking, physics induces natural agents, which overcome the stagnation and the focus of accumulated chemical and biochemical toxins. Another area of mutual collaboration bet­ween physics and chemistry in the healing process is the elimination of hydrogen cations via the channels of the affected region. We know that the biochemical events in the inflamed tis­sue lead to an excess of hydrogen cations, resulting in tissue acidosis, with a corresponding decrease of the pH in the affected area. However, let us not forget that an action potential current may withdraw these protons through the needle and by combining with the electrons from the atmosphere can eliminate them from the body as nascent hydrogen. Thus we create a system consisting of the needle, the insulating skin overlaying a channel and the necessary conditions to create an action potential through the puncture.

Routine practice indicates that the action potential (known as DA CHI: “power induction”) arises tangibly as soon as the ne­edle tip stops just in the “slit” of the channel. This, to a certain extent, reminds us of an epidural puncture. However, the latter is related to the epidural space, which is a gigantic channel, demanding an enormous dose of the drug in comparison to a pharmacy puncture. As a matter of fact the “pharmacy-acupuncture”, i.e. the administration of a low dose of the drug into the acupuncture point, has a much more powerful effect than the intravenous administration of a much greater dose. This fact leads us to conclude that the acupuncture channel allows a more exact targeting of the drug into the affected organ, with dramatically reduced side effects. These are only some of the possible mechanisms under­lying TCM.

Numerous studies, conducted by Manaka et al7 and Shang et al8 point to similarities with the fertilized ovum, whose initial signal “slits” during its growth, are followed by the additional formation of micro channels between an increasing numbers of cells, which results in a complex network. These results have been demonstrated experimentally by changes in the electric con­ductivity of the separate morphogenetic centers in animal embryos and show that, for a brief pe­riod of time, the channel network PRECEDES even morphogenesis, including the budding of extremi­ties and other events. Thus, the authors suggest that if the channels build up the system for signal transfer, then they continue functioning throughout the whole lifetime as systems inducing cell reactions. This opens up pathways for stimulating the regenerative processes in adult individuals by acupuncturing the corresponding singular points. Such processes will surely also occur during the eradication of pain by this medical method!

The experience of our Pain Clinic confirms these observations, following the introduction of TCM as the first step in the management of patients with chronic pain. Evidently the approach of the two medical systems is so different that at some point in history they began to relate to each other as A and not-A. This situation persisted up to the end of the last century, when the insight occurred that these two phenomena seem to complement each other through mutual interaction. Hence this leads us to the logical con­clusion that Medicine in the true sense should be an alloy between its’ Western and Eastern components.
Perhaps this is the future of Pain medicine?

1 Ted J. Kaptchuk – The Web That Has No Weaver: Understanding Chinese Medicine; Contemporary Books – Bulgarian edition 2002

2 Temoe and Kirlian’s effect. (Engineer F. Vigoureux, Dr M. Piquemal, 1990

3 Physique de l’acupuncture. hypothèses et approches expérimentales. par Maurice Mussat Dr LIBRAIRIE LE FRANCOIS, Paris – 1972

4 Popp FA. Biologie des Lichtes (Biology of Light). Berlin: Verlag Paul Parey, 1984. In German. Mandel P. Practical Compendium of Color puncture, vol. 1.

5 Mandel P. Practical Compendium of Color puncture. Edition Energetik 1986. … Popp FA. Consciousness as evolutionary process based on coherent states.

6 The role of water capillary forces in electro-rheological fluids – H See et al 1993 J. Phys. D: Appl. Phys. 26 746-752

7 Manaka Y, Itaya K, Birch S. (1995). Chasing the Dragon’s Tail, Brookline, Paradigm Publications. … 2. Who Can Ride the Dragon, Paradigm Publications, 1999

8 Shang Charles, Boston University School of Medicine: The Meridian System and the Mechanism of Acupuncture (Morphogenesis and the meridian system).

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2009 Mar 24 : Have a look here and you can see the chanel

Figure 1. A stereomicroscopic image of the lymphatic vessel around the caudal vena cava of a rat. The photograph (left) and its illustration (right) show the novel threadlike structure (solid arrow) that passes throw the lymphatic valve (open arrow). The photograph was taken in vivo and in situ, and a piece of black paper was put under the lymphatic vessel to exhibit the target clearly. The scale bar is 100 mm.

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Comments

Ref.: Ms. No. EJP-D-08-00128
PAIN AND ANALGESIA ACCORDING TO TRADITIONAL CHINESE MEDICINE
European Journal of Pain

Dear Dr. Rouytchev,

two editors have carefully studied your letter. It is nicely written, but we came to the conclusion that it does not meet the format and content of the EJP. Perhaps your letter would be better suited to a more philosophically oriented journal. Due to the limited space in our journal we are forced to a restrictive acceptance policy.

Thank you for giving us the opportunity to consider your work.

With kind regards,

Prof. Dr. Dr. Hermann Handwerker
Editor-in-Chief
European Journal of Pain

от Prof. Dr. Dr. Hermann Handwerker
22.05.09

Let’s combat pain
26 May, 2011

Bogdan Rouytchev posted the following response
Re: COMPLEMENTARY AND ALTERNATIVE THERAPIES TO TREAT PAIN.

Dear colleagues, all those revues with RCT, EBM and placebo effects of shame acupuncture are useless. This system to prove the evidences is created for pharmaceutical investigation of drugs, not for medical METHODS and INTERVENTIONS. Whoever heard about RCT, EBM and placebo effects of shame appendectomy e.g.?Why the effectiveness of surgery needs another assessment? May be because it’s impossible to do twice the same trial at the same individual… But no doubt we have Evidence about good result of this operation!

The second question is: which kind of acupuncture had they done in such revues? Who does know? Who does understand it? What does it mean? For me the acupuncture is a technical method of treatment comparable with injection. Any injection can to be unadapted, or unequal, or inadequate, or inopportune, or … wrong. To do it right way means to know the answers of the right questions or to know the whole medical sciences. Exactly the same is about Acupuncture! The problem is both Medical sciences are very different! A comprehensive acceptance of Oriental Medicine spends 6-7 years education.It is extremely difficult to happen on a west specialist, for example anesthetist,who had spent so many years in additional training. Myself happened one of them. And now when I know myself and many other patients treated very success fully for chronic spinal pain for example, I don’t mind about RCT. May be the right way to prove the effectiveness of the method is an integrated East-West Doctor to do System Energetic Acupuncture to patients in different Pain Clinic where they will record results? And if the results will be better the confidential drug methods in the public space should start a discussion about renovation of the West Medical Education by some new, obviously help full principles! May be…

I’m ready to prepare a short plan for such research.

от Author
1.06.11

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