4. Results …
4.3 Use of acupuncture in general
Acupuncture in Chinese Medicine practice
Chinese Medicine is characterized by its multiplicity of therapeutic methods, the main ones are the medicinal treatment and the acupuncture and moxibustion treatments, besides comes the manipulations techniques 34 including massage or tuina and the prevention techniques that optimize the circulation of Qi like Qigong. Finally other minor techniques as cupping, guasha, bloodletting, the application of plasters and fumigations are also frequently used. In Taiwan, one Chinese medicine physician usually relies on many therapeutic methods35. Nevertheless some choose to specialize only in the field of medicinal treatment, some others use both acupuncture and medicinal treatment and add others techniques like manipulation, cupping, guasha and so on. Therefore acupuncture is one of the therapeutic methods used by Chinese Medicine physicians.
The data obtained through the questionnaire showed that the most used therapeutic method was the powdered Chinese medicinal, followed by life style advices and then acupuncture.
Figure 4.3.1 Therapeutic methods used
75.5% of the physicians used “very frequently” powdered Chinese medicinal and 65% of them used “very frequently” acupuncture. We can also note the high importance of life style advice (68.4% “very frequently”) that includes recommendations about diet, sleep and exercises.
Statistical evidence demonstrated that the different therapeutic methods were strongly correlated with geographical and urban environment.
There were evidences that acupuncture was more widely used in the North than in the centre of Taiwan. The manipulations methods and the use of red lamp were also more popular in the North of the island. On the contrary, moxibustion and scalp acupuncture are more used in the south than in the centre of the country. A similar trend was also observed for the fumigations, which were more used in the south of the island, even there was
no statistical evidence. There were no differences of the frequency uses of powdered Chinese medicinal and raw Chinese medicinal between the different geographical locations.
0=Never used; 1=Rarely; 2=Occasionally; 3=Frequently; 4=Very frequently
Figure 4.3.2 Frequency of the therapeutic methods used according the geographical situation
The division between cities areas and districts areas also showed some differences in the use of therapeutics method.
Statistical evidence showed that acupuncture, moxibustion, scalp acupuncture and knife acupuncture were more used in districts areas than in cities areas. By contrast, life style advices were more important into cities areas. In general we found a larger use of therapeutics methods in districts areas than in cities areas.
0=Never used; 1=Rarely; 2=Occasionally; 3=Frequently; 4=Very frequently
Figure 4.3.3 Frequency of the therapeutic methods used regarding the cities and districts areas
Regarding the therapeutic methods there was only one statistical evidence related to the years of clinical practice. Statistics demonstrated that raw Chinese medicinal were more used by physicians with a longer clinical experience. We found the same tendencies for the bloodletting technique. In contrast, the use of powdered Chinese medicinal was more frequently use by the physician with 6 to 10 years of clinical experience.
The use of raw Chinese medicinal and bloodletting technique was also correlated with age. Older physicians favoured more the use of these two therapeutic methods than younger physicians. That also was the case for the use of ear acupuncture, which was more popular for the group age between 40 to 49 years and 50 and more years. The use of powdered Chinese medicinal was predominant for the physicians between 30 to 49 years old.
Statistical evidences also showed that the bloodletting technique was correlated to educational background. Special licence qualified physicians used considerably more this techniques than the two other groups. The
special licence qualified physicians also stand out of the other groups by the fact they used more raw Chinese medicinal and didn’t used at all knife acupuncture nor Qigong techniques. We can note that if bloodletting technique and the use of raw Chinese medicinal were strongly correlated with special licence qualified physicians that could be due to the fact that in this group the physicians were older than the physicians from the school of Chinese medicine and the school of Post baccalaureate Chinese medicine (see profile of the respondent p. 20-1).
There were no evidences for the correlation between the different hospitals and the therapeutics methods. However we can distinguish some tendencies especially concerning rural hospitals and Chinese medicine hospitals. In the rural hospitals we found a higher rate of moxibustion and fumigation use. On the contrary, we found less use of raw Chinese medicinal and knife acupuncture than in the other type of hospitals. We also found some similarity between rural hospitals and Chinese medicine hospitals were the use of manipulations and plasters were higher than in teaching and regional hospitals.
Through the multiple linear regression analysis, we found that the group of factors that influenced strongly the use of the treatment methods was those correlated with the environment. There were four evidence of association related to geographical areas (moxibustion, knife acupuncture, manipulations and the use of red lamp). Two evidences were related to the cities/districts areas (manipulations and life style advice) and finally one was related to the type of hospitals (manipulations). The age was also influencing the choice of therapeutic methods (two evidences for the use of acupuncture and the use of red lamp). Finally, one evidence was related to the education background of the physicians and it concerned the use of the bloodletting technique.
Table 4.3.1 Factors associated with the treatment methods (1st Page)
Data were analysed through Multiple Linear Model analysis and we chose to represent only the factors that attained statistical evidences.
The factors didn't showed a difference with the following treatment methods: ear acupuncture, scalp acupuncture, raw Chinese medicinal, powdered Chinese medicinal, plaster, fumigations, cupping, guasha, qigong
a. This parameter is set to zero because it is redundant
* P<.05
**P<.001
Acupuncture Moxibustion Manipulation Bloodletting
95% Special licence
-.03 Under 30 years old
30 to 39 years old 40 to 49 years old More than 50 years old
-.59 11 to 20 years of practice More than 20 years of practice
.37 Teaching hospital
Regional hospital Rural hospital
Chinese medicine hospital
-.11 North of Taiwan
Centre of Taiwan South of Taiwan
.12 Cities areas
Districts areas
-.30
Table 4.3.1 Factors associated with the treatment methods (Page 2)
Data were analysed through Multiple Linear Model analysis and we chose to represent only the factors that attained statistical evidences.
The factors didn't showed a difference with the following treatment methods: ear acupuncture, scalp acupuncture, raw Chinese medicinal, powdered Chinese medicinal, plaster, fumigations, cupping, guasha, qigong
a. This parameter is set to zero because it is redundant
* P<.05
**P<.001
Knife acupuncture Life style advices Redlamp
95% Special licence
.34 Under 30 years old
30 to 39 years old 40 to 49 years old More than 50 years old
-.07 11 to 20 years of practice More than 20 years of practice
-.16 Teaching hospital
Regional hospital Rural hospital
Chinese medicine hospital
-.03 North of Taiwan
Centre of Taiwan South of Taiwan
-.12 Cities areas
Districts areas
-.02
Diseases treated by acupuncture
Acupuncture is used to improve the communication and circulation between the meridians and regulate the flow of the Qi and the blood in the meridians36. Therefore it can treat many diseases.
Results issued from the questionnaire data showed that the most common kind of diseases treated by acupuncture were mainly diseases of the musculoskeletal system and nervous and vascular system37. Then came the ear, throat and nose diseases, digestive system disease and rheumatoid and immune diseases.
Figure 4.3.4 Diseases categories treated by acupuncture
Besides the ten major diseases picked up among the list of 64 diseases recommended by the WHO for acupuncture treatment were: low back pain, sciatica, sprain and strain, scapulo humeral periarthritis, headache, myopia of children, chronic pain of the locomotor system, dysmenorrhea, backache and facial paralysis38.
Figure 4.3.5 Most common diseases treated by acupuncture
Apart these ten first common diseases commonly treat with acupuncture, Chinese medicine physicians are also used to treat cervical spondylopathy (60 physicians), hemiplegia (58 physicians), tennis elbow (55 physicians), insomnia (55 physicians), rhinallergosis (53 physicians), migraine (36 physicians), tonic headache (32 physicians), nausea and vomiting (32 physicians), oppilation (27 physicians), prosopalgia (25 physicians)and simple obesity (20 physicians).
Comparative statistics showed some interesting features on how diseases categories treated by acupuncture were related to the physicians educational background, age and years of clinical practice as well as to the geographical environment. Furthermore some evidences also showed some links between the different kind of hospitals and the diseases treated.
The most striking statistical evidences were linked to the educational background. The special licence qualified physicians used acupuncture for a lager scope of diseases than physician graduated from the school of Chinese medicine and the school of Post baccalaureate Chinese medicine. For the 16 different diseases categories mentionned in the questionnaire, 10 showed evidences of the differences between the special licence qualified physicians with the two other groups (table 4.3) and 3 showed evidences of the differences between the special licence qualified physicians and one of the other groups. Special licence qualified physicians displayed always a higher rate of acupuncture use except for musculoskeletal, neurological diseases and poisoning where there were no differences between the three groups.
0=Never used; 1=Rarely; 2=Occasionally; 3=Frequently; 4=Very frequently
Figure 4.3.6 Diseases categories treated by acupuncture according to the education course
The age of the physician was also strongly correlated with the categories of diseases treated by acupuncture. The older the physicians were, they used acupuncture for a larger scope of diseases. We obtained statistical evidences for four categories: Rheumatoid and immune diseases, neoplasm, diseases of the respiratory system and diseases of the blood. We observed two kinds of tendencies. The first one was a progressive increase of the frequency use proportional to the group age. This tendency is represented by the use of acupuncture for rheumatoid and immune diseases. We found the same tendencies for musculoskeletal diseases, endocrine and metabolic diseases and diseases of the respiratory system.
0=Never used; 1=Rarely; 2=Occasionally; 3=Frequently; 4=Very frequently
Figure 4.3.7 Treatment of the diseases of the respiratory system in relation to the age of the physicians
The second tendencies found was an augmentation of acupuncture use proportional to the age if we merged the age of the physician into two groups:
“Under 30 to 39 years” and “40 and more years” (sometimes the differences between the group of physicians “Under 30 years” and “30 to 39 years”
wasn’t very clear). This allowed us to see the same tendency, that is to say, the older physicians used acupuncture for a larger scope of diseases. This tendency was found for neoplasm, rheumatoid and immune diseases and diseases of the blood with statistical evidence. The same trend was also found for mental and behavioural disorders, diseases of the digestive system, diseases of the ear, throat and nose, diseases of the genitourinary system and symptoms and signs not elsewhere classified.
0=Never used; 1=Rarely; 2=Occasionally; 3=Frequently; 4=Very frequently
Figure 4.3.8 Treatment of rheumatoid and immune diseases, neoplasm and diseases of the blood in relation to the age of the physicians
Regarding the years of clinical practice and the scope of acupuncture use the tendencies were less apparent. We found one statistical evidence for the rheumatoid and immune diseases that was proportionally related to the years of practice.
0=Never used; 1=Rarely; 2=Occasionally; 3=Frequently; 4=Very frequently
Figure 4.3.9 Treatment of rheumatoid and immune diseases in relation to the years of practice
This tendency was unique. The other trend we found was a higher rate of acupuncture use for the musculoskeletal diseases, mental and behavioural disorders, endocrine and metabolic diseases and diseases of the skin by the group of physicians with “more than 20 years” of practice. For the other categories, there were no clear differences between the different groups.
The general trend we found relating geographical situation and the kind of disease treated was that in the north of the island, the physicians used acupuncture for a larger scope of diseases than in the centre of the island. In the centre, acupuncture use was limited to certain categories of diseases (diseases of the musculoskeletal system and diseases of the nervous and vascular system). The south of the island was in between the results found for the north and the centre of the country. However we only found one statistical evidence for the category of “symptoms and signs not elsewhere classified”, the physicians practicing in the north of the country showed an evident prevalence of acupuncture use under both the centre and the South.
The same trend was found for neoplasm, cardiovascular diseases and diseases of the respiratory system. The other tendency concerned mainly differences between the north and the centre of the island in the treatment of the diseases with acupuncture. This was the case for mental and behavioural disorders, pregnancy and childbirth, diseases of the skin and diseases of the blood, endocrine and metabolic diseases, diseases of the digestive system, diseases of the ear, throat and nose and diseases of the genitourinary system that displayed a higher use rate in the North. For the other categories of disease there were no specific differences according to the geographical situation.
Regarding the division of the physician between cities and district areas, one evidence of difference was found between the two groups for the
to be treated by acupuncture in cities areas. Though the tendencies between cities and district areas were not clearly distinct therefore it is difficult to draw conclusion.
Comparing the different hospitals and the categories of disease treated by acupuncture we found a general trend, that was that the rural hospitals tend to have a limited scope of disease treated by acupuncture. In contrast physicians working in Chinese medicine hospital used to treat a larger scope of disease with acupuncture. Chinese medicine hospital showed a higher rate of acupuncture use for rheumatoid and immune diseases, diseases of the digestive system as well as endocrine and metabolic diseases. Regional hospital more frequently used acupuncture for treating questions regarding pregnancy, childbirth and diseases of the nervous and vascular system than the other hospitals. Finally the teaching hospital displayed a more homogeneous use of acupuncture for all the categories of diseases. Now if we separated the hospitals into two groups (Chinese medicine hospitals and Western medicine hospitals), we find an interesting tendency event there are no statistical evidences. Physicians working in Chinese medicine hospitals used acupuncture to treat a larger scope of diseases than those practicing in Western medicine hospitals. This was specially marked for endocrine and metabolic diseases, diseases of the respiratory system as well as for rheumatoid and immune diseases and diseases of the digestive system.
0=Never used; 1=Rarely; 2=Occasionally; 3=Frequently; 4=Very frequently
Figure 4.3.10 Treatment of diseases in relation to the type of hospitals
The multiple linear regression analysis showed that the strongest association of the categories of diseases treated by acupuncture was related to the educational background. Nine items showed an evidence of association with the educational background (rheumatoid and immune diseases, neoplasms, endocrine and metabolic diseases, cardiovascular diseases, diseases of the respiratory system, pregnancy and childbirth, diseases of the skin, diseases of the blood and symptoms, signs not elsewhere classified). Three items showed a correlation with the age (rheumatoid and immune diseases, diseases of the ear, nose and throat and injury and poisoning). Three items showed an evidence of association with the geographical area (neoplasms, mental and behavioural diseases and symptoms, signs not elsewhere classified). Finally the type of hospitals was associated with two items (endocrine and metabolic diseases and diseases of the respiratory system), and the cities/districts areas were associated with one item (neoplasm).
Table 4.3.2 Factors associated with the categories of diseases treated by acupuncture (1st Page)
Data were analysed through Multiple Linear Model analysis and we chose to represent only the factors that attained statistical evidences.
The factors didn't showed a difference with the following categories of diseases: musculoskeletal diseases, diseases of the nervous and vascular system, diseases of the digestive system and diseases of the genitourinary system.
a. This parameter is set to zero because it is redundant
* P<.05
**P<.001
Poisoning Neoplasm Endocrine and metabolic
diseases
Diseases of the respiratory system Special licence
-.27 Under 30 years old
30 to 39 years old 40 to 49 years old More than 50 years old
-.84 11 to 20 years of practice More than 20 years of practice
.66 Teaching hospital
Regional hospital Rural hospital
Chinese medicine hospital
.05 North of Taiwan
Centre of Taiwan South of Taiwan
-.03 Cities areas
Districts areas
-.08
Table 4.3.2 Factors associated with the categories of diseases treated by acupuncture (Page 2)
Data were analysed through Multiple Linear Model analysis and we chose to represent only the factors that attained statistical evidences.
The factors didn't showed a difference with the following categories of diseases: musculoskeletal diseases, diseases of the nervous and vascular system, diseases of the digestive system and diseases of the genitourinary system.
a. This parameter is set to zero because it is redundant
* P<.05
**P<.001
Rheumatoid and immune diseases
Symptoms and signs not
elsewhere classified Diseases of the skin Cardiovascular diseases 95% Special licence
-.79 Under 30 years old
30 to 39 years old 40 to 49 years old More than 50 years old
-1.08 11 to 20 years of practice More than 20 years of practice
-.44 Teaching hospital
Regional hospital Rural hospital
Chinese medicine hospital
-.37 North of Taiwan
Centre of Taiwan South of Taiwan
.27 Cities areas
Districts areas
-.27 Rheumatoid and immune
diseases
Symptoms and signs not
elsewhere classified Diseases of the skin Cardiovascular diseases
Factors
Table 4.3.2 Factors associated with the categories of diseases treated by acupuncture (Page 3)
Data were analysed through Multiple Linear Model analysis and we chose to represent only the factors that attained statistical evidences.
The factors didn't showed a difference with the following categories of diseases: musculoskeletal diseases, diseases of the nervous and vascular system, diseases of the digestive system and diseases of the genitourinary system.
a. This parameter is set to zero because it is redundant
* P<.05
**P<.001
Diseases of the blood Diseases of the ear, nose and
throat Pregnancy and childbirth Mental and behavioural diseases Special licence
-1.27 Under 30 years old
30 to 39 years old 40 to 49 years old More than 50 years old
-.21 11 to 20 years of practice More than 20 years of practice
.22 Teaching hospital
Regional hospital Rural hospital
Chinese medicine hospital
-.37 North of Taiwan
Centre of Taiwan South of Taiwan
.01 Cities areas
Districts areas
.16