Advances in the application of acupuncture in military first aid

Cheng-Li Sun, Hui-Lin Tao, Shi-Fei Chen, Wen Lu, Jing Xiao

Advances in the application of acupuncture in military first aid

Cheng-Li Sun1, Hui-Lin Tao1, Shi-Fei Chen1, Wen Lu1, Jing Xiao2, *

1Department of General Medicine, Shanghai Baoshan Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai 201900, China.2Department of Rehabilitation, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201910, China.

Acupuncture has a long history in China and has played an important role in military medical treatment since ancient times. Acupuncture therapy has been gradually popularized in the armies of various countries. It not only alleviates tissue damage of acute cardio-cerebrovascular injury but also can relieve all types of pain. However, compared with its rising popularity abroad, insufficient attention has been devoted to acupuncture in first aid domestically. Military health care has also ignored its potential value. The implementation of acupuncture in traditional Chinese medicine can relieve pain better and faster. Acupuncture can reduce the sequels of training-related injuries, and further improve the level of military medical security. It is significant for the establishment of an emergency medical system and the development of traditional medical techniques.

TCM, First aid, Acupuncture, Military training, Sports injury

Acupuncture plays an important role in acute cardiovascular and cerebrovascular diseases, sports injuries, acute pain, and other emergencies. It can alleviate pain quickly, reduce the sequels of training -related injuries, and improve the prognosis.

In the future, acupuncture will play an important role in emergency medical treatment, which is worthy of clinical promotion.

Introduction

In the history of traditional Chinese medicine (TCM), acupuncture has played an important role in first aid. As early as,(Ancient book of Chinese medicine) recorded a case of acupuncture applied to treat stupefaction. Some scholars have suggested that the primary points comprise Renzhong point (GV26) and Baihui point (GV20), with Shaoshang point (LU11), Yongquan point (KI1), Lidui point (ST45) and Yinbai point (SP1), and Shaochong point (HT9) as the matching point [1]. Many military doctors in past dynasties were adapted to use acupuncture in first aid, such as Cui Zhiti (, Tang dynasty), who not only used medicine accurately but also proficient with acupuncture. Moreover, he invented medical devices and introduced various external treatments [2]. There are many records of acupuncture emergency treatment in ancient medical book(Jin dynasty)

Due to economic, political, and other historical reasons, the emergency use of TCM domestically has been diminishing in modern times; however, TCM is popular abroad. In particular, acupuncture is increasingly used in Europe, the United States, and other foreign military hospitals [3-5]. The present review summarizes the role of acupuncture in the emergency treatment of acute cardiovascular and cerebrovascular diseases, sports injuries, acute pain, and other emergencies, and may provide a reference for the application of acupuncture in first aid.

Acupuncture for acute cardiovascular and cerebrovascular diseases, and traumatic cardiac and brain injury

Nearly 2 million Chinese die from stroke each year, with a mortality rate of 140.3 per 100,000 [6]. Moreover, the rates of morbidity and sudden death from cardiovascular disease are increasing. The incidence of cerebrovascular diseases in military cadre centers is also on the rise. Sports-related and traumatic brain injuries are very common in military training [7, 8]. High-intensity exercise training can lead to myocardial injury and even malignant arrhythmias, heart failure, and sudden cardiac death [9, 10]. Due to increasing traffic congestion, construction, and industrial development, the incidence of craniocerebral injury caused by accidents is increasingly high. These injuries are associated with a high rate of disability and an increasing number of deaths. Traumatic brain injury accounts for more than one-half of the 150,000 individuals who die each year in the United States. Brain injuries account for approximately two-thirds of all deaths in Great Britain [11].

In cardiovascular emergencies, for example, Western medicine generally advocates the administration of nitric acid esters for angina attack, which can quickly alleviate the situation. In TCM, Shexiangbaoxin (Chinese patent drug) and Suxiaojiuxin (Chinese patent drug) are prescribed [12]. Massage or acupuncture at Neiguan point (PC6) and Zhiyang point (GV9) can improve myocardial ischemia, regulate arrhythmia, and enhance cardiac function [13-18]. It has reported that 87% to 100% of patients return to sinus rhythm after acupuncture [19, 20]. In-depth researches on the myocardial protective effects of acupuncture performed at Neiguan point (PC6) and Zusanli point (ST36) were also reported abroad [21, 22].

Acupuncture may be safer than waiting for a contemporary method of first aid. After the occurrence of stroke, it is feasible to puncture and exsanguinate at the meridians of the hand, or to provide first aid consisting of exsanguination. This method has been used in China for thousands of years., an ancient book of Chinese medicine published in Qing dynasty,, believed that at the onset of stroke or sudden fainting, emergency acupuncture by bloodletting in all 10 fingers would relieve the symptoms [23]. Approximately 1.9 million brain cells die in every minute after the onset of stroke, and a brain deprived of oxygen ages 3.6 years every hour [24]. Therefore, the earlier emergency treatment begins, the greater of the benefit gains. When the situation is critical and conditions are insufficient, a needle can be used for bloodletting. Alternatively, the sharp edges of a broken porcelain bowl or cup can be used as a blade, instead of a needle, to puncture the Shixuan (EX-UE11) points of the fingers, so as to achieve bloodletting as a first-aid measure. The method of puncturing collaterals and bleeding first aid for stroke has been widely used across the country and has become one of the appropriate techniques promoted in the community by the state administration of TCM [25]. Clinical practice and research have shown that this method is effective for ischemic and hemorrhagic stroke and traumatic brain injury, and can effectively improve prognosis. This method of first aid can also be used to mitigate the danger of life-threatening injuries for a short time [26-29]. The therapy is easy to perform and can be used as first aid by appropriately trained medical workers. These acupuncture first-aid methods are also easy to master for the majority of soldiers, who can provide self-rescue ability of the army and avoid delays to timely treatment and ultimately affect prognosis.

Acupuncture treatment of acute sports injury is helpful for rapid recovery

Acute sports-related injuries are very common in military training, the daily training of athletes, and competitions [30]. Acupuncture has obvious analgesic and functional recovery effects on soft tissue, bone and joint injuries, and is also helpful in relieving training fatigue [31]. Cupping therapy, acupuncture, and massage are popular in international sports, and even in the United States military. It is precisely because Chinese medicine is not only beneficial for chronic strain and old injuries, but is also effective for acute sports-related injuries and excessive fatigue [32]. Experience in our practice has shown that, except for fractures, acupuncture at points, such as Shousanli point (LI10), can quickly relieve pain and activity limitations caused by acute and chronic sprains, bruising, and other injuries. Acupuncture can not only result in savings in health funding and medical resources, but also significantly improve the combat capability of the army [33]. Acupuncture at the Shousanli point (LI10) point can be effective for acute lumbar sprains, ankle sprains, and other types of sprain in a few minutes, so that the injured can quickly return to normal activities. According to foreign studies, acupuncture is effective in treating acute lumbago and preventing further progression [34-38]. Acupuncture has a good therapeutic effect on physiological injury, psychological trauma, stress disorders, and other mental diseases caused by military training and combat. Moreover, acupuncture has been proven by numerous clinical practice and research studies. Increasing attention has been devoted to the influence of the mental state and biological rhythm disorder on soldiers' combat ability, because acupuncture plays an important role in the treatment of chronic fatigue, anti-stress reactions, traumatic brain injury, and post-traumatic stress disorder. As an alternative therapy, acupuncture not only saves medical resources, but also enhances the combat effectiveness of the army. This is of great significance to the daily training, competition, and actual combat of troops and athletes, and is the “magic weapon” of first aid in China.

Acupuncture relieves acute pain

Meridians and acupuncture are unique contributions of TCM to the world of medicine. It is also widely used in health, clinic, and first aid and other fields, especially for analgesic effect. Acupuncture is a hot topic around the world. In October 2010, the United States Department of Defense reported that doctors were using acupuncture as the latest battlefield tool. According to a report on the official website of the American Medical Association in 2014, acupuncture has become a convenient technique for treating pain in the battlefield, there are significant pain relief effects of acupuncture at Shousanli (LI10) point, Hegu (LI4) point [39-41]. Acupuncture can significantly reduce the frequency and amount of analgesics. Therefore, it is widely respected and recognized abroad. In contrast, traditional Chinese acupuncture is on the verge of disappearing from the Chinese military. Even within a significant number of military hospitals, TCM is currently in a very awkward position.

Acupuncture has clearly evident effects on all types of pain. For example, headaches of all types have corresponding pain relief points, and local pain can be quickly relieved by x-shape balanced acupuncture [42, 43]. In addition, the Zusanli (ST36) point and Zhiyang (GV9) point can quickly relieve acute stomach ache and abdominal pain. The use of finger pressure, instead of an acupuncture needle, by pressing on the Zhiyang (GV9) point can be used to treat acute stomach ache and stomach cramp. Gao used this method to treat dozens of cases of acute stomach spasm and was able to relieve pain in a few seconds to a few minutes [45]. In the emergency department, the author has used Zhiyang (GV9) point to treat many patients with acute stomach ache, gastroenteritis and abdominal pain. It can relieve pain quickly (in approximately 2 min), even in some conditions for which spasmolysis drugs have no effect. Moreover, we further verified that Zhiyang (GV9) point compression has a satisfactory effect on vomiting, abdominal pain, and residual abdominal discomfort after treatment of acute gastroenteritis. Gallbladder pressure can quickly relieve acute gallbladder colic, although acupuncture has better effects. Pressing the Chengshan (BL57) point or cupping therapy can quickly relieve renal colic [45, 46]. Moreover, acupuncture anesthesia is widely used in domestic clinical practice, from which some western medicine practitioners have learned.

Acupuncture can “obtain time” while waiting for rescue Western medicine

First aid prescribed by Western medicine is characterized by strong pertinence and quick response. Most first-aid personnel have been trained systematically, but they rely heavily on medical situations and equipment. Chinese medicine, on the other hand, can use acupuncture, massage, simple tools, or herbs to act quickly, or provide temporary control of the disease. When angina pectoris or myocardial infarction occurs in the field, the application of TCM skills, such as acupuncture, or massage at Neiguan (PC6) point and Zhiyang (GV9) point, can rapidly improve myocardial blood supply, relieve angina pectoris and arrhythmia, and even relieve acute cholecystitis, acute renal colic, and acute intestinal obstruction [47-53]. With the correct treatment, most emergencies can be controlled, reducing the need for further surgery or emergency treatment. In critical situations, Chinese medicine can be used to quickly control the patient’s condition and mitigate pain and tension. This may highly necessary in the field and remote areas with limited emergency medical resources, and can greatly reduce the potential risks inherent in such situations.

Discussion

Emergency medical practice has been dominated by biomedicine in the modern society. But TCM has been developed and used against diseases which include acute and urgent illness for many thousands of years. How can Chinese and Western medicine learn from one another in attempts at joint first aid? Many studies have been successful in this regard. For example, in the treatment of acute abdominal pain, the treatment of acute severe pancreatitis with integrated TCM and Western medicine can significantly shorten the course of disease and enhance efficacy [54]. In the treatment of acute respiratory distress syndrome by the method of supernatant decoction of TCM, the recovery rate of severely affected patients can reach 80% with the addition of Liangge powder (Chinese patent drug) on the basis of comprehensive treatment [55]. In the aspect of acupuncture, electroacupuncture at the Shuigou (GV26) point on the basis of Western medicine is more effective than Western medicine alone in treating mild and moderate shock. The apparent efficiency in the acupuncture group was 52.9%, which was higher than that of the Western medicine group (18.1%,< 0.001) [56]. Guo reported on the early application of meridian point puncture and blood-letting therapy in the treatment of stroke and other brain diseases, recovered that in addition to positive effects on blood pressure, pulse rate, respiration and consciousness, blood rheology and other aspects in patients with stroke at the initial stage, the therapy can further enhance the expression of c-fos protein. It can improve the ability of nerve cells to resist stress, so as to mitigate damage and augment the repair ability of brain tissue in an ischemic area, slow the apoptosis of nerve cells, and resist ischemic brain damage [57]. Studies have shown that acupuncture can enhance the effect of drugs on reducing cranial pressure in patients with cerebral apoplexy. Acupuncture at Xinshu (BL15) and Jueyinshu (BL14) points, combined with drugs, can treat damage to cardiac and cerebral function in acute ischemic stroke [58]. Acupuncture plus Western medicine can improve the efficacy of Western medicine alone in the treatment of unstable coronary heart pain and angina, and has a synergistic effect in the relief of angina symptoms [59]. These studies provide a platform for dialogue in emergency treatment integrating TCM and Western medicine.

As a representative method of non-drug therapy, acupuncture has an obvious curative effect, a wide range of suitability, and simple equipment requirements. The use of acupuncture has rapidly spread to the militaries of various countries. China has developed training materials on acupuncture for common diseases in the military, and strengthened education about the science of acupuncture in military medicine, especially in the practice of first aid. This interdisciplinary training can be gradually integrated into schools that serve the university’s doctors and senior practice nurses [60]. From the perspective of classroom teaching, clinical practice, and later continuing education, military medical acupuncture talents are cultivated with high quality. Training a military medical team who is proficient in acupuncture and moxibustion first-aid operation and basic skills is particularly important for ensuring combat effectiveness of the army [61].

Conclusion

Acupuncture plays an important role in acute cardiovascular and cerebrovascular diseases, sports injuries, acute pain, and other emergencies. It can alleviate pain quickly, reduce the sequels of training or sports-related injuries, and improve disease prognosis. However, the effects of acupuncture are greatly influenced by the experience of the physicians and practitioners, which further affects the popularization and application of acupuncture. Presently, acupuncture has not received the same attention in the pre-hospital emergency care in our military as in foreign countries. To further strengthen the role of acupuncture in modern first aid, and to complement the advantages of TCM and Western medicine in first aid, it will further improve the medical security level of the army. It is of great practical significance to construct an emergency medical system with traditional medical characteristics and enable acupuncture to enter emergency medical systems around the world.

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TCM, Traditional Chinese medicine.

Sun CL, Tao HL, Chen SF,. Advances in the application of acupuncture in military first aid. TMR Non-Drug Therapy 2019, 2(3): 78-84.

Chang Liu

10.12032/TMRND201902008

The authors declare that there is no conflict of interests regarding the publication of this paper.

*Corresponding to:Jing Xiao, Department of Rehabilitation, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No. 725 Wanping Road, Xuhui District, Shanghai 201910, China. Email: xiaojing821230@163.com.