There’s nothing unusual about needles being used in hospitals, as anyone who has had an injection would know. However a different kind of needle treatment is getting the attention of hospital patients these days – acupuncture.

The younger generation, in particular, seems increasingly open to opting for acupuncture therapy at hospital as a complement to conventional treatment, say hospital acupuncturists.

This shift in attitude towards traditional Chinese medicine (TCM) practice is seen not only among Chinese patients but also in a good mix of patients from non-Chinese backgrounds, they add.

Acupuncture services are offered at public hospitals like Tan Tock Seng Hospital and National University Hospital, as well as at private hospitals like Raffles Medical and private clinics like those run by Eu Yan Sang. Some places, such as Singapore Thong Chai Medical Institution, give free TCM consultations.

In Singapore, TCM is carried out by TCM physicians accredited by the TCM Practitioners Board under the Ministry of Health (MOH).

“There is now a reversal, of acceptance of alternative or complementary treatment by the younger generation who are looking for a natural and safe treatment,” said Dr Richard Tan, principal resident physician at Alexandra Hospital, which is operated by Sengkang Health.

Ms Melissa Ong, an acupuncturist at Khoo Teck Puat Hospital (KTPH), said around 40 per cent of the patients who seek acupuncture at the public hospital are non-Chinese and under 25 years old. Ailments treated in hospital using acupuncture are most often musculoskeletal in nature, such as neck, back and shoulder pains, said Dr Tan.

Ms Tan Weii Zhu, a TCM physician at Raffles Chinese Medicine Tan said pain in the joints and muscles, fertility issues and stress-related conditions like insomnia and headaches are the most common conditions seen for acupuncture treatment at her clinic. “The youngest acupuncture patient that I’ve encountered is six years old and the oldest is 94,” she said.

The six-year-old girl had muscular aches in the arms and legs after too much physical activity, she recalled. Despite an apprehension of needles, the therapy was relatively painless for the child, and she felt better afterwards, Ms Tan added.

BENEFITS TO HOSPITAL PATIENTS
The Singapore Government began regulating the TCM industry in 2000, when the TCM Practitioners Act was passed in Parliament.

Under the act, all TCM practitioners have to be registered with the TCM Practitioners Board. The process began the following year (2001) – starting with the registration of acupuncturists. This was followed by TCM physicians in 2002.

Today, there are 1,396 acupuncturists certified under the Board. In 2005, the MOH allowed licensed hospitals and nursing homes to have full service TCM clinics – including acupuncture, tuina and herbal medicine services – to be co-located on their premises.

The TCM clinic must, however, be clearly distinct from the conventional medical services.

So far, having acupuncture services in hospital has offered patients some benefits.

It has, for instance, made it easier for TCM physicians to access the patient’s medical background before performing acupuncture, and to speak to the doctor who treats the patient. The TCM physician can then peruse the patient’s test results and ensure that he can safely receive acupuncture treatment.

If the patient’s health records reflect that he has an artificial heart valve or metal pacemaker, for instance, then he would not be considered for acupuncture because of the electrical currents that will pass through the needles.

“A physician practising acupuncture in hospital could have better communication with the patient’s other healthcare providers in the same hospital, and at the same time have access to tests and radiological results,” said Ms Ong.

At Alexandra Hospital, the inhouse acupuncture clinic can provide treatment in the wards, which is more convenient for patients, especially those who are bed-bound.

The service is run by Dr Tan, who is trained in both Western and TCM, and has been practising acupuncture for 10 years.

One theory behind how acupuncture works is the “gate theory”, where the needles can stimulate a release of chemicals in the body that helps to reduce pain, said Dr Tan.

He believes that TCM and Western medicine operate on fundamentally different principles. The former is more observation-based, and the latter is theory-based.

And while there are tried and tested Western medication for specific conditions, individuals respond to these drugs differently.

For example, a particular fever medication might work more effectively for some than others.

Similarly, if someone has back pain, they might respond well to painkillers like paracetamol, while others might require an additional source of pain relief such as acupuncture, said Dr Tan.

Therefore, each person should opt for the treatment that is most suitable for him, suggested Dr Tan. For 34-year-old M. Hanif, acupuncture was not on his mind when he was diagnosed temporomandibular joint (TMJ) disorder in January this year.

The disorder causes tightness of his jaw muscles and affected daily functions like talking and eating. He was prescribed the usual painkillers, but the medicine did not help him much .

Mr Hanif also knew full well the side effects of taking excessive medication – he works as a doctor at Sengkang Health. After finding out about Dr Tan’s clinic, which had about 100 patient visits last year, he decided to give it a go.

“I felt acupuncture is generally quite safe if done properly, in the sense it’s not something that you take internally,” he said.

At his fourth acupuncture session on April 10, Mr Hanif said he felt the treatment had enabled him to move his jaw with more ease.

During the session, he had 13 needles inserted in various parts of his body, including his legs, wrists and behind the ears.

“Initially I thought that it might be very painful... It doesn’t feel like a prick... (but) like an achy sensation,” said Mr Hanif.

Acupuncturist Ms Ong noted that the more significant sensation is not pain, but that of “soreness, heaviness, numbness and sometimes a current like sensation”.

“These sensations are important as they indicate that the acupuncture points are being stimulated,” she said.

However, some TCM methods offered in private acupuncture clinics are not as commonly found in public hospitals. These include moxibustion (the burning of herbs near the skin), fire cupping, meridian scraping therapy and bloodletting.

This is because hospitals are cautious about the risk of infection and skin bruising.

In general, Dr Tan advised against going straight for acupuncture therapy – instead, the patient should get diagnosed and treated by a Western doctor first. Acupuncture can then come in as a complementary treatment, such as to relieve pain.

“Alternative medicine means it’s either or – it is exclusive,” said Dr Tan “But acupuncture is complementary, which means we integrate TCM into conventional medicine.”

What to expect during a hospital acupuncture session
In Singapore, acupuncture services can be found in public and private hospitals to complement conventional Western treatment.

The Straits Times visited one such clinic run by Sengkang Health in Alexandra Hospital recently to observe how acupuncture is practised in a hospital setting.

Dr Richard Tan, principal resident physician at Alexandra Hospital, is also a registered traditional Chinese medicine (TCM) physician.

He said patients have to be assessed by their physician to see if acupuncture is suitable for them.

Those who cannot sit still or have easily torn skin are examples of those who might not be suited for this treatment, he added.

Each session, lasting between 20 and 30 minutes, begins with the patient describing his ailment. The physician will then determine the pain points to be needled, and the patient might be asked to lie down on a clinic bed or stay seated for the procedure,he said.

Needles used are the same as the ones used in private acupuncture clinics. They are extremely fine, measuring from 0.12mm to 0.35mm in diameter – much smaller than injection needles, said Ms Tan Weii Zhu, TCM physician at Raffles Chinese Medicine.

Needles usually go only a little beyond the surface of the skin. According to the British Acupuncture Council, practitioners are usually guided by the sense of contacting the energy of the patient, and this might be achieved at relatively superficial levels just beneath the skin.

An infrared lamp is placed near the area of pain to allow heat to be conducted through the needles for enhanced circulation.

A machine that produces a small electric voltage is also connected to crocodile clips attached to the acupuncture needles inserted in the skin.

This sends a small electric current through the needles, which can restore health and well-being, according to TCM theories.