What is ‘heatiness’? Do TCM and modern medicine clash? Sengkang General Hospital’s acupuncturist gives a peek into her work

SINGAPORE —  Ask 38-year-old acupuncturist Adele Lau about a memory that stands out the most in her work, and she will tell you it was the shrill, agonising screams of a terminally ill man echoing through the hospital ward.

And no, it was not because he was being pricked by acupuncture needles.

Three years ago, the senior acupuncturist with the department of anaesthesiology at Sengkang General Hospital (SKH) was called upon to assist in tending to the patient.

Severe intestinal damage had left the bedridden man in constant, unbearable pain. This was despite having received pain medication, Ms Lau said, declining to disclose what disease the patient had.

“He was screaming all the time from pain and could not sleep at all because he was in so much pain. I could hear (the screams) from the corridor in the ward,” she recounted.

For that patient, acupuncture treatment — done mainly around the abdomen area — provided temporary relief for a few hours.

Acupuncture is a type of traditional Chinese medicine (TCM) treatment that involves stimulating targeted points on the body — often by inserting fine needles.

Sometimes, other techniques may be used, such as by applying pressure or heat on targeted points along the body.

“Acupuncture definitely couldn’t cure what the patient had, but we were able to provide some relief, for around three hours,” Ms Lau said.  

For someone who suffered relentless pain, those fleeting hours of reprieve meant everything. The patient was finally able to sleep and rest for a while.

Ms Lau recalled: “When I removed the (acupuncture) needles and asked the patient how he felt, he was calm and simply said in a weak voice, ‘Thank you so much’.

“That was all I could do, but I was glad it brought him comfort for a few hours.”

As acupuncture services increasingly find their place in public healthcare institutions, practitioners such as Ms Lau demonstrate how the ancient practice can complement conventional medicine as a pain management tool.

Several public hospitals in Singapore now offer acupuncture services alongside mainstream medical treatment.

Besides SKH, they are Changi General Hospital, Khoo Teck Puat Hospital, Singapore General Hospital and Tan Tock Seng Hospital.

The Ministry of Health (MOH) has not responded to TODAY's queries on the number of registered acupuncturists at publication time.

ACUPUNCTURE AS A PAIN MANAGEMENT TOOL

At SKH, acupuncture is typically used as an adjunct to the medical care that patients receive.

The service is part of SKH’s Pain Management Centre, which operates under the department of anaesthesiology.

Ms Lau works with a multi-disciplinary team to care for patients, most of whom are referred by the hospital’s specialists after undergoing necessary investigations and interventions. 

Before referring them to the acupuncture team, the patients’ doctors would also have ensured that any pain medications are optimised, she said.

Most of Ms Lau’s patients have chronic pain due to degenerative conditions or are undergoing rehabilitation after a stroke.

Occasionally, she may also attend to patients in the emergency department who have acute pain.

She noted that conditions such as neck pain and lower back pain seem to be more common now, possibly due to reduced activity levels during the Covid-19 pandemic.

“I’ve had a number of patients who told me that they became more sedentary and started having pain since the ‘circuit breaker’ period (semi-lockdown phase in early 2020) and they’re still struggling with it now.

“Some of them feel like it affects their work and they can’t go about their deskbound job for more than 15 minutes without pain.

“Others have trouble participating in family outings because they can’t stand or walk long.” 

HOW ACUPUNCTURE WORKS

For a patient with chronic pain, acupuncture may be able to reduce pain to a more manageable level, enabling the patient to engage more actively in physiotherapy, Ms Lau said.

“Acupuncture can also reduce stiffness. If movement is limited due to pain, TCM interprets this as a blockage of energy,” she added.

In TCM, acupuncture operates on the concept that there are pathways, or meridians, in the body through which qi, or energy, flows.

Using the analogy of traffic on an expressway to describe the concept of qi, Ms Lau explained: “In an ideal scenario, there’s no traffic jam and everything flows well.

“In TCM, we call this ‘health’, where everything is in a balance. 

“However, a traffic jam can occur when the lights aren’t working well or there’s an accident, for example.

“Similarly in our meridians, energy flow can be blocked by various factors, resulting in disease or pain. In TCM, we aim to relieve the stagnation of qi.”

Acupuncture needles are like “traffic police officers”, Ms Lau quipped: “You send them to the strategic locations (along the meridians) to re-direct traffic so that everything flows better.”

That said, different people respond to acupuncture differently.

Some may have improvements shortly after treatment, while others may not respond at all.

Complex conditions may require more treatment sessions before benefits are noticeable.

Depending on the patient’s condition, Ms Lau uses between five to 30 individually packed disposable fine needles in each session.

A common misperception is that acupuncture treatment is an extremely painful process. 

“Some people imagine that the needles are quite thick. What I do is to show them the needles that we use, and they’ll feel quite reassured knowing what to expect.”

Most patients feel minimal to no pain.

Patients who have undergone acupuncture may describe the sensation as a dull ache, tingling or a sense of heaviness.

WHO SHOULD NOT GET ACUPUNCTURE

However, not everyone is suitable to undergo an acupuncture treatment due to various health considerations.

In general, patients who are too weak, hungry or nervous, have active infections or are feeling feverish may not be ready for acupuncture.

This is because these conditions may lead to reactions such as fainting due to the body being overstimulated by the acupuncture points, Ms Lau explained.

Additionally, acupuncture should be avoided if there are infected skin sores or certain skin conditions. This is to prevent the potential risk of spreading the infection.

Ms Lau said that patients with diabetes would also face a higher risk of infection, and should weigh the risks and benefits before proceeding with acupuncture.

RECONCILING MODERN MEDICINE AND TCM CONCEPTS

In 2005, Ms Lau enrolled in a five-year double-degree programme at the Nanyang Technological University (NTU) when it was taking its pioneer cohort of students for the course.

The Bachelor of Science (Honours) Degree in Biomedical Sciences is by NTU and the Bachelor of Medicine (Chinese Medicine) is conferred by the Beijing University of Chinese Medicine. 

The programme — the first of its kind offered by a public university in Singapore — trains students in biomedical sciences research as well as Chinese medicine.

Ms Lau was intrigued by the unconventional nature of the “East meets West” bilingual programme, which involved spending two years studying in China and being attached to a hospital there.

However, she often felt “confused” during her studies: How does one reconcile the seeming contradiction between the scientific biomedical concepts of disease based on pathogens, for example, with the more abstract principles of TCM such as qi, energy flow and meridians in the body?

“It was an East-meets-West programme, so you can expect a lot of differing viewpoints while trying to find common ground between the two concepts,” she added.

With experience and better understanding over time, she came to appreciate the uniqueness of each system.

Her attachment in Beijing also gave her a deeper appreciation of how TCM could be integrated into healthcare.

“I think what is best is to draw strengths from each system and see where we can complement them.

“Acupuncture is one of the (TCM) treatments where we can realise this integration,” she said.

“The fact that I'm here now in a public hospital, I think, that’s quite amazing. I would never have imagined it when I was studying.”

During her studies, Ms Lau realised that there may be similar disease presentations, or symptoms, in both systems although they use different terminologies.

An example would be the concept of “heatiness” in TCM.

“Initially, heatiness felt like a vague and abstract concept to me; it wasn’t very specific.

“During my studies, I learnt that it could arise from the environment or food we eat,” she said.

“But what I understand now is that heatiness can refer to inflammation in the body (in medical science), how the body feels and responds after an injury or certain triggers.”

Ms Lau added that there is also research to show that acupuncture can induce biomedical changes in the body, when comparing patients who received acupuncture and those who did not.

Research suggests that acupuncture can block pain signals in the spinal cord and brain, preventing them from being transmitted and reducing pain, Ms Lau added.

This effect is achieved through the release of natural chemicals in the body, regulation of the nervous system, and management of substances involved in inflammation.

NATIONAL EFFORTS TO ENHANCE TCM TRAINING

In recent years, MOH and the TCM community have been working to enhance TCM clinical training and improve career development in recent years, as part of the Healthier SG initiative that focuses on preventive care.

Last year, a new four-year Chinese Medicine degree programme was launched at NTU, with the first cohort of students enrolling this year.

At the programme’s launch in November last year, Minister for Health Ong Ye Kung also announced a new TCM clinical training programme for newly registered TCM practitioners who passed their licensing examinations in 2023.

Selected practitioners will go through clinical rotations at four participating TCM institutions, each lasting three months, he said.

The aim is to strengthen the clinical capabilities and confidence of new practitioners.

Starting January this year, they will undergo a full-time one-year structured clinical training programme. This is similar to the post-graduate Year One (PGY1) housemanship for medical students.

The training and assessment framework is adapted from the medical PGY1 programme, but modified to suit the TCM practice context.

Having seen how TCM training and career opportunities have evolved in Singapore, Ms Lau feels a sense of pride.

“I definitely feel very old, seeing how history is being made. It feels like I’m on a trail-blazing path,” she said.

For people considering TCM treatments such as acupuncture, she advises checking if the practitioner is registered with the TCM Practitioners Board. 

This is a statutory board established under the Traditional Chinese Medicine Practitioners Act 2000.

The board registers both acupuncturists and TCM physicians, accredits TCM institutions and TCM courses for the purpose of registration, and regulates the professional ethics and conduct of registered TCM practitioners.

Ms Lau said: “Sometimes, the licence might be expired. So it is important to check if the practitioner is registered with TCM Practitioners Board because we’re not supposed to practise without a valid licence.” 

TODAY has approached the TCM Practitioner Board to get more information on licences and for comments but it has not replied by publication time.