Acupuncture

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Acupuncture (from Lat. acus, "needle" (noun), and pungere, "prick" (verb)) or in Standard Mandarin, zhēn jiǔ (針灸 lit: needle - moxibustion) is a technique of inserting and manipulating needles into "acupuncture points" on the body.

According to acupunctural teachings this will restore health and well-being, and is particularly good at treating pain. The definition and characterization of these points is standardized by the World Health Organization [1] (WHO). Acupuncture is thought to have originated in China and is most commonly associated with Traditional Chinese medicine (TCM). Different types of acupuncture (Japanese, Korean, and classical Chinese acupuncture) are practiced and taught throughout the world.

Whether acupuncture is efficacious or a placebo has been the subject of ongoing scientific research. Scientists have conducted reviews of existing clinical trials according to the protocols of evidence-based medicine; some have found evidence for treatment of nausea and low back pain, but for most conditions have concluded that there is insufficient evidence to determine if acupuncture is effective. The WHO, the National Center for Complementary and Alternative Medicine (NCCAM) of the National Institute of Health (NIH), the American Medical Association (AMA) and various government reports have also studied and commented on the efficacy of acupuncture. There is general agreement that acupuncture is at least safe when administered by well-trained practitioners, and that further research is warranted.

Traditional Chinese medicine's acupuncture theory predates use of the scientific method, and has received various criticisms based on scientific thinking. There is no physically verifiable anatomical or histological basis for the existence of acupuncture points or meridians. Proponents reply that TCM is a prescientific system that continues to have practical relevance, and point to neuroimaging research suggesting that certain acupuncture points have distinct effects that are not otherwise predictable anatomically.

Acupuncturists tend to perceive TCM concepts in functional rather than structural terms, i.e. as being useful in guiding evaluation and care of patients.


Contents

[edit] Traditional theory

Chinese medicine is based on a different paradigm from scientific biomedicine. Its theory holds the following explanation of acupuncture:

Acupuncture treats the human body as a whole that involves several "systems of function" that are in some cases loosely associated with (but not identified on a one-to-one basis with) physical organs. Some systems of function, such as the "triple heater" (San Jiao, also called the "triple burner") have no corresponding physical organ. Disease is understood as a loss of homeostasis among the several systems of function, and treatment of disease is attempted by modifying the activity of one or more systems of function through the activity of needles, pressure, heat, etc. on sensitive parts of the body of small volume traditionally called "acupuncture points" in English, or "xue" (穴, cavities) in Chinese. This is referred to as treating "patterns of disharmony".

Treatment of acupuncture points may be performed along the twelve main or eight extra meridians, located throughout the body, or on tender points, called "ashi" (signifying "that's it", "ouch", or "oh yes"). Of the eight extra meridians, only two have acupuncture points of their own. The other six meridians are "activated" by using a master and couple point technique which involves needling the acupuncture points located on the twelve main meridians that correspond to the particular extra meridian. Ten of the main meridians are named after organs of the body (Heart, Liver, etc.), and the other two are named after so called body functions (Heart Protector or Pericardium, and San Jiao). The meridians are capitalized to avoid confusion with a physical organ (for example, we write the "Heart meridian" as opposed to the "heart meridian"). The two most important of the eight "extra" meridians are situated on the midline of the anterior and posterior aspects of the trunk and head. The twelve primary meridians run vertically, bilaterally, and symmetrically and every channel corresponds to and connects internally with one of the twelve Zang Fu ("organs"). This means that there are six yin and six yang channels. There are three yin and three yang channels on each arm, and three yin and three yang on each leg.

The three yin channels of the hand (Lung, Pericardium, and Heart) begin on the chest and travel along the inner surface (mostly the anterior portion) of the arm to the hand.

The three yang channels of the hand (Large intestine, San Jiao, and Small intestine) begin on the hand and travel along the outer surface (mostly the posterior portion) of the arm to the head.

The three yang channels of the foot (Stomach, Gallbladder, and Bladder) begin on the face, in the region of the eye, and travel down the body and along the outer surface (mostly the anterior and lateral portion) of the leg to the foot.

The three yin channels of the foot (Spleen, Liver, and Kidney) begin on the foot and travel along the inner surface (mostly posterior and medial portion) of the leg to the chest or flank.

The movement of qi through each of the twelve channels is comprised of an internal and an external pathway. The external pathway is what is normally shown on an acupuncture chart and it is relatively superficial. All the acupuncture points of a channel lie on its external pathway. The internal pathways are the deep course of the channel where it enters the body cavities and related Zang-Fu organs. The superficial pathways of the twelve channels describe three complete circuits of the body.

The distribution of qi through the meridians is said to be as follows: Lung channel of hand taiyin to Large Intestine channel of hand yangming to Stomach channel of foot yangming to Spleen channel of foot taiyin to Heart channel of hand shaoyin to Small Intestine channel of hand taiyang to Bladder channel of foot taiyang to Kidney channel of foot shaoyin to Pericardium channel of hand jueyin to San Jiao channel of hand shaoyang to Gallbladder channel of foot shaoyang to Liver channel of foot jueyin then back to the Lung channel of hand taiyin.

Chinese medical theory holds that acupuncture works by normalizing the free flow of qi (a difficult-to-translate concept that pervades Chinese philosophy and is commonly translated as "vital energy") throughout the body. Pain or illnesses are treated by attempting to remedy local or systemic accumulations or deficiencies of qi. Pain is considered to indicate blockage or stagnation of the flow of qi, and an axiom of the medical literature of acupuncture is "no pain, no blockage; no blockage, no pain".

Many patients claim to experience the sensations of stimulus known in Chinese as "deqi" (得氣, "obtaining the qi" or "arrival of the qi"). This kind of sensation was historically considered to be evidence of effectively locating the desired point. There are some electronic devices now available which will make a noise when what they have been programmed to describe as the "correct" acupuncture point is pressed.

The acupuncturist decides which points to treat by observing and questioning the patient in order to make a diagnosis according to the tradition which he or she utilizes. In TCM, there are four diagnostic methods: inspection, auscultation and olfaction, inquiring, and palpation (Cheng, 1987, ch. 12). Inspection focuses on the face and particularly on the tongue, including analysis of the tongue size, shape, tension, color and coating, and the absence or presence of teeth marks around the edge. Auscultation and olfaction refer, respectively, to listening for particular sounds (such as wheezing) and attending to unusual body odor. Inquiring focuses on the "seven inquiries", which are: chills and fever; perspiration; appetite, thirst and taste; defecation and urination; pain; sleep; and menses and leukorrhea. Palpation includes feeling the body for tender "ashi" points, and palpation of the left and right radial pulses at two levels of pressure (superficial and deep) and three positions (immediately proximal to the wrist crease, and one and two fingers' breadth proximally, usually palpated with the index, middle and ring fingers). Other forms of acupuncture employ additional diagnosic techniques. In many forms of classical Chinese acupuncture, as well as Japanese acupuncture, palpation of the muscles and the hara (abdomen) are central to diagnosis.

There are also theories being developed to explain effects observed for acupuncture within the orthodox Western medical paradigm.

[edit] Categories of acupuncture points

Main article: Acupuncture points

[edit] TCM perspective on treatment of disease

Although TCM is based on the treatment of "patterns of disharmony" rather than biomedical diagnoses, practitioners familiar with both systems have commented on relationships between the two. A given TCM pattern of disharmony may be reflected in a certain range of biomedical diagnoses: thus, the pattern called Deficiency of Spleen Qi could manifest as chronic fatigue, diarrhea or uterine prolapse. Likewise, a population of patients with a given biomedical diagnosis may have varying TCM patterns. These observations are encapsulated in the TCM aphorism "One disease, many patterns; one pattern, many diseases". (Kaptchuk, 1982)

Acupuncture has been used to treat a number of conditions. Classically, "(i)n clinical practice, acupuncture treatment is typically highly-individualized and based on philosophical constructs, and subjective and intuitive impressions" and not on controlled scientific research."[2].


[edit] History

Main article: History of acupuncture


[edit] Clinical practice

Most modern acupuncturists use disposable stainless steel needles of fine diameter (0.007" to 0.020", 0.18 mm to 0.51 mm), sterilized with ethylene oxide or by autoclave. These needles are far smaller in diameter (and therefore less painful) than the needles used to give shots, since they do not have to be hollow for purposes of injection. The upper third of these needles is wound with a thicker wire (typically bronze), or covered in plastic, to stiffen the needle and provide a handle for the acupuncturist to grasp while inserting. The size and type of needle used, and the depth of insertion, depend on the acupuncture style being practised.

Warming an acupuncture point, typically by moxibustion (the burning of mugwort), is a different treatment from acupuncture itself and is often, but not exclusively, used as a supplementing treatment. The Chinese term zhēn jǐu (針灸), commonly used to refer to acupuncture, comes from zhen meaning "needle", and jiu meaning "moxibustion". Moxibustion is still used in the 21st century to varying degrees among the schools of oriental medicine. For example, one well known technique is to insert the needle at the desired acupuncture point, attach dried mugwort to the external end of an acupuncture needle, and then ignite the mugwort. The mugwort will then smolder for several minutes (depending on the amount adhered to the needle) and conduct heat through the needle to the tissue surrounding the needle in the patient's body. Another common technique is to hold a large glowing stick of moxa over the needles. Moxa is also sometimes burned at the skin surface, usually by applying an ointment to the skin to protect from burns.

[edit] Indications according to acupuncturists in the West

According to the American Academy of Medical Acupuncture (2004), acupuncture may be considered as a complementary therapy for these conditions:[3]

  • Acute and chronic pain control*
  • Posttraumatic and postoperative ileus *
  • Muscle spasms, tremors, tics, contractures*
  • Paresthesias *
  • Anxiety, fright, panic*
  • Drug detoxification *
  • Neuralgias (trigeminal, herpes zoster, postherpetic pain, other)
  • Seventh nerve palsy
  • Sequelae of stroke syndrome (aphasia, hemiplegia) *
  • Certain functional gastrointestinal disorders (nausea and vomiting, esophageal spasm, hyperacidity, irritable bowel) *
  • Headache (migraine and tension-type), vertigo (Meniere disease), tinnitus *
  • Phantom pain
  • Frozen shoulder *
  • Cervical and lumbar spine syndromes*
  • Plantar fasciitis*
  • Arthritis/arthrosis *
  • Bursitis, tendonitis, carpal tunnel syndrome*
  • Sprains and contusions
  • In fractures, assisting in pain control, edema, and enhancing healing process
  • Temporo-mandibular joint derangement, bruxism *
  • Dysmenorrhea, pelvic pain *
  • Anorexia
  • Atypical chest pain (negative workup)
  • Idiopathic palpitations, sinus tachycardia
  • Allergic sinusitis *
  • Persistent hiccups*
  • Selected dermatoses (urticaria, pruritus, eczema, psoriasis)
  • Constipation, diarrhea *
  • Urinary incontinence, retention (neurogenic, spastic, adverse drug effect) *
  • Abdominal distention/flatulence*
  • Severe hyperthermia
  • Cough with contraindications for narcotics
  • Anesthesia for high-risk patients or patients with previous adverse responses to anesthetics
* Also included in the World Health Organization list of acupuncture indications.[4]


[edit] Scientific theories and mechanisms of action

Main article: Scientific theories of acupuncture


[edit] Scientific research into efficacy

Main article: Scientific research into acupuncture


[edit] Safety and risk

Main article: Safety and risk in acupuncture


[edit] Legal status

Main article: Legal status of acupuncture

Central Nervous Pathway for Acupuncture Stimulation: Localization of Processing with Functional MR Imaging of the Brain—Preliminary Experience1 Ming-Ting Wu, MD, Jen-Chuen Hsieh, MD, PhD, Jing Xiong, MD, Chien-Fang Yang, MD, Huay-Ban Pan, MD, Yin-Ching Iris Chen, PhD, Guochuan Tsai, MD, PhD, Bruce R. Rosen, MD, PhD and Kenneth K. Kwong, PhD


[edit] See also

Portal:Health and care

[edit] Internal links

[edit] External links

[edit] Bibliography

  • NIH: "NIH Consensus Statement Online" 3 November - 5 November 1997 in Acupuncture, 1997; volume 15, issue 5,pp. 1-34.
  • Richardson PH, Vincent CA: "The evaluation of therapeutic acupuncture: concepts and methods" in Pain 1986; volume 24, pp1-13.
  • B. Brinkhaus, J. Hummelsberger, S. Jena, K. Linde, D. Melchart, A. Streng, S. Wagenpfeil, H.U. Walther, S.N. Willich, C. Witt. Acupuncture in Patients with Osteoarthritis of the Knee: A Randomised Trial. The Lancet, Vol 366, July 9 2005
  • Edwards, J. Acupuncture and Heart Health. Access, February 2002
  • trans by Wolfe, H.L. Chronic Fatigue Syndrome, Acupuncture and its related modalities. Townsend Letter for Doctors and Patients, August/September 2005. (translation of article from issue 8, 2001 Zhong Guo Zhen Jiu (Chinese Acupuncture and Moxibustion)
  • Abusaisha, B.B., Constanzi, J.B., Boulton, A.J.M. Acupuncture for the treatment of chronic painful diabetic neuropathy: a long term study. Diabetes Res Clin Pract 39:115-121, 1998
  • Altshul, Sara. "Incontinence: Finally, Relief That Works." Prevention December 2005: 33. Academic Search Premier. EBSCO. 30 January 2006 <http://search.epnet.com/>
  • Bosia, I., Deluze, C., Zirbs, A. Electroacupuncture in fibromyalgia: results of a controlled trial. BMJ 1992 21 November: 305 (6864): 1249-52
  • Cademartori, Lorraine. "Facing the Point." Forbes October 2005: 85. Academic Search
  • Chen, J.D.Z., Ouyang, H. Review article: therapeutic roles of acupuncture in functional gastrointestinal disorders. Aliment Pharmacol Therapy 2004; 20:831-841
  • Cheng Xinnong, chief editor. Chinese Acupuncture And Moxibustion. Foreign Languages Press: Beijing, 1987. ISBN 7-119-00378-X
  • Helms, J.M. Acupuncture for the Treatment of Primary Dysmenorrhea. Obstet Gynecology 1987; 69:51-56
  • Jin, Guanyuan, Xiang, Jia-Jia and Jin, Lei: Clinical Reflexology of Acupuncture and Moxibustion (Chinese). Beijing Science and Technology Press, Beijing, 2004. ISBN 7-5304-2862-4
  • Jin, Guan-Yuan, Jin, Jia-Jia X. and Jin, Louis L.: Contemporary Medical Acupuncture - A Systems Approach (English). Springer, USA & Higher Education Press, PRC, 2006. ISBN 7-04-019257-8
  • Kaptchuk, Ted. The Web That Has No Weaver. Congdon and Weed, (1983) ISBN 0-86553-109-9
  • Premier. EBSCO. 30 January 2006 <http://search.epnet.com/>
  • "A Few Commonly Used Acupunture Points." Net Firms. 2 February 2006 <http://chinese-school.netfirms.com/acupunture-points.html>
  • "History of Acupuncture." Net Firms. 2 February 2006 <http://chinese-school.netfirms.com/history-of-acupuncture.html>
  • "History of Acupuncture in China." Acupuncture Care. 2 February 2006 <http://www.acupuncturecare.com/acupunct.htm>
  • Howard, Cori. "An Ancient Helper for Making a Baby." Maclean’s 23 January 2006: 40. Academic Search Premier. EBSCO. 30 January 2006 <http://search.epnet.com/>
  • "Is Acupuncture Safe?" Net Firms. 2 February 2006<http://chinese-school.netfirms.com/acupuncture-safety.html>
  • "Is Acupuncture Safe?" Brian Carter, MS, L.Ac.
  • "What Is Acupuncture?" Net Firms. 2 February 2006 <http://chinese-school.netfirms.com/acupuncture-whatis.html>
  • Health Professions Regulatory Advisory Council, Minister’s Referral Letter January 18, 2006 – Traditional Chinese Medicine (TCM) <http://www.hprac.org/english/projects.asp> 20 March 2006
  • Porkert, Manfred "The Theoretical Foundations of Chinese Medicine" MIT Press, 1974 ISBN 0-262-16058-7
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