Chinese medicine is a complete, internally consistent, and scientific system of medical diagnosis and treatment. Acupuncture, a main modality of Chinese medical treatment, stimulates specific locations in the body through the insertion and skilled manipulation of fine needles, and other supplementary modalities, to bring about therapeutic effects.
Clinical benefits of acupuncture treatment include:
- Wound and tissue healing;
- Reduction of pain and swelling;
- Increased range-of-motion, strength, and flexibility; restored functional activity capacity;
- Restored function of internal organs and neural, vascular, and endocrine, and immune systems;
- Decreased stress, anxiety, and depression; increased psycho-social functioning.
Acupuncture originated in China beginning over 3,000 years ago, and is now practiced world-wide. Until recently, many translations of Chinese medical texts into Western languages presented acupuncture as a metaphysical system inconsistent with modern science. Ancient Chinese medical texts are now being re-visited by investigators with scientific and medical backgrounds that many early translators lacked. These investigations are clarifying that acupuncture works through known anatomical structures and physiologic processes. Ancient acupuncture texts describe functional interrelationships among soma, viscera, and psyche, and the immune, endocrine, neural, and vascular systems, that are increasingly recognized in modern medicine.
Because of its long and extensive history of clinical usage, efficacy, and safety, acupuncture has also become the subject of substantial scientific investigation. Modern science is now confirming the physiologic basis, therapeutic mechanisms, and clinical efficacy of classical acupuncture. A thorough statement of both ancient and modern scientific models of acupuncture may be found in one of the first peer-reviewed English-language publications on the subject, the Dao of Chinese Medicine, by Donald Kendall, OMD, Ph.D., L.Ac.
The physiologic basis of acupuncture is a web of specific locations (“points” or “nodes”) in the skin and underlying structures characterized by high concentrations of fine nerves and blood vessels, distributed longitudinally along vessel and nerve pathways, and organized segmentally at the spinal cord. Chinese texts identify over 670 such nodes on the surface of the body, as well as neurovascular structures that link them (often represented in the West as “meridians” on the skin through which “energy” flows). Analogous concepts in Western medicine include dermatomes, myotomes, and trigger point/referred pain patterns. But acupuncture nodes and their relationships to deeper neurovascular structures comprise a distinct system that is not any of the foregoing.
Basic research has identified anatomical and physiologic characteristics of acupuncture nodes and pathways, including:
- High density of interconnected fine neural and vascular structures and cellular gap junctions;
- Locally maximal conductance, density, and polarity of skin electrical currents;
- Sensitivity both to non-specific external stimulation, and to internal pathologic processes.
Acupuncture examination, diagnosis, and treatment planning includes inspection of nodal sites for visible abnormalities, as well as palpation for tension, flaccidity, bogginess, tenderness, parasthesia, referred pain patterns, and temperature differences. Monitoring changes in abnormalities may be used to assess the patient’s responsiveness to acupuncture modalities and techniques and evaluate progress.
Information gathered from inspection and palpation of nodes is integrated with data from Eastern and standard Western history and examination procedures and analyzed to reach both standard (ICD-9) and acupuncture-specific diagnoses. The diagnostic patterns of Chinese medicine in some cases overlap and correspond closely with Western medical patterns. Chinese medicine also traditionally recognizes relationships between physical, emotional, and mental signs and symptoms in unique ways that allow the experienced practitioner to reach comprehensive and holistic diagnoses and treatment plans.
If acupuncture is indicated, the practitioner chooses a combination of functionally related nodes, typically at sites distal, local and proximal along the longitudinal nodal pathways that traverse the injury or disease site, and at the related segmental level of the spinal cord where afferent signals from the other nodal sites are integrated (usually from 4-12 needling loci). The practitioner selects modalities and techniques within the acupuncture armamentarium appropriate to the patient and their condition, and proceeds to treatment.
Insertion of needles into the superficial body requires knowledge both of the location of nodes and the underlying anatomical structures. Each node has a nominal insertion depth that is adjusted for the size and anatomical characteristics of the patient, and the goals of therapy. Needles are typically inserted perpendicularly to the skin, but some nodal locations require insertion at specific angles to accommodate local anatomical restrictions. Although nodes are found in close association with nerves and blood vessels, under no circumstances are needles inserted into these structures. Likewise, needles are never inserted into the internal organs because of likely adverse consequences.
The most commonly used needles consist of an extremely thin (0.15 to 0.30 mm) stainless steel filiform metal shaft, usually from 0.5-2.0 inches in length, with a wire-wrapped or plastic handle. The handle allows the practitioner to better manipulate the needle and prevents the needle from migrating into the body. The narrow diameter of the needles ensures that insertion causes only micro-tissue damage and minimal sensation. The use of pre-sterilized, single-use disposable needles and universal precautions virtually eliminates the possibility of infectious disease transmission.
Needles are manipulated for a short time following insertion, most commonly through bi-directional rotation and poisoning of the needle shaft, to obtain a characteristic subjective and objective response known in Chinese as “de qi”. Patients typically report mild sensations at the insertion site including cramping, distention, warmth, tingling, vibration, and itching. Sometimes these sensations are felt to travel along the longitudinal neurovascular distributions towards or reaching the target injured or diseased areas. Practitioners may also notice characteristic tissue responses including local hyperemia, and “needle grasp.” The phenomenon of needle grasp occurs as growing mechanical coupling between the needle shaft and subcutaneous connective tissue causes an increased resistance to needle rotation and manipulation.
The practitioner may vary the type, intensity, and duration of needle manipulation and retention to emphasize specific therapeutic responses (e.g., pro- vs. anti-inflammatory, or sympathetic vs. parasympathetic stimulation). Typical treatments last from 15-45 minutes, and may include gentle and/or strong needle manual manipulation, and the use of supplementary techniques.
Supplementary techniques, that may be applied near the nodal site or along nodal pathways include:
- electro-stimulation (PENS, TENS);
- pressure (massage, scraping, suction cupping);
- heat (infrared lamps, hot packs, combustion of rolls of dried Artemisia vulgaris (“moxibustion”))
- chemical stimulation (topical applications containing mineral and plant substances from the traditional Chinese pharmacopoeia)
These supplementary modalities have distinctive therapeutic properties (described in subsequent sections). Supplementary modalities are also applied to obtain, modify, and/or enhance the effects of needle therapy, principally by lowering the threshold for de qi and propagated needle sensation. Clinical research and experience suggest that de qi and resulting propagated sensations along nodal pathways are reliable indicators that therapeutic mechanisms have been activated.
The therapeutic effects of stimulating nodal pathways include:
- Descending inhibitory control of pain signals;
- Relief of muscle tension and spasms, and restoration of motor and proprioceptive function;
- Anti-inflammatory and tissue regeneration responses;
- Immune system activation;
- Regulation of sympathetic/parasympathetic balance, promoting visceral and psychological homeostasis;
- Normalization of visceral and peripheral vascular tone and blood flow.
The net effect of these processes is the restoration of homeostasis–through stimulating the body’s own self-regulatory and self-healing processes.
The number of treatments required varies with each patient and their condition. Symptom relief is frequently obtained at the first treatment. Significant and lasting clinical benefit is expected by the 3rd or 4th treatment. Lack of positive response after half a dozen treatments signifies that the diagnosis or acupuncture treatment plan is inadequate, or that referral to another modality is indicated for that patient or condition. Chronic or complex conditions may require 1-3 treatments per week for several months. More acute conditions may be resolved after only a few treatments.
Copyright Essential Health Care Network 2003
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