KEY TERMS

Ch’i: Chinese concept of the vital essence; when Ch’i is unbalanced, disease results

meridians: designated pathways in the body with points that react to acupuncture stimulation

yang: Chinese concept of the positive, male element of the universe

yin: Chinese concept of the negative, female element of the universe

INDICATIONS AND PROCEDURES

The theory and practice of acupuncture are rooted in the Chinese concept of life—the Chi or qi (both are pronounced “chee”). The belief is that all things, animate and inanimate, have an internal source of energy, the Chi. This energy stabilizes the chemical composition of matter, and when this matter is broken down, energy is released. The practice of acupuncture is thought to stimulate this energy to relieve pain and speed healing.

According to the ancient Chinese system of medicine, two categories of organs are associated with the Chi: the Tsang and the Fou. The Fou is the group of organs that absorb food, digest it, and expel waste. They are all hollow organs such as the stomach, the large and small intestines, the bladder, and the gallbladder. Tsang organs are all associated with the blood-the heart, which circulates the blood around the body; the lungs, which oxygenate the blood; the spleen, which controls the red corpuscles; and the liver and the kidneys. For the energy flow to remain steady, it must pass unimpeded from one organ to another. If the organ is weak, the resultant energy passed on to the next organ is weakened. Acupuncture stimulates specifically designated points found on pathways in the body (called “meridians”) to correct the problem.

According to the Chinese system, the human “circuit” of energy comprises twelve meridians, which stretch along with the limbs from the toes and the fingers to the face and chest. There are six meridians in the upper limbs and six in the lower. Ten meridians are connected to the main organ by the sympathetic nervous system branches. Each of these meridians contains the Chi, which varies in strength and is governed by the nerve impulses arising from the organs. The meridians and their attendant vessels contain the flow of energy that enables the body to function efficiently.

Later, the meridian line concept was hypothesized to explain the effectiveness of the points. Acupuncturists selected these meridian points by observing the effects of stimulation on particular signs and symptoms. The meridian points that proved effective for certain ailments were organized, and acupuncture practitioners gave specific names to each.

According to modern medical concepts, some of these points are thought to be relating points at which a specific visceral disorder stimulates the autonomic nervous system. Anatomically, some of the meridian points appear to correspond to areas where a nerve appears to surface from a muscle or areas where vessels and nerves are located relatively superficially, such as areas between a muscle and a bone or a bone and a joint. These areas are generally composed of connective tissue. No contemporary anatomical or physiological research has confirmed the presence or existence of Ch’i.

The insertion of needles allegedly stimulates the meridians. The commonly used needles range in size from the diameter of a hair to that of a sewing needle. In China, round and cutting needles are commonly used. In Europe, the needles are slightly shorter and slightly wider in diameter.

Acupuncture is an ancient Chinese medical practice based on the concept of meridians, channels in the body through which flows the life force called Ch’i; acupuncture involves the insertion and manipulation of tiny needles along these meridians.

The needles are gold, silver, iron, platinum, or stainless steel. Stainless steel needles are most used. Infection caused by needle puncture is said to be extremely rare. It is routine to wipe the skin with alcohol before inserting the sterilized needle. Acupuncturists usually wipe the needle with alcohol sponges before each insertion on the same patient. Needles are discarded after being used in patients with a history of jaundice or hepatitis.

Insertion of a needle requires great skill and much practice. There are three different angles of penetration into the skin: perpendicular, oblique, and horizontal. These angles correspond to 90 degrees, 45 degrees, and a minimum angle, respectively. The angles may be chosen based on the thickness of the skin and the proximity to muscle or bone at the desired puncture point. The depth of penetration will vary.

Tapping (the tube method) is one method of insertion: When the diameter of the needle is small, this method is extremely effective. The needle is placed into the tube from either direction. This tube is shorter than the needle. The tube is removed gently with the right index finger and thumb. Gentle tapping of the needle handle with the right index finger introduces the needle easily. The acupuncturist must immediately remove the tapping finger from the needle head; otherwise, it causes pain.

In the twirling method (the freehand method), the left thumb and index finger make contact at the acupuncture point. The left hand is called the “pushing hand.” Next, the skin is cut with the needle tip, after which the needle is inserted by pushing and twirling it with the right hand.

The goal of advancing the needle and the needle motion is to create a needle feeling in the patient. The patient usually feels a dull, aching, paralyzing, or compressing sensation that radiates to a distal or proximal portion of the body. When the patient notices the needle feeling, the operator increases the feeling by using various needle motions. Numerous motions are available, such as the single-stick, twirling, vibration, intermittent, and retention motions.

Light skin and muscle massage are recommended to prepare the body to accept needle stimulation. Prepuncture massage makes skin cutting easier and helps the patient relax. In addition to these advantages, massage may make it possible to detect pathologies such as nodules, spasms, pain, and depression. Postpuncture massage helps confirm muscle hypersensitivity and the disappearance of pain or hard nodules that existed before the acupuncture was performed.

The amount of stimulation equals the strength of stimulation multiplied by the number of treatments; this depends on the patient’s sensitivity. Gradual increases in stimulation are essential. For acute disease, treatment is usually given once a day for ten days and then terminated for three to seven days. Treatment is administered once every two to three days for ten treatments and then terminated for seven days for chronic ailments. The patient is placed in a supine, sitting, prone, or side position- the most convenient position for the patient and physician. However, the patient may need a special position to relax the painful area.

One of the most important factors for effective acupuncture treatment is the accurate selection of acupuncture points. These points must be selected according to the specific ailment. The precise location of acupuncture points is crucial for obtaining the maximum therapeutic effect. This is difficult because of the different sizes and shapes of patients’ bodies. Each acupuncture point is only about three millimeters in diameter.

USES AND COMPLICATIONS

Stimulation treatments such as hot soaks and the management of certain pain problems with physical therapy have long been in existence. Acupuncture, which is one mode of stimulation therapy, works by changing the pattern of the passage of stimulation from the peripheral nerves to the central nervous system. Acupuncture has been studied for decades, but the evidence that provides clinical benefits is weak and inconsistent.

The basic approach of modern medicine involves removing the causal factor of disease. However, in this approach, the pain associated with a disease or a surgical procedure may not be eradicated instantaneously. The management of pain becomes an issue until the disease is cured or until the surgery and healing are complete. Controlling chemical receptors and reducing the sensitivity of those receptors is one way of treating pain. Intensive studies of the stimulation that causes pain have indicated that intrinsic chemical substances (polypeptides) such as histamine and serotonin, which stimulate the receptors, are essential for pain. Therefore, an antagonistic drug for these chemicals is often effective in controlling pain.

Although acupuncture is used to treat conditions as diverse as allergies, circulatory disorders, dermatologic disorders, gastrointestinal disorders, genital disorders, musculoskeletal disorders, neurologic disorders, and psychiatric and emotional disorders, the use of acupuncture for pain control (analgesia) can be described as the most basic level of treatment.

The English words “anesthesia” and “analgesia” are misleading when used to describe the freedom from surgical or obstetrical pain produced by acupuncture. Suppose “analgesia” is described as insensibility to pain without loss of consciousness. In that case, it is a more appropriate word than “anesthesia,” which is described as an insensibility, general or local, induced by anesthetic agents and a loss of sensation of neurogenic or psychogenic origin.

Acupuncture can produce partial numbness in any part of the body. The patient under acupuncture analgesia remains able to converse and cooperate with the surgical or obstetrical team. Obstetric patients recognize uterine contractions and can use their muscles to bring forth the fetus. Surgical patients can tell when incisions are made but not perceive them as painful. There is no memory loss, as in hypnosis or general anesthesia, and no paresthesia (abnormal sensations) comparable to the sensations following local anesthesia. However, acupuncture is not a substitute for general anesthesia during surgery.

Acupuncture is contraindicated for children under the age of seven, hemophiliacs, pregnant women, and people who fear needles. Because of heart, liver, or kidney disease, patients with anesthetic risks tolerate acupuncture analgesia well. Most operating room deaths and cases of cardiac arrest in the United States are caused by chemical anesthesia rather than by surgery.

Acupuncture can induce a feeling of well-being and calmness to allay the fear and apprehension most patients feel before surgery. It also appears to reduce both bleeding during surgical procedures and the incidence of shock. Postoperative acupuncture analgesia patients are spared nausea and the difficulties with urinating and defecating that frequently follow chemical anesthesia. Acupuncture analgesia does not mask symptoms as chemical anesthetics and analgesics do. The patient remains aware of their symptoms, but acupuncture diminishes them to a tolerable level.

Postoperative pain does not usually occur for several hours after the termination of acupuncture analgesia. When it does occur, acupuncture can be used again instead of narcotics, and the treatment seldom needs to be repeated more than once or twice. Some acupuncturists leave small needles superficially inserted for several days to relieve postoperative pain. Others give regular acupuncture treatments, leaving the needles in place for twenty minutes per day for as many days as necessary.

The main disadvantage of acupuncture analgesia is that it is less reliable than chemical analgesia or anesthesia. In some cases, acupuncture analgesia cannot be induced or becomes inadequate during a surgical procedure. It may not produce the relaxation desirable for some abdominal surgeries. For this reason, backup chemical anesthetics and analgesics are also available in most cases.

The actual induction of acupuncture analgesia takes about twenty minutes—slightly longer than chemical anesthesia. The more skilled the acupuncturist is, the fewer needles are required. In most cases, electroacupuncture instruments must remain attached to all acupuncture needles during the entire procedure. Still, these can usually be kept away from the surgical field. According to news reports, major surgical procedures in China have been performed with only one acupuncture needle as analgesia and without electric supplementation. However, these news reports are probably bogus.

The same thin (usually 30-gauge) stainless steel needles used for acupuncture treatments are used for acupuncture analgesia. In general, the points used to relieve chronic pain in a specific area are the points of choice for analgesia. To obtain sufficient analgesia for surgery, it is usually necessary to heighten the effect of the acupuncture needles by twirling them continually or by attaching electronic instruments to them to deliver a current of about two hundred microamperes, with a pulsating wave at a frequency of two hundred per minute during the entire procedure. Electronic instruments will usually increase the depth of analgesia or prolong an analgesic effect that is beginning to wear off.

Besides the acupuncture points for analgesia of specific areas of the body, points are often used to relieve anxiety and promote well-being. Needles are usually inserted for twenty minutes the evening before surgery and for at least twenty minutes before the actual surgery begins.

The theoretical principles of vital energy transmission determine which acupuncture points should be effective for the anticipated surgery. Acupuncture points on meridians passing directly through or in the vicinity of the surgical area are usually selected. An attempt is made to use points on these meridians as far away from the surgical field as possible.

PERSPECTIVE AND PROSPECTS

According to most reports, acupuncture appears to have been developed in the northernmost area of the middle region of China around 300 BCE. People in this area were primarily nomads, moving from one area to another.

Chinese high priests, who also often served as physicians, observed that men wounded in combat often reported the sudden disappearance of illnesses from which they had suffered for years. For example, a wound in a specific foot area would reduce blood pressure or relieve a headache or toothache, or an injury on the dorsal aspect of the knee joint would cure a migraine. Over the years, the high priests recorded numerous observations of the phenomenon of a wound in one part of the body curing a long-standing complaint at another point. They discovered that it was the location of the wound that was significant. A pinprick in the correct location was enough to effect relief. It was noted that certain body points responded more noticeably to stimulation than other points and that frequently there was a direct correlation between the responsive points and a particular ailment. They were subsequently named meridian points.

Later, when metal was introduced to the culture, needles were used as an irritant at meridian points. It was thought that pain from a specific ailment was diverted linearly through the meridian points to the body’s surface. Thus, the “meridian line” concept was developed, and thus acupuncture was discovered.

At first, the surgeon-priests used fish bones and sharpened bamboo splinters to affect the pricks. Later came finely honed needles. Warlords and nobles were treated with needles forged from gold and silver. As the science of acupuncture developed, it was discovered that the needles needed only to be inserted in a point of skin measuring about one-tenth of an inch.

The earliest book describing acupuncture was written in 50 BCE. It described the clinical applications of acupuncture with anatomical and physiological references based principally on the concept of the body’s meridian lines.

In 1912, Yüan Shih-K’ai, who had trained in modern Western culture, took office as president of the Republic of China. Under his rule, old Chinese medicine—including acupuncture—that had developed from tradition and experience was unable to survive except in outlying areas of China. In 1949, however, when Mao Zedong formed the People’s Republic of China, he tried to repopularize the old Chinese medicine methods, which had been helpful to him. In the 1930s, when Mao and his followers were retreating to the north, he was forced to depend mainly on these traditional methods for medical treatment.

In 1955, Shyuken, a follower of Mao, stated his belief that acupuncture was effective in managing illness. He wished to study the ancient Chinese way of medicine more systematically, comparing it to Western medicine, which he believed too analytical. Thus, a new medical movement began that united Western and Chinese medical practices.

Stimulation therapy using local heat, massage, and pressure has been known since ancient times. Long periods of observations and analysis by Chinese physicians of the effects of irritation of varying degrees at particular points on the body surface made it possible to relate specific points on the body (meridian points) to specific conditions.

According to ancient Chinese clinical concepts, the meridian points are peepholes into the body and pass holes for energy. The total number of meridian points was believed to be 365. Each was named according to its effect, anatomical location, appearance, and relation to the meridian line. These meridian points were selected initially according to measurements based on the patient’s unique anatomical standard (using the length between certain anatomical points, for example, between the shoulders). The examiner then selected the exact location of a meridian point, felt the areas chosen by the initial measurement, and observed the patient’s response with their fingertips.

Acupuncture’s popularity, like that of most techniques and discoveries, has waxed and waned throughout the years; for the most part, however, the Chinese have remained faithful to the five-thousand-year-old practice. The laws and acupuncture methods have endured, although these methods have been increasingly combined with Western medical techniques. Gradually, acupuncture has spread throughout the world, particularly in France, Russia, Japan, Switzerland, Germany, and the United States.

In 1997, the US National Institutes of Health (NIH) concluded that the efficacy of acupuncture is highly promising and a worthwhile research endeavor, especially in treating postoperative chemotherapy nausea and dental pain. Some studies showed that acupuncture might be useful in treating asthma and addiction and stroke rehabilitation. Other research has identified many of the mechanisms of action in acupuncture, most notably the release of opioids and other peptides and the corresponding changes in neuroendocrine functioning. However, the quality of acupuncture studies varies wildly, and some claims regarding acupuncture’s healing potential have been terrifically overblown.

In 2002, the National Health Interview Survey found that 8.2 million adults in the United States had used acupuncture and that 2.1 million had used it within the last year. Although the number of people who use acupuncture is significant, the Food and Drug Administration (FDA) reports exceedingly few complications.

A review of government-funded research studies on acupuncture found numerous uses being evaluated, including labor stimulation, postsurgical wound healing, control of chemotherapy-induced vomiting, and the treatment of substance abuse, incontinence, autism, cerebral palsy, and depression.

Further Reading