The Autonomic System
Acupuncture works good for asthma. Breathing, heart beat and digestion are controlled by the autonomic nervous system. It continues to function without any conscious will, but it should not be confused with the unconscious mind, frequently alluded to in text-books on psychology.Think the autonomic system as the automatic base or foundation on which the body is built.Asthma is due to a contraction of the small breathing tubes that allow air to enter the lungs. As these tubes contract, and become gummed up, the air flow in the tubes becomes turbulent, causing the whistle or wheeze that is heard in asthma. The small breathing tubes are lined with muscle, and this muscle is largely controlled by the autonomic system. When acupuncture is used to treat this type of disease it is logical that it works through the autonomic system, and it seems possible that many of the effects of acupuncture, on diseases like indigestion and diarrhoea, work through the same system, but yet there are no unified theories that explain either the autonomic system or the effects of acupuncture on this system.
It is also possible that the body is influenced far more by the autonomic system. If the autonomic system is anaesthetized, then severe intractable pain can sometimes be alleviated; for instance, if severe arm pain is experienced then it may be possible to cure the arm pain by infiltrating local anesthetic into the autonomic nerves that supply the arm. As the local anaesthetic wears off so the arm pain returns. This observation has no real explanation at the moment, because the interplay between pain and the autonomic system is unexplained.
There are some criticism that acupuncture is no more than a complex form of 'hypnotic suggestion'.Available research work shows that those gaining benefit from acupuncture treatment are no more or less suggestible than those for whom acupuncture does not work. Therefore it seems that acupuncture does not depend on suggestibility. At the same time, acupuncture does have a certain amount of 'magic and mystery' surrounding it. Almost certainly this creates a small amount of benefit although it does not fully explain the dramatic and significant therapeutic effects of acupuncture.
Clinical Application Theories
Whatever scientific theories are used to explain the mechanism of acupuncture, not even one explains where to place an acupuncture needle when the acupuncturist is confronted by a patient. The choice is largely based on the information obtained from traditional Chinese acupuncture. We will remain dependent on the empirical experience and philosophical theories of the ancient Chinese until a method of point selection can be deduced from an understanding of the scientific mechanism of acupuncture. Science will, and should, provide an explanation for the observations of the ancient Chinese, but in the meantime we should not reject acupuncture just because we cannot explain it completely.
The Principles of Therapy
I. The Principles of Disease
- Morphine, heroin and opium are all related chemicals, collectively called opiates.
- An acupuncture recipe is a selection of points used for a particular disease. No attempt is made to follow a traditional diagnosis, the points are just learnt ant used automatically.
There are two groups of diseases.Diseases of the channels and collaterals, and diseases of the zang and fu organs.
1. Diseases of the Channels and Collaterals
These diseases are for the superficial channels of the body. Athritis and acute strains are examples of this type of disease. The internal yin and yang balance is normal but the flow blood through the channels is disrupted.This causes pain and is called a disease of 'bi' or blockage of the channels. If the flow of blood is restored then the pain will go.
2. Diseases of the Zang and Fu Organs
These diseases affect the internal organs where there is an imbalance of yin and yang inside the body.Examples of this type are Neurasthenia and asthma.To treat and diagnose these diseases, one should know the rules of point selection.
Diseases that Combine Zang and Fu, and Channel Disorders
A disease of pain, such as migraine, may combine these two ideas. Migraine is usually a disorder of the gan-liver but there is also a blockage of the flow of blood in the channels around the temple, resulting in pain. The channels and collaterals, and the zang fu, will therefore both require treatment in this disease.
II. Principles of Point Selection
Channels and Collateral diseases
The treatment for these diseases are based on the local points selected ((Ah shi points or acupuncture points), and distal point on the channel.The local points can be found out easily than distal points when the patient is examined. There are no rules for the selection of these distal points, they have just been handed on to us as a product of empirical experience.
There are some common points for each type of disease and this local points may vary from disease to disease.The tender point, or the Ah shi point (both mean the same thing) also has a part to play. If you find a very tender area that does not seem to be an acupuncture point then use it as well as the local acupuncture points. The tender point is often an acupuncture point that you have not learnt.
These are part of the basic grammar of acupuncture and they just have to be learnt. The different distal points are:
Houxi (SI 3) This point may be used for pain over the small intestine channel, especially pain from cervical syndrome that is referred to the scapular area.
Hegu (LI 4) This point may be used for pain over the large intestine channel and it is also a very important point for facial pain, headache and sinusitis.
Quchi (LI 11) This is often used as a distal point for referred pain from the shoulder or neck.
Waiguan (SJ 5) This is the most important distal point in the upper limb. If there is pain in the upper limb that is not on a channel then this point may be used. It is also used when there is pain over the Sanjiao channel.
Weizhong (UB 40) This point is used for low back pain, or any pain over the lower part of the urinary bladder channel.
Kunlun (UB 60) This point is used for upper thoracic, cervical pain or headache, i.e. pain over the upper part of the urinary bladder channel.
Yanglingquan (GB 34) This may be used for any pain over the gall bladder channel, such as migraine.
Neiting (St 44) This is used for pain over the stomach channel such as facial pain, abdominal pain or hip pain radiating down the front of the leg.
These are the most important distal points. For some diseases no distal points are used, and the common diseases where these exceptions apply are knee pain, ankle pain, wrist pain, hand pain and foot pain. For these diseases use only the local points. Sometimes the local acupuncture points may not be tender until they are carefully examined.
Zang and Fu Organs diseases
The traditional diagnosis the acupuncturist will be able to diagnose what organ is diseased and what pathogen is causing that disease.Based on this the channel is selected to correct the problem, whether to sedate or tonify a particular organ.The pathogen should also be dispelled.To select a point for a particular disease, there are many rules.The experienced acupuncturist will often select only a few points.There are no dogmatic rules governing point selection for the zang fu diseases but there are several groups of special points that represent each organ.
The most therapeutically useful groups are :
Back shu and front mu points
These points represent the surface points of the organs, the mu points are on the front and the shu points are on the back. If the zang organs are diseased (yin organs) then the back shu points are particularly effective, and if the fu organs are diseased (yang organs) then the front mu points are useful.
The shu points can be alternated with points on the ventral surface of the body. The back shu points are particularly useful in treating a zang disorder when it is associated with back pain, primarily because the position of the patient for acupuncture is much simpler.
The back shu points are prefixed by the Chinese name for the organ, for instance pi means spleen and pishu is the back shu point for the spleen; wei means stomach and weishu is the back shu point for the stomach.
Yuan source points
These points are situated near the wrist and ankle.Taixi (K 3) and Taichong (Liv 3) are points commonly used for diseases of the gan-liver and shen-kidney; both are yuan source points.
Luo connecting points
In our body each channel is interlinked either internally or externally.Eg, lung and large intestine channels are connected.The luo connecting point is the actual connection between these two channels, so the diseases of the connected channel can be treated by using the luo connecting point; for instance disease of the large intestine channel may be treated by using Lieque (Lu 7).
To treat a disease related to a specific tissue or organ, these points are used.Zhongwan (Ren 12) is often used when there is abdominal pain because it is the influential point for the fu organs.
There are other groups of points, such as the Xi-cleft points or the lower .B ut they are of limited clinical value.Each channel has a point on it that represents each of the five elements. For the zang organs the jing-well points are wood, the yung-spring points are fire, the shu-stream points are earth, the jing-river points are metal and the he-sea points are water. For the fu organs jing-well is metal, yung-spring is water, shu-stream is wood, jing-river is fire and he-sea is earth.
These points, and the system they entail, may be used to tonify or sedate an organ. Wood creates fire, so fire is the 'son' of wood and wood is the 'mother' of fire. If the organ has a xu disease then the 'mother' point is used to tonify the diseased organ, for instance, if there is xu of xin-heart (fire) then use the mother point (wood) to tonify the heart. The wood point on the heart channel is Shaochong (H 9). If there is a shi disease of the xin-heart (fire) use the 'son' point (earth) to sedate the xin-heart. The earth point on the heart channel is Shenmen (H 7). Shenmen (H 7) is nearly always used for diseases of the xin-heart because most diseases of the xin-heart are shi in nature.
Points related to symptoms
In diseases of the zang and fu organs there are many points that can be used for symptoms such as nausea. There are also some very useful points that can be used to dispel various pathogens. They are:
Taiyuan (Lu 9) : This is used for cough, haematemasis and nasal obstruction.
Neiguan (P 6) : This is used for palpitations, nausea, vomiting and insomnia.
Shenmen (H 7) : This is used for palpitations, insomnia and diseases of the xin-heart.
Hegu (LI 4) : This is used for fever, rhinitis, facial nerve paralysis and the dispersal of wind.
Waiguan (SJ 5) : This is used for colds, fever, headache and strained neck.
Houxi (SI 3) : This is used for tinnitus and malaria.
Sanyinjiao (Sp 6) : This is used for disorders of the pi-spleen, impotence, irregular menstruation, enuresis, dysuria and insomnia.
Taichong (Liv 3) : This is used for headaches, vertigo, eye diseases, pain in the costal and hypochondriac region, insomnia and diseases of the gan-liver.
Taixi (K 3) : This is used for enuresis, dysuria, inspiratory dyspnoea, tinnitus, tooth cavities, chronic diarrhoea, poor vision, vertigo and impotence. This is an important point in deficiency diseases and diseases of the shen-kidney.
Zusanli (St 36) : This is used for diseases of pi-spleen and general tonification.
Baibui (Du 20) : This is used for headaches, dizziness, lifting (in vaginal or rectal prolapse), and mental diseases.
Quchi (LI 11) : This is used for dispersing wind and heat.
Fenglong (St 40) : This is used for resolving damp and phlegm.
Dazhui (Du 14) : This is used for resolving fever and malaria.
Shanzhong (Ren 17) : This is used for asthma, bronchitis and hiccoughs.
Zhongwan (Ren 12) : This is used for disorders of the fu organs, such as vomiting or abdominal pain.
Guanynan (Ren 4) : This is used for general tonification, diseases of xu, enuresis and impotence.
Qihai (Ren 6) : This is used as a point of general tonification.
Yintang (Extra) : This is used for insomnia and neurasthenia.
Many of the points that are listed as points according to symptoms have complex traditional reasons behind their selection. They have been shown to be useful points by using a combination of traditional medicine and Chinese experience. The choice of prescription for a particular disease is not always easy and experience may be the most important factor in making that choice.
III. Ah Shi Point
The tender point is called the Ah shi point by the Chinese.This is found in painful diseases and the acupuncturist choose the point by clinical examination and experience.In many cases the Ah shi point(s) may be felt as a pea-sized nodule(s) under the skin, or the patient may draw the attention of the acupuncturist to a painful area.This should be used in diseases of pain along with local points.
The Ah shi point(s) should be treated as an acupuncture point(s) and used as part of a normal prescription with other local and distal points. The acupuncturist must also remember that the Ah shi point(s) will often change from treatment to treatment and the patient should be examined thoroughly on each occasion.
IV. Stimulation of Acupuncture Points
Acupuncture is not the only way to stimulate an acupuncture point.Classical traditional medicine also involves the use of cupping and moxa to stimulate the points, and in some diseases these methods are preferable to using a needle. Certain points are impracticable for cupping, such as points on the arm and leg, and other points are forbidden to moxa, such as Jingming (UB 1).
The acupuncturist must be aware of the underlying tissues and organs when the needle is inserted.If the needle is inserted over the lung it must be inserted obliquely to avoid the danger of a pneumothorax and these accidents can be avoided by knowledge in basic anatomy.And the needle should should be sterilized before use to avoid any possibility of transmitting serum hepatitis.
It is important to remember that the piece of skin into which you insert the needle is relatively unimportant as long as the needle stimulates the acupuncture point. The needle for Shenmen (H 7) can be inserted in several different ways but the acupuncture point has been stimulated only if the needling sensation is felt. The actual acupuncture point is always underneath the skin, and it may be an inch or more deep to the dermis. The tip of the needle is the best point locator that the acupuncturist has at his disposal.
Deqi means needling sensation and this is difficult to describe unless you have actually felt it.It is not pleasant as well as not painful. Deqi is slightly different at each point.Points on the head usually have a burning or pricking sensation, whereas points on the limbs usually have a bursting, sore, full or numb sensation when they are stimulated.
The needle is stimulated by a perpendicular and rotary movement, lifting and thrusting the needle. Unless the acupuncturist obtains deqi over each acupuncture point used then the acupuncture point has not been stimulated, and this means that the acupuncture is of questionable value.
So much work is being done in this area and the Chinese are not the best people to give a clear picture of the use of stimulators.In general the stimulator is used in anaesthesia and when it is used therapeutically it is used for conditions of severe pain, acute conditions, scalp acupuncture, and conditions where ordinary needling has failed. The Chinese do not use it very much for treating disease.
This is used in acute or shi diseases, and the reinforcing method is used in chronic or xu diseases. Strong stimulation is approximately equivalent to the reducing method and weak stimulation is roughly equivalent to the reinforcing method. This is all dependent on the individual as strong stimulation of a sensitive patient may be equivalent to weak stimulation of a less sensitive person. In weak stimulation the manipulation of the needle should be stopped as soon as the patient feels deqi, in strong stimulation the needle should be stimulated until the needling sensation is intense.
If a patient is overstimulated then this may cause a temporary worsening of the condition. This is transitory and indicates a response to acupuncture. If this occurs then stimulate less forcefully next time.
Patients receiving acupuncture for the first time
Stimulate the needles gently on the first visit. Needles are usually inserted proximally first, but in those receiving treatment for the first time it is less distressing to use the distal points first.
Moxibustion and Cupping
Both these methods are used for stimulating an acupuncture point.They are nearly always used in diseases of cold where the main treatment is to warm the affected area. The indications for moxa and cupping are mentioned in the treatment of each specific disease, but in general cupping is usually the preferred method of warming a point, and where this is impracticable, such as on a limb or on the face, moxa is used.
Moxa is made from the dried leaves of Artemesia Vulgaris, the older the moxa the more effective it is. Moxa can be used in several different forms. Loose moxa, or moxa punk, can be made into small cones and burnt on the skin (it is removed before it burns) or it may be burnt on a slice of ginger or garlic.
Moxa sticks may also be used. These are rolls of moxa which can be used to heat the skin directly, or they can be cut and burnt on the end of a needle. This method of warm handling allows heat to travel directly into the acupuncture point.
Cupping is simply the use of partially evacuated glass or bamboo cups over the acupuncture point. A partial vacuum is created inside the cup by a flame, and with an adroit flick of the hand the cup is put on to the skin.
V. Length of Treatment
It has eight sessions and these sessions are every day, or sometimes more frequently in acute diseases, but they may be less frequent in chronic diseases.In general two or three treatments are given to consolidate the effects of acupuncture (after the symptoms have gone), so strict adherence to the length of treatment may not be needed.
What Acupuncture is doing?
Some people are frightened by the thought of acupuncture and may feel that it takes a great deal of courage to inflict 'the needles' on themselves. The first thing to understand was it is not a frightening experience. It does involve the insertion of fine needles through the skin, and most acupuncturists use between six and eight acupuncture needles at each treatment session. The needles used are smaller than injection needles. Acupuncture needles have a doweled end, not a cutting end like most hypodermic needles, and therefore are far less likely to cause tissue damage or bruising when inserted.
The insertion of an acupuncture needle is not a painful experience. It would be wrong to suppose that the insertion of an acupuncture needle is devoid of any sensation, but those who experience acupuncture do not usually describe it as a painful sensation.
Belief about Acupuncture
Patients should believe in acupuncture to enable it to work. Like any other type of medicine acupuncture works on those who believe in it and those who do not. The mechanism of acupuncture is not clearly understood but, as has already been mentioned, it is quite clear that reproducible biological changes occur when an acupuncture needle penetrates the skin. Accepting that all medical treatment is more effective if the doctor is trusted by the patient, this trust is not a prerequisite for the physiological changes that occur during and after acupuncture. No medical treatment works all the time, and acupuncture is no exception to this rule. First of all the doctor must have a clear idea of the natural history of the disease; if the disease is going to get better anyway, it is a little presumptuous to claim that the cure is due to acupuncture, just because the patient has received acupuncture. Furthermore vast number of statistics must be collected and analyzed before any treatment can be adequately assessed, and in the field of acupuncture the research has not yet been satisfactorily completed.
In general most people, and their problems, do not respond magically to one treatment, and between four and eight treatment sessions may be required in order to obtain the best results from acupuncture. Acupuncture can be a cure, or it can act as a palliative treatment; this depends on the condition that is being treated. If a chronically painful arthritic knee is treated with acupuncture then, on average, the improvement will last about six months and the knee will then require re-treatment. Some acupuncturists treat their patients every three months or so to avoid any deterioration in their condition. The traditional Chinese approach is to attempt to maintain the patient in a state of health and a regular three-monthly treatment pattern is therefore justified; however, many acupuncturists just treat patients when the symptoms recur. If the condition is self-limiting, such as the pain from an attack of shingles, then no further treatment is required after the pain is relieved.