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Acupuncture

Acupuncture

Definition

Acupuncture is one of the main forms of treatment in traditional Chinese medicine. It involves the use of sharp, thin needles that are inserted in the body at very specific points. This process is believed to adjust and alter the body's energy flow into healthier patterns, and is used to treat a wide variety of illnesses and health conditions.

Origins

The original text of Chinese medicine is the Nei Ching, The Yellow Emperor's Classic of Internal Medicine, which is estimated to be at least 2,500 years old. Thousands of books since then have been written on the subject of Chinese healing, and its basic philosophies spread long ago to other Asian civilizations. Nearly all of the forms of Oriental medicine which are used in the West today, including acupuncture, shiatsu, acupressure massage, and macrobiotics, are part of or have their roots in Chinese medicine. Legend has it that acupuncture developed when early Chinese physicians observed unpredicted effects of puncture wounds in Chinese warriors. The oldest known text on acupuncture, the Systematic Classic of Acupuncture, dates back to 282 a.d. Although acupuncture is its best known technique, Chinese medicine traditionally utilizes herbal remedies, dietary therapy, lifestyle changes and other means to treat patients.

In the early 1900s, only a few Western physicians who had visited China were fascinated by acupuncture, but outside of Asian-American communities it remained virtually unknown until the 1970s, when Richard Nixon became the first U.S. president to visit China. On Nixon's trip, journalists were amazed to observe major operations

being performed on patients without the use of anesthetics. Instead, wide-awake patients were being operated on with only acupuncture needles inserted into them to control pain . During that time, a famous columnist for the New York Times, James Reston, had to undergo surgery and elected to use acupuncture instead of pain medication, and he wrote some convincing stories on its effectiveness.

Today acupuncture is being practiced in all 50 states by more than 9,000 practitioners, with about 4,000 MDs including it in their practices. Acupuncture has shown no-table success in treating many conditions, and more than 15 million Americans have used it as a therapy. Acupuncture, however, remains largely unsupported by the medical establishment. The American Medical Association has been resistant to researching it, as it is based on concepts very different from the Western scientific model.

Several forms of acupuncture are being used today in America. Japanese acupuncture uses extremely thin needles and does not incorporate herbal medicine in its practice. Auricular acupuncture uses acupuncture points only on the ear, which are believed to stimulate and balance internal organs. In France, where acupuncture is very popular and more accepted by the medical establishment, neurologist Paul Nogier developed a system of acupuncture based on neuroendocrine theory rather than on traditional Chinese concepts, which is gaining some use in America.

Benefits

The World Health Organization (WHO) recommends acupuncture as an effective treatment for over forty medical problems, including allergies , respiratory conditions, gastrointestinal disorders, gynecological problems, nervous conditions, and disorders of the eyes, nose and throat, and childhood illnesses, among others. Acupuncture has been used in the treatment of alcoholism and substance abuse. In 2002, a center in Maine received a unique grant to study acupuncture treatment for substance abuse. Although recognizing that acupuncture had been used before for helping those with abuse, this study sought to show that ear acupuncture's effects on relaxation response helped those abusing drugs and alcohol better deal with the anxiety and life circumstances thought to lead them to substance abuse.

Acupuncture is an effective and low-cost treatment for headaches and chronic pain, associated with problems like back injuries and arthritis. It has also been used

to supplement invasive Western treatments like chemotherapy and surgery. Acupuncture is generally most effective when used as prevention or before a health condition becomes acute, but it has been used to help patients suffering from cancer and AIDS . In 2002, the National Institutes of health announced that pain from certain musculoskeletal conditions like fibromyalgia could be helped by acupuncture. Acupuncture is limited in treating conditions or traumas that require surgery or emergency care (such as for broken bones).

Description

Basic ideas of Chinese medicine

Chinese medicine views the body as a small part of the universe, and subject to universal laws and principles of harmony and balance. Chinese medicine does not draw a sharp line, as Western medicine does, between mind and body. The Chinese system believes that emotions and mental states are every bit as influential on disease as purely physical mechanisms, and considers factors like work, environment, lifestyle, and relationships as fundamental to the overall picture of a patient's health. Chinese medicine also uses very different symbols and ideas to discuss the body and health. While Western medicine typically describes health in terms of measurable physical processes made up of chemical reactions, the Chinese use ideas like yin and yang, chi, the organ system, and the five elements to describe health and the body. To understand the ideas behind acupuncture, it is worthwhile to introduce some of these basic terms.

YIN AND YANG. According to Chinese philosophy, the universe and the body can be described by two separate but complementary principles, that of yin and yang. For example, in temperature, yin is cold and yang is hot. In gender, yin is female and yang is male. In activity, yin is passive and yang is active. In light, yin is dark and yang is bright; in direction yin is inward and downward and yang is outward and up, and so on. Nothing is ever completely yin or yang, but a combination of the two. These two principles are always interacting, opposing, and influencing each other. The goal of Chinese medicine is not to eliminate either yin or yang, but to allow the two to balance each other and exist harmoniously together. For instance, if a person suffers from symptoms of high blood pressure, the Chinese system would say that the heart organ might have too much yang, and would recommend methods either to reduce the yang or to increase the yin of the heart, depending on the other symptoms and organs in the body. Thus, acupuncture therapies seek to either increase or reduce yang, or increase or reduce yin in particular regions of the body.

CHI. Another fundamental concept of Chinese medicine is that of chi (pronounced chee, also spelled qi ). Chi is the fundamental life energy of the universe. It is invisible and is found in the environment in the air, water, food and sunlight. In the body, it is the invisible vital force that creates and animates life. We are all born with inherited amounts of chi, and we also get acquired chi from the food we eat and the air we breathe. The level and quality of a person's chi also depends on the state of physical, mental and emotional balance. Chi travels through the body along channels called meridians.

THE ORGAN SYSTEM. In the Chinese system, there are twelve main organs: the lung, large intestine, stomach, spleen, heart, small intestine, urinary bladder, kidney, liver, gallbladder, pericardium, and the "triple warmer," which represents the entire torso region. Each organ has chi energy associated with it, and each organ interacts with particular emotions on the mental level. As there are twelve organs, there are twelve types of chi which can move through the body, and these move through twelve main channels or meridians. Chinese doctors connect symptoms to organs. That is, symptoms are caused by yin/yang imbalances in one or more organs, or by an unhealthy flow of chi to or from one organ to another. Each organ has a different profile of symptoms it can manifest.

THE FIVE ELEMENTS. Another basis of Chinese theory is that the world and body are made up of five main elements: wood, fire, earth, metal, and water. These elements are all interconnected, and each element either generates or controls another element. For instance, water controls fire and earth generates metal. Each organ is associated with one of the five elements. The Chinese system uses elements and organs to describe and treat conditions. For instance, the kidney is associated with water and the heart is associated with fire, and the two organs are related as water and fire are related. If the kidney is weak, then there might be a corresponding fire problem in the heart, so treatment might be made by acupuncture or herbs to cool the heart system and/or increase energy in the kidney system.

The Chinese have developed an intricate system of how organs and elements are related to physical and mental symptoms, and the above example is a very simple one. Although this system sounds suspect to Western scientists, some interesting parallels have been observed. For instance, Western medicine has observed that with severe heart problems, kidney failure often follows, but it still does not know exactly why. In Chinese medicine, this connection between the two organs has long been established.

MEDICAL PROBLEMS AND ACUPUNCTURE. In Chinese medicine, disease as seen as imbalances in the organ system or chi meridians, and the goal of any remedy or treatment is to assist the body in reestablishing its innate harmony. Disease can be caused by internal factors like emotions, external factors like the environment and weather, and other factors like injuries, trauma, diet, and germs. However, infection is seen not as primarily a problem with germs and viruses, but as a weakness in the energy of the body that is allowing a sickness to occur. In Chinese medicine, no two illnesses are ever the same, as each body has its own characteristics of symptoms and balance. Acupuncture is used to open or adjust the flow of chi throughout the organ system, which will strengthen the body and prompt it to heal itself.

A VISIT TO THE ACUPUNCTURIST. The first thing an acupuncturist will do is get a thorough idea of a patient's medical history and symptoms, both physical and emotional. This is done with a long questionnaire and interview. Then the acupuncturist will examine the patient to find further symptoms, looking closely at the tongue, the pulse at various points in the body, the complexion, general behavior, and other signs like coughs or pains. From this, the practitioner will be able to determine patterns of symptoms which indicate which organs and areas are imbalanced. Depending on the problem, the acupuncturist will insert needles to manipulate chi on one or more of the twelve organ meridians. On these twelve meridians, there are nearly 2,000 points that can be used in acupuncture, with around 200 points being most frequently used by traditional acupuncturists. During an individual treatment, one to 20 needles may be used, depending on which meridian points are chosen.

Acupuncture needles are always sterilized and acupuncture is a very safe procedure. The depth of insertion of needles varies, depending on which chi channels are being treated. Some points barely go beyond superficial layers of skin, while some acupuncture points require a depth of 1-3 in (2.5-7.5 cm) of needle. The needles generally do not cause pain. Patients sometimes report pinching sensations and often pleasant sensations, as the body experiences healing. Depending on the problem, the acupuncturist might spin or move the needles, or even pass a slight electrical current through some of them. Moxibustion may be sometimes used, in which an herbal mixture (moxa or mugwort ) is either burned like incense on the acupuncture point or on the end of the needle, which is believed to stimulate chi in a particular way. Also, acupuncturists sometimes use cupping, during which small suction cups are placed on meridian points to stimulate them.

How long the needles are inserted also varies. Some patients only require a quick in and out insertion to clear problems and provide tonification (strengthening of health), while some other conditions might require needles inserted up to an hour or more. The average visit to an acupuncturist takes about 30 minutes. The number of visits to the acupuncturist varies as well, with some conditions improved in one or two sessions and others requiring a series of six or more visits over the course of weeks or months.

Costs for acupuncture can vary, depending on whether the practitioner is an MD. Initial visits with non-MD acupuncturists can run from $50-$100, with follow-up visits usually costing less. Insurance reimbursement also varies widely, depending on the company and state. Regulations have been changing often. Some states authorize Medicaid to cover acupuncture for certain conditions, and some states have mandated that general coverage pay for acupuncture. Consumers should be aware of the provisions for acupuncture in their individual policies.

Precautions

Acupuncture is generally a very safe procedure. If a patient is in doubt about a medical condition, more than one physician should be consulted. Also, a patient should always feel comfortable and confident that their acupuncturist is knowledgable and properly trained.

Research & general acceptance

Mainstream medicine has been slow to accept acupuncture; although more MDs are using the technique, the American Medical Association does not recognize it as a specialty. The reason for this is that the mechanism of acupuncture is difficult to scientifically understand or measure, such as the invisible energy of chi in the body. Western medicine, admitting that acupuncture works in many cases, has theorized that the energy meridians are actually part of the nervous system and that acupuncture relieves pain by releasing endorphins, or natural pain killers, into the bloodstream. Despite the ambiguity in the biochemistry involved, acupuncture continues to show effectiveness in clinical tests, from reducing pain to alleviating the symptoms of chronic illnesses, and research in acupuncture is currently growing. The Office of Alternative Medicine of the National Institute of Health is currently funding research in the use of acupuncture for treating depression and attention-deficit disorder.

Training & certification

Medical acupuncture has evolved in America which uses traditional methods mainly as surgical techniques and pain management, and not as part of Chinese medicine overall. Medical acupuncture is performed by an MD or an osteopathic physician (DO). Currently 23 states allow only this type of acupuncture. Practitioners get their training as part of conventional medical school programs. As any MD can legally perform acupuncture, The American Academy of Medical Acupuncture (AAMA) was chartered in 1987 to support the education and correct practice of physician-trained acupuncturists. Its members must be either MDs or DOs who have completed proper study of acupuncture techniques. Address: 5820 Wilshire Blvd., Suite 500, Los Angeles, CA 90036, (323) 937-5514, http://medicalcupuntcture.org

For traditional acupuncturists, The National Commission for Certification of Acupuncturists (NCCA) conducts certification exams, promotes national standards, and registers members. Most states that license acupuncturists use the NCCA standards as certification. Address: 11 Canal Center Plaza, Ste. 300, Alexandra, VA 22314, (703) 548-9004, http://www.nccaim.org.

The American Association of Acupuncture and Oriental Medicine (AAAOM) is the largest organization for practitioners, with more than 1,600 members. Address: 1925 W. County Rd B2, Roseville, MN 55113, (651) 631-0204, http://www.aaaom.org.

Resources

BOOKS

Fleischman, Dr. Gary F. Acupuncture: Everything You Ever Wanted To Know. New York: Barrytown, 1998.

Kakptchuk, Ted. The Web That Has No Weaver: Understanding Chinese Medicine. New York: Congdon and Weed, 1983.

Requena, Yves, MD. Terrains and Pathology in Acupuncture. Massachusetts: Paradigm, 1986.

PERIODICALS

American Journal of Acupuncture. 1840 41st Ave., Suite 102, P.O. Box 610, Capitola, CA 95010.

Assefi, Nassim. "Acupuncture for Fibromyalgia." Alternative Medicine Alert. (February 2002): 13.

Savage, Lorraine. "Grant to Study Acupuncture"s Effectiveness on Patients Suffering from Substance Abuse." Healthcare Review. (March 19, 2002): 16.

OTHER

American Association of Oriental Medicine. http://www.aaom.org/ (December 28, 2000).

North American Society of Acupuncture and Alternative Medicine. http://www.nasa-altmed.com/ (December 28, 2000).

Douglas Dupler

Teresa G. Odle

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Acupuncture

Acupuncture

Definition

Acupuncture is one of the main forms of treatment in traditional Chinese medicine. It involves the use of sharp, thin needles that are inserted in the body at very specific points. This process is believed to adjust and alter the body's energy flow into healthier patterns, and is used to treat a wide variety of illnesses and health conditions.

Purpose

The World Health Organization (WHO) recommends acupuncture as an effective treatment for over forty medical problems, including allergies, respiratory conditions, gastrointestinal disorders, gynecological problems, nervous conditions, and disorders of the eyes, nose and throat, and childhood illnesses, among others. Acupuncture has been used in the treatment of alcoholism and substance abuse. It is an effective and low-cost treatment for headaches and chronic pain, associated with problems like back injuries and arthritis. It has also been used to supplement invasive Western treatments like chemotherapy and surgery. Acupuncture is generally most effective when used as prevention or before a health condition becomes acute, but it has been used to help patients suffering from cancer and AIDS. Acupuncture is limited in treating conditions or traumas that require surgery or emergency care (such as for broken bones).

Description

Origins

The original text of Chinese medicine is the Nei Ching, The Yellow Emperor's Classic of Internal Medicine, which is estimated to be at least 2,500 years old. Thousands of books since then have been written on the subject of Chinese healing, and its basic philosophies spread long ago to other Asian civilizations. Nearly all of the forms of Oriental medicine which are used in the West today, including acupuncture, shiatsu, acupressure massage, and macrobiotics, are part of or have their roots in Chinese medicine. Legend has it that acupuncture developed when early Chinese physicians observed unpredicted effects of puncture wounds in Chinese warriors. The oldest known text on acupuncture, the Systematic Classic of Acupuncture, dates back to 282 A.D. Although acupuncture is its best known technique, Chinese medicine traditionally utilizes herbal remedies, dietary therapy, lifestyle changes and other means to treat patients.

In the early 1900s, only a few Western physicians who had visited China were fascinated by acupuncture, but outside of Asian-American communities it remained virtually unknown until the 1970s, when Richard Nixon became the first U.S. president to visit China. On Nixon's trip, journalists were amazed to observe major operations being performed on patients without the use of anesthetics. Instead, wide-awake patients were being operated on with only acupuncture needles inserted into them to control pain. During that time, a famous columnist for the New York Times, James Reston, had to undergo surgery and elected to use acupuncture instead of pain medication, and he wrote some convincing stories on its effectiveness.

Today, acupuncture is being practiced in all 50 states by over 9,000 practitioners, with over 4,000 MDs including it in their practices. Acupuncture has shown notable success in treating many conditions, and over 15 million Americans have used it as a therapy. Acupuncture, however, remains largely unsupported by the medical establishment. The American Medical Association has been resistant to researching it, as it is based on concepts very different from the Western scientific model.

Several forms of acupuncture are being used today in America. Japanese acupuncture uses extremely thin needles and does not incorporate herbal medicine in its practice. Auricular acupuncture uses acupuncture points only on the ear, which are believed to stimulate and balance internal organs. In France, where acupuncture is very popular and more accepted by the medical establishment, neurologist Paul Nogier developed a system of acupuncture based on neuroendocrine theory rather than on traditional Chinese concepts, which is gaining some use in America.

KEY TERMS

Acupressure Form of massage using acupuncture points.

Auricular acupuncture Acupuncture using only points found on the ears.

Chi Basic life energy.

Meridian Channel through which chi travels in the body.

Moxibustion Acupuncture technique which burns the herb moxa or mugwort.

Tonification Acupuncture technique for strengthening the body.

Yin/Yang Universal characteristics used to describe aspects of the natural world.

Basic ideas of Chinese medicine

Chinese medicine views the body as a small part of the universe, and subject to universal laws and principles of harmony and balance. Chinese medicine does not draw a sharp line, as Western medicine does, between mind and body. The Chinese system believes that emotions and mental states are every bit as influential on disease as purely physical mechanisms, and considers factors like work, environment, lifestyle and relationships as fundamental to the overall picture of a patient's health. Chinese medicine also uses very different symbols and ideas to discuss the body and health. While Western medicine typically describes health in terms of measurable physical processes made up of chemical reactions, the Chinese use ideas like yin and yang, chi, the organ system, and the five elements to describe health and the body. To understand the ideas behind acupuncture, it is worthwhile to introduce some of these basic terms.

YIN AND YANG. According to Chinese philosophy, the universe and the body can be described by two separate but complementary principles, that of yin and yang. For example, in temperature, yin is cold and yang is hot. In gender, yin is female and yang is male. In activity, yin is passive and yang is active. In light, yin is dark and yang is bright; in direction yin is inward and downward and yang is outward and up, and so on. Nothing is ever completely yin or yang, but a combination of the two. These two principles are always interacting, opposing, and influencing each other. The goal of Chinese medicine is not to eliminate either yin or yang, but to allow the two to balance each other and exist harmoniously together. For instance, if a person suffers from symptoms of high blood pressure, the Chinese system would say that the heart organ might have too much yang, and would recommend methods either to reduce the yang or to increase the yin of the heart, depending on the other symptoms and organs in the body. Thus, acupuncture therapies seek to either increase or reduce yang, or increase or reduce yin in particular regions of the body.

CHI. Another fundamental concept of Chinese medicine is that of chi (pronounced chee, also spelled qi ). Chi is the fundamental life energy of the universe. It is invisible and is found in the environment in the air, water, food and sunlight. In the body, it is the invisible vital force that creates and animates life. We are all born with inherited amounts of chi, and we also get acquired chi from the food we eat and the air we breathe. The level and quality of a person's chi also depends on the state of physical, mental and emotional balance. Chi travels through the body along channels called meridians.

THE ORGAN SYSTEM. In the Chinese system, there are twelve main organs: the lung, large intestine, stomach, spleen, heart, small intestine, urinary bladder, kidney, liver, gallbladder, pericardium, and the "triple warmer," which represents the entire torso region. Each organ has chi energy associated with it, and each organ interacts with particular emotions on the mental level. As there are twelve organs, there are twelve types of chi which can move through the body, and these move through twelve main channels or meridians. Chinese doctors connect symptoms to organs. That is, symptoms are caused by yin/yang imbalances in one or more organs, or by an unhealthy flow of chi to or from one organ to another. Each organ has a different profile of symptoms it can manifest.

THE FIVE ELEMENTS. Another basis of Chinese theory is that the world and body are made up of five main elements: wood, fire, earth, metal, and water. These elements are all interconnected, and each element either generates or controls another element. For instance, water controls fire and earth generates metal. Each organ is associated with one of the five elements. The Chinese system uses elements and organs to describe and treat conditions. For instance, the kidney is associated with water and the heart is associated with fire, and the two organs are related as water and fire are related. If the kidney is weak, then there might be a corresponding fire problem in the heart, so treatment might be made by acupuncture or herbs to cool the heart system and/or increase energy in the kidney system.

The Chinese have developed an intricate system of how organs and elements are related to physical and mental symptoms, and the above example is a very simple one. Although this system sounds suspect to Western scientists, some interesting parallels have been observed. For instance, Western medicine has observed that with severe heart problems, kidney failure often follows, but it still does not know exactly why. In Chinese medicine, this connection between the two organs has long been established.

MEDICAL PROBLEMS AND ACUPUNCTURE. In Chinese medicine, disease as seen as imbalances in the organ system or chi meridians, and the goal of any remedy or treatment is to assist the body in reestablishing its innate harmony. Disease can be caused by internal factors like emotions, external factors like the environment and weather, and other factors like injuries, trauma, diet, and germs. However, infection is seen not as primarily a problem with germs and viruses, but as a weakness in the energy of the body which is allowing a sickness to occur. In Chinese medicine, no two illnesses are ever the same, as each body has its own characteristics of symptoms and balance. Acupuncture is used to open or adjust the flow of chi throughout the organ system, which will strengthen the body and prompt it to heal itself.

A VISIT TO THE ACUPUNCTURIST. The first thing an acupuncturist will do is get a thorough idea of a patient's medical history and symptoms, both physical and emotional. This is done with a long questionnaire and interview. Then the acupuncturist will examine the patient to find further symptoms, looking closely at the tongue, the pulse at various points in the body, the complexion, general behavior, and other signs like coughs or pains. From this, the practitioner will be able to determine patterns of symptoms which indicate which organs and areas are imbalanced. Depending on the problem, the acupuncturist will insert needles to manipulate chi on one or more of the twelve organ meridians. On these twelve meridians, there are nearly 2,000 points which can be used in acupuncture, with around 200 points being most frequently used by traditional acupuncturists. During an individual treatment, one to twenty needles may be used, depending on which meridian points are chosen.

Acupuncture needles are always sterilized and acupuncture is a very safe procedure. The depth of insertion of needles varies, depending on which chi channels are being treated. Some points barely go beyond superficial layers of skin, while some acupuncture points require a depth of 1-3 in (2.5-7.5 cm) of needle. The needles generally do not cause pain. Patients sometimes report pinching sensations and often pleasant sensations, as the body experiences healing. Depending on the problem, the acupuncturist might spin or move the needles, or even pass a slight electrical current through some of them. Moxibustion may be sometimes used, in which an herbal mixture (moxa or mugwort) is either burned like incense on the acupuncture point or on the end of the needle, which is believed to stimulate chi in a particular way. Also, acupuncturists sometimes use cupping, during which small suction cups are placed on meridian points to stimulate them.

How long the needles are inserted also varies. Some patients only require a quick in and out insertion to clear problems and provide tonification (strengthening of health), while some other conditions might require needles inserted up to an hour or more. The average visit to an acupuncturist takes about thirty minutes. The number of visits to the acupuncturist varies as well, with some conditions improved in one or two sessions and others requiring a series of six or more visits over the course of weeks or months.

Costs for acupuncture can vary, depending on whether the practitioner is an MD. Initial visits with non-MD acupuncturists can run from $50-$100, with follow-up visits usually costing less. Insurance reimbursement also varies widely, depending on the company and state. Regulations have been changing often. Some states authorize Medicaid to cover acupuncture for certain conditions, and some states have mandated that general coverage pay for acupuncture. Consumers should be aware of the provisions for acupuncture in their individual policies.

Precautions

Acupuncture is generally a very safe procedure. If a patient is in doubt about a medical condition, more than one physician should be consulted. Also, a patient should always feel comfortable and confident that their acupuncturist is knowledgable and properly trained.

Research and general acceptance

Mainstream medicine has been slow to accept acupuncture; although more MDs are using it, the American Medical Association does not recognize it as a specialty. The reason for this is that the mechanism of acupuncture is difficult to scientifically understand or measure, such as the invisible energy of chi in the body. Western medicine, admitting that acupuncture works in many cases, has theorized that the energy meridians are actually part of the nervous system and that acupuncture relieves pain by releasing endorphins, or natural pain killers, into the bloodstream. Despite the ambiguity in the biochemistry involved, acupuncture continues to show effectiveness in clinical tests, from reducing pain to alleviating the symptoms of chronic illnesses, and research in acupuncture is currently growing. The Office of Alternative Medicine of the National Institute of Health is currently funding research in the use of acupuncture for treating depression and attention-deficit disorder.

Resources

PERIODICALS

American Journal of Acupuncture. 1840 41st Ave., Suite 102, P.O. Box 610, Capitola, CA 95010.

OTHER

American Association of Oriental Medicine. December 28, 2000. http://www.aaom.org.

North American Society of Acupuncture and Alternative Medicine. December 28, 2000. http://www.nasa-altmed.com.

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Within the “Cite this article” tool, pick a style to see how all available information looks when formatted according to that style. Then, copy and paste the text into your bibliography or works cited list.

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Notes:
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Acupuncture

Acupuncture

Definition

Acupuncture, one of the main forms of therapy in traditional Chinese medicine (TCM), has been practiced for at least 2,500 years. In acupuncture, certain points on the body associated with energy channels or meridians are stimulated by the insertion of fine needles. Unlike the hollow hypodermic needles used in mainstream medicine to give injections or draw blood, acupuncture needles are solid. The points can be needled between 15 and 90 degrees in range relative to the skin's surface, depending on treatment.

Acupuncture is thought to restore health by removing energy imbalances and blockages in the body. Practitioners of TCM believe that there is a vital force or energy called qi (pronounced "chee") that flows through the body, and between the skin surface and the internal organs, along channels or pathways called meridians. There are 12 major and 8 minor meridians. Qi regulates the spiritual, emotional, mental, and physical harmony of the body by keeping the forces of yin and yang in balance. Yang is a principle of heat, activity, brightness, outwardness, while yin represents coldness, passivity, darkness, interiority, etc. TCM does not try to eliminate either yin or yang, but to keep them in harmonious balance. Acupuncture may be used to raise or lower the level of yin or yang in a specific part of the body in order to restore the energy balance.

Acupuncture was virtually unknown in the United States prior to President Nixon's trip to China in 1972. A reporter for the New York Times named James Reston wrote a story for the newspaper about the doctors in Beijing who used acupuncture to relieve his pain following abdominal surgery. By 1993, Americans were making 12 million visits per year to acupuncturists, and spending $500 million annually on acupuncture treatments. By 1995, there were an estimated 10,000 certified acupuncturists practicing in the United States; as of 2000, there were 20,000. About a third of the credentialed acupuncturists in the United States as of 2002 are MDs.

Acupuncture's record of success has been sufficiently impressive to stimulate a number of research projects investigating its mechanisms as well as its efficacy. Research has been funded not only by the National Center for Complementary and Alternative Medicine (NCCAM), but also by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Institute of Dental Research, the National Institute of Neurological Disorders and Stroke (NINDS), and the National Institute on Drug Abuse. In 1997 a consensus panel of the National Institutes of Health (NIH) presented a landmark report in which it described acupuncture as a sufficiently promising form of treatment to merit further study. In 2000, the British Medical Association (BMA) recommended that acupuncture should be made more readily available through the National Health Service (NHS), and that family doctors should be trained in some of its techniques.

Purpose

As already noted, the purpose of acupuncture in TCM is the rebalancing of opposing energy forces in different parts of the body. In Western terms, acupuncture is used most commonly as an adjunctive treatment for the relief of chronic or acute pain. In the United States, acupuncture is most widely used to treat pain associated with musculoskeletal disorders, but it has also been used in the treatment of substance abuse, and to relieve nausea and vomiting. A study done in 2001 showed that acupuncture was highly effective in stopping the intense vomiting associated with a condition in pregnant women known as hyperemesis gravidarum. In the past several years, acupuncture has been tried with a new patient population, namely children with chronic pain syndromes. One study of 30 young patients with disorders ranging from migraine headaches to endometriosis found that 70% felt that their symptoms had been relieved by acupuncture, and described themselves as "pleased" by the results of treatment. In addition to these disorders, acupuncture has been used in the United States to treat asthma, infertility, depression, anxiety, HIV infection, fibromyalgia, menstrual cramps, carpal tunnel syndrome, tennis elbow, pitcher's shoulder, chronic fatigue syndrome, and postoperative pain. It has even been used in veterinary medicine to treat chronic pain and prevent epileptic convulsions in animals. As of 2002, NCCAM is sponsoring research regarding the effectiveness of acupuncture in the rehabilitation of stroke patients.

The exact Western medicine mechanism by which acupuncture works is not known. Western researchers have suggested three basic explanations of acupuncture's efficacy in pain relief:

  • Western studies have found evidence that the traditional acupuncture points conduct electromagnetic signals. Stimulating the acupuncture points causes these signals to be relayed to the brain at a higher than normal rate. These signals in turn cause the brain to release pain-relieving chemicals known as endorphins, and immune system cells to weak or injured parts of the body.
  • Other studies have shown that acupuncture activates the release of opioids into the central nervous system. Opioids are also analgesic, or pain-relieving compounds.
  • Acupuncture appears to alter the chemical balance of the brain itself by modifying the production and release of neurotransmitters and neurohormones. Acupuncture has been documented to affect certain involuntary body functions, including immune reactions, blood pressure, and body temperature.

In addition to its efficacy in relieving pain and other chronic conditions, acupuncture has gained in popularity because of several additional advantages:

  • It lacks the side effects associated with many medications and surgical treatments in Western medicine.
  • It is highly cost-effective; it may be used early in the course of a disease, potentially saving the patient the cost of hospitalizations, laboratory tests, and high-priced drugs.
  • It can easily be combined with other forms of therapy, including psychotherapy.
  • It is noninvasive.
  • It carries relatively few risks.

Precautions

Although the risk of infection in acupuncture is minimal, patients should make sure that the acupuncturist uses sterile disposable needles. In the United States, the Food and Drug Administration (FDA) mandates the use of sterilized needles made from nontoxic materials. The needles must be clearly labeled as having their use restricted to qualified practitioners.

Patients should also inquire about the practitioner's credentials. Since acupuncture is now taught in over forty accredited medical schools and osteopathic colleges in the United States, patients who would prefer to be treated by an MD or an osteopath can obtain a list of licensed physicians who practice acupuncture in their area from the American Academy of Medical Acupuncture. With regard to nonphysician acupuncturists, 31 states have established training standards that acupuncturists must meet in order to be licensed in those states. In Great Britain, practitioners must qualify by passing a course offered by the British Acupuncture Accreditation Board.

Patients seeking acupuncture treatment should provide the practitioner with the same information about their health conditions and other forms of treatment that they would give their primary care doctor. This information should include other alternative and complementary therapies, especially herbal remedies.

Acupuncture should not be used to treat severe traumatic injuries and other emergency conditions requiring immediate surgery. In addition, it does not appear to be useful in smoking cessation programs.

As is true with other forms of medical treatment, a minority of patients do not respond to acupuncture. The reasons for nonresponsiveness are not known at the present stage of research.

Description

In traditional Chinese medicine, acupuncture treatment begins with a thorough physical examination in which the practitioner evaluates the patient's skin color, vocal tone, and tongue color and coating. The practitioner then takes the patient's pulse at six locations and three depth levels on each wrist. These thirty-six pulse measurements will tell the practitioner where the qi in the patient's body might be blocked or unbalanced. After collecting this information, the acupuncturist will then identify the patterns of energy disturbance and the acupuncture points that should be stimulated to unblock the qi or restore harmony. Up to ten or twelve acupuncture needles will be inserted at strategic points along the relevant meridians. In traditional Chinese practice, the needles are twirled or rotated as they are inserted. Many patients feel nothing at all during this procedure, although others experience a prickling or mild aching sensation, and still others a feeling of warmth or heaviness.

The practitioner may combine acupuncture with moxibustion to increase the effectiveness of the treatment. Moxibustion is a technique in which the acupuncturist lights a small piece of wormwood, called a moxa, above the acupuncture point above the skin. When the patient begins to feel the warmth from the burning herb, it is removed. Cupping is another technique that is a method of stimulation of acupuncture points by applying suction through a metal, wood, or glass jar, and in which a partial vacuum has been created. Producing blood congestion at the site, the site is thus stimulated. The method is used for lower back pain, sprains, soft tissue injuries, as well as relieving fluid from the lungs in chronic bronchitis.

In addition to the traditional Chinese techniques of acupuncture, the following are also used in the United States:

  • Electroacupuncture. In this form of acupuncture, the traditional acupuncture points are stimulated by an electronic device instead of a needle.
  • Japanese meridian acupuncture. Japanese acupuncture uses thinner, smaller needles, and focuses on the meridians rather than on specific points along their course.
  • Korean hand acupuncture. Traditional Korean medicine regards the hand as a "map" of the entire body, such that any part of the body can be treated by stimulating the corresponding point on the hand.
  • Western medical acupuncture. Western physicians trained in this style of acupuncture insert needles into so-called trigger points in sore muscles, as well as into the traditional points used in Chinese medicine.
  • Ear acupuncture. This technique regards the ear as having acupuncture points that correspond to other parts of the body. Ear acupuncture is often used to treat substance abuse and chronic pain syndromes.

A standard acupuncture treatment takes between 45 minutes to an hour and costs between $40 and $100, although initial appointments often cost more. Chronic conditions usually require 10 treatment sessions, but acute conditions or minor illnesses may require only one or two visits. Follow-up visits are often scheduled for patients with chronic pain. As of 2000, about 70%80% of health insurers in the United States reimbursed patients for acupuncture treatments.

Preparation

Apart from a medical history and physical examination, no specific preparation is required for an acupuncture treatment. In addition to using sterile needles, licensed acupuncturists will wipe the skin over each acupuncture point with an antiseptic solution before inserting the needle.

Aftercare

No particular aftercare is required, as the needles should not draw blood when properly inserted. Many patients experience a feeling of relaxation or even a pleasant drowsiness after the treatment. Some patients report feeling energized.

Risks

Several American and British reports have concluded that the risks to the patient from an acupuncture treatment are minimal. Most complications from acupuncture fall into one of three categories: infections, most often from improperly sterilized needles; bruising or minor soft tissue injury; and injuries to muscle tissue. Serious side effects with sterilized needles are rare, although cases of pneumothorax and cardiac tamponade have been reported in the European literature. One American pediatrician estimates that the risk of serious injury from acupuncture performed by a licensed practitioner ranges between 1:10,000 and 1:100,000 or about the same degree of risk as a negative reaction to penicillin.

Normal results

Normal results from acupuncture are relief of pain and/or improvement of the condition being treated.

Abnormal results

Abnormal results from acupuncture include infection, a severe side effect, or worsening of the condition being treated.

Resources

BOOKS

Pelletier, Kenneth R., MD. "Acupuncture: From the Yellow Emperor to Magnetic Resonance Imaging (MRI)." Chapter 5 in The Best Alternative Medicine. New York: Simon and Schuster, 2002.

Reid, Daniel P. Chinese Herbal Medicine. Boston, MA: Shambhala, 1993.

Svoboda, Robert, and Arnie Lade. Tao and Dharma: Chinese Medicine and Ayurveda. Twin Lakes, WI: Lotus Press, 1995.

PERIODICALS

Cerrato, Paul L. "New Studies on Acupuncture and Emesis (Acupuncture for Relief of Nausea and Vomiting Caused by Chemotherapy)." Contemporary OB/GYN 46 (April, 2001): 749.

Kemper, Kathi J., and others. "On Pins and Needles? Pediatric Pain: Patients' Experience with Acupuncture." Pediatrics 105 (April 2000): 620633.

Kirchgatterer, Andreas. "Cardiac Tamponade Following Acupuncture." Chest 117 (May 2000): 15101511.

Nwabudike, Lawrence C., and Constantin Ionescu-Tirgoviste. "Acupuncture in the Treatment of Diabetic Peripheral Neuropathy." Diabetes 49 (May 2000): 628.

Silvert, Mark. "Acupuncture Wins BMA Approval (British Medical Association)." British Medical Journal 321 (July 1, 2000): 637639.

Vickers, Andrew. "Acupuncture (ABC of Complementary Medicine)." British Medical Journal 319 (October 9, 1999): 704-708.

ORGANIZATIONS

American Academy of Medical Acupuncture/Medical Acupuncture Research Organization. 5820 Wilshire Boulevard, Suite 500, Los Angeles, CA 90036. (800) 521-2262 or (323) 937-5514. Fax: (323) 937-0959. <www.medicalacupuncture.org>.

American Association of Oriental Medicine. 433 Front Street, Catasaqua, PA 18032. (610) 266-1433. Fax: (610) 264-2768. <www.aaom.org>.

National Center for Complementary and Alternative Medicine (NCCAM) Clearinghouse. P.O. Box 7923, Gaithersburg, MD 20898. (888) 644-6226. TTY: (866) 464-3615. Fax: (866) 464-3616. <www.nccam.nih.gov>.

OTHER

National Center for Complementary and Alternative Medicine (NCCAM). Fact Sheets. Acupuncture Information and Resources. <www.nccam.nih.gov/fcp/factsheets/ acupuncture>.

Rebecca J. Frey, Ph.D.

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Acupuncture

Acupuncture

Definition

Acupuncture, one of the main forms of therapy in traditional Chinese medicine (TCM), has been practiced for at least 2,500 years. In acupuncture, certain points on the body are stimulated by the insertion of fine needles. Unlike the hollow hypodermic needles used in mainstream medicine to give injections or to draw blood, acupuncture needles are solid. The points can be needled between 15° and 90° relative to the skin's surface, depending on treatment.

Acupuncture is thought to restore health by removing energy imbalances and blockages in the body. Practitioners of TCM believe that there is a vital force or energy called qi (pronounced "chee") that flows through the body and between the skin surface and the internal organs, along channels or pathways called meridians. There are 12 major and eight minor meridians. Qi regulates the spiritual, emotional, mental, and physical harmony of the body by keeping the forces of yin and yang in balance. Yang is a principle of heat, activity, brightness, outwardness, while yin represents coldness, passivity, darkness, interiority, etc. TCM does not try to eliminate either yin or yang, but rather keep them in harmonious balance. Acupuncture may be used to raise or lower the level of yin or yang in a specific part of the body in order to restore the energy balance.

Acupuncture was virtually unknown in the United States prior to President Richard Nixon's trip to China in 1972. A reporter for the New York Times named James Reston wrote a story for the newspaper about the doctors in Beijing who used acupuncture to relieve his pain following abdominal surgery. By 1993, Americans were making 12 million visits per year to acupuncturists, and spending $500 million annually on acupuncture treatments. By 1995, there were an estimated 10,000 certified acupuncturists practicing in the United States; as of 2000, there were 20,000. About a third of the credentialed acupuncturists in the United States as of 2002 are MDs.

Acupuncture's record of success has stimulated a number of research projects investigating its mechanisms as well as its efficacy. Research has been funded not only by the National Center for Complementary and Alternative Medicine (NCCAM), but also by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Institute of Dental Research, the National Institute of Neurological Disorders and Stroke (NINDS), and the National Institute on Drug Abuse. In 1997, a consensus panel of the National Institutes of Health (NIH) presented a report in which it described acupuncture as a sufficiently promising form of treatment to merit further study. In 2000, the British Medical Association (BMA) recommended that acupuncture should be made more readily available through the National Health Service (NHS), and that family doctors should be trained in some of its techniques.

Purpose

The purpose of acupuncture in TCM is the rebalancing of opposing energy forces in different parts of the body. In Western terms, acupuncture is used most commonly as an adjunctive treatment for the relief of chronic or acute pain. In the United States, acupuncture is most widely used to treat pain associated with musculoskeletal disorders, but it has also been used in the treatment of headaches, other painful disorders, and nausea and vomiting. In addition to these disorders, acupuncture has been used to treat a variety of disorders such as asthma, infertility, depression , anxiety, HIV infection, and fibromyalgia, although its efficacy in relieving these disorders is largely unproven. Acupuncture should not be used to treat traumatic injuries and other emergency conditions requiring immediate surgery. Also, while it appears to have benefits in relieving symptoms such as pain under the proper circumstances, it has not been shown to alter the underlying course of a disease.

The exact mechanism by which acupuncture works is not known. Studies have demonstrated a variety of physiologic effects such as release in the brain of various chemicals and hormones, alteration of immune function, blood pressure, and body temperature.

Precautions

The risk of infection in acupuncture is minimal if the acupuncturist uses sterile disposable needles. In the United States, the Food and Drug Administration (FDA) mandates the use of sterilized needles made from nontoxic materials. The needles must be clearly labeled as having their use restricted to qualified practitioners.

Patients should also inquire about the practitioner's credentials. People who would prefer to be treated by an MD or an osteopath can obtain a list of licensed physicians

who practice acupuncture in their area from the American Academy of Medical Acupuncture. With regard to non-physician acupuncturists, 31 states have established training standards that acupuncturists must meet in order to be licensed in those states. In Great Britain, practitioners must qualify by passing a course offered by the British Acupuncture Accreditation Board.

People seeking acupuncture treatment should provide the practitioner with the same information about their health conditions and other forms of treatment that they would give their primary care doctor.

As is true with other forms of medical treatment, a minority of patients do not respond to acupuncture. The reasons for nonresponsiveness are not known at the present stage of research.

Description

In traditional Chinese practice, the needles are twirled or rotated as they are inserted. Many patients feel nothing at all during this procedure, while others experience a prickling or aching sensation, and still others a feeling of warmth or heaviness.

The practitioner may combine acupuncture with moxibustion to increase the effectiveness of the treatment. Moxibustion is a technique in which the acupuncturist lights a small piece of wormwood, called a moxa, above the acupuncture point above the skin. When the patient begins to feel the warmth from the burning herb, it is removed. Cupping is another technique that is a method of stimulation of acupuncture points by applying suction through a metal, wood, or glass jar, and in which a partial vacuum has been created. Cupping produces blood congestion at the site, and the site is thus stimulated.

In addition to the traditional Chinese techniques of acupuncture, the following are also used in the United States:

  • Electroacupuncture. In this form of acupuncture, the traditional acupuncture points are stimulated by an electronic device instead of a needle.
  • Japanese meridian acupuncture. Japanese acupuncture uses thinner, smaller needles, and focuses on the meridians rather than on specific points along their course.
  • Korean hand acupuncture. Traditional Korean medicine regards the hand as a "map" of the entire body, such that any part of the body can be treated by stimulating the corresponding point on the hand.
  • Western medical acupuncture. Western physicians trained in this style of acupuncture insert needles into socalled trigger points in sore muscles, as well as into the traditional points used in Chinese medicine.
  • Ear acupuncture. This technique regards the ear as having acupuncture points that correspond to other parts of the body. Ear acupuncture is often used to treat substance abuse and chronic pain syndromes.

A standard acupuncture treatment takes between 45 minutes to an hour and costs between $40 and $100, although initial appointments often cost more. Chronic conditions usually require 10 treatment sessions, but acute conditions or minor illnesses may require only one or two visits. Follow-up visits are often scheduled for patients with chronic pain. As of 2000, about 7080% of health insurers in the United States reimbursed patients for acupuncture treatments.

Preparation

Apart from a medical history and physical examination, no specific preparation is required for an acupuncture treatment. In addition to using sterile needles, licensed acupuncturists will wipe the skin over each acupuncture point with an antiseptic solution before inserting the needle.

Aftercare

No particular aftercare is required, as the needles should not draw blood when properly inserted. Many patients experience a feeling of relaxation or even a pleasant drowsiness after the treatment. Some patients report feeling energized.

Risks

Most complications from acupuncture fall into one of three categories: infections, most often from improperly sterilized needles; bruising or minor soft tissue injury; and injuries to muscle tissue. Rarely, serious side effects from improper application of the needle may result in pneumothorax and cardiac tamponade.

Normal results

Normal results from acupuncture are relief of pain and/or improvement of the condition being treated.

Abnormal results

Abnormal results from acupuncture include infection, a severe side effect, or worsening of the condition being treated.

Resources

BOOKS

Pelletier, Kenneth R., MD. "Acupuncture: From the Yellow Emperor to Magnetic Resonance Imaging (MRI)." Chapter 5 in The Best Alternative Medicine. New York: Simon and Schuster, 2002.

Reid, Daniel P. Chinese Herbal Medicine. Boston, MA: Shambhala, 1993.

Svoboda, Robert, and Arnie Lade. Tao and Dharma: Chinese Medicine and Ayurveda. Twin Lakes, WI: Lotus Press, 1995.

PERIODICALS

Cerrato, Paul L. "New Studies on Acupuncture and Emesis (Acupuncture for Relief of Nausea and Vomiting Caused by Chemotherapy)." Contemporary OB/GYN 46 (April 2001): 749.

Kemper, Kathi J., et al. "On Pins and NeedlesPediatric Pain: Patients' Experience with Acupuncture." Pediatrics 105 (April 2000): 620633.

Kirchgatterer, Andreas. "Cardiac Tamponade Following Acupuncture." Chest 117 (May 2000): 15101511.

Nwabudike, Lawrence C., and Constantin Ionescu-Tirgoviste. "Acupuncture in the Treatment of Diabetic Peripheral Neuropathy." Diabetes 49 (May 2000): 628.

Silvert, Mark. "Acupuncture Wins BMA Approval (British Medical Association)." British Medical Journal 321 (July 1, 2000): 637639.

Vickers, Andrew. "Acupuncture (ABC of Complementary Medicine)." British Medical Journal 319 (October 9, 1999): 704708.

ORGANIZATIONS

American Academy of Medical Acupuncture/Medical Acupuncture Research Organization. 5820 Wilshire Boulevard, Suite 500, Los Angeles, CA 90036. (800) 521-2262 or (323) 937-5514; Fax: (323) 937-0959. (May 9, 2004.) <http://www.medicalacupuncture.org>.

American Association of Oriental Medicine. 433 Front Street, Catasaqua, PA 18032. (610) 266-1433; Fax: (610) 264-2768. (May 9, 2004.) <http://www.aaom.org>.

National Center for Complementary and Alternative Medicine (NCCAM) Clearinghouse. P.O. Box 7923, Gaithersburg, MD 20898. (888) 644-6226; TTY: (866) 464-3615; Fax: (866) 464-3616. (May 9, 2004.) <http://www.nccam.nih.gov>.

Rebecca Frey, PhD

Rosalyn Carson-DeWitt, MD

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acupuncture

acupuncture is perhaps most helpfully defined in general as the insertion of one or more needles into the body with therapeutic intent. The advantage of this wide definition is that it covers the many current different variants of this ancient practice, without being specifically tied to any one of them. At the broadest level, the most critical difference of approach lies between classical Oriental forms of acupuncture and those rooted more in modern Western biomedicine. Most of the main differences in practice are based on this dichotomy, although there are significant distinctions both between and within these two traditions, in terms of such issues as the model used to explain the operation of acupuncture and the scope of its practice. There are also debates in both traditions about the number and location of the acupuncture points themselves.

What is not in dispute, however, is that acupuncture has a history spanning well over 2000 years, taking its origin from ancient China. One of the oldest known books on acupuncture here is the Yellow Emperor's classic of internal medicine (the Nei Jing), which is held to date back many hundreds of years bc. From China, acupuncture spread to such local cultural areas as Korea and Japan, where it became incorporated into mainstream medicine by the seventh and eighth centuries ad. By the sixteenth and seventeenth centuries knowledge of it had reached Europe, mainly through missionaries and ships' surgeons who had witnessed its use in the East, but who had only a rudimentary understanding of its operation.

In the early nineteenth century it began to be practised by a number of doctors in Britain and the US. It went into something of a decline in most countries in the Western world thereafter — and even, briefly, in China in the modernization period under the Kuomintang in the first half of the twentieth century. However, the advent of ‘ping-pong’ diplomacy between China and the West in the first half of the 1970s, associated with dramatic television pictures of open-heart surgery being carried out by the Chinese with the use of ‘acupuncture anaesthesia’, led to spiralling public interest. This interest has continued to grow in both medical and non-medical circles up to the present day, alongside other complementary and alternative therapies—resulting in increasing numbers of acupuncturists and its widespread employment in the West in pain clinics and other settings.

In its classic application within traditional Chinese medicine, acupuncture is seen as being underpinned by the interplay of yin and yang; disease is seen as deriving from the disequilibrium of such opposing forces. In this conceptualization, drawing on Taoist philosophy, acupuncture treatment for the sick is used to correct imbalances and to maintain equilibrium in the healthy to prevent illness. This involves manipulating the patient's Qi, the life force, by stimulating needles strategically placed at selected acupuncture points which lie on the 12 main meridians that run along the body and connect with central internal organs. Typically, the needles are placed in sites at a distance from the condition itself. In this frame of reference — and as employed in China and many other Oriental societies — acupuncture is seen as something of a panacea, which can deal with a wide range of disorders spanning from asthma and ulcers to depression and angina.

Acupuncture, though, is characteristically used very differently in Western biomedicine — mainly as a more narrowly defined remedy for pain and for addictions of various kinds. The traditional Chinese philosophies about acupuncture are usually seen as problematic within this framework, not least because there is no consistent correspondence between biomedical conceptions of the physical structures of the body and the classical acupuncture points and the meridians along which they are held to run. Indeed, within more Westernized approaches, needling often occurs in situ rather than at a distance. Other explanations of its operation have also typically been sought by Western doctors, generally based on neurophysiology. Initially the ‘gate-control’ theory was widely adopted, centred on the notion that the stimulation of the larger nerve fibres can block pain. More recently, however, emphasis has shifted to the notion that endorphins — opiates of a type naturally produced by the body — are released by acupuncture, thus giving rise to its analgesic effects. However, neither theory adequately explains the long-term relief of chronic pain nor the wider therapeutic effects traditionally claimed for acupuncture.

From a conventional Western perspective, many studies of acupuncture to date have been methodologically unsound — although its proponents might point to the difficulties of evaluating its efficacy through randomized trials in view of its holistic, classical Oriental origins. Current evidence based on trials of its efficacy in treating pain is growing, though, even if rigorous trials of acupuncture for other disorders are few and far between and are not always supportive of the claimed benefits. Another important issue in the West is the regulation of acupuncture practice and whether it should be formally restricted either to doctors or to those appropriately trained in acupuncture, given that it is an invasive technique. In untutored hands, acupuncture has occasionally given rise to a number of complications, such as Hepatitis B and AIDS, and the puncturing of the heart and lungs, which carry potentially fatal consequences.

It should be stressed in conclusion that, even as discussed here, there are difficulties in clearly defining the boundaries of acupuncture. There are, for example, associated forms of treatment which do not employ needles, but which use acupuncture points. These range from the traditional application of finger pressure, through shiatsu and the burning of a herb, moxa, at such points, to the stimulation of acupuncture points using electrodes, as with techniques such as TENS (transcutaneous electrical nerve stimulation) in modern medical practice. Equally, there are surgical techniques, like suturing and the injection of medicinal substances, that are closer to the definition of acupuncture in so far as they involve needles, but are not conventionally regarded as such. Notwithstanding these definitional issues, though, acupuncture in both its traditional and modern forms looks as if it will continue to be important in the foreseeable future in both the contemporary Western and Eastern worlds, where it is being subjected to increasing use and scientific study.

Mike Saks

Bibliography

Lewith, G.,, Kenyon, J.,, and and Lewis, P. (1996). Complementary medicine: an integrated approach. Oxford University Press.
Lu Gwei-Djen and and Needham, J. (1980). Celestial lancets: a history and rationale of acupuncture and moxa. Cambridge University Press.
Mole, P. (1992). Acupuncture: energy balancing for body, mind and spirit. Element, Longmead.
Saks, M. (1995). Professions and the public interest: medical power, altruism and alternative medicine. Routledge, London.

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Acupuncture

Acupuncture

An ancient Chinese medical system over five thousand years old, recently revived in China and demonstrated to Western doctors. It is based on the belief that subtle energy flows in the body related to the cosmic principles of Yin and Yang. Yin relates to shadow, moon, passivity, softness, femininity; Yang denotes sunlight, activity, masculinity, hardness. The balance of these energies in the human body affects health and disease. Acupuncture therapy alters these energy flows by inserting needles at key points for varying periods of time. Anesthesia for surgical operations can also be effected by acupuncture. Both ancient Chinese and Hindu medical systems are related to a philosophical or mystical view of the universe, and the concept of Yin and Yang and subtle energy flows has much in common with the kundalini energy of the Hindu yoga system. In hatha yoga, the system of asanas, or physical positions, affect the vital energies in the body through muscular tension and relaxation. Comparison may also be made with the theories of Wilhelm Reich and his concept of orgone energy.

Special developments of acupuncture include shiatsu and acupressure, a form of acupuncture without needles, and acupuncture charts locating ear and hand points. Dr. Lester Sacks, a Los Angeles doctor, introduced a system of ear acupuncture in which a special "gun" fires a surgical staple into the ear near a particular acupuncture point, to help patients who want to lose weight or stop smoking, drinking, or taking drugs. Whenever the patient feels his craving coming on, he wiggles the staple, and the craving apparently subsides.

A simple device for self-treatment of acupuncture points on the back is the "MA-roller," a specially shaped wooden rod, on which the patient lies. It is marketed by Great Earth Therapeutics, Forest Row, Sussex, England.

Acupuncture came into the West in 1928 when Soulie de Morant, the French consul in China, returned home with the texts he had translated into French and persuaded several doctors to examine the practice. Interest grew steadily throughout Europe and America after World War II. The Acupuncture International Association was founded in 1949 by a group of nonconventional physicians in the United States. J. R. Worsley established the Chinese College of Acupuncture in England in 1960. However, the major opening for acupuncture in the West came in the early 1970s, when the United States reestablished friendly relations with the People's Republic of China. In 1973 the National Institute of Health sponsored an Acupuncture Research Conference, a signal of official approval for the testing of acupuncture's claims. Over the next few years a host of acupuncture texts appeared, acupuncture associations formed, and journals initiated.

The literature of acupuncture is extensive, and there are now several journals devoted to the subject, including Acupuncture News, American Journal of Acupuncture, and Journal of the Acupuncture Association of Great Britain. The American Association of Acupuncture and Oriental Medicine may be contacted at 1424 16th St. NW, Washington, DC 20036. There is also an International Veterinary Acupuncture Society at 2140 Conestoga Rd., Chester Springs, PA 19425.

Sources:

Academy of Traditional Chinese Medicine. An Outline of Chinese Acupuncture. New York: Pergamon Press, 1975; Peking: Foreign Language Press, 1975.

Austin, Mary. Acupuncture Therapy. 2nd ed. New York: ASI Publishers, 1972.

Dubrin, Stanley, and J. Keenan. Acupuncture and Your Health. Chatsworth, Calif.: Books for Better Living, 1974.

Hashimoto, M. Japanese Acupuncture. New York: Liveright Publishing, 1968; London: Thursons, 1966.

Mann, Felix. Acupuncture. New York: Random House, 1963; London: W. Heinemann Medical Books, 1962.

Matsumoto, Teruo. Acupuncture for Physicians. Springfield, Ill.: Thomas, 1974.

McGarey, William. Acupuncture and Body Energies. Phoenix, Ariz.: Gabriel Press, 1974.

Nanking Army Ear Acupuncture Team. Ear Acupuncture: A Chinese Medical Report. Emmaus, Pa.: Rodale Press, 1974.

Nightingale, Michael. The Healing Power of Acupuncture. New York: Javalin Books, 1986.

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Acupuncture

Acupuncture

Acupuncture is an ancient method for relieving pain and treating disease using very fine metal needles. While the invention date of acupuncture is not known, the theory behind it has been handed down through the centuries. According to acupuncture practitioners, certain points on the surface of the body are linked to internal organs. When a patient becomes ill, the illness often manifests itself on a surface site. Treating the external siteor a specific area of skincreates a link to the internal imbalance.

Philosophy Explains Illness

Early Chinese medical practitioners learned that certain areas of the skin showed sensitivity during illness or organ malfunction. These points of sensitivity were discovered to be part of a pattern. Chinese doctors drew "body maps" to help keep track of the various points. The lines they used to connect the pattern points were called meridians. Each meridian was linked to certain body organs and physical conditions.

According to Chinese Taoist philosophy (a system of religion based on the teachings of philosopher Lao-tse), these points of skin sensitivity relate to the life force or energy called Qi, which circulates throughout the body. Balance within the body depends on the interplay between two forms of energy, called yin and yang. When these forces are in harmony, the body is healthy. When either force becomes dominant, disease or pain occurs. Acupuncture restores the balance between yin and yang by tapping into the body's channels, or meridians, through which these energy forms flow.

The basic reference book on acupuncture is the Nei Ching, or Yellow Emperor's Classic of Internal Medicine, said to have been written by Huang Ti (2697-2596 b.c.), also known as the Yellow Emperor. The Nei Ching, or "Canon of Internal Medicine," is divided into two parts. The first, Su Wen, explains the theoretical basis of Chinese medicine. The second, Ling Shu, tells exactly how to use acupuncture to treat and prevent every then-known disease and gives detailed needle insertion points. An edition of the original Nei Ching was compiled by Wang Ping in a.d. 762 and revised around a.d. 1200. This later edition is the basis for the modern Nei Ching, which remains the foundation of today's acupuncture.

Early Acupuncture Tools

The earliest acupuncture needles are thought to have been made of stone, fish bones, and bamboo. These materials were later replaced by metals such as copper, brass, silver, and gold. Today most acupuncture needles are made of stainless steel, gold, or silver. The needles may be several inches long and are inserted to various depths and then twirled or vibrated. A tiny electric charge may be added. Insertion is painless or, at the most, mildly uncomfortable for a moment. Acupuncture students practice needle insertion on themselves thousands of times while perfecting their technique. The Nei Ching prescribed 365 insertion points; modern acupuncturists use 650 to 800.

Westerners Experiment with Acupuncture

Knowledge of acupuncture was brought to the West by Jesuit missionaries in the 1600s, although detailed descriptions of acupuncture theory and practice were not available to Westerners until Soulie de Morant's writings in the 1940s. Western interest in acupuncture, as well as the medical philosophies that accompany its practice, has been growing steadily since then.

Today, acupuncture is still an important element of Chinese medicine. In fact, acupuncture is often used as an anesthetic when major surgery is performed in China. Western scientists acknowledge acupuncture's effectiveness, noting that the skin does in fact have different levels of electrical resistance at the ancient acupuncture points. Western researchers speculate that acupuncture may stimulate production of the body's natural pain relievers, or endorphins, or it may interrupt nervous system pain messages.

[See also Anesthesia ; Endorphin and enkephalin ; Surgical instruments ]

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acupuncture

acupuncture (ăk´yŏŏpŭng´chər), technique of traditional Chinese medicine, in which a number of very fine metal needles are inserted into the skin at specially designated points. For thousands of years acupuncture has been used, along with herbal medicine, for pain relief and treatment of various ailments. It has often been combined with moxabustion, the burning of leaves of moxa, the Chinese wormwood tree. Today it is widely used in China in the treatment of hay fever, headaches, and ulcers, and some types of blindness, arthritis, diarrhea, and hypertension. Acupuncture is also used, especially in China, as a general anesthetic during childbirth and some types of surgery. Unlike conventional anesthesia, acupuncture does not reduce blood pressure or depress breathing; in addition, the patient stays fully conscious and there is no postoperative hangover or nausea.

Generally, in the practice of acupuncture, needles varying in length from 1/2 in. (1.27 cm) to several inches are inserted in appropriate points of the body, not necessarily near the affected organ. The needles are twirled and vibrated in specific ways; the depth of insertion also affects the treatment. Modern technique sometimes adds electrical stimulation applied through the needles. The traditional acupuncture points (there are about 800) are arranged along 14 lines, or meridians, running the length of the body from head to foot.

The traditional Chinese explanation of the effectiveness of acupuncture is based on the Taoist philosophy (see Taoism), according to which good health depends on a free circulation of chi (qi), or life-force energy, throughout all the organs of the body. The chi, in turn, depends upon a balance of the two opposing energies of yin (negative, dark, feminine) and yang (positive, bright, masculine). The meridians are the main channels of flow. When energy flow is impeded at any point, e.g., because of a diseased organ or stress, illness in other organs may result. Piercing the channels at the proper points is believed to correct the imbalances.

Western researchers have found that the acupuncture points correspond to points on the skin having less electrical resistance than other skin areas. It has been suggested that acupuncture works by stimulating or repressing the autonomic nervous system in various ways, and there is some evidence that stimulation of the skin can affect internal organs by means of nerve reflex pathways. One theory is that acupuncture stimulates the release of natural pain-relieving chemicals called endorphins. Another is that it stimulates the pituitary gland, which in turn stimulates the adrenal gland to release anti-inflammatory chemicals.

Since the early 1970s, acupuncture has gradually become more accepted in the United States. Many states now accredit schools of acupuncture and administer licensing examinations for nonphysicians. Some physicians are studying and using acupuncture as an adjunct treatment. In the United States acupuncture has been used most often for pain control and drug and alcohol addiction. One impediment to total acceptance is the difficulty of fitting a traditional technique from another culture into the strict methods of scientific clinical trials customary in Western medicine. Studies have shown some benefit from acupuncture, but it is difficult to control for the placebo effect; so-called sham acupuncture, involving the use of needles superficially at points not used in acupuncture, has also shown some pain-relief benefits when used as a control in studies.

See S. T. Chang, The Complete Book of Acupuncture (1976); G. S. De Morant, Chinese Acupuncture (2 vol., tr. 1989).

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acupuncture

acupuncture System of medical treatment in which long needles are inserted into the body to assist healing, relieve pain, or for anaesthetic purposes. In ancient Chinese philosophy, acupuncture is proposed to restore the balance of yin and yang by freeing the flow of life-energy (chi) through pathways in the body. A possible scientific explanation is that the needles activate deep sensory nerves that stimulate the pituitary gland and hypothalamus to produce endorphins.

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Acupuncture

Acupuncture. One of the nine branches of Chinese traditional medicine. Since the body acts as a channel, especially for chʾi, the points of insertion of the needles of acupuncture do not have to be proximate to the place of pain and disorder: they stimulate and promote the body's own ability to treat itself; thus the carefully mapped points of insertion (the numbers vary from 350 to 450) are related to the body's internal system of communication and control.

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acupuncture

acupuncture (ak-yoo-punk-cher) n. a complementary therapy, developed by Eastern physicians, in which thin metal needles are inserted into selected points beneath the skin. It is used to relieve the symptoms of a wide range of physical and psychological conditions.
www.acupuncture.org.uk Website of the British Acupuncture Council, the UK's main regulatory body for the practice of acupuncture

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acupuncture

ac·u·punc·ture / ˈakyəˌpəngkchər/ • n. a system of complementary medicine that involves pricking the skin or tissues with needles, used to alleviate pain and to treat various conditions. DERIVATIVES: ac·u·punc·tur·ist / -ist/ n.

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acupuncture

acupuncturebotcher, gotcha, top-notcher, watcher, wotcha •imposture, posture •firewatcher • birdwatcher •debaucher, scorcher, torture •Boucher, voucher •cloture, encroacher, poacher, reproacher •jointure • moisture •cachucha, future, moocher, smoocher, suture •butcher •kuccha, scutcher, toucher •structure •culture, vulture •conjuncture, juncture, puncture •rupture • sculpture • viniculture •agriculture • sericulture •arboriculture • pisciculture •horticulture • silviculture •subculture • counterculture •aquaculture • acupuncture •substructure • infrastructure •candidature • ligature • judicature •implicature •entablature, tablature •prelature • nomenclature • filature •legislature • musculature •premature • signature • aperture •curvature •lurcher, nurture, percher, searcher

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Acupuncture

Acupuncture

Definition

Purpose

Precautions

Description

Preparation

Aftercare

Risks

Normal results

Abnormal results

Resources

Definition

Acupuncture, one of the main forms of therapy in traditional Chinese medicine (TCM ), has been practiced for at least 2,500 years. In acupuncture, certain points on the body associated with energy channels or meridians are stimulated by the insertion of fine needles. Unlike the hollow hypodermic needles used in mainstream medicine to give injections or draw blood, acupuncture needles are solid. The points can be needled between 15 and 90 degrees in range relative to the skin’s surface, depending on treatment.

Acupuncture is thought to restore health by removing energy imbalances and blockages in the body. Practitioners of TCM believe that there is a vital force or energy called qi (pronounced “chee”) that flows through the body, and between the skin surface and the internal organs, along channels or pathways called meridians. There are 12 major and eight minor meridians. Qi regulates the spiritual, emotional, mental, and physical harmony of the body by keeping the forces of yin and yang in balance. Yang is a principle of heat, activity, brightness, outwardness, while yin represents coldness, passivity, darkness, interiority, etc. TCM does not try to eliminate either yin or yang, but to keep them in harmonious balance. Acupuncture may be used to raise or lower the level of yin or yang in a specific part of the body in order to restore the energy balance.

Acupuncture was virtually unknown in the United States prior to President Nixon’s trip to China in 1972. A reporter for the New York Times named James Reston wrote a story for the newspaper about the doctors in Beijing who used acupuncture to relieve his pain following abdominal surgery. By 1993, Americans were making 12 million visits per year to acupuncturists, and spending $500 million annually on acupuncture treatments. By 1995, there were an estimated 10,000 certified acupuncturists practicing in the United States; as of 2000, there were 20,000. About a third of the credentialed acupuncturists in the United States are MDs.

Acupuncture’s record of success has been sufficiently impressive to stimulate a number of research projects investigating its mechanisms as well as its efficacy. Research has been funded not only by the National Center for Complementary and Alternative Medicine (NCCAM), but also by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Institute of Dental Research, the National Institute of Neurological Disorders and Stroke (NINDS), and the National Institute on Drug Abuse. In 1997 a consensus panel of the National Institutes of Health (NIH) presented a landmark report in which it described acupuncture as a sufficiently promising form of treatment to merit further study. In 2000, the British Medical Association (BMA) recommended that acupuncture should be made more readily available through the National Health Service (NHS), and that family doctors should be trained in some of its techniques.

Purpose

The purpose of acupuncture in TCM is the rebalancing of opposing energy forces in different parts of the body. In Western terms, acupuncture is used most commonly as an adjunctive treatment for the relief of chronic or acute pain. In the United States, acupuncture is most widely used to treat pain associated with musculoskeletal disorders, but it has also been used in the treatment of substance abuse, and to relieve nausea and vomiting. A study done in 2001 showed that acupuncture was highly effective in stopping the intense vomiting associated with a condition in pregnant women known as hyperemesis gravidarum. In the past several years, acupuncture has been tried with a new patient population, namely children with chronic pain syndromes. One study of 30 young patients with disorders ranging from migraine headaches to endometriosis found that 70% felt that their symptoms had been relieved by acupuncture, and described themselves as “pleased” by the results of treatment. In addition to these disorders, acupuncture has been used in the United States to treat asthma, infertility, depression, anxiety, HIV infection, fibromyalgia, menstrual cramps, carpal tunnel syndrome, tennis elbow, pitcher’s shoulder, chronic fatigue syndrome, and postoperative pain. It has even been used in veterinary medicine to treat chronic pain and prevent epileptic convulsions in animals. As of 2002, NCCAM is sponsoring research regarding the effectiveness of acupuncture in the rehabilitation of stroke patients.

The exact Western medicine mechanism by which acupuncture works is not known. Western researchers have suggested three basic explanations of acupuncture’s efficacy in pain relief:

  • Western studies have found evidence that the traditional acupuncture points conduct electromagnetic signals. Stimulating the acupuncture points causes these signals to be relayed to the brain at a higher than normal rate. These signals in turn cause the brain to release pain-relieving chemicals known as endorphins, and immune system cells to weak or injured parts of the body.
  • Other studies have shown that acupuncture activates the release of opioids into the central nervous system. Opioids are also analgesic, or pain-relieving compounds.
  • Acupuncture appears to alter the chemical balance of the brain itself by modifying the production and release of neurotransmitters and neurohormones. Acupuncture has been documented to affect certain involuntary body functions, including immune reactions, blood pressure, and body temperature.

In addition to its efficacy in relieving pain and other chronic conditions, acupuncture has gained in popularity because of several additional advantages:

  • It lacks the side effects associated with many medications and surgical treatments in Western medicine.
  • It is highly cost-effective; it may be used early in the course of a disease, potentially saving the patient the cost of hospitalizations, laboratory tests, and high-priced drugs.
  • It can easily be combined with other forms of therapy, including psychotherapy.
  • It is noninvasive.
  • It carries relatively few risks.

Precautions

Although the risk of infection in acupuncture is minimal, patients should make sure that the acupuncturist uses sterile disposable needles. In the United States, the Food and Drug Administration (FDA) mandates the use of sterilized needles made from nontoxic materials. The needles must be clearly labeled as having their use restricted to qualified practitioners.

Patients should also inquire about the practitioner’s credentials. Since acupuncture is now taught in over forty accredited medical schools and osteopathic colleges in the United States, patients who would prefer to be treated by an MD or an osteopath can obtain a list of licensed physicians who practice acupuncture in their area from the American Academy of Medical Acupuncture. With regard to non-physician acupuncturists, 31 states have established training standards that acupuncturists must meet in order to be licensed in those states. In Great Britain, practitioners must qualify by passing a course offered by the British Acupuncture Accreditation Board.

Patients seeking acupuncture treatment should provide the practitioner with the same information about their health conditions and other forms of treatment that they would give their primary care doctor. This information should include other alternative and complementary therapies, especially herbal remedies.

Acupuncture should not be used to treat severe traumatic injuries and other emergency conditions requiring immediate surgery. In addition, it does not appear to be useful in smoking cessation programs.

As is true with other forms of medical treatment, a minority of patients do not respond to acupuncture. The reasons for nonresponsiveness are not known at the present stage of research.

Description

In traditional Chinese medicine, acupuncture treatment begins with a thorough physical examination in which the practitioner evaluates the patient’s skin color, vocal tone, and tongue color and coating. The practitioner then takes the patient’s pulse at six locations and three depth levels on each wrist. These 36 pulse measurements will tell the practitioner where the qi in the patient’s body might be blocked or unbalanced. After collecting this information, the acupuncturist will then identify the patterns of energy disturbance and the acupuncture points that should be stimulated to unblock the qi or restore harmony. Up to 10 or 12 acupuncture needles will be inserted at strategic points along the relevant meridians. In traditional Chinese practice, the needles are twirled or rotated as they are inserted. Many patients feel nothing at all during this procedure, although others experience a prickling or mild aching sensation, and still others a feeling of warmth or heaviness.

The practitioner may combine acupuncture with moxibustion to increase the effectiveness of the treatment. Moxibustion is a technique in which the acupuncturist lights a small piece of wormwood, called a moxa, above the acupuncture point above the skin. When the patient begins to feel the warmth from the burning herb, it is removed. Cupping is another technique that is a method of stimulation of acupuncture points by applying suction through a metal, wood, or glass jar, and in which a partial vacuum has been created. Producing blood congestion at the site, the site is thus stimulated. The method is used for lower back pain, sprains, soft tissue injuries, as well as relieving fluid from the lungs in chronic bronchitis.

In addition to the traditional Chinese techniques of acupuncture, the following are also used in the United States:

  • Electroacupuncture. In this form of acupuncture, the traditional acupuncture points are stimulated by an electronic device instead of a needle.
  • Japanese meridian acupuncture. Japanese acupuncture uses thinner, smaller needles, and focuses on the meridians rather than on specific points along their course.
  • Korean hand acupuncture. Traditional Korean medicine regards the hand as a “map” of the entire body, such that any part of the body can be treated by stimulating the corresponding point on the hand.
  • Western medical acupuncture. Western physicians trained in this style of acupuncture insert needles into so-called trigger points in sore muscles, as well as into the traditional points used in Chinese medicine.
  • Ear acupuncture. This technique regards the ear as having acupuncture points that correspond to other parts of the body. Ear acupuncture is often used to treat substance abuse and chronic pain syndromes.

A standard acupuncture treatment takes between 45 minutes to an hour and costs between $40 and $100, although initial appointments often cost more. Chronic conditions usually require 10 treatment sessions, but acute conditions or minor illnesses may require only one or two visits. Follow-up visits are often scheduled for patients with chronic pain. About 70-80% of health insurers in the United States reimbursed patients for acupuncture treatments.

Preparation

Apart from a medical history and physical examination, no specific preparation is required for an acupuncture treatment. In addition to using sterile needles, licensed acupuncturists will wipe the skin over each acupuncture point with an antiseptic solution before inserting the needle.

Aftercare

No particular aftercare is required, as the needles should not draw blood when properly inserted. Many patients experience a feeling of relaxation or even a pleasant drowsiness after the treatment. Some patients report feeling energized.

Risks

Several American and British reports have concluded that the risks to the patient from an acupuncture treatment are minimal. Most complications from acupuncture fall into one of three categories: infections, most often from improperly sterilized needles; bruising or minor soft tissue injury; and injuries to muscle tissue. Serious side effects with sterilized needles are rare, although cases of pneumothorax and cardiac tamponade have been reported in the European literature. One American pediatrician estimates that the risk of serious injury from acupuncture performed by a licensed practitioner ranges between 1:10,000 and 1:100,000—or about the same degree of risk as a negative reaction to penicillin.

KEY TERMS

Cardiac tamponade —A condition in which blood leaking into the membrane surrounding the heart puts pressure on the heart muscle, preventing complete filling of the heart’s chambers and normal heartbeat.

Electroacupuncture —A variation of acupuncture in which the practitioner stimulates the traditional acupuncture points electronically.

Endorphins —A group of peptide compounds released by the body in response to stress or traumatic injury. Endorphins react with opiate receptors in the brain to reduce or relieve pain.

Hyperemesis gravidarum —Uncontrollable nausea and vomiting associated with pregnancy. Acupuncture appears to be an effective treatment for women with this condition.

Meridians —In traditional Chinese medicine, a network of pathways or channels that convey qi (also sometimes spelled “ki”), or vital energy, through the body.

Moxibustion —A technique in traditional Chinese medicine that involves burning a Moxa, or cone of dried wormwood leaves, close to the skin to relieve pain. When used with acupuncture, the cone is placed on top of the needle at an acupuncture point and burned.

Neurotransmitter —A chemical in the brain that transmits messages between neurons, or nerve cells.

Opioids —Substances that reduce pain and may induce sleep. Some opioids are endogenous, which means that they are produced within the human body. Other opioids are produced by plants or formulated synthetically in the laboratory.

Pneumothorax —A condition in which air or gas is present in the chest cavity.

Qi —The Chinese term for energy, life force, or vital force.

Yin and yang —In traditional Chinese medicine and philosophy, a pair of opposing forces whose harmonious balance in the body is necessary to good health.

Normal results

Normal results from acupuncture are relief of pain and/or improvement of the condition being treated.

Abnormal results

Abnormal results from acupuncture include infection, a severe side effect, or worsening of the condition being treated.

Resources

BOOKS

Pelletier, Kenneth R., MD. “Acupuncture: From the Yellow Emperor to Magnetic Resonance Imaging (MRI).” Chapter 5 in The Best Alternative Medicine. New York: Simon and Schuster, 2002.

Reid, Daniel P. Chinese Herbal Medicine. Boston, MA: Shambhala, 1993.

Svoboda, Robert, and Arnie Lade. Tao and Dharma: Chinese Medicine and Ayurveda. Twin Lakes, WI: Lotus Press, 1995.

PERIODICALS

Cerrato, Paul L. “New Studies on Acupuncture and Emesis (Acupuncture for Relief of Nausea and Vomiting Caused by Chemotherapy).” Contemporary OB/GYN 46 (April 2001): 749.

Kemper, Kathi J., and others. “On Pins and Needles? Pediatric Pain: Patients’ Experience with Acupuncture.” Pediatrics 105 (April 2000): 620-633.

Kirchgatterer, Andreas. “Cardiac Tamponade Following Acupuncture.” Chest 117 (May 2000): 1510–1511.

Nwabudike, Lawrence C., and Constantin Ionescu-Tirgoviste. “Acupuncture in the Treatment of Diabetic Peripheral Neuropathy.” Diabetes 49 (May 2000): 628.

Silvert, Mark. “Acupuncture Wins BMA Approval (British Medical Association).” British Medical Journal 321 (July 1, 2000): 637-639.

Vickers, Andrew. “Acupuncture (ABC of Complementary Medicine).” British Medical Journal 319 (October 9, 1999): 704-708.

ORGANIZATIONS

American Academy of Medical Acupuncture/Medical Acupuncture Research Organization. 5820 Wilshire Boulevard, Suite 500, Los Angeles, CA 90036. Telephone: (800) 521-2262 or (323) 937-5514. Fax: (323) 937-0959. <http://www.medicalacupuncture.org>.

American Association of Oriental Medicine. 433 Front Street, Catasaqua, PA 18032. Telephone: (610) 266-1433. Fax: (610) 264-2768. <http://www.aaom.org>.

National Center for Complementary and Alternative Medicine (NCCAM) Clearinghouse. P.O. Box 7923, Gaithersburg, MD 20898. Telephone: (888) 644-6226. TTY: (866) 464-3615. Fax: (866) 464-3616. <http://www.nccam.nih.gov>.

OTHER

National Center for Complementary and Alternative Medicine (NCCAM). Fact Sheets. Acupuncture Information and Resources. <http://www.nccam.nih.gov/fcp/factsheets/acupuncture>.

Rebecca J. Frey, Ph.D.

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Acupuncture

Acupuncture

Resources

Acupuncture is an ancient method of therapy that originated in China more than 2,000 years ago. It consists of inserting solid, hair-thin needles through the skin at very specific sites to achieve a cure of a disease or to relieve pain.

Until the 1990s, acupuncture was viewed skeptically by Western physicians. However, as of 2006, the practice has become more widespread and accepted. As evidence of this change in perception, a 1998 consensus statement released by the National Institutes of Health (NIH) in the United States said evidence clearly shows acupuncture helps relieve many types of chronic and acute pain; nausea and vomiting associated chemotherapy, anesthesia, and pregnancy; and alters immune system functions. Statistics compiled in 2002 as part of the National Health Interview Survey revealed that an estimated 8.2 million adult Americans have used acupuncture, with over 2 million Americans having done so in the previous year.

In the Far East, acupuncture has been used extensively for over 2,000 years. It is considered one part of a

total regimen that includes herbal medicine, closely guided dietetics, and psychological counseling. In ancient Chinese philosophy, good health depends on the uninterrupted flow of vital energy called qi (sometimes written as chi but pronounced chee) throughout the body. When qi is interrupted, pain and disease follow. Qi flows through 12 pairs of pathways called meridiansone pair of each meridian lies on either side of the body. An additional two meridians run along the midline of the front and back. So-called extrameridians are scattered about and connect the meridians on each side. Other points outside the meridianson the hands, ears, and facehave specific reflex effects. Altogether, there are more than 1,000 acupuncture points. Inserting needles into points along appropriate meridians unblocks qi, restoring energy balance and health.

The concept of meridians developed as the ancient Chinese discovered that pain in a given area responded not only to pressure or puncture in its immediate vicinity, but also to pressure at distant points. Pain in one arm, for example, often responds to acupuncture in the opposite arm in the area corresponding to the painful arm. As the concept of acupuncture took shape, the ancient Chinese learned that points on the body, when stimulated, helped to ease pain or heal internal diseases. They also discovered other points that were distant from the affected area that could be stimulated to achieve pain relief in the affected area. As the number of points grew, they were connected by the meridians and were labeled by their function. The large intestine meridian, for example, originates at the root of the fingernail of the first finger. The channel courses along the thumb side of the arm, over the shoulder, up the neck to the face, and ends at the nostril. The stomach meridian begins below the eye, courses across the face up to the forehead, then reverses direction to run down the throat, along the chest and abdomen, down the front of the thigh and lower leg, across the ankle and foot, and ends at the lateral side of the root of the second toenail. The Conception Vessel is the name given to one of the midline meridians. Its route is from the genital area straight up the middle of the abdomen to end at the center of the lower lip. The posterior midline meridian, the Governor Vessel, starts at the tailbone, courses up the spine, over the midline of the head and ends on the front of the upper gum.

During the acupuncture procedure, 1-20 hair-thin needles are inserted under the skin, some of which may be inserted as deep as 3 in (7.6 cm). Short needles are used for areas that are less fleshy, while longer needles are utilized in areas of deep flesh and muscle. The needles will remain inserted from 15-30 minutes. Needles are always solid; nothing is ever injected through them into the body. When the needle enters the skin, the patient may feel minor transient pain. When the needle tip reaches the depth of the meridian, the patient will have a sensation of radiating warmth or fullness. The insertion points nearest the painful area are usually treated first, then the distant points. For acute conditions, the treatment may be given twice a day. For a long-lasting condition (chronic pain), the treatment can be given every second or third day for up to 20 treatments, after which no acupuncture should be given for several weeks.

Because acupuncture points are very specifically located, and because people are different sizes, the Chinese developed a special system of measuring the body called cun, or human inch. This term has since been modernized to the Acupuncture Unit of Measurement (AUM). The AUM divides a given distance on the human body into equal parts. For example, the AUM of the chest is the division of the distance between the nipples into eight AUM. The distance from the lower end of the breastbone (sternum) to the umbilicus also is eight AUM. Thus, a broad-chested man may have a distance of 12 in (30.48 cm) between the nipples and the smaller man may have only 10 in (25.4 cm). Nevertheless, the distance is divided into eight units because it is eight AUM across the thorax. The upper arm from crease of the elbow to armpit is nine AUM, the lower arm from crease of the elbow to crease of the wrist is 12 AUM, and so on until all the areas of the body have been given standard AUM dimensions.

When the appropriate points have been located and the needles inserted, the acupuncturist rotates the needles occasionally or, in some cases, a mild electric current is passed through them to stimulate the meridian. Another technique, known as moxibustion, uses heat stimulation. After the needle is inserted, a small piece of dried leaf from the Artemisia vulgaris plant is

KEY TERMS

Analgesia The effect of relieving pain. A drug or procedure that provides analgesia is an analgesic.

Anesthetic A substance that will induce sleep so that an individual can undergo surgery or remain unconscious until a crucial and painful period of a surgical procedure has passed.

Chronic A disease or condition that develops slowly and exists over a long period of time.

Opioid peptides Natural substances produced by the brain to desensitize against pain.

Thalamus Portion of the brain involved in transmission and integration of certain physical sensations.

Thorax The area just below the head and neck; the chest.

placed in a little cup on the needles exposed end and lighted. The heat passes through the needle to the area of pain. A few points on the body are not suited to needle insertion. In these instances, a small, smoldering cone of Artemisia vulgaris is placed directly on the skin and the heat is allowed to penetrate.

What makes acupuncture effective remains a matter of scientific investigation. However, the meridians seem to be pathways of nerve fibers. There are some adverse side effects of acupuncture, most of which result from lack of knowledge or unhygienic practices on the part of the acupuncturist.

See also Acupressure; Alternative medicine.

Resources

BOOKS

Kidson, Ruth. Acupuncture for Everyone: What It Is, Why It Works, and How It Can Help You. Rochester, VT: Healing Arts Press, 2000.

Lian, Yu-Lin, Chun-Yan Chen, Michael Hammes, and Bernard C. Kolster. Pictorial Atlas of Acupuncture; an Illustrated Manual of Acupuncture Points. Cologne: Konemann, 2005.

Liang, Lifang. Acupuncture & IVF. Boulder: Blue Poppy Press, 2003.

PERIODICALS

Acupuncture Illustrated. Consumer Reports 59 (January 1994): 54-57.

Bonta, I. L. Acupuncture Beyond the Endorphine Concept? Medical Hypotheses 58, 3 (2002): 221-24.

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Acupuncture

Acupuncture

Definition

Acupuncture is one of the main forms of therapy in traditional Chinese medicine (TCM) and has been practiced for 2500 to 3000 years. An acupuncturist stimulates certain points on the body associated with energy channels or meridians by the insertion of fine needles. Unlike the hollow hypodermic needles used in mainstream medicine to give injections or draw blood, acupuncture needles are solid. In the United States, acupuncture is considered a form of complementary and alternative medicine (CAM) rather than a mainstream form of therapy.

Description

History and theory

Acupuncture in TCM is based on a prescientific theory of energy flow within the body that dates as far back as the sixth century B.C. Archaeologists have found manuscripts that describe this energy theory in tombs in the Mawangdui region of China, which predate by about two centuries the oldest Chinese medical text, the Inner Classic of the Yellow Emperor.

Acupuncture is thought to restore health by clearing or removing energy imbalances in the body. Practitioners of TCM believe that there is a vital force or energy called chi (sometimes spelled qi and pronounced “chee”) that flows through the body, and between the skin surface and the internal organs, along channels or pathways called meridians. Many practitioners of acupuncture count 12 major and 8 minor meridians, although some count only 14.

Chi regulates the spiritual, emotional, mental, and physical harmony of the body by balancing two cosmic forces known as yin and yang. These two forces govern the entire universe, not just the human body. Yang, a principle of heat, activity, and brightness, governs the outer portions of the body, while yin represents coldness, passivity, and darkness and governs the interior organs. TCM does not try to eliminate either yin or yang, but rather seeks to keep them in harmonious balance. Acupuncture is used to raise or lower the level of yin or yang in a specific part of the body in order to restore the energy balance. Practitioners of TCM have identified at least 2,000 acupuncture points, or acupoints, along the 14 (or 20) meridians that can be stimulated to unblock the flow of chi.

Acupuncture was virtually unknown in the United States prior to President Nixon's trip to China in 1972. James Reston, a reporter, wrote a story for the New York Times about the doctors in Beijing who used acupuncture to relieve his pain following emergency abdominal surgery. By 1993, Americans were making 12 million visits per year to acupuncturists, and spending $500 million annually on acupuncture treatments. By 1995, there were an estimated 10,000 certified acupuncturists practicing in the United States; as of 2000, there were 20,000. About a third of the credentialed acupuncturists in the United States as of 2002 are MDs.

How it works

A practitioner of traditional Chinese medicine begins an acupuncture treatment with a thorough physical examination in which he or she evaluates the patient's skin color, vocal tone, and tongue color and coating. The practitioner then takes the patient's pulse at six locations and three depth levels on each wrist. These thirty-six pulse measurements tell the practitioner where the chi or qi in the patient's body might be blocked or unbalanced. After collecting this information, the acupuncturist identifies the patterns of energy disturbance and the acupuncture points that should be stimulated to unblock the chi or restore harmony. Ten or twelve acupuncture needles are inserted at strategic points along the relevant meridians. In traditional Chinese practice, the needles are twirled or rotated as they are inserted.

Many patients feel nothing at all during this procedure, others experience a prickling or mild aching sensation, and still others have a feeling of warmth or heaviness. Practitioners of TCM use the term de chi (or de qi), which means “drawing the chi,” to describe the tingling or aching sensation that the patient feels when the needle is inserted. Historically, de chi was regarded as proof that the acupuncturist had located the correct acupoint. Some acupuncturists now use electronic devices programmed to beep or buzz when the acupoint has been correctly identified and stimulated. In the United States, the acupuncturist is required to dispose of the needles after the treatment, although some other countries permit reuse of acupuncture needles provided they are sterilized after use.

In the United States, a standard acupuncture treatment takes between 45 minutes to an hour and costs between $60 and $120, although initial appointments often cost more. Chronic conditions usually require about 10 treatment sessions, but acute conditions or minor illnesses may require only one or two visits. Follow-up visits are often scheduled for patients with chronic pain. As of 2008, about 70–80 percent of health insurers in the United States reimburse patients for acupuncture treatments. Apart from a medical history and physical examination, no specific preparation is required for an acupuncture treatment. In addition to using sterile needles, licensed acupuncturists will wipe the skin over each acupoint with an antiseptic solution before inserting the needle.

Acupuncture needles

Acupuncture needles are made of stainless steel. They are extremely fine (0.007 to 0.020 of an inch, or 0.18 to 0.51 mm), since they do not have an inner channel for purposes of injecting medications. The upper third of the needle is wound with bronze wire or coated with plastic to give the acupuncturist a handle for inserting the needle without damaging its sterility. The number of needles used and the depth of placement depend on the disorder being treated. The acupuncturist leaves the needles in place for about 15 to 20 minutes and then removes them.

Associated treatments and variations

The practitioner may combine acupuncture with moxibustion to increase the effectiveness of the treatment. Moxibustion is a technique in which the acupuncturist lights a small piece of wormwood beaten to a fibrous mass called a moxa above the acupuncture point. When the patient begins to feel the warmth from the burning herb, it is removed.

In addition to the traditional Chinese techniques of acupuncture, the following are also used in the United States:

  • Electroacupuncture. In this form of acupuncture, the traditional acupuncture points are stimulated by an electronic device instead of a needle.
  • Japanese meridian acupuncture. Japanese acupuncture uses thinner, smaller needles and focuses on the meridians rather than on specific points along their course.
  • Korean hand acupuncture. Traditional Korean medicine regards the hand as a “map” of the entire body, such that any part of the body can be treated by stimulating the corresponding point on the hand.
  • Western medical acupuncture. Western physicians trained in this style of acupuncture insert needles into so-called trigger points in sore muscles, as well as into the traditional points used in Chinese medicine.
  • Auricular (ear) acupuncture. This technique regards the ear as having acupuncture points that correspond to acupoints in other parts of the body. Auricular acupuncture is often used to treat substance abuse and chronic pain syndromes. It is commonly used in Korea and China for treatment of insomnia, headaches, and other chronic health disorders in the elderly.

Acupuncture research

The claims made for acupuncture have been sufficiently impressive to cause a number of research projects to explore its mechanisms and efficacy. Acupuncture research has been funded not only by the National Center for Complementary and Alternative Medicine (NCCAM), but also by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Institute of Dental Research, the National Institute of Neurological Disorders and Stroke (NINDS), and the National Institute on Drug Abuse (NIDA). In 1997 a consensus panel of the National Institutes of Health (NIH) presented a landmark report which described acupuncture as a sufficiently promising form of treatment to merit further study. As of 2008, over 10,000 studies of acupuncture had been published in medical journals around the world.

As of early 2008, the NIH was recruiting subjects for 69 clinical trials of acupuncture for various diseases and disorders. Many of these were open to seniors, including a trial of acupuncture in the rehabilitation of stroke patients, a trial of acupuncture in postoperative care of breast cancer patients, and an trial of acupuncture for uncontrolled pain.

Demographics

Acupuncture is most commonly practiced in China, Japan, Korea, and other countries in the Far East. It has been used in these regions for thousands of years. It has, however, become more widely used in the United States. According to the National Health Interview Survey of 2002, the most recent large-scale survey of CAM therapies in the United States, an estimated 8.2 million U.S. adults have been treated with acupuncture at least once, and an estimated 2.1 million U.S. adults had used acupuncture during the year preceding the survey (2001).

Seniors appear to be showing greater interest in acupuncture as a CAM treatment in the early 2000s. A Canadian study of acupuncture in palliative care reported in 2007 that 80 percent of patients in a hospital unit for the care of advanced cancer expressed an interest in seeing an acupuncture practitioner if one were made available on the care unit.

Purpose

As has been mentioned, the purpose of acupuncture in TCM is the rebalancing of opposing energy forces in different parts of the body. In Western terms, acupuncture is used most commonly as an adjunctive treatment for the relief of chronic or acute pain. It is used in Germany to reduce the need for postoperative pain relievers in seniors having a total hip joint or knee joint replacement . In the United States, acupuncture is most widely used to treat pain associated with musculoskeletal disorders, but it has also been used in the treatment of substance abuse and to relieve nausea and vomiting following cancer chemotherapy . In addition to these disorders, acupuncture has been used in U.S. and Canadian hospitals to treat asthma , infertility, depression, anxiety , HIV infection, fibromyalgia , menstrual cramps, carpal tunnel syndrome, tennis elbow, pitcher&s shoulder, chronic fatigue syndrome, and postoperative pain. It has even been used in veterinary medicine to treat chronic pain and prevent epileptic convulsions in cats, dogs, and horses.

Western researchers do not, however, usually accept the explanation offered by TCM for the healing effects of acupuncture. They have suggested three alternative explanations of acupuncture's efficacy in pain relief based on what is known in the early 2000s about the transmission of pain signals between the brain and the rest of the body:

  • Western studies using functional magnetic resonance imaging (fMRI) have found evidence that the traditional acupuncture points conduct electromagnetic signals. Stimulating the acupuncture points causes these signals to be relayed to the brain at a higher than normal rate. These signals in turn cause the brain to release pain-relieving chemicals known as endorphins and release immune system cells to weak or injured parts of the body. Acupuncture also appears to increase the rate of electromagnetic signals to portions of the brain that govern motor (movement) activity. A study conducted in Boston in 2007 found that stroke patients who received acupuncture for 10 weeks showed noticeable improvement in arm function, including range of motion.
  • Other studies have shown that acupuncture activates the release of opioids into the central nervous system. Opioids are analgesic or pain-relieving compounds. It is thought that the effect of acupuncture helps to explain the lowered need for pain relievers after surgery in patients treated with acupuncture.
  • Acupuncture appears to alter the chemical balance of the brain itself by modifying the production and release of neurotransmitters and neurohormones. Acupuncture has been documented to affect certain involuntary body functions, including immune reactions, blood pressure, rate of blood flow, and body temperature. A German study reported in 2007 that acupuncture was effective in lowering blood pressure in a group of 160 outpatients over the age of 50 by an average of 6.4 mm Hg for systolic blood pressure and 3.7 mm Hg for diastolic pressure.

In addition to its efficacy in relieving pain and other chronic conditions, acupuncture has gained in popularity in the United States and Canada because of several other advantages:

  • It lacks the side effects associated with many medications and surgical treatments in Western medicine.
  • It is highly cost-effective; it can be used early in the course of a disease, and save the patient some of the costs of hospitalizations, laboratory tests, and highpriced drugs.
  • It can easily be combined with other forms of therapy.
  • It is noninvasive.
  • It carries relatively few risks.

Challenges

Although the risk of infection from properly administered acupuncture is very low, patients should make sure that the acupuncturist uses sterile disposable needles. In the United States, the Food and Drug Administration (FDA) mandates the use of sterilized needles made from nontoxic materials. The acupuncture needles must be clearly labeled as approved for single use only and as having their use restricted to qualified practitioners.

Seniors interested in acupuncture should also inquire about the practitioner's credentials. Since acupuncture is taught in over forty accredited medical schools and osteopathic colleges in the United States, patients who would prefer to be treated by an MD or an osteopath can obtain a list of licensed physicians who practice acupuncture in their area from the American Academy of Medical Acupuncture (AAMA). Membership in the AAMA is restricted to graduates of American or Canadian medical schools or schools of osteopathic medicine who have completed a minimum of 300 hours of training in acupuncture (200 hours of classroom work and 100 hours of clinical practice) at a training program approved by the American Board of Medical Acupuncture (ABMA). They must then pass an examination in order to be board certified. With regard to nonphysician acupuncturists, 31 states have established training standards that acupuncturists must meet in order to be licensed in those states. As of 2008, all states except Alabama, Delaware, Mississippi, North Dakota, and Wyoming have some type of examination or licensure requirements for acupuncturists. Information on each state's rules and regulations may be obtained online at http://www.acupuncture.com/statelaws/statelaw.htm.

KEY TERMS

Auricular —Pertaining to the ear. Auricular acupuncture is based on the theory that the acupoints on the ear correspond to acupoints on other parts of the body and to certain internal disorders.

Cardiac tamponade —A condition in which blood leaking into the membrane surrounding the heart puts pressure on the heart muscle, preventing complete filling of the heart's chambers and normal heartbeat.

De chi (de qi) —A Chinese phrase that means “drawing the chi.” It refers to the tingling or slightly aching sensation that some patients experience when the acupuncturist inserts the needle. It has traditionally been regarded as proof that the practitioner has identified the correct acupoint.

Electroacupuncture —A variation of acupuncture in which the practitioner stimulates the traditional acupuncture points electronically.

Meridians —In traditional Chinese medicine, a network of pathways or channels that convey chi, or vital energy, through the body.

Moxibustion —A technique in traditional Chinese medicine that involves burning a moxa, or cone of dried wormwood leaves, close to the skin to relieve pain. When used with acupuncture, the cone is placed on top of the needle at an acupuncture point and burned.

Pneumothorax —A condition in which air or gas is present in the chest cavity.

Trigger point —An area of skeletal muscle tissue that is sore to the touch and contains small lumps or nodules in the muscle fibers. Some practitioners use acupuncture to relieve the pain and loosen the muscle fibers in trigger points.

Seniors seeking acupuncture treatment should provide the practitioner with the same information about their health conditions and other forms of treatment that they would give their primary care doctor. This information should include other alternative and complementary therapies being used, especially herbal remedies.

Acupuncture should not be used to treat severe traumatic injuries and other emergency conditions requiring immediate surgery. In addition, it does not appear to be useful in smoking cessation programs.

As is true with other forms of medical treatment, a minority of patients do not respond to acupuncture. The reasons why some individuals do not respond to treatment was not understood as of 2008.

Risks

Several American and British reports have concluded that the risks to the patient from an acupuncture treatment are minimal. Most complications from acupuncture fall into one of three categories: infections, most often from improperly sterilized needles; bruising or minor soft tissue injury; and injuries to muscle tissue. A few patients with a known fear of needles or injections have reported feeling slightly dizzy after acupuncture treatment.

Serious side effects are rare, although cases of pneumothorax and cardiac tamponade have been reported in the European literature. One American physician estimated that the risk of serious injury from acupuncture performed by a licensed practitioner ranges between 1:10,000 and 1:100,000—or about the same degree of risk as a negative reaction to penicillin.

Results

Normal results from acupuncture are relief of pain and/or improvement of the condition being treated. Abnormal results from acupuncture include infection, a severe side effect, or worsening of the condition being treated.

Resources

PERIODICALS

Ernst, E., et al. “Acupuncture: Its Evidence-Base Is Changing.” American Journal of Chinese Medicine 35 (January 2007): 21–25.

Faily, J., and D. Oneschuk. “Acupuncture in Palliative Care.” Supportive Care in Cancer 15 (August 2007):1003–1007.

Flachskampf, F. A., J. Gallasch, O. Gefeller, et al. “Randomized Trial of Acupuncture to Lower Blood Pressure.” Circulation 115 (June 19, 2007): 3121–3129.

Gooneratne, N. S. “Complementary and Alternative Medicine for Sleep Disturbances in Older Adults.” Clinics in Geriatric Medicine 24 (February 2008):121–138.

Haake, M., H. H. Müller, C. Schade-Brittinger, et al. “German Acupuncture Trials (GERAC) for Chronic Low Back Pain: Randomized, Multicenter, Blinded, Parallel-group Trial with 3 Groups.” Archives of Internal Medicine 167 (September 24, 2007): 1892–1898.

Kim, K. B., and S. R. Sok. “Auricular Acupuncture for Insomnia: Duration and Effects in Korean Older Adults.” Journal of Gerontological Nursing 33 (August 2007): 617–624.

Schaechter, J. D., B. D. Connell, W. B. Stason, et al. “Correlated Change in Upper Limb Function and Motor Cortex Activation after Verum and Sham Acupuncture in Patients with Chronic Stroke.” Journal of Alternative and Complementary Medicine 13 (June 2007): 527–532.

Usichenko, T. I., M. Dinse, V. P. Lysenyuk, et al. “Auricular Acupuncture Reduces Intraoperative Fentanyl Requirement during Hip Arthroplasty—A Randomized Double-Blinded Study.” Acupuncture and Electrotherapeutics Research 31 (2006): 213–221.

Weiner, D. K., T. E. Rudy, N. Morone, et al. “Efficacy of Periosteal Stimulation Therapy for the Treatment of Osteoarthritis-Associated Chronic Knee Pain: An Initial Controlled Clinical Trial.” Journal of the American Geriatrics Society 55 (October 2007):1541–1547.

Wu, T. P., F. P. Chen, J. Y. Liu, et al. “A Randomized Controlled Clinical Trial of Auricular Acupuncture in Smoking Cessation.” Journal of the Chinese Medical Association 70 (August 2007): 331–338.

OTHER

Acupuncture (PDQ), health professional version. National Cancer Institute (NCI). January 11, 2008 [cited February 12, 2008]. http://www.cancer.gov/cancertopics/pdq/cam/acupuncture/healthprofessional/allpages.

Backgrounder: Manipulative and Body-Based Practices: An Overview. National Center for Complementary and Alternative Medicine (NCCAM). NCCAM Publication No. D404. Bethesda, MD: NCCAM, 2007. [cited February 12, 2008]. http://nccam.nih.gov/health/acupuncture/.

ORGANIZATIONS

American Academy of Acupuncture and Oriental Medicine (AAAOM), 1925 West County Road, B2, Roseville, MN, 55113, (651) 631-0216, http://www.aaaom.edu/index.php.

American Academy of Medical Acupuncture (AAMA), 4929 Wilshire Boulevard, Suite 428, Los Angeles, CA, 90010, (323) 937-5514, [email protected], http://www.medicalacupuncture.org/index.html.

National Center for Complementary and Alternative Medicine (NCCAM), 9000 Rockville Pike, Bethesda, MD, 20892, (301) 519-3153, (888) 644-6226, (866) 464-3616, [email protected], http://nccam.nih.gov.

National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM), 76 South Laura Street, Suite 1290, Jacksonville, FL, 32202, (904) 598-1005, (904) 598-5001, http://www.nccaom.org/index.html.

Natural Standard, 245 First Street, 18th Floor, Cambridge, MA, 02142, (617) 444-8629, (617) 758-4274, [email protected], http://www.naturalstandard.com/.

Rebecca J. Frey Ph.D.

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Acupuncture

Acupuncture

While acupuncture has been a successful Chinese medical treatment for over 5,000 years, it was not well known to the general U.S. public until the early 1970s, when President Nixon reopened relationships with China. Acupuncture was first met with skepticism, both by the U.S. public at large and the conventional American Medical Association. Slowly, Americans and other western countries began to conduct studies, sometimes in conjunction with the Chinese, about the efficacy of acupuncture. Certain types of acupuncture, particularly for pain management and drug related addictions, were easily translated into western medical theory and could be easily learned and used by western doctors. Thus, the idea of using some acupuncture gained mainstream acceptance. As this acceptance grew, so did the use of acupuncture and Chinese medical theories and methods, at least amongst the numbers of people open to "alternative" medicine. By the 1990s, despite initial scientific skepticism, acupuncture became one of the most accepted "alternative" medicines in the United States, used to varying degrees by AMA physicians and licensed Chinese doctors, and accepted on some levels by health and government institutions.

Acupuncture theory purports that the body has an energy force called Qi ("chee") that runs through pathways, called meridians. Qi involves not only the physical, but also spiritual, intellectual, and emotional aspects of people. When the flow of Qi is disrupted for any reason, ill-health ensues. To get the Qi flowing smoothly and health restored, points along the meridians are stimulated either by acupuncture (very fine needles), moxibustion (burning herbs over the points), or acupressure (using massage on the points). Often, these three methods are used together. The concept of Qi is also used in other medical and spiritual philosophies, and was broadly used in the "New Age" theories of the 1980s and 1990s, which helped popularize acupuncture and vice versa.

Acupuncture began to be used in the United States primarily for pain relief and prevention for ailments including backaches, headaches, arthritic conditions, fibromylgia, and asthmatic conditions. Because the type of acupuncture used for these ailments was easy to learn and adapt to western medicine, it was more quickly accepted. The introduction of acupuncture in the United States sparked interest by western medical researchers to gain a more complete understanding of traditional Chinese medicine and to learn why, in western terms, acupuncture "works." Theories soon abounded and those couched in western terms further popularized acupuncture. A study by Canadian Dr. Richard Chen, for instance, found that acupuncture produces a large amount of cortisol, the body's "natural" cortisone, a pain killer. In 1977, Dr. Melzach, a noted physician in the field of pain, found that western medicine's trigger points, used to relieve pain, correspond with acupuncture points.

Methods of acupuncture that became common in western culture were ones that seemed "high-tech," were (partially or mostly) developed within western culture, or developed in contemporary times, such as Electro-acupuncture and Auricular acupuncture. Electro-acupuncture, often used for pain relief or prevention, administers a small amount of electric power with various frequencies to send small electrical impulses through an acupuncture needle. Electro-acupuncture was first reported successfully used as an anesthesia for a tonsillectomy in China in 1958, and the Chinese thereafter have used it as a common surgical anesthesia. Doctors at Albert Einstein Medical Center and Northville State Hospital successfully conducted surgeries using Electro-acupuncture as an anesthesia between 1971 and 1972. Contemporary Auricular acupuncture, or ear acupuncture, developed largely outside China in France in the 1950s. It started becoming popular in the United States mostly for treating addictions like cigarette smoking, alcoholism, and drug addiction.

By the 1980s, the popularity of acupuncture supported the establishment of many U.S. schools teaching acupuncture within a "Traditional Chinese Medicine" degree. Approximately sixty such schools existed by the late 1990s. A quasi-governmental peer review group recognized by the U.S. Department of Education and by the Commission on Recognition of Postsecondary Accreditation, called ACAOM (Accreditation Commission for Acupuncture and Oriental Medicine) was devoted specifically to accrediting schools of Traditional Chinese Medicine. Many states licensed acupuncturists and doctors of Traditional Chinese Medicine, while some states would allow only American Medical Association physicians to practice acupuncture.

Acupuncture also gained broader acceptance by the government and health institutions in the 1990s. The World Health Organization (WHO) estimated that there were approximately 10,000 acupuncture specialists in the United States and approximately 3,000 practicing acupuncturists who were physicians. In 1993 the Food and Drug Administration (FDA) reported that Americans were spending $500 million per year and making approximately 9 to 12 million patient visits for acupuncture treatments. A few years later, the FDA lifted their ban of acupuncture needles being considered "investigational devices." In late 1997, the National Institute of Health announced that "… there is clear evidence that needle acupuncture treatment is effective for postoperative and chemotherapy nausea and vomiting, nausea of pregnancy, and postoperative dental pain … there are a number of other pain-related conditions for which acupuncture may be effective as an adjunct therapy, an acceptable alternative, or as part of a comprehensive treatment program." In late 1998, the prestigious and often conservative Journal of the American Medical Association published an article agreeing that acupuncture, as well as other alternative therapies, can be effective for certain disease management. This admission from the AMA was a sign of how far acupuncture and Chinese medicine had been accepted in "popular culture"—if the AMA had accepted acupuncture under certain conditions, then the general public certainly had accepted it to a much greater extent.

—tova stabin

Further Reading:

Bischko, Johannes. An Introduction to Acupuncture. 2nd ed. Heidelberg, Germany, Karl F. Haug, 1985.

Butler, Kurt. A Consumer's Guide to "Alternative Medicine": A Close Look at Homeopathy, Acupuncture, Faith-healing, and Other Unconventional Treatments. Buffalo, New York, Prometheus Books, 1992.

Cargill, Marie. Acupuncture: A Viable Medical Alternative. Westport, Connecticut, Praeger, 1994.

Cunningham, M. J. East & West: Acupuncture, An Alternative to Suffering. Huntington, West Virginia, University Editions, 1993.

Dale, Ralph Alan. Dictionary of Acupuncture: Terms, Concepts and Points. North Miami Beach, Florida, Dialectic Publishing, 1993.

Firebrace, Peter, and Sandra Hill. Acupuncture: How It Works, How It Cures. New Canaan, Connecticut, Keats, 1994.

Mann, Felix. Acupuncture: The Ancient Chinese Art of Healing and How It Works Scientifically. New York, Vintage Books, 1973.

Tinterow, Maurice M. Hypnosis, Acupuncture and Pain: Alternative Methods for Treatment. Wichita, Kansas, Bio-Communications Press, 1989.

Tung, Ching-chang; translation and commentary by Miriam Lee.Tung shih chen chiu cheng ching chi hsüeh hsüeh/Master Tong's Acupuncture: An Ancient Alternative Style in Modern Clinical Practice. Boulder, Colorado, Blue Poppy Press, 1992.

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Acupuncture

Acupuncture

Acupuncture is an ancient method of therapy that originated in China more than 2,000 years ago. It consists of inserting solid, hair-thin needles through the skin at very specific sites to achieve a cure of a disease or to relieve pain . Although it is not part of conventional medical treatment in most of the Western world, a 1998 consensus statement released by the National Institutes of Health (NIH) in the United States said evidence clearly shows acupuncture helps relieve many types of chronic and acute pain; nausea and vomiting associated chemotherapy, anesthesia , and pregnancy; and alters immune system functions. The World Health Organization, in conjunction with the International Acupuncture Training Center at Shanghai College of Traditional Chinese Medicine, declares acupuncture can be effective for dozens of problems—from bed wetting and allergies to chronic fatigue syndrome and anxiety disorders. Although many American physicians remain skeptical about its use as an anesthetic for surgery or cure for grave diseases, by 1999, approximately 10,000 acupuncturists held licenses in the United States, including some 3,000 physicians.

In the Far East, acupuncture is used extensively. It is considered one part of a total regimen that includes herbal medicine , closely guided dietetics, and psychological counseling. In ancient Chinese philosophy, good health depends

on the uninterrupted flow of so-called "vital energy " called "qi" (sometimes written as chi but pronounced chee) throughout the body. When qi is interrupted, pain and disease follow. Qi flows through 12 pairs of pathways called meridians—one pair of each meridian lying on either side of the body. An additional two meridians run along the midline of the front and back. So-called extrameridians are scattered about and connect the 14 meridians on each side. Other points outside the meridians—on the hands, ears, and face—have specific reflex effects. Altogether, there are more than 1,000 acupuncture points. Inserting needles into points along appropriate meridians unblocks qi, restoring energy balance and health.

The concept of meridians developed as the ancient Chinese discovered that pain in a given area responded not only to pressure or puncture in its immediate vicinity, but also to pressure at distant points. Pain in one arm, for example, often responds to acupuncture in the opposite arm in the area corresponding to the painful arm. As the concept of acupuncture took shape, the ancient Chinese learned that points on the body, when stimulated, helped to ease pain or heal internal diseases. They also discovered other points that were distant from the affected area that could be stimulated to achieve pain relief in the affected area. As the number of points grew, they were connected by the imaginary meridians and were labeled by their function. The large intestine meridian, for example, originates at the root of the fingernail of the first finger. The channel courses along the thumb side of the arm, over the shoulder, up the neck to the face, ending at the nostril. The stomach meridian begins below the eye , courses across the face up to the forehead, then reverses direction to run down the throat, along the chest and abdomen, down the front of the thigh and lower leg, across the ankle and foot, ending at the lateral side of the root of the second toenail. The Conception Vessel is the name given to one of the midline meridians. Its route is from the genital area straight up the middle of the abdomen to end at the center of the lower lip. The posterior midline meridian, the Governor Vessel, starts at the tail-bone, courses up the spine, over the midline of the head and ends on the front of the upper gum.

During the acupuncture procedure, 1-20 hair-thin needles are inserted under the skin, some of which may be inserted as deep as 3 in (7.6 cm). Short needles are used for areas that are less fleshy and longer needles in areas of deep flesh and muscle. The needles will remain inserted from 15-30 minutes. Needles are always solid; nothing is ever injected through them into the body. When the needle enters the skin, the patient may feel minor transient pain. When the needle tip reaches the depth of the meridian, the patient will have a sensation of radiating warmth or fullness. The insertion points nearest the painful area are usually treated first, then the distant points. For acute conditions, the treatment may be given twice a day. For a long-lasting condition (chronic pain), the treatment can be given every second or third day for up to 20 treatments, after which no acupuncture should be given for several weeks.

Because acupuncture points are very specifically located, and because people are different sizes, the Chinese developed a special system of measuring the body called "cun," or "human inch." This term has since been modernized to the Acupuncture Unit of Measurement (AUM). The AUM divides a given distance on the human body into equal parts. For example, the AUM of the chest is the division of the distance between the nipples into eight AUM. The distance from the lower end of the breastbone (sternum) to the umbilicus also is eight AUM. Thus, a broad-chested man may have a distance of 12 in (30.48 cm) between the nipples and the smaller man may have only 10 in (25.4 cm). Nevertheless, the distance is divided into eight units because it is eight AUM across the thorax. The upper arm from crease of the elbow to armpit is nine AUM, the lower arm from crease of the elbow to crease of the wrist is 12 AUM, and so on until all the areas of the body have been given standard AUM dimensions.

When the appropriate points have been located and the needles inserted, the acupuncturist rotates the needles occasionally or, in some cases, a mild electric current is passed through them to stimulate the meridian. Another technique, known as moxibustion, uses heat stimulation. After the needle is inserted, a small piece of dried leaf from the Artemisia vulgarisplant is placed in a little cup on the needle's exposed end, and lighted. The heat passes through the needle to the area of pain. A few points on the body are not suited to needle insertion. In these instances, a small, smoldering cone of Artemisia vulgaris placed directly on the skin and the heat is allowed to penetrate.

What makes acupuncture effective remains a matter of scientific investigation. However, the meridians may be pathways of nerve fibers. Dr. Leonard Wisneski of the NIH said clinical evidence shows opioid peptides—the body's natural painkillers—are released by the brain during acupuncture. Also, a study conducted by Abass Alvi, M.D., chief of nuclear medicine at the University of Pennsylvania Medical Center, used single photon emission computer tomography (SPECT) to show that, after needles were inserted, every patient had increased blood flow to the thalamus, the portion of the brain that transmits pain and other sensory signals. Dr. Lee Nauss, emeritus anesthesiologist at the Mayo Clinic, Rochester, Minnesota, said they have used acupuncture in their pain clinic since 1974 and find it "quite beneficial" for patients who do not respond to traditional treatment such as medication and nerve blocks.

There are some adverse side effects of acupuncture, most of which result from lack of knowledge or unhygienic practices on the part of the acupuncturist. Treatment should be sought from a well-trained practitioner. The NIH panel concluded there is "sufficient evidence of acupuncture's value to expand its use into conventional medicine and to encourage study designs that can withstand rigorous scientific scrutiny." Some health insurance programs cover treatment.

See also Acupressure; Alternative medicine.


Resources

periodicals

"Acupuncture." (fact sheet). National Institutes of Health Office of Alternative Medicine, 1993.

"Acupuncture Illustrated." Consumer Reports 59 (January 1994): 54-57.

Bonta, I.L. "Acupuncture Beyond the Endorphine Concept?" Medical Hypotheses 58, 3(2002): 221-224.

Botello, J.G. "Acupuncture: Getting the Point." Lears 6 (November 1993): 43-44.

KEY TERMS

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analgesia

—The effect of relieving pain. A drug or procedure that provides analgesia is an analgesic.

Anesthetic

—A substance that will induce sleep so that an individual can undergo surgery or remain unconscious until a crucial and painful period of a surgical procedure has passed.

Chronic

—A disease or condition that devlops slowly and exists over a long period of time.

Opioid peptides

—Natural substances produced by the brain to desensitize against pain

Thalamus

—Portion of the brain involved in transmission and integration of certain physical sensations

Thorax

—The area just below the head and neck; the chest.

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Acupuncture

ACUPUNCTURE

All science is based on assumptions that define, a priori, the relative weaknesses and strengths of their practical application. As western science and technology have run up against limits to their comprehension and effectiveness, other approaches to both knowledge and practice have emerged to complement them. Nowhere is this more an issue than in medicine: Acupuncture has become a popular alternative to the drugs and surgeries offered by the biomedical sciences. In its fundamentally holistic approach acupuncture also presents an implicit ethical challenge to western technoscience to see the human patient in his or her entirety and within the context of the patient's life circumstances.

Acupuncture is the practice of inserting thin needles into the body to influence physiological functioning. It is an integral part of Chinese medicine, which also includes herbal medicine, massage, nutrition, and exercise. Chinese medicine began to take form during the Shang dynasty (1766–1050 b.c.e.), and an early form of acupuncture might have been practiced then, with the oldest needles having been made of sharpened stone (Gwei-Djen and Needham 1980, Unschuld 1985). There are bronze needles dating from the Chou dynasty (approximately 600 b.c.e.). By the Warring States period (475–221 b.c.e.) the classic acupuncture text, the Huang Di Nei Jing Su Wen [Yellow emperor's classic of internal medicine], had appeared.


Nature and Origins

The practice of acupuncture is thought to have started when shamans used needles to kill evil spirits that were thought to cause illnesses (Unschuld 1985). Over thousands of years the properties of specific points were discovered empirically, and those observations were tied in to traditional theories. What originally began as a superstitious ritual gradually became a flourishing medical field. The practice has grown further since its introduction to the West in the 1970s; there are more than fifty accredited schools of Chinese medicine in the United States, and practitioners are licensed independently in over forty states.

Chinese medicine was first introduced to Europe in the 1600s by Jesuit priests returning from the Orient. By the 1950s major schools of acupuncture were established in England and France. Acupuncture lost state support in China by the late 1800s and languished until a decree by Chairman Mao in 1958 that Chinese medicine should be revived according to the principles of dialectical materialism. Despite the "scientization" of Chinese in China, older traditions more grounded in a spiritual world view have survived both in Europe and in other parts of Asia that were not suppressed by the Chinese totalitarian regime.


Philosophical Orientation

According to the Shen Nong Ben Cao, one of China's oldest medical texts (second century c.e.), the highest aspect of healing involves helping patients fulfill their destiny so that they can live out the years allotted to them by heaven. The next highest aspect is the nourishment of people's inborn nature. Finally, the lowest class of healing is to treat specific physical illnesses. In its highest form, then, Chinese medicine focuses on individuals' health in the overall context of their lives. Health is manifested when one lives in harmony with the laws of nature and represents a profound integration of function on all levels: spiritual, mental, and physical. The presence of illness represents a denial and loss of the true self.

As a holistic practitioner an acupuncturist uses several diagnostic methods to determine the overall functional balance of a patient. Diagnoses occur largely within the perspective of the Chinese models of the universal poles of yin and yang and the five-element system, both of which provide qualitative standards for interpreting a range of physiological phenomena. From the yin/yang perspective practitioners consider observations in terms of internal/external, soft/hard, deficient/excess, and cold/hot, all of which point toward understanding the particular thermodynamic state of individuals and the unique manifestations of their illnesses or imbalances. For example, a practitioner might note that cold in nature tends to have a slowing and contracting influence. If the patient's pulse is slow and his or her muscles are tight the practitioner might deduce the presence of cold.

The five-element system (wuxing) was elaborated fully around 350 b.c.e. by Zou Yen (Kaptchuk 1983). The term wuxing denotes five dynamic movements—water, wood, fire, earth, and metal—that continually transform into each other as the seasons do. The language used by the early Chinese to describe their world was one of simple poetic images rich in allusions. Water is the element associated with winter because of its tendency to freeze and become focused in that season. Wood is associated with spring because it grows rapidly at that time of the year. Fire is associated with summer because of the increased heat during those months as the sun reaches its zenith. Earth is associated with late summer when the fields are full of the earth's bounty. Minerals are a natural expression of the metal element because they lie hidden beneath the ground; they symbolize the essential, precious, and rarefied aspects of life. Metal is associated with the fall, when what is of value must be harvested by the farmer's knife and everything else must be left to wither in the fields (Connelly 2002, Jarrett 1999).

Over the course of thousands of years laws were discovered and codified that described the functional dynamics of natural change. The five-element model is one example of these laws. Relating physiological functions to these qualitative standards, an acupuncturist is able to generate a diagnosis that is unique to each individual. The goal of treatment is to harmonize individuals both internally and within the context of their natural environment. The internal health of the individual and the integrity of the natural environment are seen as mutually dependent, a worldcentric view that is especially relevant at a time when technoscience has achieved the power to destroy much of nature.


How Acupuncture Works

The attempts by Western scientific research to describe how acupuncture works rely on modern biomedical concepts. Popular theories include the notion that the mode of efficacy of acupuncture can be attributed to its influence on the structure and function of the body's different systems, including the nervous, circulatory, and immune systems (National Institutes of Health 1997, World Health Organization 2002). However, to appreciate acupuncture on its own terms one must understand the traditional explanations of how acupuncture works.

Western biomedicine focuses on the quantitative analysis of physical structure; it is mechanistic and reductionist in character. By contrast, Chinese medicine focuses on the qualitative analysis of function; it is holistic and synthetic in nature (Jarrett 1999, 2003). Over four millennia the Chinese have developed a rigorous language for discussing the subtleties of human physiological function. The central physiological concept is predicated on the notion of qi (chi), a universally present influence that maintains the functional integrity not only of the organism but of all natural processes (Porkert 1982, Jarrett 1999). The functions of qi are manifest in five forms: movement, transformation, protection, retention, and warming. Any dysfunction of these attributes in any aspect of being, whether physical, psychological, or spiritual, is said to be an imbalance of qi.

Acupuncture points are discrete locations on the external surface of the human body where the internal function of the organs can be influenced and the quality and directionality of their qi can be mediated. Points that are functionally related are said to constitute a specific meridian. Each meridian is associated with the function of an internal organ system or "official." Rather than naming specific organs anatomically, the ancient Chinese conceived of each organ as being an official with a specific duty to fill. When each official did his duty, health and harmony resulted. In the Huang Di Nei Jing Su Wen each organ is personified as being in charge of specific functions (Larre and de la Vallée Rochat 1987). For example, the fourteen points most closely associated with the function of the liver official constitute the liver meridian. The liver traditionally is likened to a military general in charge of planning and decision making. Its function is associated with growth, vision, and flexibility in all aspects of being. Hence, visual disturbances, poor planning, frustration, and tightness in the tendons that limits flexibility all can be treated through acupuncture points on the liver meridian.

Each point harmonizes an unbalanced aspect of function on a continuum ranging from deficient to excessive. For example, if a patient's heart rate is too slow or too fast, an acupuncture point such as Heart-7 (shenmen, or "Spirit Gate") can be used to increase or decrease the pulse to achieve the correct rate. Similarly, a point such as Liver-14 (qimen, or "Gate of Hope") can be used to help calm a belligerent person or enhance self-esteem in a timid person.

Acupuncture has evolved as a sophisticated science of human function for at least 2,500 years. As Chinese medicine is integrated into Western cultures, patients are afforded the benefits of both biomedical and functional medicine. The worldcentric and holistic view of Chinese medicine holds special promise for helping humanity face the unique challenges of the dawn of the twenty-first century.


LONNY S. JARRETT

SEE ALSO Complementary and Alternative Medicine; Confucian Perspectives; Daoist Perspectives; Galenic Medicine; Medical Ethics.




BIBLIOGRAPHY

Connelly, Dianne M. (2002). Traditional Acupuncture: The Law of the Five Elements. Columbia, MD: Traditional Acupuncture International.

Gwei-Djen, Lu, and Joseph Needham. (1980). Celestial Lancets: A History and Rationale of Acupuncture and Moxa. Cambridge, UK, and New York: Cambridge University Press.

Jarrett, Lonny S. (1999). Nourishing Destiny: The Inner Tradition of Chinese Medicine. Stockbridge, MA: Spirit Path Press.

Jarrett, Lonny S. (2003). The Clinical Practice of Chinese Medicine. Stockbridge, MA: Spirit Path Press.

Kaptchuk, Ted J. (1983). The Web That Has No Weaver: Understanding Chinese Medicine. Chicago: Congdon & Weaver.

Larre, Claude, and Elisabeth Rochat de la Vallée. (1987). The Secret Treatise of the Spiritual Orchid. East Grinstead, UK: International Register of Oriental Medicine.

Porkert, Manfred. (1982). The Theoretical Foundations of Chinese Medicine. Cambridge, MA: MIT Press.

Unschuld, Paul U. (1985). Medicine in China: A History of Ideas. Berkeley: University of California Press.

World Health Organization. (2002). Acupuncture: Review and Analysis of Reports on Controlled Clinical Trials. Geneva: Author.


INTERNET RESOURCE

National Institutes of Health. (1997). Acupuncture. NIH Consensus Statement 15(5): 1–34. Available from http://odp.od.nih.gov/consensus/cons/107/107_intro.htm

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