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Acupuncture

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Acupuncture (from Latin, acus (needle) and punctura (to puncture)) is a form of alternative or complimentary medicine and a key component of Traditional Chinese Medicine (TCM).

aiguille-1280088_1280Acupuncture is a 5,000 year-old Chinese therapy.   Formerly known as Zhenjiu, it is based on the theory that dysfunction or illness is a result of barriers in the network of meridian pathways that extend throughout the body.   These obstructions cause disparities in the flow of vital Qi energy.  Health is maintained when the opposite forces of Yin and Yang are in equilibrium and chi flows without disruption.  These channels of energy do not exist in a physical form like the way blood travels through veins, even though some research suggests otherwise.   They do, however, exist in a more elusive, vibrational mode.

The best way to visualize meridians is as an energy freeway that traverses through all parts of the human body.  Meridians flow in matching pairs with acupuncture points along their pathway.  The meridian system is often referred to as an energetic distribution network.  Basically, it is best to consider it a process, not a structure.

There are twelve main meridians throughout the body through which Qi (or energy) flows.  Each limb is traversed by six channels, three Yin (on the inside), and three Yang (on the outside).  Each of the twelve regular channels corresponds to five Yin organs, six Yang organs, the Pericardium, and San Jiao.  It is important to remember that these are not western “organs” but relate to processes in the body.

When a meridian has a balanced flow of chi the corresponding organs and body systems will have a better chance of operating optimally.  To cultivate this and balance this flow acupuncture points (acupoints) along each of the meridians are activated to dissipate any obstructions by inserting fine needles into them or applying other forms of stimulation.

Acupuncture is one of the fundamental techniques found in traditional Chinese medicine.  It is well documented, scientifically analyzed, and widely becoming acceptable in western medicine.

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Clinical Application

Acupuncture is a form of Integrative or Complimentary Medicine.  It is commonly used for pain relief, though it is also used to treat a wide range of conditions. The majority of people who seek out acupuncture do so for musculoskeletal problems, including low back pain, shoulder stiffness, and knee pain.  Acupuncture is rarely used alone but rather as an adjunct to other treatment modalities.  Published guidelines recommend the use of acupuncture for the management of non-specific low back pain, among other treatments.  For example, the American Society of Anesthesiologists states it may be considered in the treatment for nonspecific, noninflammatory low back pain only in conjunction with conventional therapy.  A recent study by Q.L. Yuan found that, “Acupuncture, acupressure, and cupping could be efficacious in treating the pain and disability associated with Chronic Neck Pain or Chronic Lower Back Pain in the immediate term” (Yuan Q-l, Traditional Chinese Medicine for Neck Pain and Low Back Pain).

Acupuncture is the stimulation of specific acupuncture points along the skin of the body using thin needles. It can be associated with the application of heat, pressure, or laser light to these points.  In modern acupuncture, a consultation is followed by taking the pulse on both arms and inspecting the tongue. This initial evaluation may last up to sixty minutes. Subsequent visits typically last about a half an hour. The number and frequency of acupuncture sessions vary, but most practitioners do not think one session is sufficient. A common treatment plan for a single complaint usually involves six to twelve treatments, to be carried out over a few months. A typical session entails lying still while approximately five to twenty needles are inserted; for the majority of cases, the needles will be left in place for ten to twenty minutes. There is also a non-invasive therapy developed in early 20th century Japan using an elaborate set of “needles” for the treatment of children (shōnishin or shōnihari).

 

Screen Shot 2016-05-03 at 10.10.30 AMClinical practice varies depending on the country.  Acupuncturists generally practice acupuncture as an overall system of care, which includes using traditional diagnostic techniques, acupuncture needling, and other ancillary treatments.  Chinese herbs are also often used.  There is a diverse range of acupuncture approaches, involving different philosophies.  Although various different techniques of acupuncture practice have emerged, the method used in traditional Chinese medicine (TCM) seems to be the most widely adopted in the US.  Traditional acupuncture involves needle insertion, moxibustion, and cupping therapy.

The main methods practiced in the UK are TCM and Western medical acupuncture. The term Western medical acupuncture is used to indicate an adaptation of TCM-based acupuncture which focuses less on TCM.  The Western medical acupuncture approach involves using acupuncture after a medical diagnosis.  According to a recent study (MacPherson, H., Unanticipated Insights into Biomedicine), trials of acupuncture for back pain and for chronic headache and migraine both demonstrated clear evidence of cost-effectiveness as well as clinical effectiveness.  As a result, these trials contributed to a major shift in health policy…both were cited by The National Institute for Health and Care Excellence (NICE) as providing key evidence for the recommendations that acupuncture should be offered within the National Health Service as an option for both persistent low back pain, headache, or migraines.

In traditional acupuncture, the acupuncturist decides which points to treat by observing and questioning the patient to make a diagnosis according to the tradition used. In TCM, the four diagnostic methods are: inspection, auscultation and olfaction, inquiring, and palpation. Inspection focuses on the face and particularly on the tongue, including analysis of the tongue size, shape, tension, color and coating, and the absence or presence of teeth marks around the edge.  Auscultation and olfaction involves listening for particular sounds (such as wheezing) and attending to body odor. Inquiring involves focusing on the “seven inquiries”: chills and fever; perspiration; appetite, thirst and taste; defecation and urination; pain; sleep; and menses and leukorrhea. Palpation is focusing on feeling the body for tender “A-shi” points and feeling the left and right radial pulses.

De-qi sensation

De-qi refers to a sensation of numbness, distension, or electrical tingling at the needling site which might radiate along the corresponding meridian. If de-qi can not be generated, then inaccurate location of the acupoint, improper depth of needle insertion, inadequate manual manipulation, or a very weak constitution of the patient can be considered.  All of which are thought to decrease the likelihood of successful treatment. If the de-qi sensation does not immediately occur upon needle insertion, various manual manipulation techniques can be applied to promote it (such as plucking, shaking or trembling.  Once de-qi is achieved, further techniques might be utilized which aim to “influence” the de-qi.  For example, by certain manipulation the de-qi sensation allegedly can be conducted from the needling site towards more distant sites of the body. Other techniques aim at “tonifying” or “sedating.”  The former techniques are used in deficiency patterns, the latter in excess patterns.  De qi is more important in Chinese acupuncture, while Western and Japanese patients may not consider it a necessary part of the treatment.

What the Experts Say

One of the first comprehensive studies compiled in the efficacy of Acupuncture was by the World Health Organization (WHO) in 2003.   More than one hundred indications were discussed and divided into four groups concerning the strength of the evidence that existed at that time.  

The WHO concluded that there were “promising results showing efficacy of acupuncture in adult postoperative and chemotherapy nausea and vomiting and in postoperative dental pain” In other conditions, mostly various kinds of pain, acupuncture “might be useful as an adjunct treatment or an acceptable alternative”

The complete list of diseases, symptoms or conditions for which acupuncture has been proved (according to the report) through controlled trials—to be an effective treatment:

  • Adverse reactions to radiotherapy and/or chemotherapy

  • Allergic rhinitis (including hay fever)

  • Biliary colic

  • Depression (including depressive neurosis and depression following stroke)

  • Dysentery, acute bacillary

  • Dysmenorrhoea, primary

  • Epigastralgia, acute (in peptic ulcer, acute and chronic gastritis, and gastrospasm)

  • Facial pain (including craniomandibular disorders)

  • Headache

  • Hypertension, essential

  • Hypotension, primary

  • Induction of labour

  • Knee pain

  • Leukopenia

  • Low back pain

  • Malposition of fetus, correction of

  • Morning sickness

  • Nausea and vomiting

  • Neck pain

  • Pain in dentistry (including dental pain and temporomandibular dysfunction)

  • Periarthritis of shoulder

  • Postoperative pain

  • Renal colic

  • Rheumatoid arthritis

  • Sciatica

  • Sprain

  • Stroke

  • Tennis elbow

According to the most recent in-depth information available from the National Center for Complementary and Integrative Health (NIH), there have been extensive studies conducted on acupuncture, especially for back and neck pain, osteoarthritis or knee pain, and headache. However, researchers are only beginning to understand whether acupuncture can be helpful for other health conditions.  Acupuncture may help reduce the frequency of tension headaches and prevent migraine headaches. Therefore, acupuncture appears to be a reasonable option for people with chronic pain. However, clinical practice guidelines are inconsistent in recommendations about acupuncture.  Current evidence suggests that many factors—like expectation and belief—that are unrelated to acupuncture needling may play important roles in the beneficial effects of acupuncture on pain.

NIH Findings by Condition

Lower Back Pain
  • A 2012 analysis of data on participants in acupuncture studies looked at back and neck pain together and found that actual acupuncture was more helpful than either no acupuncture or simulated acupuncture.
  • A 2010 review by the Agency for Healthcare Research and Quality found that acupuncture relieved low-back pain immediately after treatment but not over longer periods of time.
  • A 2008 systematic review of studies on acupuncture for low-back pain found strong evidence that combining acupuncture with usual care helps more than usual care alone. The same review also found strong evidence that there is no difference between the effects of actual and simulated acupuncture in people with low-back pain.
  • Clinical practice guidelines issued by the American Pain Society and the American College of Physicians in 2007 recommend acupuncture as one of several nondrug approaches physicians should consider when patients with chronic low-back pain do not respond to self-care (practices that people can do by themselves, such as remaining active, applying heat, and taking pain-relieving medications).
Neck Pain
  • A 2009 analysis found that actual acupuncture was more helpful for neck pain than simulated acupuncture, but the analysis was based on a small amount of evidence (only three studies with small study populations).
  • A large German study with more than 14,000 participants evaluated adding acupuncture to usual care for neck pain. The researchers found that participants reported greater pain relief than those who didn’t receive it; the researchers didn’t test actual acupuncture against simulated acupuncture.
For Osteoarthritis/Knee Pain
  • A 2014 Australian clinical study involving 282 men and women showed that needle and laser acupuncture were modestly better at relieving knee pain from osteoarthritis than no treatment, but not better than simulated (sham) laser acupuncture. Participants received 8 to 12 actual and simulated acupuncture treatments over 12 weeks. These results are generally consistent with previous studies, which showed that acupuncture is consistently better than no treatment but not necessarily better than simulated acupuncture at relieving osteoarthritis pain.
  • A major 2012 analysis of data on participants in acupuncture studies found that actual acupuncture was more helpful for osteoarthritis pain than simulated acupuncture or no acupuncture.
  • A 2010 systematic review of studies of acupuncture for knee or hip osteoarthritis concluded that actual acupuncture was more helpful for osteoarthritis pain than either simulated acupuncture or no acupuncture. However, the difference between actual and simulated acupuncture was very small, while the difference between acupuncture and no acupuncture was large.
For Headache
  • A 2012 analysis of data on individual participants in acupuncture studies looked at migraine and tension headaches. The analysis showed that actual acupuncture was more effective than either no acupuncture or simulated acupuncture in reducing headache frequency or severity.
  • A 2009 systematic review of studies concluded that actual acupuncture, compared with simulated acupuncture or pain-relieving drugs, helped people with tension-type headaches. A 2008 systematic review of studies suggested that actual acupuncture has a very slight advantage over simulated acupuncture in reducing tension-type headache intensity and the number of headache days per month.
  • A 2009 systematic review found that adding acupuncture to basic care for migraines helped to reduce migraine frequency. However, in studies that compared actual acupuncture with simulated acupuncture, researchers found that the differences between the two treatments may have been due to chance.
For Other Conditions
  • Results of a systematic review that combined data from 11 clinical trials with more than 1,200 participants suggested that acupuncture (and acupuncture point stimulation) may help with certain symptoms associated with cancer treatments.
  • There is not enough evidence to determine if acupuncture can help people with depression.
  • Acupuncture has been promoted as a smoking cessation treatment since the 1970s, but research has not shown that it helps people quit the habit.

Acupuncture is generally considered safe when performed by an experienced, well-trained practitioner using sterile needles. Improperly performed acupuncture can cause serious side effects.  Check your providers credentials and State’s or Country’s laws regarding certification.

 

References

– Cho YJ, Song YK, Cha YY, Shin BC, Shin IH, Park HJ, et al. Acupuncture for chronic low back pain: a multicenter, randomized, patient-assessor blind, sham-controlled clinical trial. Spine (Phila Pa 1976). 2013; 38(7): 549–557.

-Lee JH, Choi TY, Lee MS, Lee H, Shin BC, Lee H. Acupuncture for acute low back pain: a systematic review. Clin J Pain. 2013; 29(2): 172–185. doi: 10.1097/AJP.0b013e31824909f9 PMID: 23269281

-MacPherson, H., Hammerschlag, R., Coeytaux, R. R., Davis, R. T., Harris, R. E., Kong, J., & … Wayne, P. M. (2016). Unanticipated Insights into Biomedicine from the Study of Acupuncture. Journal Of Alternative And Complementary Medicine (New York, N.Y.), 22(2), 101-107. doi:10.1089/acm.2015.0184

-Ratcliffe J, Thomas KJ, MacPherson H, Brazier J. A randomised controlled trial of acupuncture care for persistent low back pain: cost effectiveness analysis. BMJ. 2006;333: 626–628.

-Sun Y, Gan TJ, Dubose JW, Habib AS. Acupuncture and related techniques for postoperative pain: a systematic review of randomized controlled trials. Br J Anaesth. 2008; 101(2): 151–160. doi: 10.1093/ bja/aen146 PMID: 18522936

-Thomas KJ, MacPherson H, Thorpe L, et al. Randomised controlled trial of a short course of traditional acupuncture compared with usual care for persistent non-specific low back pain. BMJ. 2006;333:623–626.

-Vickers AJ, Rees RW, Zollman CE, et al. Acupuncture for chronic headache in primary care: large, pragmatic, randomised trial. BMJ 2004;328:744.

-Vickers AJ, Cronin AM, Maschino AC, Lewith G, MacPherson H, Foster NE, et al. Acupuncture for chronic pain: individual patient data meta-analysis. Arch Intern Med. 2012; 172(19): 1444–1453. doi: 10.1001/archinternmed.2012.3654 PMID: 22965186

-Wonderling D, Vickers AJ, Grieve R, McCarney R. Cost effectiveness analysis of a randomised trial of acupuncture for chronic headache in primary care. BMJ. 2004;328:747.

-Yuan Q-l, Guo T-m, Liu L, Sun F, Zhang Y-g (2015) Traditional Chinese Medicine for Neck Pain and Low Back Pain: A Systematic Review and MetaAnalysis. PLoS ONE 10(2): e0117146. doi:10.1371/ journal.pone.0117146

Comprehensive Literature Guide

  1. Pyne, D.; Shenker, N. G. (2008). “Demystifying acupuncture”. Rheumatology 47 (8): 1132–1136. doi:10.1093/rheumatology/ken161. ISSN 1462-0324. PMID 18460551.
  2. Berman, Brian; Langevin, Helene; Witt, Claudia; Dubner, Ronald (29 July 2010). “Acupuncture for Chronic Low Back Pain”. New England Journal of Medicine 363 (5): 454–461. doi:10.1056/NEJMct0806114. PMID 20818865.
  3. Liu, Gang; Ma, Hui-juan; Hu, Pan-pan; Tian, Yang-hua; Hu, Shen; Fan, Jin; Wang, Kai (2013). “Effects of painful stimulation and acupuncture on attention networks in healthy subjects”Behavioral and Brain Functions 9 (1): 23. doi:10.1186/1744-9081-9-23. ISSN 1744-9081. PMC 3680197. PMID 23758880.
  4. Adams, D; Cheng, F; Jou, H; Aung, S; Yasui, Y; Vohra, S (Dec 2011). “The safety of pediatric acupuncture: a systematic review”. Pediatrics 128 (6): e1575–e1587. doi:10.1542/peds.2011-1091. PMID 22106073.
  5. Ernst, E.; Lee, Myeong Soo; Choi, Tae-Young (2011). “Acupuncture: Does it alleviate pain and are there serious risks? A review of reviews” (PDF). Pain 152 (4): 755–764. doi:10.1016/j.pain.2010.11.004. ISSN 0304-3959. PMID 21440191.
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  8. de las Peñas, César Fernández; Arendt-Nielsen, Lars; Gerwin, Robert D (2010). Tension-type and cervicogenic headache: pathophysiology, diagnosis, and management. Jones & Bartlett Learning. pp. 251–254. ISBN 9780763752835.
  9. Hutchinson, Amanda J P; Ball, Simon; Andrews, Jeremy C H; Jones, Gareth G (2012). “The effectiveness of acupuncture in treating chronic non-specific low back pain: a systematic review of the literature”. Journal of Orthopaedic Surgery and Research 7 (1): 36. doi:10.1186/1749-799X-7-36. ISSN 1749-799X. PMID 23111099.
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