Acupuncture

針砭 (zhēn biān) or 針灸 (zhēn jiǔ),

 

Acupuncture needle

Acupuncture is a technique of inserting and manipulating fine needles into specific points on the body with the aim of relieving pain and for therapeutic purposes. These acupuncture points lie along meridians (or channels) along which Qi, the vital energy, flows. According to the NIH consensus statement on acupuncture, despite it's extensive history, it contines "to play an important role in the evaluation of patients and the formulation of treatment in acupuncture."

Acupuncture originated in China and is used in Traditional Chinese Medicine (TCM), which incorporates other therapies such as herbal medicine, massage, cupping and diet therapy. According to a study commissioned by the World Health Organisation, TCM remains as one of the world's oldest and most popular forms of primary care. Whilst China is it's birthplace, acupuncture is practiced and taught throughout the world.

History

In China, the practice of acupuncture can perhaps be traced as far back as the Stone Age, with the Bian shi, or sharpened stone acupuncture needles dating back to 3000 B.C. Clearer evidence exists from the 1st millennium BCE.

Recent examinations of, a 5,000-year-old mummy found in the Alps (called Ötzi) have identified over 50 tattoos on his body, some of which are located on acupuncture points that would today be used to treat ailments Ötzi suffered from. Some scientists believe that this is evidence that practices similar to acupuncture were practiced elsewhere in  Eirasoa during the early Bronze Age.  According to an article published in The Lancet by Dorfer et al., "We hypothesised that there might have been a medical system similar to acupuncture (Chinese Zhenjiu: needling and burning) that was practiced in Central Europe 5,200 years ago... A treatment modality similar to acupuncture thus appears to have been in use long before its previously known period of use in the medical tradition of ancient China. This raises the possibility of acupuncture having originated in the Eurasian continent at least 2000 years earlier than previously recognised."

The earliest Chinese medical text that first describes acupuncture is the Yellow Emperor’s Classic of Internal Medicine  - Huang Di Nei Jing, which was compiled around 305–204 B.C.

According to one legend, acupuncture started in China when some soldiers who were wounded by arrows in battle experienced a relief of pain in other parts of the body, and consequently people started experimenting with arrows (and later needles) as therapy.

Acupuncture spread from China to Japan, Korea, Vietnam and elsewhere in East Asia. Portuguese missionaries in the 16th century were among the first to bring reports of acupuncture to the West.

Following the Revolution of 1911 in China, Western Medicine was introduced and acupuncture and Chinese herbology were in drastic decline.  Due to the large population and need for medical care, acupuncture and herbs remained popular among the folk people, and later on with the emergence of "barefoot doctors".

Acupuncture was used exclusively during the Long March and despite harsh conditions it helped maintain the health of the People's Liberation Army.  This led Mao Zedong, the leader of the Chinese Communist Party, to see that acupuncture remained an important element in China's medical system, stating; "Chinese medicine and pharmacology are a great treasure house and efforts should be made to explore them and raise them to a higher level."  In the late 1950s to the 1960s, acupuncture research continued with further study of the ancient texts, clinical effect on various diseases, acupuncture anesthesia, and acupuncture's effect on the internal organs.

Representatives were sent out across China to collect information about the theories and practices of Chinese medicine. Traditional Chinese medicine is the formalized system of Chinese medicine that was created out of this effort. TCM combines the use of acupuncture, Chinese herbal medicine, tui na, and other modalities. After the Cultural Revolution, TCM instruction was incorporated into university medical curricula under the "Three Roads" policy, wherein TCM, biomedicine, and a synthesis of the two would all be encouraged and permitted to develop.

From the 1970s to the present, acupuncture continues to play an important role in China's medical system, and China has taken the lead in researching all aspects of acupuncture's application and clinical effects.

In the 1970s, acupuncture became popular in America after American visitors to China brought back firsthand reports of patients undergoing major surgery using acupuncture as their sole form of anesthesia. The National Acupuncture Association (NAA), the first national association of acupuncture in the US, introduced acupuncture to the West through seminars and research presentations. The NAA created and staffed the UCLA Acupuncture Pain clinic in 1972. This was the first legal clinic in a medical school setting in the US.

Traditional theory

Traditional Chinese medicine

Chinese Medicine is based on a pre-scientific paradigm of medicine that developed over several thousand years. Its theory holds the following explanation of acupuncture:

Health is a condition of balance of Yin and Yang within the body. Particularly important in acupuncture is the free flow of Qi, a difficult-to-translate concept that pervades Chinese philosophy and is commonly translated as "Vital Energy". Qi is immaterial and hence yang; its yin, material counterpart is Blood (capitalized to distinguish it from physiological blood, and very roughly equivalent to it). Acupuncture treatment regulates the flow of Qi and Blood, tonifying where there is deficiency, draining where there is excess, and promoting free flow where there is stagnation.  An axiom of the medical literature of acupuncture is "no pain, no blockage; no blockage, no pain."

Many patients claim to experience the sensations of stimulus known in Chinese as de qi ("obtaining the Qi" or "arrival of the Qi"). This kind of sensation was historically considered to be evidence of effectively locating the desired point.

TCM treats the human body as a whole that involves several "systems of function" generally named after anatomical organs but not directly associated with them. The Chinese term for these systems is Zang Fu, where zang is translated as "viscera" or solid organs and fu is translated as "bowels" or hollow organs. In order to distinguish systems of function from physical organs, Zang Fu are capitalized in English, thus Lung, Heart, Kidney, etc. Disease is understood as a loss of balance of Yin, Yang, Qi and Blood (which bears some resemblance to homeostasis).  Treatment of disease is attempted by modifying the activity of one or more systems of function through the activity of needles, pressure, heat, etc. on sensitive parts of the body of small volume traditionally called "acupuncture points" in English, or "xue" (穴, cavities) in Chinese. This is referred to in TCM as treating "patterns of disharmony."

Most of the main acupuncture points are found on the "twelve main meridians" and two of the "8 extraodinary meridians" (Du Mai and Ren Mai) a total of "fourteen channels", which are described in classical and traditional Chinese medical texts, as pathways through which Qi and "Blood" flow. There also exist "extra points" not belonging to any channel. Other tender points (known as "ashi points") may also be needled as they are believed to be where stagnation has gathered.

Treatment of acupuncture points may be performed along several layers of pathways, most commonly the twelve primary channels, or mai, located throughout the body. The first twelve channels correspond to systems of function: Lung, Large Intestine, Stomach, Spleen, Heart, Small Intestine, Bladder, Kidney, Pericardium, San Jiao (an intangible, also known as Triple Burner), Gall Bladder, and Liver. Other pathways include the Eight Extraordinary Pathways (Qi Jing Ba Mai), the Luo Vessels, the Divergents and the Sinew Channels. Ashi (tender) points are generally used for treatment of local pain.

Of the eight extraordinary pathways, only two have acupuncture points of their own: the Ren Mai and Du Mai, which are situated on the midline of the anterior and posterior aspects of the trunk and head respectively. The other six meridians are "activated" by using a master and couple point technique which involves needling the acupuncture points located on the twelve main meridians that correspond to the particular extraordinary pathway.

The twelve primary pathways run vertically, bilaterally, and symmetrically and every channel corresponds to and connects internally with one of the twelve Zang Fu ("organs"). This means that there are six Yin and six Yang channels. There are three yin and three yang channels on each arm, and three yin and three yang on each leg.

The movement of Qi through each of the twelve channels comprises an internal and an external pathway. The external pathway is what is normally shown on an acupuncture chart and is relatively superficial. All of the acupuncture points of a channel lie on its external pathway. The internal pathways are the deep course of the channel where it enters the body cavities and related Zang Fu organs. The superficial pathways of the twelve channels describe three complete circuits of the body, chest to hands, hands to head, head to feet, feet to chest, etc.

The distribution of Qi through the pathways is said to be as follows (the based on the demarcations in TCM's Chinese Clock): Lung channel of hand taiyin to Large Intestine channel of hand yangming to Stomach channel of foot yangming to Spleen channel of foot taiyin to Heart channel of hand shaoyin to Small Intestine channel of hand taiyang to Bladder channel of foot taiyang to Kidney channel of foot shaoyin to Pericardium channel of hand jueyin to San Jiao channel of hand shaoyang to Gallbladder channel of foot shaoyang to Liver channel of foot jueyin then back to the Lung channel of hand taiyin. According to the "Chinese clock", each channel occupies two hours, beginning with the Lung, 3AM-5AM, and coming full circle with the Liver 1AM-3AM.

Traditional diagnosis

The acupuncturist decides which points to treat by observing and questioning the patient in order to make a diagnosis according to the tradition which he or she utilizes. In TCM, there are four diagnostic methods: inspection, auscultation and olfaction, inquiring, and palpation:

TCM perspective on treatment of disease

Although TCM is based on the treatment of "patterns of disharmony" rather than biomedical diagnoses, practitioners familiar with both systems have commented on relationships between the two. A given TCM pattern of disharmony may be reflected in a certain range of biomedical diagnoses: thus, the pattern called Deficiency of Spleen Qi could manifest as chronic fatigue , diarrhea or uterine prolapse. Likewise, a population of patients with a given biomedical diagnosis may have varying TCM patterns. These observations are encapsulated in the TCM aphorism "One disease, many patterns; one pattern, many diseases".