Acupuncture is a form of alternative medicine in which thin needles are inserted into the body.It is a key component of traditional Chinese medicine (TCM). TCM theory and practice are not based upon scientific knowledge,and acupuncture is a pseudoscience.There is a diverse range of acupuncture theories based on different philosophies,and techniques vary depending on the country.The method used in TCM is likely the most widespread in the United States.It is most often used for pain relief,though it is also used for a wide range of other conditions. Acupuncture is generally used only in combination with other forms of treatment.
Basic Rules for Acupuncture
Important elements of therapy are as follows
- Patient undergoing the procedure must remain in a lying or sitting position, and his muscles relaxed.
- Through punctures that cause slight pain, the patient receives the therapeutic effect. If he experiences severe pain, then this indicates an error during the operation.
- Area around the chest and belly is pierced on the breath.
- Needles, which are used during the procedure must be properly prepared.
- Test procedure is the first. She reports on how the patient responds to acupuncture. One procedure lasts on average about 30 min.
- Recommended that the patient went from 2-3 treatments per week, and the course of treatment is 15-20 times. Before the repeated courses are recommended two-week break.
- If after 3 courses of acupuncture, the patient does not feel the expected results, the follow-up procedures.
Indications/Uses of Acupuncture
Research carried out in Germany has shown that acupuncture may help relieve tension headaches and migraines.
The NCCIH note that it has been proven to help in cases of
- Low back pain
- Neck pain
- Knee pain
- Headache and migraine
They list additional disorders that may benefit from acupuncture, but which require further scientific confirmation.
In 2003, the World Health Organization (WHO) listed a number of conditions in which they say acupuncture has been proven effective.
- High and low blood pressure
- Chemotherapy-induced nausea and vomiting
- Some gastric conditions, including peptic ulcer
- Painful periods
- Allergic rhinitis
- Facial pain
- Morning sickness
- Rheumatoid arthritis
- Tennis elbow
- Dental pain
- Reducing the risk of stroke
- Inducing labor
Other conditions for which the WHO say that acupuncture may help but more evidence is needed include
- Post-operative convalescence
- Substance, tobaccor and alcohol dependence
- Spine pain
- Stiff neck
- Vascular dementia
- Whooping cough, or pertussis
- Tourette syndrome
Case-controlled clinical studies have shown that acupuncture has been an effective treatment for the following diseases, symptoms or conditions
- 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)
- Induction of labor
- Knee pain
- Low back pain
- Malposition of fetus, correction
- 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
- Tennis elbow
The following diseases, symptoms or conditions have limited but probable evidence to support the therapeutic use of acupuncture
- Abdominal pain (in acute gastroenteritis or due to gastrointestinal spasm)
- Acne vulgaris
- Alcohol dependence and detoxification
- Bell’s palsy
- Bronchial asthma
- Cancer pain
- Cardiac neurosis
- Cholecystitis, chronic, with acute exacerbation
- Competition stress syndrome
- Craniocerebral injury, closed
- Diabetes mellitus,
- Epidemic haemorrhagic fever
- Epistaxis, simple (without generalized or local disease)
- Eye pain due to subconjunctival injection
- Female infertility
- Facial spasm
- Female urethral syndrome
- Fibromyalgia and fasciitis
- Gastrokinetic disturbance
- Gouty arthritis
- Hepatitis B virus carrier status
- Herpes zoster (human (alpha) herpesvirus 3)
- Labour pain
- Lactation, deficiency
- Male sexual dysfunction, non-organic
- Ménière disease
- Neuralgia, post-herpetic
- Opium, cocaine and heroin dependence
- Pain due to endoscopic examination
- Pain in thromboangiitis obliterans
- Polycystic ovary syndrome (Stein-Leventhal syndrome)
- Post-extubation in children
- Postoperative convalescence
- Premenstrual syndrome
- Prostatitis, chronic
- Radicular and pseudoradicular pain syndrome
- Raynaud syndrome, primary
- Recurrent lower urinary-tract infection
- Reflex sympathetic dystrophy
- Retention of urine, traumatic
- Sialism, drug-induced (excessive salivation)
- Sjögren syndrome
- Sore throat (including tonsillitis)
- Spine pain, acute
- Stiff neck
- Temporomandibular joint dysfunction
- Tietze syndrome
- Tobacco dependence
- Tourette syndrome
- Ulcerative colitis
- Vascular dementia
- Whooping cough (pertussis)
Contra Indications of Acupuncture
The Acupuncture Association of Chartered Physiotherapists provides guidelines on contraindications aimed specifically at physiotherapists practicing acupuncture.
Absolute Contraindications of Acupuncture
They state that absolute contraindications to be
- The use of points LI 4; SP 6; UB 60, 67 and sacral foraminal points B 31, 32, 33, 34 during pregnancy.
- The use of acupuncture with patient who have uncontrolled movements.
- The needling of and oedematous limb at risk of lymphoedma
- Areas of spinal instability where as the result relaxation of the surrounding muscles could potentially give rise to spinal cord compression.
- The needling of scars, keloid, recent incisional wounds or skin with sensory deficit.
- The needling of intracapusular points if the patient is on anticoagulant therapy or is a haemophiliac.
Relative Contraindications of Acupuncture
And relative contraindications to include
- Acute stroke
- Patients with cancer
- Areas of poor skin condition
- Diabetic patients
- Patients with epilepsy
- Hemophilia or other clotting disorders
The most common mechanism of stimulation of acupuncture points employs penetration of the skin by thin metal needles, which are manipulated manually or the needle may be further stimulated by electrical stimulation (electroacupuncture).Acupuncture needles are typically made of stainless steel, making them flexible and preventing them from rusting or breaking. Needles are usually disposed of after each use to prevent contamination.Reusable needles when used should be sterilized between applications.Needles vary in length between 13 to 130 millimetres (0.51 to 5.12 in), with shorter needles used near the face and eyes, and longer needles in areas with thicker tissues; needle diameters vary from 0.16 mm (0.006 in) to 0.46 mm (0.018 in),with thicker needles used on more robust patients. Thinner needles may be flexible and require tubes for insertion. The tip of the needle should not be made too sharp to prevent breakage, although blunt needles cause more pain.
The skin is sterilized and needles are inserted, frequently with a plastic guide tube. Needles may be manipulated in various ways, including spinning, flicking, or moving up and down relative to the skin. Since most pain is felt in the superficial layers of the skin, a quick insertion of the needle is recommended.Often the needles are stimulated by hand in order to cause a dull, localized, aching sensation that is called de qi, as well as “needle grasp,” a tugging feeling felt by the acupuncturist and generated by a mechanical interaction between the needle and skin. Acupuncture can be painful.The skill level of the acupuncturist may influence how painful the needle insertion is, and a sufficiently skilled practitioner may be able to insert the needles without causing any pain.
To insert needles as quickly and painlessly as possible, one of the following techniques should be used
- Stretch the skin over the acupuncture point between the thumb and index finger while applying moderate pressure. Using the other hand, grasp the needle firmly by its handle and pierce the skin rapidly. This minimizes any sensation of pain or discomfort and the needle can then be inserted to the desired depth.
- Pinch the skin over the acupuncture point and press it firmly between the thumb and index finger. Puncture rapidly with the needle and insert to desired depth.
- Press the thumb firmly as close as possible to the point selected and puncture the skin rapidly. Then advance needle to desired depth.
- For maximum accuracy it is important that the hand holding the needle be as steady as possible. To ensure this, rest the wrist against the patient’s body, making certain that there is sufficient freedom for rapid movement when placing the needle into the patient’s skin.
Acupuncture is thought to operate by
- Release of opioid peptides – Opioids are naturally occurring chemicals in the brain that have an analgesic effect. The release of these opioids plays a significant role in the reduction of pain. There has been considerable evidence to support that acupuncture stimulates the central nervous system, releasing these chemicals.
- Alteration in the secretion of neurotransmitters and neurohormones –Acupuncture is said to activate the hypothalamus and pituitary gland and thereby alter secretion of these chemicals. These particular chemicals play a direct role in the sensation of pain as well as the activity of an organ or organs. Evidence has shown that acupuncture alters this secretion in a manner that reduces pain. Documentation has also shown that acupuncture positively affects immune functions in the body.
- Stimulation of electromagnetic points on the body – The 2,000 points of the body that acupuncture focuses on are theorized to be strategic conductors of electromagnetic signals. Stimulation of these areas is believed to start the flow of endorphins—the body’s natural painkillers.
Angles Needles may be inserted in three ways
- Perpendicularly at 90° – This angle is used for points which are deep-seated or are located in heavy muscle.
- Obliquely at 30-60° – This angle is used for points in the proximity of bone or the thoracic or lumbar areas, and is particularly useful for avoiding possible pneumothorax.
- Horizontally at 10-20° – This angle is used for points on the head and face and other areas where there is minimal subcutaneous tissue and muscle; also when penetration from one point through to an adjacent one is recommended.
Once the needles are in place, and after Teh Chi has been obtained, the needles should be manipulated in one or more of the following ways
- By rotating the needle between finger and thumb through not more than 180°. More than this can cause tissue damage and should be avoided. While rotating, the shaft can be scratched gently and it can be tapped; these movements help to conduct the acupuncture effect to the structures surrounding the point being acupunctured.
- By oscillating the needle back and forth while holding the handle firmly between index finger and thumb. This conveys a gentle tremor to the area around the point and enhances the acupuncture effect.
- By twirling the needle rapidly between the index finger and thumb, or by using rapid “pecking” movements up and down. This is useful when strong stimulation is required.
- By electric stimulation at selected points.
Stimulation of needles at acupuncture points using electrically powered or battery-operated units recently introduced into China is now coming into general use in the West. It offers a number of advantages over the traditional hand manipulation of needles. The degree of stimulation, for example, is easily controlled by the practitioner, and a more continuous, uniform, and relatively standardized degree of stimulation can be delivered than is possible with the manual method. It is also possible to obtain stronger stimulation. It is particularly helpful when lengthy treatments must be undertaken, as these have, in the past, tended to become highly fatiguing for the practitioner.
Many different kinds of power units are now readily available. These include stimulators using direct or alternating current, buzzer stimulators using induced current, and units with vacuum tubes or transistors. The most popular units are solid state stimulators that work on the principle of the electric doorbell and generate uniform, steady pulses. The most commonly used stimulators are 6- or 9-V battery-operated transistors, generating frequencies ranging from 120 to 2,400 pulses/min. The output potential of such a unit varies from 0 to 70 V. Intensity is generally 50 V for the positive portion of the pulse and 35 V for the negative portion of the pulse. The width of the positive pulse is 0.5 msec and that of the negative pulse, 0.25 msec. This type of stimulator can produce pulse frequencies of 120 to 2,400 cycles/min, to a maximum of 5 ,000 cycles for continuous wave, and frequencies as low as 14 to 26 cycles/min for interrupted or variable internal waves.
To use an electric stimulator, pairs of two, four, or six acupuncture points in close proximity to one another are chosen. When the needles have been inserted correctly, the positive electrode is connected to one of the paired needles and the negative electrode is connected to the other. The stimulator is then switched on and the current gradually increased. Optimum stimulation is achieved when the patient experiences either Teh Chi, or a tingling sensation, or is just below the threshold of tolerance.
This form of treatment is usually given over a 15- to 20-min period but can be extended when necessary, as in some cases of chronic muscle or joint pain for which 30-40 min is more appropriate. Continuous electric stimulation has been given safely for up to 4 or 5 hr, particularly during major surgery, with no known ill effects or complications developing. It should be avoided, however, in pregnant women and in patients with cardiac pacemaker implants for obvious reasons.
In addition to the usual complications said to be associated with acupuncture and described elsewhere in this book, electroacupuncture may cause unexpected skin reactions, bums, or nerve or muscle damage. Electric bums can occur because excessively high current is used or because the electrodes are spaced too closely together. Faulty connections may be a cause of electrocution, and high current may cause ventricular fibrillation and death. Battery-powered units are, therefore, the safest to use.
Whatever unit is selected, it must always be carefully and frequently tested before each use. Electrical output, voltage, polarity of the electrodes, and grounding provisions should also be meticulously and frequently checked out.
Degree of Stimulation
Strong stimulation – is used when analgesic, sedative, or hypnotic effects are desired. Twirling and rotating needles rapidly while increasing the arc through which they are moved back and forth usually increases the strength of the stimulation at the point of acupuncture. Fifteen minutes is considered adequate time for treatment.
Weak stimulation – is used clinically for functional disturbances or in diseases in which emaciation and wasting occur. Once the needle is inserted and Teh Chi obtained, it should be left in place for 10-15 min with no further manipulation.
Medium stimulation – is the most usual type of stimulation used in acupuncture. Fifteen minutes is considered adequate time to obtain the maximum effect of acupuncture in most cases, and needles can be with-
drawn after this period.The foregoing applies to both manual and electric stimulation.
Needles can be easily removed by gentle twirling and quick withdrawal. If slight bleeding occurs, local pressure should be applied to the point for 1 min.
Bent Needles – A bent needle is usually the result of undue force being exerted on a needle and causing enough stress on it to change the angle of insertion beyond the limit of tolerance. This may happen if a patient shifts position suddenly, thus causing unexpected stress on one or more needles, or it may be a result of the acupuncturist using too much force to overcome unusual resistance while twirling or rotating needles during a treatment.
Bent needles should be withdrawn carefully by easing them out slowly and allowing for the angle of insertion and degree to which they have become bent; this will help to avoid breakage. Such needles should never be straightened out and used again but should be discarded immediately.
“Frozen” Needles – A needle may on occasion seem to be caught tightly in tissue and appear impossible to remove. This is usually due to muscle spasm around the acupuncture point and can be easily overcome. The patient should be calmed and reassured, and then slight vibration applied to the needle accompanied by gentle massage to the surrounding skin and muscles. This will relieve the muscle spasm and loosen the needle for easy removal.
A second needle inserted close to the “frozen” one may also help reduce muscle spasm. It is important to avoid haste or unnecessary force when removing such needles, otherwise bending or breakage may occur.
Broken Needles – Broken needles are caused by a variety of circumstances, including improper quality control that results in poor quality materials being used for needles, the handle or shaft becoming loose or worn, or, once again, the patient who shifts position during acupuncture placing too much stress on a needle and causing it to break.
Since prevention is always better than cure, all needles should be carefully examined for possible flaws and wear and tear before each use. However, once a needle does break while in a patient, a pair of forceps should be used to remove the broken fragments. Gentle pressure to the surrounding tissue may help force small pieces out. In rare instances, surgical intervention may be necessary.
- Acupressure, a non-invasive form of bodywork, uses physical pressure applied to acupressure points by the hand or elbow, or with various devices.
- Acupuncture is often accompanied by moxibustion, the burning of cone-shaped preparations of moxa (made from dried mugwort) on or near the skin, often but not always near or on an acupuncture point. Traditionally, acupuncture was used to treat acute conditions while moxibustion was used for chronic diseases. Moxibustion could be direct (the cone was placed directly on the skin and allowed to burn the skin, producing a blister and eventually a scar), or indirect (either a cone of moxa was placed on a slice of garlic, ginger or other vegetable, or a cylinder of moxa was held above the skin, close enough to either warm or burn it).
- Cupping therapy is an ancient Chinese form of alternative medicine in which a local suction is created on the skin; practitioners believe this mobilizes blood flow in order to promote healing.
- Tui na is a TCM method of attempting to stimulate the flow of qi by various bare-handed techniques that do not involve needles.
- Electroacupuncture is a form of acupuncture in which acupuncture needles are attached to a device that generates continuous electric pulses (this has been described as “essentially transdermal electrical nerve stimulation masquerading as acupuncture”).
- Fire needle acupuncture also known as fire needling is a technique which involves quickly inserting a flame-heated needle into areas on the body.
- Sonopuncture is a stimulation of the body similar to acupuncture using sound instead of needles.This may be done using purpose-built transducers to direct a narrow ultrasound beam to a depth of 6–8 centimetres at acupuncture meridian points on the body. Alternatively, tuning forks or other sound emitting devices are used.
- Acupuncture point injection is the injection of various substances (such as drugs, vitamins or herbal extracts) into acupoints.
- Auriculotherapy, commonly known as ear acupuncture, auricular acupuncture, or auriculoacupuncture, is considered to date back to ancient China. It involves inserting needles to stimulate points on the outer ear. The modern approach was developed in France during the early 1950s. There is no scientific evidence that it can cure disease; the evidence of effectiveness is negligible.
- Scalp acupuncture, developed in Japan, is based on reflexological considerations regarding the scalp.
- Hand acupuncture, developed in Korea, centers around assumed reflex zones of the hand. Medical acupuncture attempts to integrate reflexological concepts, the trigger point model, and anatomical insights (such as dermatome distribution) into acupuncture practice, and emphasizes a more formulaic approach to acupuncture point location.
- Cosmetic acupuncture is the use of acupuncture in an attempt to reduce wrinkles on the face.
- Bee venom acupuncture is a treatment approach of injecting purified, diluted bee venom into acupoints.
- A 2006 review of veterinary acupuncture found that there is insufficient evidence to “recommend or reject acupuncture for any condition in domestic animals”. Rigorous evidence for complementary and alternative techniques is lacking in veterinary medicine but evidence has been growing.
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