Acupuncture – Uses, Contra Indications; Procedure

Acupuncture

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

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.

These include

Other conditions for which the WHO say that acupuncture may help but more evidence is needed include

Case-controlled clinical studies have shown that acupuncture has been an effective treatment for the following diseases, symptoms or conditions

The following diseases, symptoms or conditions have limited but probable evidence to support the therapeutic use of acupuncture

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 patients who have uncontrolled movements.
  • The needling of and oedematous limb at risk of lymphoedema
  • Areas of spinal instability whereas 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 the sensory deficit.
  • The needling of intracapsular points if the patient is on anticoagulant therapy or is a hemophiliac.

Relative Contraindications of Acupuncture

And relative contraindications to include

Needles 

Traditional and modern Japanese guiding tube needles

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 millimeters (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.

Needling technique

Insertion

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.

Procedures

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 the desired depth.
  • Press the thumb firmly as close as possible to the point selected and puncture the skin rapidly. Then advance the needle to the 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 the 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 that 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.

Needle Manipulation

Once the needles are in place, and after Thi 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 the 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.

Electric Stimulation

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 Thi 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 the 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, the 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 an 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 Thi 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.

Removing Needles

Needles can be easily removed by gentle swirling 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 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 spasms 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 a 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 spasms. 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.

Related practices

  • 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 another 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 that 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 centimeters 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.

Point Location and Indication Holographic Acupuncture System

HEAD

  • Location: When a loose fist is made, the point is on the radial side of the distal end of the second metacarpal bone.
  • Indications: Disorders of the head, eyes, ears, nose, mouth, and teeth.

FOOT

  • Location: At the radial side of the second metacarpal bone, proximal to the end of the second metacarpal base.
  • Indications: Foot and ankle problems.

STOMACH

  • Location: Midway between the Head and Foot points.
  • Indications: Stomach, pancreas, and spleen disorders.

LUNG/HEART

  • Location: Midway between the Head and Stomach points.
  • Indications: Lung, heart, chest, breast, trachea, esophagus, and back problems.

NECK

  • Location: At the intersection of the distal one-third and proximal two-thirds between the Head and Lung/Heart points.
  • Indications: Problems of the neck, thyroid, throat, esophagus, and trachea.

ARM

  • Location: At the intersection of the proximal one-third and distal two-thirds between the Head and Lung/Heart points.
  • Indications: Problems of the shoulder, upper arm, elbow, forearm, wrist, hand, trachea, and esophagus.

LIVER

  • Location: Midway between the Lung/Heart and Stomach points.
  • Indications: Liver and gallbladder problems.

LUMBAR

  • Location: Midway between the Stomach and Foot points.
  • Indications: Back, umbilicus, large intestine, and small intestine disorders.

DUODENUM

  • Location: At the intersection of the distal one-third and proximal two-thirds between the Stomach and Lumbar points.
  • Indications: Problems of the duodenum and colon.

KIDNEY

  • Location: At the intersection of the proximal one-third and distal two-thirds between the Stomach and Lumbar points.
  • Indications: Kidney, large intestine, and small intestine problems.

LOW ABDOMEN

  • Location: At the intersection of the distal one-third and proximal two-thirds between the Lumbar and Foot points.
  • Indications: Abdominal pain, as well as bladder, uterus, ovary, testicle, vagina, urethra, rectum, appendix, anus, sacrum, leg, and knee problems.

LEG

  • Location: At the intersection of the proximal one-third and distal two-thirds between the Lumbar and Foot points.
  • Indications: Leg and knee problems.

EXAMINATION OF THE SECOND METACARPAL BONE

The second metacarpal bone may be examined using palpation with pressure. The patient should be sitting opposite the practitioner. The examiner should hold one hand of the patient, while the patient relaxes the muscles of the hand and makes a loose fist. Palpate firmly with the thumb, holding the thumb vertical with the bone, using pressure and slight rotation. Use moderate pressure one to three times on each point, beginning with the Head point. If the patient has a sensation of numbness, soreness, heaviness, or distension, apply more pressure to the point. If the patient reacts strongly by pulling the hand away or making a facial expression of pain, this point has a positive reaction. A positive reaction usually indicates one of the following:

  • It indicates disease in the related organ or area of the body. For example, if the Lung point is tender on palpation, this may indicate that the patient has disease in the lung, heart, chest, esophagus, or back.
  • It indicates that part of the disorder is related to the internal organs. For example, if the patient has tenderness on the Liver point, this might indicate an eye disorder, or possibly a tendon problem.
  • If the patient’s tenderness on palpation is more on the left side than on the right, this is an indication that the disorder is manifested on the left side of the body.

Fifth Metacarpal Bone Acupuncture

  • Fifth metacarpal bone acupuncture is the same as second metacarpal bone acupuncture; both use the metacarpal bone to target a specific part of the body. As with holographic theory, each part of the body is an individual small ratio body unit. Point distribution and indications are similar to the second metacarpal bone acupuncture system.

HEAD/FACE

  • Location: Ulnar side of the hand in the depression at the distal end of the fifth metacarpal bone.

FOOT

  • Location: Ulnar side of the hand in the depression at the proximal end of the fifth metacarpal bone.

KIDNEY/LUMBAR

  • Location: Midpoint between the Head and Foot points.

HEART/LUNG/CHEST

  • Location: Midpoint between the Head/Face and Kidney/Lumbar points.

ARM

  • Location: Midway between the Heart/Lung/Chest and Head/Face points.

LIVER/GALLBLADDER/SPLEEN/STOMACH

  • Location: Midway between the Heart/Lung/Chest and Kidney/Lumbar points.

BLADDER/REPRODUCTION

  • Location: Midway between the Kidney/Lumbar and Foot points.

INTESTINE

  • Location: Midway between the Kidney/Lumbar and Bladder/Reproduction points.

LEG

  • Location: Midway between the Bladder/Reproduction and Foot points.

Lateral Forearm Acupuncture

POINT LOCATIONS

  • Lateral forearm acupuncture follows the holographic theory, using the forearm bones to represent parts of the body as individual small ratio body units. All indications for the lateral forearm acupuncture system are directly related to the holographic body part area that is being treated (Figure 22-3).

First-line

On the radial side of the radius bone.

OCCIPITAL

  • Location: On the radial side of the wrist in the depression between the tendons of the extensor pollicis longus and brevis muscles. Same as the LI 5 (Yang Xi) point.

BUTTOCKS

  • Location: Midway between the lateral end of the transverse cubital crease and the lateral epicondyle of the humerus. Same as the LI 11 (Qu Chi) point.

SPLEEN

  • Location: Midway between the Occipital and Buttocks points on the radial side of the radius.

LUNG

  • Location: Midway between the Occipital and Spleen points on the radial side of the radius.

NECK

  • Location: Midway between the Occipital and Lung points.

LIVER

  • Location: Midway between the Lung and Spleen points on the radial side of the radius.

HEART

  • Location: Midway between the Lung and Liver points on the radial side of the radius.

KIDNEY

  • Location: At the junction of the distal one-third and proximal two-thirds of the distance between the Spleen and Buttocks points.
LUMBAR
  • Location: At the junction of the proximal one-third and distal two-thirds of the distance between the Spleen and Buttocks points.

Second line

  • Between the radius and ulnar bones.

SIDE OF HEAD

  • Location: Directly above the transverse crease of the dorsal side of the wrist, between the radius and ulnar bones. At the midpoint between the transverse crease and SJ 5 (Wai Guan).

URINARY BLADDER

  • Location: At the proximal end of the radius and ulnar bones, midway between the Lumbar and Buttocks points.

STOMACH

  • Location: Between the radius and ulnar bones. Midway between the Side of the Head and the Urinary Bladder points.

GALLBLADDER

  • Location: Between the radius and ulnar bones, midway between the Hand and Liver points.

SHOULDER

  • Location: Between the radius and ulnar bones, 2.0 cun above the transverse crease at the dorsal side of the wrist; same as SJ 5 (Wai Guan).

EAR

  • Location: Midway between the Side of the Head and Shoulder points.

SMALL INTESTINE

  • Location: At the junction of the distal one-third and proximal two-thirds of the distance between the Gallbladder and Urinary Bladder points.

LARGE INTESTINE

  • Location: Directly below the Urinary Bladder point, at the junction of the proximal one-third and the distal two-thirds of the distance between the Urinary Bladder point and the Gallbladder point.

Third line

  • On the ulnar side of the ulnar bone.

FOREHEAD

  • Location: In the depression between the styloid process of the ulna and the triquetral bone.

FOOT

  • Location: On the ulnar side of the ulnar bone level close to the humeroulnar joint.

KNEE

  • Location: On the ulnar side of the ulnar bone level with the Lumbar point.

HAND

  • Location: Midway between the Forehead and Knee points on the ulnar side of the ulna bone.

MOUTH

  • Location: At the junction of the distal one-third and proximal two-thirds of the distance between the Forehead and Hand points.

ELBOW

  • Location: At the junction of the proximal one-third and distal two-thirds of the distance between the Hand and Forehead points.

EYE

  • Location: At the junction of the distal one-third and proximal two-thirds of the distance between the Forehead and Mouth points.

NOSE

  • Location: At the junction of the proximal one-third and distal two-thirds of the distance between the Mouth and Forehead points.

References

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