ACUPUNCTURE

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ACUPUNCTURE

Acupuncture is the stimulation of specific acupoints along the skin of the body involving various methods such as the application of heat, pressure, or laser or penetration of thin needles. It is a form of complementary and alternative medicine and a key component of traditional Chinese medicine (TCM). According to TCM, stimulating specific acupuncture points corrects imbalances in the flow of qi through channels known as meridians.  Acupuncture aims to treat a range of conditions, though is most commonly used for pain relief.

Acupuncture is a form of Chinese medicine that has been practiced for centuries. It’s based on the theory that energy, called chi, flows through and around your body along pathways called meridians.

Acupuncturists believe that illness occurs when something blocks or unbalances your chi. Acupuncture is a way to unblock or influence chi and help it flow back into balance.

Acupuncture is done by putting very thin needles into your skin at certain points on your body. This is done to influence the energy flow. Sometimes heat, pressure, or mild electrical current is used along with needles.

Your acupuncture provider will give you an exam and ask questions about your pain and how well you are functioning. He or she will also ask about your overall health.    Then your provider will look for the places on your body to access the chi that is blocked or not flowing right. Each of the points relates to certain health problems or body functions.     Your provider will look for landmarks on your body—using certain muscles or bones, for example—to find the points so that he or she can place the needles.

After the provider finds the points, he or she will quickly tap very thin needles into your skin. He or she will probably place several needles. Some may be placed deeper than others, depending on what the provider believes is needed to restore the flow of chi.  The treatments last at least 15 minutes.

You may feel slight pressure when a needle goes in. Most people find that it doesn’t hurt. The area may tingle, feel numb, itch, or be a little sore. Providers believe that this is a sign that the energy flow, or chi, has been accessed.  After the needle is placed, your provider may roll the needle slightly back and forth. Or he or she may use heat or electrical current on the needle.

Acupuncture has been the subject of active scientific research both in regard to its basis and therapeutic effectiveness since the late 20th century. Any evidence on the effectiveness of acupuncture is variable and inconsistent for all conditions.   Although minimally invasive, the puncturing of the skin with acupuncture needles poses problems when designing trials that adequately control for placebo effects.   To that end, a systematic review found no difference between “true” acupuncture and “sham” acupuncture, and, therefore, the validity of traditional acupuncture theories including acupuncture point locations has been questioned.   Some of the research results suggest acupuncture can alleviate pain but others suggest, not inconsistently, that acupuncture’s effects are mainly due to placebo.  It remains unclear whether acupuncture reduces pain independent of a psychological impact of the needling ritual.

Acupuncture is generally safe when done using clean technique and single use needles.   When properly delivered it has a low rate of mostly minor adverse effects.  Between 2000 and 2009, at least ninety-five cases of serious adverse events including five deaths were reported to have resulted from acupuncture.  Many of the serious events were reported from developed countries and many were due to malpractice.  While serious adverse events continue to be reported, to reduce the risk, it is recommended that acupuncturists be trained sufficiently.   A meta-analysis found that acupuncture for chronic low back pain was cost-effective as a complement to standard care, but not as a substitute for standard care except in cases where comorbid depression presented while a systematic review found insufficient evidence for the cost-effectiveness of acupuncture in the treatment of chronic low back pain.

Acupuncture is currently used widely throughout China and many other countries, including the U.S.   It is uncertain exactly when acupuncture was generally thought to have originated in ancient China and how it evolved.   Chinese history attributes the introduction of acupuncture to the emperor Shennong.   Hieroglyphs and pictographs have been found dating from the Shang Dynasty which suggests that acupuncture was practiced along with moxibustion.  The tattoo marks identified on the Ice Man who died around 3300 BCE suggested that a form of stimulatory treatment resembling acupuncture developed independent of China.

Acupuncture is the stimulation of precisely defined, specific acupoints along the skin of the body involving various methods such as the application of heat, pressure, or laser, or penetration of thin needles.   In a modern acupuncture session, an initial consultation is followed by taking the pulse on both arms, and an inspection of the tongue. Classically, in clinical practice, acupuncture is highly individualized and based on philosophy and intuition, and not on controlled scientific research.  The number and frequency of acupuncture sessions vary but most practitioners don’t think one session is sufficient.   In the United States, acupuncture typically lasts from 10 to 60 minutes, with diagnosis and treatment for a single session ranging from $25 to $80 in 2011. Sometimes needles are left in the ear for up to 3 days.

Clinical practice varies depending on the country.   A comparison of the average number of patients treated per hour found significant differences between China and the United States.  Traditional acupuncture involves needle insertion, moxibustion, and cupping therapy.  Acupuncturists generally practice acupuncture as an overall system of care, which includes using traditional diagnostic techniques, acupuncture needling, and other adjunctive treatments.   Chinese herbs are also often used.

Acupuncture needles are typically made of stainless steel, making them flexible and preventing them from rusting or breaking.  Once needles have been used they are thrown away to prevent contamination.   They are usually disposable, but reusable needles are sometimes used as well, though they must be sterilized between uses.   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 more fleshy areas; 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.

Apart from the usual filiform needle, there are also other needle types which can be utilized, such as three-edged needles and the Nine Ancient Needles.   Japanese acupuncturists use extremely thin needles that are used superficially, sometimes without penetrating the skin, and surrounded by a guide tube (a 17th-century invention adopted in China and the West).   Korean acupuncture uses copper needles and has a greater focus on the hand.

The skin is sterilized, with alcohol, and the needles are inserted, frequently with a plastic guide tube. Needles may be manipulated in various ways, spun, flicked, or moved 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.   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.

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’t be generated, inaccurate location of the acupoint, improper depth of needle insertion, inadequate manual manipulation, or a very weak constitution of the patient have to be considered, all of which are thought to decrease the likelihood of successful treatment.   If the de-qi sensation doesn’t 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” qi.     De qi is more important in Chinese acupuncture, while Western and Japanese patients may not consider it a necessary part of the treatment.

 Kathy Kiefer

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