The Taiwan Report
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(1982)
Postgraduate Course in Veterinary AP, Sydney, 1991
SUMMARY
Section 1 summarises the trip schedule between November 13-28th, 1982.
Section 2 summarises the present status of Chinese medicine in Taiwan. Acupuncture (AP) is only one part of Chinese medicine, which also includes "Western" medicine, moxibustion and herbal medicine.
AP and allied techniques, as seen there, are discussed under various headings: simple needling versus electro-AP, the use of AhShi ("Ah Yes!", sensitive) points, myofascial syndromes and AhShi points, Earpoints, Local points, Distant points, methods of needling, quick needling of AhShi points, the DeQi (Teh Ch'i) phenomenon, personal experience of "needle sensations", moxibustion, cupping, APin paralysis/paraplegia. Scar therapy was not seen during this trip. It is discussed in the hope that it may stimulate interest in this valuable therapy.
Section 3 discusses 49 of the clinical cases observed at the Veterans' General Hospital, Taipei (VGH) and China Medical College, Taichung (CMC). Many other cases were observed, but details were not noted. Most of the cases presented for treatment involved pain syndromes but I was assured that many syndromes other than pain are also treated successfully. The great majority (69%) were helped markedly or moderately by AP in 1-20 minutes.
Cases are discussed under: multiple aches and pains, tension, insomnia, neurasthenia, pain following traumatic injury, head and neck stiffness/ pain, shoulder pain/stiffness, upper limb pain, respiratory difficulty, lowback pain/stiffness + sciatica, lower limb problems, post-CVA cases.
Section 4 discusses AP research in Taiwan under the main centres and topics for research listed in the literature and Symposium abstracts, which were made available to me.
Section 5 discusses AP training in Taiwan. Courses in English are available for foreign professionals. Emphasis ranges from classical (traditional) concepts to modern concepts of neurophysiology and trigger point therapy, depending on the teaching body and the type of course chosen.
What one sees and hears during a 2-week trip is automatically biased by the observer and by the people and places visited. It may not represent the real day-to-day situation of the whole country. Nevertheless, my report may interest open-minded Westerners to go and see for themselves.
1. SCHEDULE
Nov 13th: Aircraft Dublin-London-Dubai-Hong Kong.
Nov 14th: Landing in Hong Kong Airport was exciting ! Had I not known that this is one of the world's most tricky landing places, I might have thought we were crash-landing in the centre of the city! Coming in, after dark, the aerial view of the city, with its millions of street lights and multi-coloured advertisements, was astonishing. After a 2-hour stop, I got the China Airlines flight to Taipei.
On arrival at Taipei, I heard my name called. What had I done ? No! It was to report to the Airport Authority for VIP treatment! I was whisked through Customs and Immigration before I could say "Jack Robinson".
Dr. Jen-Hsou Lin met me at the Arrivals Hall and he had arranged transport to the city. My first impression of the city was the chaotic traffic. Thousands of motor bikes, cars, trucks, bicycles and pedestrians seemed to converge on intersections. Drivers who stay accident-free in Taipei must be among the best in the world.
Then Dr. Lin pointed to the Grand Hotel. It is a wonderful sight, a huge hotel in magnificent Chinese style, perched on top of a hill and fronted by a beautiful Chinese gate. So this was Taipei! The car swept up to the main door. We entered the lobby. What a sight! It must have been 50 m x 50 m - the most impressive hotel lobby I have seen. The architecture, sculpture and decoration was quite unlike anything in my previous experience.
Nov 15th: A lazy day, spent relaxing with Dr. Lin, his wife and children. We visited Yang Ming Mountain, in beautiful sunshine. The weather was like high summer in Ireland. (I had left Dublin in wet cold November weather).
Nov 16th: Down to business. Discussions with Dr. Lin about his work in the Department of Animal Husbandry, National Taiwan University. Introductions to his colleagues and some of his students. Afternoon with Dr. Chien Chung in the APDepartment, Veterans' General Hospital, Taipei (VGH).
Nov 17th: Attended lectures by Chung at the Chinese AP Research Foundation (CARF) Headquarters, Taipei. The lectures were on his research and clinical effects of needling AhShi points, and on his use of YangLingQuan (GB34) in pain control in acute traumatic injury. These were excellent lectures and were listened to attentively by a group of visiting M.D.'s on a CARF training course. Lunch with Chung. Afternoon in the AP Department, VGH.
Nov 18th: Discussions with Dr. Lin at his laboratory. We attempted our first APanalgesia test in the cow. It was 90% successful (see later). Afternoon in the VGH. Lectures to Dr. Lin's students.
Nov 19th: Opening of the Taipei AP Symposium. Evening Banquet and Kampe!
Nov 20th: Symposium. Banquet and more Kampe!
Nov 21st: Symposium closed at 1700h. Banquet and still more Kampe
Nov 22nd: Trip to China Medical College, Taichung (CMC). Stayed at Lucky Hotel. Banquet and Kampe, Kampe!
Nov 23rd: Veterinary AP Seminar, Taichung Vet School. Another banquet. Kampe, Kampe, Kampe! I'll never survive this!
Nov 24th: Visit AP Department, CMC. Return to Taipei. Farewell to Drs. Ha, Hand, Pomeranz. Stay at YWCA! Dinner at the home of Dr. Lin and his family.
Nov 25th: Pig Research Institute, Chunan. Lecture to Institute staff and local vets. Evening meal with Dr. Lin's co-workers (Chang Chia, Shieh Meei Hwa, Tsou Li Mei, Ms. Wang and Chin Sun).
Nov 26th: Visit Dr. Sun at the Yang Ming Medical School. See Dr. Ha's research facilities there. Afternoon in Chung's Department, VGH.
Nov 27th: Very relaxing day, driving around the Northern coast of Taiwan. Fishing and seafood. Our host was Eddie Tsang. Sulphur baths at Yang Ming Mountain. Final banquet (Mr. Tsang).
Nov 28th: Sad farewell to Jen-Hsou and Li-Fei Lin. Flew Taipei-Singapore-London-Dublin. Composed my poem "Taiwan" on the back of the Qantas menu card, leaving Singapore. This poem is dedicated to Jen-Hsou and Li-Fei Lin as a gesture of thanks for their friendship and hospitality and as a memory of a beautiful land and its people.
2. CHINESE MEDICINE IN TAIWAN
Four afternoons were spent at the AP Department, VGH, one morning session at CARF, two sessions at the AP Department of CMC and one morning at the Yang Ming Medical School, Taipei. The case load for AP in VGH and CMC clinics was said to be 100-150 patients/day.
The following section is based on personal observations in the clinics and on discussions with Drs. Chien C. Chung, Han Ping Lee, Ming T. Lin and Wei Tse Hsiung (VGH), and Drs. Hong Chien Ha, Chung-Gwo Chang and R.T. Chiang (CMC) and Dr. Albert Sun, Yang Ming Medical School, Taipei.
1. Chinese medicine, as practised in Taiwan, combines the best of "Western" and "Traditional Chinese" medicine. Some doctors are trained in "Western" medicine, some in "Chinese" medicine and some in both systems.
2. Traditional Chinese medicine (TCM) involves study of AP, moxibustion and HERBAL MEDICINE. The latter is most important. Although medical theory (Yin-Yang,Five Phases, Perverse Causes of Disease, Disease Syndromes andDiagnostics) is the same for all branches of TCM, some herbalists do not know APand some acupuncturists do not know herbal medicine.
The Chinese herbal pharmacopoeia is very extensive. Some of the plants are cultivated locally and processed in special pharmacies, such as in the CMC. Some of the herbal medicines are imported in crude or processed forms. I did not witness the use or efficacy of these medicines, but I was told by many doctors that they are very powerful and (when used by experts) are extremely valuable in conditions as diverse as CVA, hypertension, neurasthenia and many other internal diseases. Western doctors (and vets!) have much to learn about these medicines.
3. AP and allied techniques in clinical practice: Considerable variation exists in the choice of points for therapy and in the methods of manipulating the needles. In general, I saw very little use of electro-AP (although the stimulators were freely available in every clinic visited). There was general agreement that manual needling alone was as good as, or better, than electro-needling for most conditions requiring AP. Exceptions are (a) in AP analgesia before surgery (not witnessed) and (b) in certain chronic conditions, especially paralysis/paresis after CVA or nerve injury.
3.1. AhShi points: AhShi means " Ah Yes, or Ouch!", the exclamation from the subject when a painful point is pressed. The best AhShi point for therapy is the Trigger Point (TP), i.e. palpation pressure on the point causes a pain sensation toradiate to the problem area, muscle, or organ. It is seldom located in the area of pain. Patients usually are unaware of its presence until it is palpated. Other pain-sensitive areas (motor points, "fibrositic nodules", local pain-points etc) may be useful in therapy but they are not as powerful as the TPs (the "real AhShi" points).
Great emphasis is placed on a careful search for AhShi points. These are usually present in pain conditions, such as headache (esp. neck and shoulder muscles),joint pain (shoulder, elbow, lowback syndrome, hip, knee) and myofascial syndromes. They may also arise in some cases of internal disease (lung, heart, liver, gall bladder, g/i/t, g/u tract). In internal disease the Shu points (organ reflex points on the BL Channel (paravertebral)) are carefully palpated, as are the Mu points (Alarm points on the abdominal/thoracic area). All pressure-sensitive areas are AhShipoints but AhShi points are not always Trigger Points (TPs)!
AhShi points may be located near to or far away from the problem area. AhShi/TPpoints can recruit new triggers elsewhere, usually in the muscles. Painful areas inscarred tissue may also act as powerful TPs and these areas must be treated to obtain optimum results. Little emphasis was placed on this fact (see section 9 below).
AhShi therapy is the best introduction to the value of needle therapy. Unfortunately, AhShi points are not present in every case, and Western doctors who know only the AhShi method are unable to help by needle techniques in such cases.AhShi points disappear when the condition resolves and the disappearance of AhShipoints during a course of therapy indicates a good prognosis.
Chung did extensive clinical research with AhShi points and published the English version of his book (C. Chung (1983) "AH SHIH Point: The pressure pain point in AP: Illustrated guide to clinical AP", Chen Kwan Book Co., Taipei). This book alone would enable Western MD's (and vets) who know little or nothing about AP to begin AhShitherapy immediately and to get very good clinical results from it. (Although AhShitherapy sometimes gives better results than traditional AP, it was agreed that even better results can be got if a proper study of the AP system is made).
3.1.1. Myofascial syndrome and AhShi points: Chung defines the syndrome as one involving muscle pain/stiffness, especially around joints. The joints often are stiff, but show no inflammatory or X-ray lesions. There often is a history of intermittent recurrence. AhShi (TP) points often are present, but the patient is unaware of them until they are pressed. The diet usually is satisfactory and the neural causes of the pain are obscure.
The AhShi points usually show decreased electrical resistance and decreased local skin temperature. Local vasomotor abnormalities and dermatographic changes occur in the AhShi area.
Histology of the AhShi area shows local cell infiltration and non-specific inflammatory changes. There is sometimes a fibrous infiltration of the AhShi area (ropy muscle sign). Pressure on the AhShi often refers pain to the "problem area". Needling theAhShi often causes the "Jump Sign"; local muscle contractions cause the needle to jump.
Chung emphasises that some acupuncturists needle the problem (local) area i.e. the area of referred pain. This is inferior AP (although it can help). Much better results can be obtained by a careful search for the TP (AhShi point). In myofascial syndromes, AhShi therapy can give dramatic (and often immediate) relief of pain.AhShi therapy in these cases can give better results than traditional AP using local and distant points.
AhShi points may arise anywhere in the muscles, but they are often near the problem area. The most important muscles to search for upper body problems are: the neck muscles, infraspinatus and GB21 area. For lower body problems search the gluteus, vastus medialis, soleus, gastrocnemius. In upper limb pain (shoulder, elbow, arm, etc) the AhShi is often in the infraspinatus of the affected limb. Inshoulder pain, the AhShi may be in the GB21 area, or scalenus muscle. Inbilateral anterolateral shoulder pain, the AhShi is often in the sternalis muscle. In such cases, one needle in the sternal AhShi can give immediate pain relief. In abdominal and intercostal pain, check the back and sides for AhShi. In heel pain, the AhShi is often in the soleus area, left or right of BL57. In plantar pain, theAhShi is often in the gastrocnemius. In middle finger pain, search muscles nearTH08. In lowback/leg pain, search the gluteus muscle.
About 33% of all cases of aching pain are myofascial in origin and respond fast and reliably to AhShi therapy. Expect excellent results in 38% and good results in 60% of cases (98% total cases). Disappearance of the AhShi is an excellent prognostic sign.
Chung's AhShi findings agree well with Western experiences of TP therapy, as described by Ronald Melzack (Canada), Pekka Pontinen (Finland) and Alex Macdonald (UK).
Miscellaneous (Chung):
Renal colic pain/spasm: GB34, LV03, SP04,06
Gastric colic/pain/spasm: ST36, CV12
Biliary colic/pain/spasm: GB34
3.2 Earpoints
I did not observe a single case of ear-AP. However, I was told by some local doctors that earpoints are sometimes used alone or in combination with body points, with good success (see Symposium report also).
3.3 Body points
a. The most commonly used points seen in use were the Channel points, especially LU07, LI04,10,11,15, ST25,36,37,38, SP04,06,09, HT07,SI03,06,09,11,19, BL10,11,23,40,57,60,62, KI03, PC06, TH05,14,15,GB20,21,30,31,34,39, LV03, CV04,12. (GV points were seldom seen used. GV15 (YaMen), needled 2" deep in one patient, appeared to cause a very severe left-sided headache, needle shock and some loss of power in the legs. The patient, an elderly lady, was being treated for facial paralysis and slurred speech following a minor CVA. She was most unhappy when questioned by me about one hour after treatment. (See CVA, later).
b. Extra-Channel Points (points not on the main Channels): These points often were used for their local or distant effects. The most commonly observed were Hand Points "Loin & Leg" between the proximal heads of metacarpals 2-3 and 4-5 respectively. These Hand Points gave immediate relief in some cases of lumbago and lowback/leg pain. Hand Point "Neck" (between the knuckles of fingers 2-3 with fist tightly closed, needled 1" deep towards the wrist. This point gave immediate relief of neck pain/restricted movement in one patient. Other Extra-Channel points used were: LanWei (Appendix point) in abdominal pain/constipation, XiYan (Knee Eyes) in knee pain, YinTang (between eyebrows) and TaiYang (temporal fossa) in headache, sinusitis.
c. Distant points: Distant points are often used in VGH (and to a lesser extent in CMC). The clinical response to needling distant points (when no local points are used) can be dramatic and cannot always be explained by short reflexes. It is known that a stimulus via one spinal nerve may activate reflex responses in areas innervated by up to 6 segments above or below the input nerve. Examples are the use of the points "Loin and Leg" or "Lumbar Area" (on the dorsum of hand) or SI06 to treat lowback/leg problems; ST38, GB39 or GB34 to treat shoulder or neck problems;LU07 in headaches. The use of TH03, SI03, Hand point "Neck" is not so inexplicable in neck/shoulder problems because the innervation is related to these areas.
In myofascial and some arthrotic syndromes, Chung prefers to use Distant rather thanLocal points. If patient is not helped within 20 minutes, the needles may be left in situ for up to 40 minutes and other points (AhShi, local points) may be tried also.
4. Needle Manipulation
All operators were very careful to cleanse the skin (alcohol swab), use sterile needles (disposable in VGH) and to touch only the handle (not the body) when inserting the needle.
Styles of inserting the needle varied between operators. In general, staff at VGH inserted the needle while twirling vigorously clockwise and anticlockwise until the skin was penetrated, and then the needle was advanced with less twirling. "Sparrow pecking" (up and down movement) was fast and strong, often combined with some twirling.
Vigorous needle twirling and pecking was continued for 5-30 seconds until definite "DeQi" was reported by the patient and the visible signs were observed by the operator.
In contrast, Dr. R.T. Chiang (CMC) inserted the needle through the skin with one, deft half-twirl and push. He then advanced the needle with minimal, if any, twirling to its correct depth. His sparrow-pecking and subsequent twirling was slower and more deliberate than in VGH. He also scratched the handle vigorously and "went around the clock" (moved needle handle like the hands of a clock through 360 degrees) once or twice, to get DeQi. He told me that the classic (traditional) methods of needle manipulation ("tonification" and "sedation" manipulation) are very important in difficult cases. (Staff at VGH do not appear to put importance on the classical needle manipulations used to tonify or sedate Qi).
In both hospitals, needles usually were left in position for 15-30 minutes (estimated average 20 minutes). In VGH, some twirling and pecking was repeated just before needle removal. This was mainly to ensure that the needle was not "caught" in the tissues and to avoid rough removal of a "caught" needle. In contrast, at CMC, a quick check that the needle was "free" was followed by gentle removal of the needle.
At VGH, a cotton-bud was used to apply pressure at the point for a few seconds after removal, to prevent local pinpoint bleeding.
4.1. Needling AhShi/TP points: This was one exception to the 20-minute needling time. Chung twirled the needle and pecked very strongly for 15-60 seconds. The patient often had very strong reaction to this (grunts, slight groans, facial grimaces etc). In many cases, the needle was removed within the 15-60 seconds. To my amazement (and that of other observers) the pain or stiffness which the patient had reported before needling seemed to have disappeared (as judged by the consternation or smile on the patient's face and/or visible and marked improvement in neck/shoulder/lumbar/knee movement)!!
The immediate responses seen after AhShi needling in some patients at VGH were hard to believe but I witnessed them many times (see case notes later). This is certainly similar to the Huneke "Sekunden phanomen" (instantaneous phenomenon) and is a typical reaction to TP therapy (Melzack, Pontinen, Macdonald, Lewit ). See Section 9. I was told that similar responses are not uncommon at CMC but I did not witness any there, probably, because the total number of cases I observed there were much less than in the VGH, due to shortage of time to stay at CMC.
5. DeQi
All experts agreed that it is essential to get DeQi if the best results are to be obtained in needle therapy. In Chinese medical experience, DeQi is known to have subjective (patient), subjective (operator) and objective characteristics.
5.1. Patient's sensations: The patient reports strong sensations running, proximally, or distally from the needle. Sometimes the sensation is said to travelproximally and distally. The sensations are described as: "sore", "heavy", "tingling," "electric shock-like", "running", "aching" (but not painful). The observable reactions of the patient at this time included grunts, groans, flinching of the limb or part being needled, explosive intake or expulsion of breath, facial grimaces and occasionally (in strong reactors) sudden jerks involving all or part of the body, and occasional expletives.
During the Symposium, I was needled at left LI10 by a Master. This man claimed that with really expert needle use, the PCS sensation should be felt not only along the needled Channel (LI Channel goes from index finger to nose) but also into its following Channel (ST follows LI, goes from eye to second toe via nipple and anterolateral knee). I felt the classic DeQi sensations and reacted as a typical strong reactor, as described above and in 5.3 below. However, the sensation travelled a maximum of 6" upwards, whereas it travelled distally to the dorsum of the hand and was most marked in the 6" below the point. After 3-4 minutes, the palm of my left hand became very cold and sweaty. My right palm was (normally) warm and was sweating less than the left. I had no queasiness, nausea or other signs of needle shock. The dull ache (6" above, to 6" below LI10) persisted about 2 hours afterwards. The point was slightly sensitive to local pressure for 2 days afterwards. I have needled many APpoints on my body, obtained DeQi most times but without such a strong PCS reaction.
5.2 Operator's sensations: The operator usually has the sensation that the needle is being gripped by the tissue, i.e. especially on withdrawal of the needle, (when a definite "nipple" seems to form at the skin surface) or on twirling of the needle (when the needle seems to "lock" at the end of each twirl).
5.3 Objective signs of DeQi are the "nipple" and the patient's reaction. After a few minutes, a definite zone of hyperaemia (1-3 cm diameter) may appear around the needle in some patients.
5.4 Propagated Channel Sensation (PCS): When needled correctly, certain ("sensitive") patients claim to feel the sensation (PCS) radiating along most or all of the Channel. Some also report sensations radiating to the organ controlled by theChannel! Chung stresses that correct needling of the AhShi point almost always sends strong sensations to the problem area, muscle or organ.
5.5 Over-stimulation of points such as LI04, ST36, etc can cause "needle shock" (weakness, dizziness, nausea, vomiting, fainting, syncope, etc).
6. Moxibustion
Although Moxa was available in all clinics, it was not seen in use except once or twice. This is because (a) the smell of moxa smoke is a nuisance in a crowded clinic, and (b) patients are shown by the nurse how to apply moxa at home. The points for moxibustion (if required) are circled with biro or felt pen. Moxa is considered helpful in: Asthma, chronic G/I problems, general malaise, physical development problems (ill-thrift), arthralgia, rheumatism, obstetrics (to turn the baby in-utero) moxa BL67.
7. Cupping
Was not observed in VGH. It was seen in two cases in CMC. It was applied for 1-3 minutes (over the needles) until the skin became red-purple. The cups were then removed but the needles were left in situ for the usual 20 minutes. Both were cases of lowback syndrome and the cups were applied bilaterally in the area of BL23-34 (4 x 2 cups in one patient and 3 x 2 in another).
8. AP in paralysis/paraplegia
At both VGH and CMC, workers told me that AP and herbal medicine can greatly help many patients suffering from paralysis as a sequel to CVA or in peripheral paralysis due to trauma. They also mentioned facial paralysis as being a good indication for AP. The number of patients which I observed being treated for post-CVA paralysis was small - one in VGH and two in CMC. There was general agreement that sensory paralysis on the affected side abolishes the needle sensation (DeQi) and there is little value in needling the affected side. In that case, needles are put in theunaffected side at key points such as GB34, ST36, BL40, GB30, LI04, TH05, LI11,GB20,21. Facial paralysis, slurred speech or absence of speech, etc are treated by local needles. GV15 (YaMen) is a dangerous point (mutism) if needled too deeply.Scalp motor points on the contralateral side are often combined with body points.
9. Scar therapy
"Anything that happens along or near the course of a main Channel influences thatChannel and the organ that bears its name" (Felix Mann).
Many authors emphasise the role of scars as causes of referred pain, functional disorders and (in late stages) organ disease in man (1,5,6,7,8,9) . Scars also may cause similar problems in animals (2,3). In Germany, scar therapy (especially scar infiltration with procaine solution) has been used for decades to relieve pain and other disorders triggered by the scar (4). The relationship was observed quite independently of AP. The reaction to scar injection was often instantaneous. Problems which had existed for months or years disappeared in seconds, the "Sekunden Phanomen" of Huneke (4).
Acupuncturists have noted that injuries, bruises, or bad scars (especially if heavily fibrosed, twisted or keloid) along the course of a Channel may cause functional symptoms associated with the Channel or its organ. If the scar remains untreated, the symptoms may progress to physical (organic) pathology of the organ. Furthermore, theChannel above and below the scarred Channel ("mother" and "son" in the Qi cycle:LU - LI - ST - SP - HT - SI - BL - KI - PC - TH - GB - LV - LU) may be involved as a secondary effect. For example, I treated a man who had a very twisted scar across theBL Channel on the right thorax. He complained of recurrent intermittent symptoms over 8 years including: haematuria, haemorrhagic cystitis, right sciatic area pain and lumbar pain, right scapular and shoulder area pain in the area of BL Channel, right headache near the BL Channel, right eye conjunctivitis, right ear tinnitus, right arm pain/spasm in the SI Channel area and pain in the little finger. Orthodox treatment by eye-, ear-, orthopaedic-, cardiac- and internal disease specialists over years had only temporary effects and symptoms continued to recur (usually singly) at intervals. All the symptoms related to KI, BL, KI, Channels, but mainly to BL. (In the Qi cycle, the sequence is SI->BL->KI. A block in BL would give excess in SI and deficiency in KI, as well as excess in the upper part and deficiency in the lower part of BL Channel). Scar therapy (physiotherapy, massage and needling of the scar), with needling of theBL Channel, eliminated all the symptoms and the patient remained well.
This is a most important concept! Bruises, injuries and scars may cause disease. The blockages include: moxa scars, surgical scars (external and internal), injury (external and internal), cuts, local fibrosis (cicatrization due to abscess, carbuncle, etc. Reinhold Voll taught that individual tooth sockets relate to specific areas and that socket inflammation/scars, dental caries, etc may cause reflex pathology in the associatedChannels and organs.
A routine part of anamnesis should be to question the patient or client as to the existence of any scars, bruises or injuries on the body and to examine the location of these injuries in relation to the location of the other symptoms and the time of occurrence of the injury in relation to the time of onset of the symptoms.
Not all scars need cause problems. Longitudinal scars are not as serious as transverse (they are less likely to cut as many nerves or Channels). Well healed (clean) scars are not as dangerous as thickened, twisted, keloid scars, or scars which have painful spots to pressure.
Scar therapy can use simple needles (under the scar, or at each end), ultrasound, physiotherapy, laser or procaine injection or B12 injection along the scar. The concept is to restore energy flow through the scarred area and to reduce size, thickness and adhesion in the scar. One to three treatments are usually sufficient.
Seeing many scars on patients in Taiwan, I was amazed that I did not see a single case of scar therapy. On questioning my colleagues in the Clinics, I was told that the concept of scar therapy was not widely known in Taiwan. Perhaps this section may awaken interest in this valuable therapy ?
SCAR THERAPY REFERENCES
1) Austin, Mary (1974). AP therapy. Turnstone Books, London, 290 pp.
2) Cain, Marvin (1981,1982) Effects of superficial scars in horses. Personal communication.
3) Gilchrist, David (1981). Manual of AP for small animals. Box 303, Redcliffe, Queensland 4020, Australia.
4) Huneke, F. (1961). Das Sekunden Phanomen (The Instantaneous Phenomenon) Karl F. Haug Verlag, Ulm, Donau, Germany.
5) Kajdos, V. (1974). Neural therapy: its possibilities in everyday practice. Amer. J. Acup. 2, 113-.
6) Khoe, Willem H. (1979). Scar injection in AP: Huneke's "Sekunden" neural therapy. Amer. J. Acup., 7, 15-.
7) Lewit, Karel (1979). The neural effect in the relief of myofascial pain.
Pain, 6,3-.
8) Mann, Felix (1973). AP cure of many diseases. William Heinemann Medical Books, London, 123 pp.
9) Rogers, Carole (1982). AP therapy for postoperative scars. Amer. J. Acup., 10, 201-.
3. CLINICAL CASES OBSERVED AT VGH AND CMC
I attended 4 long clinics at VGH and two short clinics at CMC. I observed over 100 clinical cases presented for their first treatment. (Repeat treatments were being given in other clinics, but I wished to see each case, as presented, for the first time and to assess the response (if any) to AP at that treatment. The patients, nursing staff and doctors were most helpful and friendly. They discussed freely each case history, allowed me access to the medical records and discussed why a particular combination of points was chosen. I wish to thank these generous people most sincerely for helping me to learn more about AP and human nature.
Most cases involved pain syndromes (headache, neck, shoulder, elbow, wrist, hand pain + stiffness, back and lowback rain + stiffness, hip, thigh, knee, ankle or foot pain + stiffness, chest or abdominal pain). A few cases with constipation, asthma, numbness of extremities, muscle tremor, facial paralysis and post CVA paralysis were also seen.
The cases were scored from 0 to (+++) on the result obtained at the end of the first session: (0) = no improvement was noted or reported; (+) = slight improvement; (++) = good improvement; (+++) = excellent improvement; (?) = result unknown.
It should be noted that selection of points is not a routine, standardised procedure. It depends on the doctor, the patient and on the response obtained. Furthermore, most of these patients would require further treatment sessions before they could be said to be cured or stabilized. My notes are not complete and many other cases observed were not detailed in writing.
Table 1 shows a summary of the responses noted at the end of the treatment session (usually about 20 min) in 39 cases for which my notes had a result indicated (0 to +++). The notes did not record a result in 9 patients. Good or excellent relief occurred in 69.2% of the cases. Slight relief occurred in 23.1%. Only 7.7% reported no relief. In the 39 recorded responses, 13 (33.3%) had a marked response within two minutes (cases 11-14,16,17,24-26,34,40,43 and 45). These rapid responses are comparable to those reported in the Huneke Phenomenon.
These results are most impressive, especially when one realises that they were responses to the first session of AP. Most disorders require 1-6 or more sessions of AP to obtain maximum response. A good initial response is usually an excellent prognosis for a satisfactory outcome. Many patients with a poor response to the first session can be helped by further sessions.
TABLE 1
Summary of responses noted (0 to +++) and unknown (?) in 48 cases from my notes. (Case 4 was included twice).
Details recorded in my notes
1. Aches and pains "all over the body"
Some patients report "wandering pains" or static pains in head, neck, back, upper limbs, lower limbs or "all over the body." These cases would be difficult to treat (too many needles) if each area had to be treated separately. In such cases, the VGH clinic uses needles in LI04 and LV03 (bilateral) for 2-3 sessions, at which time the pain usually "localises" in 1-2 areas and is easier to treat then. In the early stages, many TP/AhShi areas may be found but the real TPs can be isolated after 2-3 sessions of LI04, LV03.
Female: "aches and pains all over": (GB area of head, legs, shoulders) with insomnia and malaise. LI04, LV03 (bilateral) needled. Doctor was very gentle and caring with this patient and the "Tender Loving Care" (TLC) had marked effect on her reaction to the staff. Response (?).
Tension, insomnia, neurasthenia: In VGH, I was told that AP can help these problems. Main points included LI04, HT07, ST36, LV03. However, many sessions may be required and other causes and therapies must be considered. I saw few such cases during my visits. None could be assessed as to the outcome.
2. Insomnia, tension for 10 years: LI04, LV03 (bilateral). Response (?)
AP in pain following local trauma: Many of the pain syndromes presented for APtherapy are caused by local trauma (falls, industrial accidents, car crashes, athletic injury etc). In acute cases, presented soon after the injury, AP is a highly efficient method of controlling the pain. It also has anti-inflammatory and restorative effects which speed up the resolution of the injury, especially where this involves soft tissue injury, bruising, oedema and swelling. Chung has done extensive clinical research in this area.
Acute traumatic injury: Ipsilateral GB34 is the pain-point par excellence. On its own, it often controls the pain (and reduces swelling). Sometimes, ipsilateral BL62 or an APpoint near the local area may improve the effect. Chung reports that pain relief is more efficient if AP is given on or after day 2 (rather than day 1) of the accident. About 70% of acute traumatic pain (including fracture pain) may be relieved following one 20-min session of AP. Treatment 1-2 times/day for 3 occasions gives pain control in > 95% of cases.
In contusions GB34
In abrasions GB34
In fractures GB34 (66% excellent results)
In costal trauma, especially lateral GB34
GB34 (ipsilateral) is the key point for traumatic pain anywhere in the body. Because of the marked analgesic effects it is most important to diagnose the cause of the pain and togive supplementary treatment (for example, plaster cast in simple fractures). It is possible to do severe damage in the region of a broken bone if one uses it following APanalgesia, unaware that the fracture was present.
To obtain complete relief from chronic pain, caused by trauma some weeks or months previously, AP may be required 1-2 times/week for 1-2 months. GB34 (ipsilateral) is also used in chronic cases, but other points are often added. These include AhShi points, when present.
Chronic traumatic pain of:
head and neck:GB34 + LU07 + BL62
lumbar area :GB34 + BL40 + SI06
elbow area :GB34
ankle area :GB34
GB34 is also useful for joint and muscle stiffness which often follows removal of a plaster cast. GB34 controls the muscles and sinews.
3. Left lowback pain following trauma: Needling ipsilateral GB34 caused radiating sensation to flank and costal area. SI06 (contra- lateral) needled. 20 min. Pain was greatly eased but not completely gone (+++).
4. Knee and shoulder pain (bilateral) following car accident some weeks previously. Scar on anterior thigh. Bilateral TP/AhShi were located in infraspinatus. Needled AhShi, GB34,BL40,57,62, TH05. Twenty minutes. Pain slightly improved. (+)
5. Elbow pain following local trauma: GB34, LI11 ipsilateral. Twenty minutes. Pain gone completely (+++).
6. Eye pain and swelling following local trauma: GB34 ipsilateral. Within minutes, patient opened eye, Pain gone when needle removed at 20 min. (+++). (One treatment is often sufficient in "black eyes": C.C. Chung).
7. Pain in left palm near HT07, due to local trauma (fall from bicycle) one month before. Left GB34 needled. Marked pain relief in 20 min.(+++)
Head and neck problems
Many patients are treated for headaches, neck pain and whiplash. (Facial paralysis and trigeminal neuralgia is also treated but few such cases were seen by me).
Headache: In VGH, LU07 is used often as the main point, often combined with GB20 +TaiYang (Z 09), YinTang (Z 03), GV20 (depending on location of headache).
Neck pain and stiffness: The Hand point "Neck" is very effective. The patient is asked to close the fist. The point is between the knuckles at the lower end of metacarpals 2-3. It is often combined with SI03.
8. Pain and stiffness in neck, with intermittent headaches (headache not present at presentation). Needled: "Neck" point (knuckles 2-3) plus LU07 (bilateral). Twenty minutes. Great improvement. (+++).
9. Throbbing pain and sensation of tightness in occiput and behind temples for 2 weeks. Worse at night. AhShi found (bilateral) near GB10. Needled. Points GB20, LU07,BL40 needled bilaterally for 20 min. Slight improvement was reported. (+).
10. Tinnitus (Side and duration and causes not recorded). Needled TH17, GB20, ST36, ipsilateral. Response (?). (Note: many authors report poor results with AP in tinnitus).
11. Acute neck pain and rigidity in an in-patient (developed overnight). Hardly any rotation or other movement of neck was possible. One needle was put in the point "Neck" between knuckles 2-3 and was strongly pecked and twirled for one minute. Patient was then asked to try to move his neck slowly. The consternation on his face when he found he had full movement and no pain after 1 minute was hilarious! Immediate result. (+++).
Shoulder pain, stiffness, "frozen" shoulder
Many patients had these symptoms for up to 5 years before AP treatment. Careful searching of the scapular muscles (especially infraspinatus) often shows up AhShi points. SometimesAhShi also occur near GB21. The most important distant points for shoulder are SI03,GB34, ST38, plus AhShi points.
12. Frozen shoulder: Very restricted right shoulder movement with pain and stiffness. Duration 5 years. Two AhShi points located in infraspinatus Strong deep needling for one minute. Patient lifted arm much higher immediately. AhShi had disappeared in one minute! Then ST38 was needled (right side) strongly for one minute. Further improvement in arm movement. Then SI03 (right) needled strongly. Needles left in SI03 and ST38 for 20 min. Great improvement in arm movement and pain was much less. However, patient could not put arm behind his head or behind his back and some pain and stiffness remained (++).
13. Shoulder-joint pain/limited movement, with pain in the hand, especially metacarpal-phalangeal joint of index finger for 3 months before AP. Left side. AhShi in infraspinatus (left) and AhShi in front of shoulder joint. Both AhShi needled strongly. All pain was gone and movement markedly improved in two minutes. A further AhShi near SI09 was needled. The amazement on the patient's face, on discovering the dramatic improvement within 3 minutes, was a joy to watch! (+++).
14. Pain in shoulder, elbow and wrist, with marked hand tremor which interfered with use of chopsticks and made writing impossible. (Tremor appeared only when pen or chopsticks were grasped). Little limitation of joint movement. Duration two years before treatment. AhShi located in right infraspinatus. Needled strongly for one minute. All pain had disappeared. Chung asked the patient to write his name. The tremor was gone! No further treatment at that session. (+++ immediate).
15. Shoulder area and neck pain: Needled at GB21, SI09,11, 20 min.
Slight relief only. (+).
16. Pain and pulled scapular muscles (right) with difficulty raising, arm for 7 months following golfing incident. (Pain in right temple had been present earlier, but was gone now). No AhShi points located. ST38 caused "sensation of electricity travelling from foot to side of face!" The pain was gone in 1 min. GB34 was added for added effect (2 needles only: ST38,GB34, right side). Patient "could not believe the effect"!
(+++, immediate).
17. Shoulder pain (anterior muscles) when arm brought behind body. Duration 1 month. Strong needling at SI03 gave total relief of pain in 1 min. Strong needling at GB34 and LI04 added for extra effect. All needles left in situ for 20 min. (GB34 referred sensations to the shoulder area!). Total pain relief. (+++, immediate).
18. Frozen shoulder: Pain and severe restriction of raising right arm. Needled: right ST38,BL40, GB34 plus left LI15. Twenty minutes. Some improvement in pain but little change in movement. (This case was long-standing and had muscle atrophy) (+).
19. Stiff shoulder: Left side, limitation of movement, with feeling of heaviness to the wrist and also some lowback pain. Duration unknown. AhShi point in infraspinatus needled plus left ST38 and TH03 (for the shoulder). "Loin and Leg" points added for lowback. Response (?).
20. Scapular area pain, left. Duration unrecorded. AhShi not found. Needles in GB34,TH03 , BL40, GB20 (left). Twenty min. Marked improvement (+++).
21. Scapular area pain, with degenerative lesions in cervical spine plus facial palsy. Duration unknown. Needled AhShi (infraspinatus) and TH03 (for shoulder) plus LI04,20 (for the face). Scapular pain greatly improved in 20 min. (+++).
Upper limb problems
22. Pain in forearm muscles below lateral epicondyle of humerus on both arms for 6 months. AhShi located in right infraspinatus, also below left GB20 and (bilateral) in forearm muscles near LI10. Needles in all AhShi plus GB34 (bi). Less pain after 20 min. (+).
23. Elbow pain and muscular stiffness: Duration and cause not noted. GB34 + localAhShi point needled, 20 minutes. Good response reported (++).
Respiratory difficulty
AP is used often to help patients with respiratory problems, such as asthma, dyspnoea, tight sensation in chest, shortage of breath. The main points include: PC06, LI11, BL13, SP04,ST40. Few such cases were seen during my visit. AP at PC06 was said to be very useful to help to control angina pectoris and improve cardiac microcirculation.
24. Difficult breathing and shortage of breath, with sensation of tightness in chest in patient with history of asthma. Needles put (bilateral) in PC06 and SP04 gave relief within 2 minutes. Left in situ for 20 min. Patient was delighted with response. (+++ immediate).
Lowback pain and stiffness + sciatica
Lowback pain is often caused by unaccustomed back exercise (lifting, twisting etc). Sometimes it is associated with degenerative disc disease, spondylitis, disc prolapse. The new points "Loin and Leg" (dorsum of hand between the upper heads of metacarpals 4-5 and 2-3) often give immediate or rapid pain relief. Other useful points include: BL23,40,57,60,GB30,31,34, AhShi, SI06, LV03, LI04.
25. Right lumbar and posterior thigh pain associated with X-ray evidence of degenerative disc disease. Had been treated unsuccessfully for 5 months in the Orthopaedic Dept. of the same hospital. Needles in: "Loin and Leg" points (right), SI06 (left). Pain improved within 2 min but extension of leg still caused some pain. After 20 min pain was "95% gone". (+++, immediate).
26. Pain radiating from left thigh to lower leg: Intermittent over 1 year. Left face pain. Worse at night. Slight degeneration of lumbar spine on X-ray. Pain in both shouldersfor 3 months. Needled (for lowback/leg): "Loin and Leg" (left). Pain relief was immediate (but not complete) in one minute! AhShi found in left gluteal muscle. Massaged, then needled, plus BL62. For the shoulder pain, SI06 (bilateral) needled. AhShi near GB20 (bilateral) also needled. 20 minutes. Pain in shoulder and lower limb "greatly improved!" (+++ immediate).
27. Lowback and sciatica pain (right thigh, radiating to lower leg) for one month. X-ray indicated degenerative disc disease of low lumbar spine. Straight leg raising test (SLRT) 90 degrees left, 45 degrees right. Disc disease diagnosed in lumbar area. Needled: "Loin and Leg" and GB34 (right side) 20 min. No improvement in pain or SLRT at this session (0).
28. Severe lumbar pain and stiffness following back strain about 1 week previously. Needled: "Loin and Leg", LV03, LI04 bilateral). Greatly improved back movement and pain almost gone in 20 min. (+++).
29. Acute lumbago for past few days. No history of back strain. "Loin and Leg", GB34 (bilateral) needled. 20 min. Stiffness and pain greatly improved. (+++).
30. Acute sciatic-area pain (right). Duration unknown. Suspected lumbar disc on SLRT. Needled: BL23,40,60, GB30,34 (all on right). Response (?).
31. Acute lumbar sprain: Duration unknown. Needles placed in BL23,26,30,34,40 bilateral. The lumbosacral area was cupped (bilateral) over the needles. Good pain relief after 20 min. (CMC). (++).
32. Sciatic area pain (left). Duration unknown. SLRT unknown. Needles in left BL40,60 plus AhShi below wing of left ilium. 20 min. Pain relief reported. (++).
33. Sciatic area pain (right) in patient who earlier complained of numbness and ache in lower leg for one year. Lumbar vertebrae showed bridging on X-ray. AhShi (very sensitive) atGB31 (control point of the tensor fascia lata - Chung). Needles in AhShi plus GB30,BL40,60. Response (?).
34. Lowback stiffness, pain and inability to bend forward: Duration about 3 days. Needles (bilateral) in "Loin and Leg" points, strong stimulation for about 30 seconds each. Patient was then asked to try to bend forward. There was marked improvement in movement and less pain. BL40 and GB34 added (bilateral) 20 min. Marked improvement (+++, immediate).
Lower limb problems
35. Ache and tenderness over right lateral ankle following a fall (ballet dancer) 8 months previously. Needled: right SI06 plus left GB34. 20 min. Slight improvement reported (+).
36. Weakness in both legs for 13 years following cystectomy. "Loin and Leg", BL40,GB34, LU07 needled bilaterally. Response (?).
37. Ache in anterior aspect both thighs for one week. AhShi points in muscles of medial and anterior thigh. Needles in AhShi points for 20 min. Marked improvement in pain (+++).
38. Pain in and under left heel for 10 years. Earlier X-ray (some years previously) showed soft tissue calcification behind ankle joint. AhShi located above BL57. Needling sent sensation to gastrocnemius tendon area. Slight improvement in pain after 10 min. (+).
39. Pain in sole of the foot: Duration not recorded. Needled ipsilateral GB34, BL57. Response (?).
40. Pain, spasm in both knees in 74 year old woman. Duration > one month. Also tightness in right gluteal muscles. Needles were placed in LI11 to relax knee muscles. The response was immediate and dramatic (knee movement improved markedly). ThenGB34, SP09 (bilateral) added. Marked improvement in movement and pain in 20 min. (+++, immediate).
41. "Cold knees": For some months patient had cold sensations in both knees and used knee warmers in an attempt to "warm" them. Needles in GB31 and ST36 (bilateral) for 20 min. Patient reported "warm sensations" in knees during needling (+).
42. Multiple joint pain in lower limbs, worst in knees, with some lumbar pain. Needles in the hand point "Sciatic area" (between distal heads of metacarpals 3 and 4 on dorsum of hand) plus GB34, SP09, SI06 (all bilateral). Response (?).
43. Pain and swelling in knee and ankle (left), intermittently over 6 months. AhShifound near left SP10. Strong needling of AhShi for one minute gave marked relief of pain. A second AhShi found 2.5 inches below and behind left GB34, bilateral. Needled 1 min. Patient could hardly believe the result! (+++, immediate).
44. Left knee pain (no details). Needles GB34, SP09 (left). Twenty minutes. Good relief of pain (++).
Post CVA cases: Note: If there is sensory paralysis, there is little value in needling that side. In such cases, the "good" side would be used plus the Motor points on the scalp.
45. Right facial paralysis, slurred speech and poor control of tongue in elderly woman. Minor stroke 3 months before. GV15 was needled 2" deep. Within one minute, she had marked improvement in speech and tongue control! CV23 was then added, plus LI04,HT07, GB34 (bilateral). All needles were left in situ. After 10 minutes, patient went pale, developed cold sweat on face/forehead, yawned a lot and complained of severe headache behind right eye. On attempting to get up, she nearly collapsed. She had to be helped to lie down. She felt very tired and weak. (When I saw her one hour later, she was still complaining of leg weakness and a headache) (+++ immediate).
46. Right hemiparesis arm-leg after stroke (hospitalised in CMC). Simple needling on right LI04,11, TH05, GB34, SP06, plus left LI04, GB34. No improvement noted (0).
47. Hemiplegia (left side) (CMC hospital): left LI04, TH05, BL40, GB34, GB20,21, GV16. No improvement noted (0).
4. AP RESEARCH IN TAIWAN, R.0.C.
During my visit, I received reprints of their research in AP from medical and vet colleagues. Abstracts of the 1982 International AP Symposium (1982), the Vet AP Seminar (1982) and the National AP Symposium (1979) were also given to me. From these sources, the addresses of the main centres of AP research in Taiwan were compiled. They are:
1. Taipei
Chinese AP Research Foundation (Box 84-223). This group attempts to integrate and disseminate the medical and vet AP research in Taiwan. This group produces "AP Research Quarterly", in which some of the current AP research is published.
National Taiwan University, College of Medicine (Depts. Physiology and Neurology).
National Taiwan University Hospital (Depts. Medicine a Physiology).
National Taiwan University, Depts. Animal Husbandry & Zoology.
Yang Ming Medical College (Depts. Anatomy & Microbiology and Institute of Neuroscience).
National Defence Medical Centre (Depts. Physiology, Biophysics and Biomorphics).
National Institute of Preventive Medicine (Dept. Serology).
Academia Sinica (Institute of Physics)
Taipei Medical College (Pain Clinic)
Taipei City Hoping Hospital (Pain Clinic)
Taipei Municipal Drug Addiction Centre
Airforce General Hospital (Aerospace Medical Research Laboratory)
Tri-Service General Hospital (Depts. AP Research & Pathology) VGH (Depts. AP, Ophthalmology, Obstetrics and Gynaecology).
2. Taichung
China Medical College (AP Research Centre; Institute of Chinese Medical Science and Dept. Physiology)
Chung Shin Hospital (Dept. Urological Surgery)
Veterinary College (Dept. Vet Medicine, and Vet Teaching Hospital)
3. Lungtan Institute of Nuclear Energy Research
4. Hsinchu National Tsing Hua University (Institute of Radiation Biology)
5. Changhua Success Clinic of Chinese Medicine.
I visited the research facilities of Yang Ming Medical College (Taipei), VGH (Taipei) and CMC (Taichung). The equipment in these centres was impressive and modern. It included: electron microscopy; automated scintillation and isotope counters; modern histological processing and microscopy; automated spectroscopy; HPLC apparatus; microcomputer-controlled integrators.
Yang Ming Medical College also had sophisticated multichannel electronic recorders for physiological monitoring; stereotactic surgical equipment and primate/rodent handling facilities for experimentation in pain research.
I was told that Government funding for AP research had been somewhat limited until recently but that increased funding was expected in future, due to (a) positive research results from Taiwanese projects, and (b) a growing awareness of international advances in the field of AP, neurophysiology and neuroendocrinology.
Since 1976, or so, the main areas of AP research in Taiwan can be divided into experimental and clinical research.
Experimental studies:
Experimental AP research in Taiwan is based largely on researching the physiological effects of stimulating some of the Master Points, especially LU07, LI04,11, ST25,36, SP06,HT07, BL23,52,40, PC06, GB20,34, LV03, GV14,26.
Drug interactions and the pathways activated in the nervous system are also being studied. The approach is pragmatic. There is great awareness of the need for properly controlled observations.
The ancient concepts of Five Phases, Pulse Diagnosis, the Perverse External Insults, etc receive little (if any) credence from medical or veterinary scientists trained in the "Western" method. These concepts are still held by those doctors whose training is solely in traditional Chinese medicine. However, since few of the Traditionalists are active in AP research, I conclude that current research in Taiwan largely ignores the esoteric aspects of traditional APand concentrates on the physiological effects and the mechanisms involved from a "Western Scientific" viewpoint. Research areas include:
a. AP analgesia: In experimental pain in animals (rats, monkeys), using tail flick test, Jaw opening reflex, Naloxone effects on AP analgesia in animals, Long-term abolition of APanalgesia by severing the dorsolateral funiculus in the cervical 2-3 area in monkeys, APeffects on stimulation evoked potentials in the human cortex - the importance of DeQi(needle feeling), The role of Dorsal Root Antidromic Activity in AP analgesia, AP effects on pain threshold in normal and paraplegic humans.
b. Brain sites activated by AP: Sensory projection of AP sites in the cortex of monkeys,AP effects on brain membrane changes, AP effects on the feeding and chewing centres in rabbits.
c. Cord sites activated by AP: AP effects on Dorsal Root Antidromic Activity in animals, Horseradish peroxidase retrograde transport to label cord sites activated by AP.
d. Brain stimulation effects: Effects of raphe nucleus stimulation on cardiovascular function during painful stimulation, Stimulation-produced analgesia in periaqueductal grey area - effects of naloxone.
e. AP effects on cardiovascular function, metabolic rate and thermoregulation:
AP effects in cardiac function,
AP effects on experimental cardiac abnormalities in animals,
AP effects on skin temperature/vasomotor responses in normal/paraplegic humans;
AP effects on metabolic rate and human body temperature;
ST36 implants on thyroxine levels and pulmonary function in rabbits;
AP at GV14 on thermoregulation in experimental fever in rabbits.
f. The DeQi Phenomenon:
The role in DeQi of reflex muscle contraction around the needle;
The role in DeQi of mechanical twining of connective tissue around the needle tip;
The induction of DeQi in "non-points."
g. Miscellaneous physiological effects of AP:
at GB20 on bile flow in rabbits and on high density lipoproteins in blood;
on levels of cholesterol and lipoproteins in normal and hyperlipoproteinaemic humans;
at GB34 on cholesterol levels in rabbits fed high cholesterol diets;
on blood sugar in alloxan-induced diabetes in mice;
on experimental alcoholism in pigs & mice;
on Kirlian auras in man;
on pupil width in cats;
on phagocytosis, leucocytosis and lymphoid cells in animals;
in recovery from experimental x-irradiation sickness in animals (red cells, white cells; spleen, thymus and bone marrow metabolism);
on antibody production to various antigens including cobra toxin in animals.
Clinical studies include: Many studies on effects of AP in clinical pain syndromes in man; Comparison of simple needling with low-frequency electro AP in pain control in man; Comparison of TP/AhShi therapy and AP therapy using distant points in control of clinical pain syndromes; Earpoint AP in control of clinical pain in man; AP analgesia for human surgery; Studies of AP in withdrawal symptoms from narcotics and tobacco; AP effects on blood pressure of normal and hypertensive patients; AP and moxibustion effects in asthmatic patients; Earpoint AP in the treatment of refractive disorders of the eye; EA at SP04 in the prevention of threatened abortion or premature labour in women; Earpoint AP in disorders of the G/I tract; reproductive disorders and psycho-neurological disorders; Effects of AP on T4, LH and IgE levels in blood of human patients; AP in piglet diarrhoea - comparison with antibiotic therapy; AP in bovine infertility (repeat breeders, anoestrus, cystic ovaries).
Vet AP research projects planned for the future:
Pig production is most important to the agricultural economy of Taiwan. Clinical AP research will be aimed at control of three major problems in pigs:
1. Delayed puberty in gilts;
2. Postpartum anoestrus and infertility in sows;
3. Postpartum agalactia.
Milk and beef are less important to the Taiwan economy. However, because of very positive results in preliminary trials, further work will be conducted on AP effects on bovine fertility.
These projects will be carried out under the direction of Jen-Hsou Lin from the Dept. Animal Husbandry, National Taiwan University (Taipei) and H.P. Fung, of the Vet School (Taichung), in co-operation with other vets and commercial stockmen.
5. AP TRAINING IN TAIWAN, R.0.C.
The quality of AP training in Taiwan varies widely. It ranges from weekend "crash-courses" (which are usually intended as an ongoing part of an integrated study of AP) to formal courses lasting one month to three years. As well as this, one may opt for "self- study" from the humanAP textbooks, with or without formal course work.
Unscrupulous people who attend one or two weekend crash-courses (and who may happen to be medical or vet graduates!) may use this as their "qualification" to practice AP. Poor clinical results by such people brings AP into disrepute and unsuspecting patients suffer as a result of the incompetence of the charlatans. This problem is not confined to Taiwan - it is now an international problem.
Each teaching centre has its own methods of assessing its students but the course content and duration vary widely. Taiwan, as is the case in most other countries, appears to have no standard Examination or Assessment Board at State (National) level to assess and certify the level of competence of AP practitioners. Thus, the level of competence varies from excellent (as observed in the VGH and CMC) to poor.
The content (orientation) of courses varies with the teaching centre. In VGH (Taipei) the course content is mainly "Western" oriented - little emphasis is placed on the ancient traditional concepts of Pulse Diagnosis; Five Phase Laws and Points; the Perverse Causes of Disease etc. Because of its closer ties to traditional medicine, CMC (Taichung) places more emphasis on traditional concepts and on traditional needling techniques (tonification/dispersion etc). However, CMC is also very "Western" oriented in its basic undergraduate medical training. Students from this college understand both Eastern and Western concepts. CARF (Taipei) because its faculty numbers include both "traditional" and "Western" doctors, also teaches the two differing concepts. There are many other centres forAP training in Taiwan, but I have no information on them.
The foregoing three organisations accept foreign medical graduates and vet surgeons on their courses. Students attending any of these courses can expect to have extensive exposure to clinical material, because VGH/CMC have their own (large) clinics, and CARF can provide clinical instruction in co-operation with Taipei hospitals. The cost of tuition depends on the duration of the course. For example, medical or vet graduates (who have already studied basic AP techniques elsewhere) may enrol for a 1-month intensive advanced course, including clinical work, at any of the above 3 centres. The cost of tuition plus lectures notes etc is approximately 1200 US $. Specialised courses (for example in E.N.T. diseases; internal diseases; myofascial pain, etc) can be arranged by negotiation with the Faculty.
The concession to allow vets to attend these courses was granted by CMC and VGH in 1982 on the understanding that the techniques learned there would be used primarily in vet practice, or for research purposes. It is recognised and accepted throughout China, Taiwan, Japan and other Far Eastern countries that knowledge and skill in AP is not confined to medical or traditional doctors. Many people learn it as part of their cultural training in the martial arts, TaiQi, QiGong and other mental and physical disciplines. It is also common that one may have a basic knowledge of AP for self-help, or for use in "First-Aid" in minor problems and for family use, for example, the AP or massage techniques to relieve tension headaches; teething problems in babies; indigestion in children; pulled muscles; tension insomnia etc.
I recommend these courses to vet colleagues who may have the opportunity to take an extended holiday-cum-study trip in a most beautiful country. I would advise them to ask for an outline of the course material (and the fees involved) and to make their reservations in plenty of time. Those interested may contact the AP Dept., VGH, Taipei, the AP Dept., CMC, Taichung or CARF, Box 84-223, Taipei.
Accommodation in Taiwan and travel to and from the course is the responsibility of the candidate but each organisation offers assistance and advice, if required.
ACKNOWLEDGEMENTS
My first trip to the Far East was made possible by Drs. Hong Chien Ha and T.C. Hsu of the Committee of the First International Symposium on AP and Moxibustion, Taipei, and by Jen-Hsou Lin of the Committee of the Veterinary AP Seminar, Vet School, Taichung. These men arranged for my travel to and accommodation in Taiwan. Great credit and thanks are due to them for their organisation of the scientific sessions and their fantastic hospitality during my stay, from 14th to 28th November 1982.
My sincere thanks are due to all who helped to make my visit enjoyable and educational; the Taiwan Government, for funding the trip; the organisers of the International Symposium and the Veterinary Seminar, for inviting me; medical colleagues at VGH, Yang Ming Medical College and CARF (Taipei) and CMC (Taichung); vet colleagues, staff and students at the Vet College (Taichung), the Pig Research Institute (Chunan) and the Dept. Animal Husbandry, National Taiwan University (Taipei) for their patience in answering so many questions, and for showing me their skills; to the Tsang brothers for their time, car and generosity; to my friend and colleague, Jen-Hsou Lin, who made it all possible; his wife Li Fei, who fed me, and to their little girls I Chen and I Chien, who made the red-haired barbarian laugh on Yang Ming mountain.
AP ANALGESIA (AA) IN COWS
Summary from Sheila White's article (1982) Murdoch Vet. School, West Australia 6150.
White has recently had good analgesia for 2 abdominal operations in cows. #1 was rumenotomy for rumen/omasal/abomasal impaction.
#2 was large (45 cm) abscess with adhesions in the spiral colon (right incision below the paralumbar fossa).
Three points were used. Cows were >600 kg.
A: BaiHui (GV03, lumbosacral space), depth 5 cm;
B: MingMen (GV04), in the space between lumbar 2-3, depth 4 cm;
C: YaoPang (Veterinary point, at tip of transverse process of Lumbar 1. A long needle (12 cm) was inserted anteriorly (pointed at body of last thoracic vertebra) and angled downwards, to slide under the wing of the transverse process, aimed at body of last thoracic vertebra. Depth 5.5-6 cm.
Needles B and C were joined by copper wire and connected to one lead of 73-10 stimulator. Needle A was connected to the other lead. Frequency 15-28 Hz, square wave.
Analgesia in #cow 1 at 20 minutes.
Analgesia in #cow 2 not good at 20 minutes. Needle removed and replaced. Good analgesia 30 minutes later (i.e. at 50 minutes).
Both operations were satisfactory under EA, with no other anaesthetic required. The operations lasted 2-3 hours. Both cows recovered uneventfully.
Note, for right flank operation, right YaoPang was used. For left operation, left YaoPang was used.
AA ATTEMPT IN A COW IN TAIPEI
by J.H. Lin and P.A.M. Rogers
We attempted to induce AA in a Friesian cow at the Dept. Animal Husbandry, NTU. We have used BaiHui, MingMen and left YaoPang, as described above. The stimulator used was made locally. The frequency was approximately 15 Hz.
The pain stimulus used was to (attempt to) transfix a fold of skin grasped between thumb and index finger using a 1.5", 21 gauge needle. The cow had a very nervous temperament. Any quick touching of the skin (of either flank) by the needle, evoked strong, immediate reflex muscle twitch, and defensive action.
After 20 min. of stimulation, the cow reacted as before to quick needle stimulus and no penetration of a skin fold was attempted because of this. After 30 min. of stimulation, the reaction to quick stimulus was less active but still present on most sites. Then we realised that (because of the nervous temperament of the cow) the reaction to quick needle stimulus might have been due to touch (rather than pain). We then applied slow, gradual and firm pressure on the needle to a skin fold. There was no reaction and it was possible to completely transfix the fold. In c. 9/10 sites tested on the left flank, perinaeum, vulva and upper (posterior) aspect of the udder, no defensive reaction or rapid muscle twitch was elicited on transfixing the fold. Full sensitivity was still present at this time on the right flank and on the right and left thorax.
We concluded that the attempt (our first, using these points) was about 90% effective to the slow transfixion and that the hypoalgesia was limited mainly to the left flank area.
TAIWAN
WOOD - BEGINNING
0 terrible orgasm of Mother Earth,
Awesome power in aeons past,
With mighty roars she came and came-
No pleasure here, no slippery thighs,
No gentle fingers, no trembling sighs
But bowels churning with white heat-
Gushing, pouring, spewing, heaving
Sulphurous molten rock:
Taiwan.
FIRE - BIRTH
Alone and unattended She,
Her bearing closed by sand and sea,
Through gaping wound across Her belly
Expelled Her screaming child.
Up, up it rose from ocean floor
To tower high o'er boiling shore:
Taiwan.
EARTH - GROWTH/DEVELOPMENT
O'er Yang Ming peak I saw you born.
Fierce winds and waves and whistling sprays
Scraped and shaped your wondrous bays.
On Chunan plains you saved the corn.
From little junks you hauled your nets.
In alleyways you placed your bets.
On crowded streets you hurried by,
By taxis, cycles nearly killed.
0 slant-eyed beauty of black eye !
You caused my semen to be spilled
Ten billion times:
Taiwan.
METAL - MATURITY
Young girls proud in country free,
Young men summoning TaiQi,
Army alert constantly
Face the threat from o'er the sea:
Taiwan.
WATER - DEATH/REBIRTH
Little jewel of the East
May your people live in peace.
May they never have to see
Obscenity like Nag'saki.
May the West learn what you teach:
Hard work, honour, close family,
Pride of self and history:
Taiwan.
QUESTIONS
Channel codes used in these questions are: LU, LI, ST, SP, HT, SI, BL, KI, PC, TH, GB, LV, CV, GV.
1. One of the following statements is not correct. Indicate the incorrect statement:
(a) Chinese medicine, as practised in Taiwan, combines the best of "Western" and "Traditional Chinese" medicine.
(b)TCM involves study of AP, moxibustion and Herbal Medicine. The latter is most important.
(c) For all branches of TCM, the medical theory (Yin-Yang, Five Phases, Perverse Causes of Disease, Disease syndromes and Diagnostics) is the same.
(d) In Taiwan, all herbalists are trained in AP and all acupuncturists are trained in Herbal Medicine.
(e) Chinese Herbal Medicine is very valuable in CVA, hypertension, neurasthenia and many other internal diseases.
2. One of the following statements is not correct. Indicate the incorrect statement:
(a) "The Red Book of Chinese Medicine" (by Mao Tse Tung) was the basic text used by most Taiwanese experts in acupuncture.
(b) Methods of selecting AP points for therapy, and of manipulating the needles, were highly individualistic in Taiwan.
(c) There was general agreement that manual needling alone was as good as, or better, than electro-needling for most conditions requiring AP.
(d) Though electrostimulators were freely available in every clinic visited, Rogers saw very little use of electro-AP. Exceptions were: AP analgesia before surgery and in certain chronic conditions, especially paralysis/paresis after CVA or nerve injury.
(e) Great emphasis was placed on a careful search for AhShi points.
3. One of the following statements is not correct. Indicate the incorrect statement:
(a)AhShi points usually are present in pain conditions, such as headache, joint pain and myofascial syndromes.
(b)AhShi points may also arise in some cases of internal disease (lung, heart, liver, gall bladder, gastrointestinal and urogenital tracts).
(c) The Shu points (T3 to S4 on the inner line of the BL Channel) are palpated carefully in internal disease, as are the Mu points (Alarm points on the abdomen/thorax).
(d)AhShi points often arise in joint pain (shoulder, elbow, lowback syndrome, hip, knee)
(e)Headache seldom arises from AhShi points in the neck and shoulder muscles
4. One of the following statements is not correct. Indicate the incorrect statement:
(a) All pressure-sensitive areas are AhShi points but AhShi points are not always Trigger Points (TPs).
(b)The best AhShi point for therapy is the Trigger Point (TP), i.e. palpation pressure on the point causes a pain sensation to radiate to the problem area, muscle, or organ.
(c) The AhShi point seldom occurs within the area of pain. Patients usually are unaware of its presence until it is palpated.
(d)AhShi points always occur far away from the problem area.
(e)AhShi/TP points can recruit new triggers elsewhere, usually in the muscles.
5. One of the following statements is not correct. Indicate the incorrect statement:
(a) Painful areas in scarred tissue may act as powerful TPs and these areas must be treated to obtain optimum results.
(b) Taiwanese acupuncturists placed great emphasis on searching for (and treating) TPs in scarred areas.
(c) Other pain-sensitive areas (motor points, "fibrositic nodules" etc) are useful in therapy but they are not as powerful as the TPs.
(d)AhShi therapy is the best introduction to the benefits of needle therapy.
(e) Unfortunately, AhShi points are not present in every case, and Western doctors who know only the AhShi method are unable to help by needle techniques in such cases.
6. One of the following statements is not correct. Indicate the incorrect statement:
(a)AhShi points disappear when the condition resolves and their disappearance during a course of therapy indicates a good prognosis.
(b)Dr. Chien Chung did extensive clinical research with AhShi points and published the English version of his book ("AhShih point: The pressure pain point in AP - Illustrated guide to clinical AP (1983)".
(c)AhShi therapy consistently gives better results than traditional AP.
(d)Myofascial syndrome involves muscle pain/stiffness, especially around joints. The joints are often stiff, but show no inflammatory or X-ray lesions. There is often a history of intermittent recurrence. The diet usually is satisfactory and the neural causes of the pain are obscure.
(e)AhShi (TP) points often are present in myofascial syndromes, but the patient is unaware of them until they are pressed.
7. One of the following statements is not correct. Indicate the incorrect statement:
(a)AhShi points usually show decreased electrical resistance and decreased local skin temperature.
(b) Local vasomotor abnormalities and dermatographic changes occur in the AhShi area.
(c) Histology of the AhShi area shows local cell infiltration and non-specific inflammatory changes. There is sometimes a fibrous infiltration of the AhShi area (ropy muscle sign).
(d) Pressure on the AhShi often refers pain to the "problem area". Needling the AhShi often causes the "Jump Sign": local muscle contractions cause the needle to jump.
(e)Master acupuncturists always needle the area of referred pain (the area of subjective pain).
8. One of the following statements is not correct. Indicate the incorrect statement:
(a) In myofascial syndromes, AhShi therapy very seldom gives dramatic or immediate relief of pain.
(b)AhShi therapy in myofascial cases can give better results than traditional AP using local and distant points.
(c)AhShi points may arise anywhere in the muscles, but they are often near the problem area.
(d) The most important muscles to search for upper body problems are: infraspinatus, neck muscles and GB21 area. In upper limb pain (shoulder, elbow, arm, etc) the AhShi is often in the infraspinatus of the affected limb. In shoulder pain, sometimes the GB21 area, or scalenus muscle may hold the AhShi. In bilateral anterolateral shoulder pain, the AhShi is often in the sternalis muscle. In such cases, one needle in the sternal AhShi can give immediate pain relief. In middle finger pain, search muscles near TH08.
(e)In abdominal and intercostal pain, check the back and sides for AhShi. For lower body problems search the gluteus, vastus medialis, soleus, gastrocnemius. In heel pain, the AhShi is often in the soleus area, left or right of BL57. In plantar pain, the AhShi is often in the gastrocnemius. In lowback/leg pain, search the gluteus muscle.
9. One of the following statements is not correct. Indicate the incorrect statement:
(a) About 33% of all cases of aching pain are myofascial in origin and respond fast and reliably to AhShi therapy. Expect excellent results in 38% and good results in 60% of cases (98% total cases).
(b) Chung's AhShi findings disagree in major respects from Western experiences of TP therapy, as described by Ronald Melzack (Canada), Pekka Pontinen (Finland) and Alex Macdonald (UK).
(c) Chung found the following points to be useful: Renal colic pain/spasm: GB34, LV03, SP04,06; Gastric colic/pain/spasm: ST36, CV12; Biliary colic/pain/spasm: GB34
(d) Rogers did not see use of Earpoints in Taiwan, but was told that earpoints are sometimes used alone or in combination with body points, with good success.
(e)The most commonly used points use were the Channel points, especially LU07; LI04,10,11,15; ST25,36,37,38; SP04,06,09; HT07; SI03,06,09,11,19; BL10,11,23,40,57,60,62, KI03, PC06, TH05,14,15, GB20,21,30,31,34,39, LV03, CV04,12.
10. One of the following statements is not correct. Indicate the incorrect statement:
(a)GV points were seldom seen used. GV15, needled 2" deep in one patient, appeared to cause a very severe left-sided headache, needle shock and some loss of power in the legs. The patient was being treated for facial paralysis and slurred speech following a minor CVA.
(b)Extra-Channel Points (points not on the main Channels) often were used for their local or distant effects. The most commonly seen were Hand Points "Loin & Leg" between the proximal heads of metacarpals 2-3 and 4-5 respectively. These Hand Points gave immediate relief in some cases of lumbago and lowback/leg pain.
(c) Hand Point "Neck" (between the knuckles of fingers 2-3 with fist tightly closed, needled 1" deep towards the wrist. This point gave immediate relief of neck pain/restricted movement in one patient.
(d) Other points used were: LanWei (Appendix point) in abdominal pain/ constipation, XiYan (Knee Eyes) in knee pain, YinTang (between eyebrows) and TaiYang (temporal fossa) in headache, sinusitis.
(e) As they seldom give good results, distant points were seldom used. For example, the following points gave poor results: ST38, GB39 or GB34 in shoulder or neck problems; LU07 in headaches; TH03, SI03 in neck/shoulder problems.
11. One of the following statements is not correct. Indicate the incorrect statement:
(a) Chung seldom used distant points in myofascial or arthrotic syndromes.
(b) If patient was not helped within 20 minutes, the needles were left in situ for up to 40 minutes and other points (AhShi, Local points) were tried also.
(c)In needle use, operators were very careful to cleanse the skin (alcohol swab), use sterile and/or disposable needles and to touch only the handle (not the shaft) when inserting the needle.
(d) Styles of inserting and manipulating the needle varied between operators but most operators placed great importance on obtaining DeQi after needle insertion.
(e) Chung twirled and pecked the needle very strongly in AhShi/TP points for 15-60 seconds. The patient often had very strong reaction to this (grunts, slight groans, facial grimaces etc). In many cases, the needle was removed within the 15-60 seconds.
12. One of the following statements is not correct. Indicate the incorrect statement:
(a)DeQi has subjective (patient and operator) and objective characteristics.
(b) The patient reports strong sensations ("sore, heavy, tingling, electric shock-like, running, aching but not painful") running, proximally, or distally from the needle. Sometimes the sensation is said to travel proximally and distally.
(c) The patient may grunt, groan, flinch the limb or part being needled. Other responses include explosive intake or expulsion of breath, facial grimaces and occasionally (in strong reactors) sudden jerks involving all or part of the body, and occasional expletives.
(d) The operator usually has the sensation that the needle is being gripped by the tissue, i.e. especially on withdrawal of the needle, (when a definite "nipple" seems to form at the skin surface) or on twirling of the needle (when the needle seems to "lock" at the end of each twirl).
(e) A clear 1-3 cm diameter blanched zone (vasoconstriction) appears around the needle after a few minutes in some patients.
Answers
| 1 = d | 2 = a | 3 = e | 4 = d | 5 = b | 6 = c |
| 7 = e | 8 = a | 9 = b | 10 = e | 11 = a | 12 = e |