The Taiwan Report

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.