Traditional versus modern Acupuncture

7. THERAPY IN TCM

All methods aim to correct imbalances of Qi. Where the cause is bad lifestyle (XS eating; XS work; insufficient food or sleep; XS alcohol etc) steps are taken to advise on moderating this. As far as possible, the patient is advised on environmental, behaviourial or dietary changes etc which may be necessary to alleviate or remove the cause. To restore the normal balance of Qi (resistance), many methods are used alone or in combination.

TCM relies heavily on herbal medicine (HM). The Chinese herbal pharmacopoeia is very extensive, running into thousands of plants, herbs, venoms, inorganic compounds, animal by-products etc. These remedies are prepared as decoctions, concoctions, powders, ointments etc and a typical prescription would contain 4-10+ separate components. Many of the crude extracts have been purified in recent years and the active alkaloids or other compounds have been isolated. Several HMs, or extracts of them, have potent antitoxic effects in patients on cytotoxic radiotherapy or chemotherapy (cisplatin etc) for cancer. Herbal products and HM extracts have many high-ranking pharmacological properties, including immunomodulators, hypoglycaemic, anticancer, antiinflammatory, antiviral, antibacterial, antiprotozoal, antiasthmatic, antioxidant, antihypertensive and anti-liver disease activities.

Other methods include physiotherapy (exercises; massage; moxibustion (cautery of the AP points); Taichi (ritual slow movements to utilise every muscle of the body in conjunction with breathing exercises) and psychotherapy (Qi Kung (visualisation-meditation of the energy flow through the Channel circuits, together with specific slow deep breathing exercises, inhalation for centripetal Channels and exhalation for centrifugal Channels); mental/emotional exercises to balance the emotions).

AP is only a small part (maybe 20%) of the total TCM system.

8. AP METHODS

For proper use, AP, moxibustion and Chinese massage (acupressure) depend on a detailed knowledge of the point and Channel system. Having selected the points most suitable for the patient, these points are stimulated by many different methods, depending on the training and preferences of the practitioner and the equipment available. The most common type of AP uses fine stainless steel, solid, needles 1-6 cm long and 25-32 gauge. The most common needle is about 3.5 cm long, 30 gauge, but others (including some barbaric-looking instruments) are occasionally used in remote, rural areas. In veterinary AP, the needles vary with the species. For experimental work in small animals and laboratory animals, the finest human-type needles may be used. For clinical work in the dog-cats, one usually uses 1-6 cm, 28-30 gauge needles. In larger animals (pigs, ruminants, horses, mules etc), larger and thicker needles are used (2.5-15 cm needles 18-28 gauge, depending on the preferences of the practitioner and the depth of the points).

The skin around the point is prepared as aseptically as possible. Sterile needles are inserted to the correct depth and are stimulated (by twirling and pecking) to obtain DeQi. This phenomenon ("the arrival of Qi") is regarded as crucial to AP success. It is similar to the "funny bone sensation": paraesthesia, tingling, numbness, heaviness, "sour feeling" etc in the vicinity of the point.

In humans, the objective and subjective sensations are unmistakable - the verbal feedback from the patient ensures this. It is not uncommon for human patients to invoke the name of the founder of the Christian religion when Qi arrives! In animals, however (because they cannot relate their subjective feelings), the main signs of DeQi are: sudden change in the animal's behaviour: a temporarily fractious animal suddenly standing quite motionless or a quiet animal suddenly beginning to tremble or vocalise. Respiration may be temporarily inhibited or accelerated. Local muscle spasms or twitches may be seen.

DeQi is more often obvious when the point is directly over a peripheral nerve (such as with the Great Points of AP, for instance: LI04; PC06; TH05; LI11; ST36; GB34; BL40 etc or directly over motor points (places where the motor nerve plunges into the muscle).

Once DeQi is obtained, the needle is left for 30 seconds to 20 minutes. In general, acute conditions require only short periods of needling and chronic conditions require 20 minutes or more. Before removal of the needle, it is twirled/pecked again.

Classical AP demands specific types of needle manipulation depending on whether the condition is diagnosed as a Shi (Excess) or Xu (Deficiency) type. These specific Syndromes of manipulation are described in standard texts but the issue is controversial in that many successful practitioners ignore them still obtain excellent results - the use the simple method described above.

The most comprehensive textbook on techniques of AP is "Current AP Therapy" by Lee and Cheung (1978). This is an excellent text and is recommended as ESSENTIAL reading for serious students.

Apart from simple needling, cautery and massage, other methods are common. They include electro-AP (with or without needles); injection of the points; ultrasound-, microwave-, laser-, cryo-, faradic-, static field-, magnetic field- and other therapies applied to the specific points. They also include implants, incisions direct massage of the exposed nerves etc.

In general, the simple needling technique is adequate for most purposes and expensive pieces of equipment (electro stimulators, lasers etc) are luxuries to impress the public rather than to enhance the results. There are some exceptions to this which will be discussed in other seminars.

The number of sessions and the intervals between sessions vary with the condition. Chronic conditions are normally treated 1-2 times per week for 4-20 sessions. In general, if there is not an obvious response by session 4-6, the chances of ultimate success are poor. Acute (but simple) conditions are treated every 6-48 hours, depending on the condition. For instance, acute traumatic pain could be treated for 20 minutes daily (GB34 on the affected side and 1 or 2 local points). Expect 70% success after 1 session and >90% after 3 sessions. Acute conditions usually require 1 to 5 sessions.

9. METHODS OF CHOOSING EFFECTIVE AP POINTS

Which methods are chosen will depend on the training, skill and experience of the practitioner. Classical AP has more than 14 laws for consideration, apart from the use of the Five Phase balancing method:

a. local points

b. distant points

c. points on affected Channel

d. points on related Channels (Husband-Wife pair of Channels or Channels passing near the affected one)

e. one point on each of the 4 limbs

f. encircling the affected area

g.Ahshi points

h.Mu and Shu points

i. the source point of affected Channel and the Passage (Luo) point of its linked Channel

j. "Fore and Aft" points ((in front of and behind the affected area)

k. a chain of points along the affected Channel

l. points long recognised as highly effective for specific symptoms or body areas (eg) PC06, ST36 for nausea and vomiting; LI04 for mouth, nose and throat

m.Xi (cleft) points.