What is acupuncture?

Indications and Procedures

The theory and practice of acupuncture are rooted in the Chinese concept of life—the Chi or qi (both are pronounced “chee”). The belief is that all things, animate and inanimate, have an internal source of energy, the Chi. This energy stabilizes the chemical composition of matter, and when this matter is broken down, energy is released. The practice of acupuncture is thought to stimulate this energy to relieve pain and speed healing.

According to the ancient Chinese system of medicine, two categories of organs are associated with the Chi: the Tsang and the Fou. The Fou is the group of organs that absorb food, digest it, and expel waste. They are all hollow organs such as the stomach, the large and small intestines, the bladder, and the gallbladder. Tsang organs are all associated with the blood—the heart, which circulates the blood around the body; the lungs, which oxygenate the blood; the spleen, which controls the red corpuscles; and the liver and the kidneys. For the flow of energy to remain steady, it must pass unimpeded from one organ to another. If the organ is weak, the resultant energy that is passed on to the next organ is weakened. Acupuncture stimulates specifically designated points found on pathways in the body (called meridians) to correct the problem.

According to the Chinese system, the human “circuit” of energy is made up of twelve meridians, which stretch along the limbs from the toes and the fingers to the face and chest. There are six meridians in the upper limbs and six in the lower. Ten meridians are connected to a main organ by branches from the sympathetic nervous system, and each of these meridians contains the Chi, which varies in strength and is governed by the nerve impulses arising from the organs. The meridians and their attendant vessels contain the flow of energy that enables the body to function efficiently.

The meridian points that proved to be effective for certain ailments were organized, and specific names were given to each. Later, the meridian line concept was hypothesized in order to explain the effectiveness of the points. These meridian points were selected by observing the effects of stimulation on particular signs and symptoms.

According to modern medical concepts, some of these points are thought to be relating points at which the autonomic nervous system is stimulated by a specific visceral disorder. Anatomically, some of the meridian points appear to correspond to areas where a nerve appears to surface from a muscle or areas where vessels and nerves are located relatively superficially, such as areas between a muscle and a bone or between a bone and a joint. These areas are generally composed of connective tissue.

The meridians are stimulated by the insertion of needles. The needles that are commonly used range in size from the diameter of a hair to that of a sewing needle. In China, round and cutting needles are commonly used. In Europe, the needles are slightly shorter and slightly wider in diameter.

The needles are made of gold, silver, iron, platinum, or stainless steel. Stainless steel needles are most commonly used. Infection caused by needle puncture is said to be extremely rare. This may be the case because the minor injury created by the needle is controlled by biological reaction. It is routine to wipe the skin with alcohol before inserting the sterilized needle. The needle itself may be wiped with alcohol sponges before each insertion on the same patient. Needles are discarded after being used in patients with a history of jaundice or hepatitis.

Insertion of a needle requires great skill and much practice. There are three different angles of penetration into the skin: perpendicular, oblique, and horizontal. These angles correspond to 90 degrees, 45 degrees, and a minimum angle, respectively. The angles may be chosen on the basis of the thickness of the skin and the proximity to muscle or bone at the desired puncture point. The depth of penetration will vary.

Tapping (the tube method) is one method of insertion: When the diameter of the needle is small, this method is extremely effective. The needle is placed into the tube from either direction, and the tube is shorter than the needle. Gentle tapping of the needle handle with the right index finger introduces the needle easily. The tapping finger must be removed from the needle head immediately; otherwise, it causes pain. The tube is removed gently with the right index finger and thumb.

In the twirling method (the freehand method), the left thumb and index finger make contact at the acupuncture point. The left hand is called the pushing hand. Next, the skin is cut with the needle tip, after which the needle is inserted by pushing and twirling it with the right hand.

The objective of the advancement of the needle and the needle motion is to create a needle feeling in the patient. This is a dull, aching, paralyzing, or compressing feeling or a combination of these sensations that radiates to a distal or proximal portion of the body. When the patient notices the needle feeling, the operator increases the feeling by using various needle motions. Numerous motions are available, such as the single-stick, twirling, vibration, intermittent, and retention motions.

Light skin and muscle massage is recommended in order to prepare the body to accept needle stimulation. Prepuncture massage makes skin cutting easier and helps the patient relax. In addition to these advantages, massage may make it possible to detect pathologies such as nodules, spasms, pain, and depression. Postpuncture massage helps to confirm muscle hypersensitivity and the disappearance of pain or hard nodules that existed before the acupuncture was performed.

The amount of stimulation equals the strength of stimulation multiplied by the number of treatments; this is dependent on the sensitivity of the patient. Gradual increases of stimulation are essential. In general, for acute disease, treatment is usually given once a day for ten days and then terminated for three to seven days. For chronic ailments, treatment is administered once every two to three days for ten treatments and then terminated for seven days. The patient is placed in a supine, sitting, prone, or side position—the position that is most convenient for the patient and physician. A special position, however, may be needed in order to relax the painful area.

One of the most important factors to be considered in effective acupuncture treatment is the accurate selection of acupuncture points. These points must be selected according to the specific ailment. The precise location of acupuncture points is crucial for obtaining the maximum therapeutic effect. This is difficult because of the different sizes and shapes of patients’ bodies. Each acupuncture point is considered to be only about 3 millimeters in diameter.

Uses and Complications

Acupuncture, which is one mode of stimulation therapy, works by changing the pattern of passage of stimulation from the peripheral nerves to the central nervous system. Stimulation treatments such as hot soaks and the management of certain pain problems with physical therapy have long been in existence.

The basic approach of modern medicine involves removing the causal factor of disease. In this approach, the pain associated with disease or with a surgical procedure may not be eradicated instantaneously, however, and the management of pain becomes an issue until the disease is cured or until the surgery and recuperation are complete. Controlling chemical receptors and reducing the sensitivity of those receptors is one way of treating pain. Intensive studies of the stimulation that causes pain have indicated that intrinsic chemical substances (polypeptides) such as histamine and serotonin, which stimulate the receptors, are essential for pain. Therefore, an antagonistic drug for these chemicals is often effective in controlling pain.

Although acupuncture is used to treat conditions as diverse as allergies, circulatory disorders, dermatologic disorders, gastrointestinal disorders, genital disorders, musculoskeletal disorders, neurologic disorders, and psychiatric and emotional disorders, the use of acupuncture for pain control (analgesia) can be described as the most basic level of treatment.

The English words “anesthesia” and “analgesia” are misleading when used to describe the freedom from surgical or obstetrical pain that can be produced by acupuncture. If “analgesia” is described as insensibility to pain without loss of consciousness, it is a more appropriate word than “anesthesia,” which is described as an insensibility, general or local, induced by anesthetic agents, and a loss of sensation of neurogenic or psychogenic origin.

Acupuncture can produce numbness in any part of the body. The patient under acupuncture analgesia remains able to converse and cooperate with the surgical or obstetrical team. Obstetric patients are aware of uterine contractions and are able to use their muscles to bring forth the fetus. Surgical patients can tell when incisions are made but do not perceive them as painful. There is no loss of memory, as in hypnosis or general anesthesia, and no paresthesia (abnormal sensations) comparable to the sensations following local anesthesia.

Most operating room deaths and cases of cardiac arrest in the United States are caused by chemical anesthesia rather than by surgery. Patients with anesthetic risks because of heart, liver, or kidney disease tolerate acupuncture analgesia well. Acupuncture is contraindicated for children under the age of seven, hemophiliacs, pregnant women, and people who have a fear of needles.

Acupuncture can be used to induce a feeling of well-being and calmness to allay the fear and apprehension most patients feel before surgery. It also appears to reduce both bleeding during surgical procedures and the incidence of shock. Postoperative acupuncture analgesia patients are spared nausea and the difficulties with urinating and defecating that frequently follow chemical anesthesia. Acupuncture analgesia does not mask symptoms as chemical anesthetics and analgesics do. The patient remains aware of his or her symptoms, but acupuncture diminishes those symptoms to a tolerable level.

Postoperative pain does not usually occur for several hours after acupuncture analgesia has been terminated. When it does occur, acupuncture can be used again instead of narcotics, and the treatment seldom needs to be repeated more than once or twice. Some acupuncturists leave small needles superficially inserted for several days to give postoperative pain relief. Others give regular acupuncture treatments, leaving the needles in place for twenty minutes per day for as many days as are necessary.

The main disadvantage of acupuncture analgesia is that it is less reliable than chemical analgesia or anesthesia. In some cases, acupuncture analgesia cannot be induced or becomes inadequate during a surgical procedure. It may not produce the relaxation desirable for some abdominal surgeries. For this reason, backup chemical anesthetics and analgesics are also available in most cases.

The actual induction of acupuncture analgesia takes about twenty minutes—slightly longer than chemical anesthesia. In most cases, electroacupuncture instruments must remain attached to all acupuncture needles during the entire procedure, but these can usually be kept away from the surgical field. The more skilled the acupuncturist, the fewer the needles required. In China, major surgical procedures have been performed with only one acupuncture needle as analgesia and without electric supplementation.

The same type of thin (usually 30-gauge) stainless steel needles that are used for acupuncture treatments are used for acupuncture analgesia. In general, the points that are used to relieve chronic pain in a specific area are the points of choice for analgesia. To obtain sufficient analgesia for surgery, it is usually necessary to heighten the effect of the acupuncture needles by twirling them continually or by attaching electronic instruments to them to deliver a current of about two hundred microamperes, with a pulsating wave at a frequency of two hundred per minute during the entire procedure. The use of electronic instruments will usually increase the depth of analgesia or prolong an analgesic effect that is beginning to wear off.

Besides the acupuncture points for analgesia of specific areas of the body, points are often used to relieve anxiety and promote a feeling of well-being. Needles are usually inserted for twenty minutes the evening before surgery, as well as for at least twenty minutes before the actual surgery begins.

The theoretical principles of vital energy transmission are used in determining which acupuncture points should be effective for the anticipated surgery. Acupuncture points on meridians passing directly through, or in the vicinity of, the surgical area are usually selected. An attempt is made to use points on these meridians that are as far away from the surgical field as possible.

Perspective and Prospects

According to most reports, acupuncture appears to have been developed in the northernmost area of the middle region of China around 300 BCE. People in this area were primarily nomads, moving from one area to another.

Chinese high priests, who also often served as physicians, observed that men who were wounded in combat often reported the sudden disappearance of illnesses from which they had suffered for years. For example, a wound in a specific area of the foot would reduce blood pressure or relieve a headache or toothache, or an injury on the dorsal aspect of the knee joint would cure a migraine. Over the years, the high priests recorded numerous observations of the phenomenon of a wound in one part of the body curing a long-standing complaint at another point. They discovered that it was the location of the wound that was significant. A pinprick in the correct location was enough to effect relief. It was noted that certain points of the body responded more noticeably to stimulation than other points and that frequently there was a direct correlation between the points that were responsive and a particular ailment. They were subsequently named meridian points.

At a later time, when metal was introduced to the culture, needles were used as an irritant at meridian points, and it was thought that pain from a specific ailment was diverted in a linear fashion through the meridian points to the surface of the body. Thus the concept of the “meridian line” was developed, and thus acupuncture was discovered.

At first, the surgeon-priests used fish bones and sharpened splinters of bamboo to effect the pricks. Later came finely honed needles. Warlords and nobles were treated with needles forged from gold and silver. As the science of acupuncture developed, it was discovered that the needles needed only to be inserted in a point of skin measuring about one-tenth of an inch.

The earliest book describing acupuncture was written in 50 BCE. It described the clinical applications of acupuncture with anatomical physiological references that were based principally on the concept of the meridian lines of the body.

In 1912, Yüan Shih-K’ai, who had trained in a modern Western culture, took office as president of the Republic of China. Under his rule, old Chinese medicine—including acupuncture—that had developed from tradition and experience was unable to survive except in outlying areas of China. In 1949, however, when Mao Zedong formed the People’s Republic of China, he tried to repopularize the old methods of Chinese medicine, which had been helpful to him. In the 1930s, when Mao and his followers were retreating to the north, he was forced to depend mainly on these traditional methods for medical treatment.

In 1955, Shyuken, a follower of Mao, stated his belief that acupuncture was effective in the management of illness. He wished to study the ancient Chinese way of medicine more systematically, comparing it to Western medicine, which he believed to be too analytical. Thus, a new medical movement began that united Western and Chinese medical practices.

Stimulation therapy using local heat, massage, and pressure has been known since ancient times. Long periods of observations and analysis by Chinese physicians of the effects of irritation of varying degrees at particular points on the body surface made it possible to relate specific points on the body (meridian points) to specific conditions.

According to ancient Chinese clinical concepts, the meridian points served as peeping holes into the body and passing holes for energy. The total number of meridian points was believed to be 365. Each was named according to its effect, anatomical location, appearance, and relation to the meridian line. These meridian points were selected initially according to measurements based on the patient’s own unique anatomical standard (using the length between certain anatomical points; for example, between the shoulders). The exact location of a meridian point was then selected by the examiner, who felt with his or her fingertips the areas chosen by the initial measurement and observed the patient’s response.

Acupuncture’s popularity, like that of most techniques and discoveries, has waxed and waned throughout the years; for the most part, however, the Chinese have remained faithful to the five-thousand-year-old practice. The laws and methods of acupuncture have endured, although these methods have been increasingly combined with Western medical techniques. Gradually, the practice of acupuncture has spread throughout the world, particularly in France, Russia, Japan, Switzerland, Germany, and the United States.

In 1997, the US National Institutes of Health (NIH) concluded that the efficacy of acupuncture is highly promising and a worthwhile research endeavor, especially in treating postoperative chemotherapy nausea and dental pain. It was noted that acupuncture could be useful in asthma and addiction treatment and in stroke rehabilitation. Research has identified many of the mechanisms of action in acupuncture, most notably the release of opioids and other peptides and the corresponding changes of neuroendocrine functioning.

In 2007, the National Health Interview Survey found that there were 79.2 visits to an acupuncture practitioner per 1,000 people that year, a significant increase compared with the numbers from 1997. In 2010, the United Nations Organization for Education, Science and Culture added Chinese acupuncture to its Representative List of the Intangible Cultural Heritage of Humanity, which was designed to promote awareness of the significance of intangible cultural traditions and practices. Although the number of people who use acupuncture is significant, the Food and Drug Administration (FDA) reports exceedingly few complications. However, some instances of pneumothorax related to acupuncture have been reported over the years, especially concerning practitioners performing the procedure without proper training. In early 2015, a woman filed a lawsuit against a San Diego chiropractor for collapsing her lung during an acupuncture treatment that he was not licensed to conduct.

A review of government-funded research studies on acupuncture found numerous uses being evaluated, including labor stimulation, postsurgical wound healing, control of chemotherapy-induced vomiting, and the treatment of substance abuse, incontinence, autism, cerebral palsy, and depression. As of 2015, the effectiveness of acupuncture remains debated and under scientific review.

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