Acupuncture Therapy

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Dr. Sinan Butrus F.I.C.M.S

Kurdistan Board for Medical SpecialtiesClinical Standards & Guidelines

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What is Acupuncture?

• Acus meaning needle

• Pungare meaing to pierce

• Moxabustion (jiu)

Applied heated element

• Acupuncture is the

insertion of needles

in specific points

on the body

• First needles were made from Stone

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The Needles

10 cm

Bleeding needles Fire needles

Fine bleeding needle Standard needles

Snader, 1994 4

History of Acupuncture

• Practiced in China for over 4,000 years

• Used in western countries from around 1950’s

• 1958; the first case of acupuncture anesthesia in Shanghai.

• 2002; a Taipei medical center used acupuncture as anesthesia to transplant liver.

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• Acupuncture and Chinese Traditional Medicine CTM are the fastest growing movement in healthcare today at a rate of 230% per year.

• Approximately 4,000 physicians in the United States have received training in acupuncture therapy

• 10-15 million Americans spend ~$500 million per year on acupuncture

• 1 in 10 Americans have tried acupuncture

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Dr. Freddie Fu’s experience with acupuncture

• Dr. Freddie Fu, chairman of the orthopedic surgery department and head of sports medicine at University of Pittsburgh Medical Center.

• Fu said acupuncture helped improve the range of motion in his left leg, which was broken when a motorist hit him on his bicycle.

• “We see tons of patients for therapy and non-operative things that Western techniques may not be able to treat," said Fu. “ I think definitely there's a place for acupuncture. Surgery is not for everyone and a lot of people don't like taking pills for pain or allergies. With acupuncture, patients induce their bodies' systems and defenses to heal themselves."

(Source: Pittsburgh Post Gazette— Oct. 14, 2003)

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Comparison of East & West

• Empirical Observations over Thousands of Years

• Scientific Methods Case-Based Medicine

East. Ancient East. Ancient West. ModernWest. Modern

Art of MedicineArt of Medicine

Holistic ViewHolistic View

Circular LogicCircular Logic

EnergeticEnergetic

Technology of MedicineTechnology of Medicine

Molecular and Organ ViewMolecular and Organ View

Linear LogicLinear Logic

MechanisticMechanistic

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Scientific Evidence ?

Acupuncture Theory (1)1. Qi

the vital energy originates from the major organs, and flows along the continuously circulatory channels called meridian.

2. Meridianchannel from the surface of the body to the very deep of the body.

3. Acupuncture pointsthose where the energy flow can be stimulated and the function of related organs can be regulate.

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Acupuncture Theory (2)

4. Ying & yangthe two forces opposite to each other. Yin is the negative power while yang is the positive. According to Zhou-yi, everything contains both of them.

5. The five elements Metal Wood Water Fire Earth These five natural forces can add power to one of the others ,and at the same time, reduce the power of another element.

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What is Acupuncture?

Acupuncture works on energy in the body known as Qi (pronounced chi)

Manipulating body balance through regulating flow of Qi

Energy Flows through the 14 meridians in the body, these meridians connect to each organ in the body

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What exactly is Chi?

• Chi is an energy that, according to ancient Chinese beliefs, permeates all things

• Qi is body’s energy, vitality or “life force” it’s what gives an organism an “aliveness.”

• Chi must be able to flow freely throughout the body in order for a person to maintain overall health

• Chi flows along the meridians of the body

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Rice Vapor Qi

Qi (Character with vapor rising above cooking rice)

“Life Force” made up of air and food transformed by body into blood and body fluids

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Meridians

• Meridians have decreased electrical resistance relative to surrounding skin

• Qi flows as micro-electrical current– Flows in a circuit

– Toes to fingers to head to toes

– Up on anterior surface of the body

– Down on posterior surface of the body

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14 Major Meridians• Lung Meridian: LU

• Heart Meridian: HT

• Pericardium M.: PC

• Spleen Meridian: SP

• Liver Meridian: LIV

• Kidney Meridian: KID

• Conception Vessels: CV

• Large Intestines M.: LI

• Small Intestines M.: SI

• Triple Heater M.: TH

• Stomach Meridian: ST

• Gallbladder M.: GB

• Bladder Meridian: BL

• Governing Vessels M.: GV

Meridians

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The acupuncture points are located where the Meridians surface at the skin and are easily accessible by needling.

The points located at neurovascular bundles where nerves penetrate the body fascia and bifurcate

Blood vessel walls (veins) appear to have AP points directly on or in them

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Originally there were 365

acupuncture points,

but through the years

this number has increased

to over 2,000

Each point is believed to

correspond with a particular

illness or injury

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YIN YANG

White Black

Left Right

Cold Hot

South North

Night Day

Water Fire

female Male

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YIN YANG

Yin and Yang are always opposites of

each other. If they are not balanced

then there will be illness.

Injury or illness cause yin and yang to

become distressed and unbalanced

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Five Elements Metal Wood Water Fire Earth

– Chronic overwork/abuse/disease leads to deficiency of Water (fatigue, chronic UTI/stones/incontinence, joint pains, low back pain, fear, low self-esteem)

Water controls Fire (Water Def – Fire Excess)

Excess Fire symptoms result (anxiety, hot flashes, palpitations, insomnia, inflammation) Acupuncture works by trying to balance the body

Treat by

“Tonifying” deficiencies and “Dispersing” excesses

– Release excess Fire

– Tonify deficient Water

  FIRE EARTH METAL WATER WOOD

Yin Organs Ht Pericardium Spleen Lungs Kidneys Liver

Yang Organs Small Intestine Stomach Large Intestine Urinary Bladder Gall Bladder

Sense Organs Tongue Mouth Nose Ears Eyes

Tissues Vessels Muscles Skin Bone Tendons

Tastes Bitter Sweet Pungent Salty Sour

Colors red yellow white blue/black green

Sounds Laughing Singing Crying Groaning Shouting

Odor scorched fragrant rotten putrid rancid

Emotions JoyWorry/Pensivenes

sGrief/Sadness Fear Anger

Seasons Summer Late Summer Autumn Winter Spring

Environment Heat Dampness Dryness Cold Wind

Developmental Stages

Growth Transformation Harvest Storage Birth

Direction south center west north east

Is there a medical basis to acupuncture?

• Acupuncture is not based on modern medical science

• There is no obvious correlation between the 14 identified meridians and the actual location of organs and nerves within the body

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How Does Acupuncture Work?

• The physiologic effects of acupuncture therapy cannot be explained by a single mechanism, but rather a series of interactions among the

Nervous, Endocrine & Immune System

• Simple in concept, complex in action

• Starts from Local Effects

• Expands to involve the entire Neural Axis

Traditional Chinese Medicine TCM Physiology

• Stomach separates pure from impure Qi of food

– Impure to Small Intestine (process repeats again)

– Pure Qi to Spleen

• Spleen sends Food Qi to Lung

Lung combines it with pure Qi extracted from air

Food/Air Qi “heated” by Qi provided by Kidney to make “Nutritive Qi” The Life Force

In Heart to blood & tissue fluid to make Health

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Acupuncture involves the insertion of thin needles.

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Safety

The FDA approved acupuncture

needles for use in 1996.

The FDA requires that sterile,

non-toxic needles be used and disposed of after use.

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Diagnosis

• Questioning includes: sleep quality, mood, dietary preferences, functioning of senses, digestion and elimination, urination, condition of skin and hair, energy level, exercise and work habits,

menstrual cycle and childbearing history for women

• Visual examination of complexion, emotional affect, body language; reveals state of Qi in the body

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• Palpation: variations in temp, hardness or softness of tissues, dryness, dampness, discoloration, lumps and bumps, sensations of tenderness or pain

• Radial pulse reveals amount, strength, smoothness indicate flow of Qi and blood in various parts of the body

• Tongue looking at shape, coat, color

Initially a course is recommended• 6 sessions, every week once a week• Top up sessions as and when required

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Tongue Diagnosis

shape, color, size, coating, positioning,movement and sublingual veins

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Kidney Yin DeficiencyExcess Heat in Heart

Long, thin, dry, red body with lateral deviation

Dry yellow coat

Heart Yin and Blood Deficiency

Tongue body pale and tip red and pointed

No coat

Severe Yin DeficiencyLong-standing heat

or fire (LR or ST)

Red tongue body with black, dry central coat

(KI) Yang deficiency

Swollen, pale, scalloped, thin clear coat

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World Health Organization Endorses Acupuncture• Allergic rhinitis & sinusitis• Dysentery, acute bacillary• Facial pain• Hypotension, primary• Hypertension, essential• Leukopenia• Morning sickness• Pain in dentistry• Renal colic• Adverse rxns to radiation

and chemotherapy• Biliary colic• Dysmenorrhea,• Malposition of the fetus

• Headache• Low back pain• Nausea and vomitting• Periarthritis of shoulder• Rheumatoid arthritis• Stroke• Depression• Epigastralgia• Knee pain• Sprain• Neck pain• Postoperative pain• Sciatica• Tennis elbow

( http://www.who.int/medicines/library/trm/acupuncture/acupuncture_trials.pdf) 36

Ten Reasons to Try Acupuncture

1. It works

2. Western doctors recommend it

3.It treats the root cause of your medical problem

4. An ounce of prevention is worth a pound of cure

5. It relieves your stress while helping your medical problems

6. It boosts your immune system

7. It has a very low risk of side effects

8. You want to avoid surgery

9. Nothing else has helped your medical problems

10. It is one of the oldest continually practiced forms of medicine in the world

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Conditions acupuncture is NOT recommended

• Difficulty breathing, shortness of breath• Dizziness• Acute chest/upper abdomen pain or pressure• Sudden weakness or severe pain• Sudden bleeding• Falls• Suicide attempts• Severe infection• Heart failure

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Risks 1

Absolute Phobia of needles! Pacemaker

Anticoagulation Pregnancy Not a contraindication. Theoretical concern of causing

contractions

• Allergic reaction to needles• Infection from unsterilized needles• Retained Needle• Putting off treatments that are known to be effective

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Risks 2

• Fainting• Convulsions• Nerve Damage• Temporary (24hr) clinical worsening

• Organ puncture (Bladder or lung puncture)

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