Chinese Acupuncture

Mel Drisko, MSTCM, L.Ac.

Distinguish between western biological rationale for

medical acupuncture and Chinese acupuncture.

Compare and contrast diagnostics and treatment

approach from a medical acupuncture vs. TCM

perspective.

Identify medical conditions treated with

acupuncture, and resources for referral & further

learning.

The contents of this document are provided for informational purposes

only, to scientists, health care professionals and academics. Neither the

statements in this document nor statements made by the presenter

should be interpreted as providing medical advice, a physician-to-

physician consultation, professional diagnosis, a medical or health-

related opinion, treatment, or services to you or any other individual;

nor should they be interpreted as recommending any product, therapy,

or course of treatment.

Health care professionals are responsible for their own independent

treatment decisions relative to their patients. Not responsible or liable

for any advice, course of treatment, or diagnosis made by a health care

professional, nor for any course of action taken by an individual.

Legal disclaimer:

Chinese Medicine

• Oracular / Demonic

• Religious / quasi-religious

• Buddhist, Ayurvedic

• Pragmatic drug therapy

• Systematic correspondence

• Western bio-medicine

Unschuld, P.U., Medicine in China, A History of ideas. Univ of Calif Press 1985

Xia Shang Zhou Han Song Yuan Ming Qing

Ancient Greece

Rome Medieval Renaissance

Reason

3500 year history

• Shamanism

• Ancestors

• feng shui

200 BC 200 CE 900 1850 19552000 BC

Tao, L. Achievements of Chinese medicine in the Qin and Han Dynasties. Chinese

Medicine Journal, Vol. 71, No.5, 300-386, Sept-Oct1953.

History

Confucianism

Taoism

Systematic correspondence

Confucianism

Taoism

Systematic Correspondence

Everything in Universe is connected with everything else

Human body

Parts of the body

Organs

Animals

Plants

Minerals

Natural phenomena

Climate/weather

Musical notes

Numbers

•Belief in unity of nature

•Finest particles of matter as basis of life

•Certain characteristics of a united empire

•Yin Yang and the Five Phase theories

Unschuld, P.U., Medicine in China, A History of ideas. Univ of Calif Press 1985

Systematic Correspondence

Sky

Human

Earth

yang

taiji

yin

Yin Yang

Structure

Contraction

Responsive

Quiescent

Conservation

Earth

Female

Cold

Moist

Function

Expansion

Aggressive

Dynamic

Destruction

Sky

Male

Hot

Dry

Five Phase - wu xing

Legge, James. The Chinese Classics, 5:531, Hong Kong 1960

Yin Yang combined with five phases in a systematic correspondence

Yang/yin Yang/Yang Yin/yang Yin/Yin

Phase Wood Fire Earth Metal Water

Season Spring Summer late Autumn Winter

Viscera Liver Heart Spleen Lung Kidney

Bowels GB SI Stomach LI UB

Color green red yellow white black

Flavor sour bitter sweet pungent salty

Orifice eyes ears nose mouth sluices

Emotion anger joy sympathy grief fear

Evil - xie

xie gui , xie mo– evil demons

xie qi – unnatural trend or influence

Unhealthy influences

Wiseman and Feng. A Practical Dictionary of Chinese Medicine. Brookline, Mass,

1998.( ISBN 0-912111-54-2).

Environmental

Emotional stresses

Dietary

Exercise/leisure/overexertion

Trauma

Parasites and poisons

Wrong treatment

Qi or Chi

“Rising vapors”

“Rice”

“breath”, “vapors”, “gas”, “pneuma”

Edelstein, Ludwig. Ancient Medicine, pg. 116, Baltimore Press, 1967

Wiseman and Feng. A Practical Dictionary of Chinese Medicine. Brookline, Mass,

1998.( ISBN 0-912111-54-2).

200 BC 200 CE 900 1850 19552000 BC

Classical Period:

Nei Jing

Shang Han Lun

Nan Jing

Zhen jiu jia yi jing

History

Tao, L. Achievements of Chinese medicine in the Qin and Han Dynasties.

Chinese Medicine Journal, Vol. 71, No.5, 300-386, Sept-Oct1953.

200 BC 200 CE 900 1300 1850 19552000 BC

Song-Jin-Yuan

History

Tao, L. Achievements of Chinese medicine in the Sui and Tang Dynasties.

Chinese Medicine Journal, Vol. 71, No.4, 801-820, July-Aug 1953.

200 BC 200 CE 900 1300 1800 19552000 BC

History

Ming

Tao, L. Achievements of Chinese medicine in the Sui and Tang Dynasties.

Chinese Medicine Journal, Vol. 71, No.4, 801-820, July-Aug 1953.

History

Pre-modern Period:

200 BC 200 CE 900 1800 19502000 BC

200 BC 200 CE 900 1800 19502000 BC

Traditional Chinese

Medicine ( TCM )

History

Acupuncture

Origins

•6000 BC

•168 BC Ma Huang Di tombs

• 90 BC

• 100 CE

White, A. & Ernst, E. A brief history of acupuncture. Rheum 2004; 43:662-663.

Acupuncture Channels (jingmai, luomai, sunmai)

•Occur between “skin and flesh”

•Carry qi and blood

• Well, spring, stream, river, sea

• Limits in analgesic effects

Acupuncture Channels

12 paired channels

8 single channels

Extra points

Then

Amulets

Geomancy

Exorcism

Oral spells

Bleeding

Massage-tuina

Moxa-cautery

Bathing-fuimigation

13 acupoints

Stone needles

Now Electro-acupuncture

TENS

Filiform needle

3 edge needle

7 star hammer

Intradermal needle

Massage/acupressure

Cupping/Moxibustion

Point injection therapy

Infrared

Laser

Over 400 acupoints

Prioreschi, Plinio. History of Medicine: Primitive and Ancient Medicine, Vol.1, 1996

• Three treasures: qi, shen, jing

• Vital substances:

Jing qi blood fluids shen

Kd Lu Lv Sp Ht

• Organ correspondences

TCM - physiology

Lungs Skin

Spleen Pancreas

GB acupoints

Liver qi, tendons

Kidney bones, reproductive

Heart emotions

TCM – pathology

Many patterns for one disease

Many diseases with the same pattern

TCM Diagnosis• History, interview

• Observation (laboratory tests)

• Palpation, physical exam

• Pulse

Tao, L. Achievements of Chinese medicine in Ming Dynasties. Chinese Medicine

Journal, Vol. 76, No.2, 178-198, Feb 1958a.

Tongue Inspection

Kim, HB. Handbook of Oriental Medicine 5th Edition,AcupunctureMedia, p30

Kim, HB. Handbook of Oriental Medicine 5th Edition,AcupunctureMedia, p33

Zaslawki, C. Clinical Reasoning in traditional Chinese medicine: implications for

clinical research. Clinical Acupuncture and Oriental Medicine. Vol.4, No.2-3, 94-

101, 2003

1. Synthesis of signs and symptoms

2. Eight Principles

yin-yang Interior-Exterior Hot-Cold Deficient – Excess

3. Disease “pattern” (bian zheng)

- qi and blood patterns

- organ patterns

- channel patterns

TCM Diagnostic and Treatment Sequence

Hogeboom CJ, Sherman KJ, Cherkin DC. Variation in diagnosis and treatment of chronic low

back pain by traditional Chinese medicine acupuncturists. Compl Ther Med. 2001; 9(3): 154-

66.

Zaslawki, C. Clinical Reasoning in traditional Chinese medicine: implications for clinical

research. Clinical Acupuncture and Oriental Medicine. Vol.4, No.2-3, 94-101, 2003

TCM Diagnostic and Treatment Sequence

5. Diagnosis

6. Treatment Principle

4. Root (ben) or branch (biao) manifestation

Numerous correspondences

but little to no causation.

Chronic Gastritis

DW Zou, WH Chen, K Iwakiri, R. Rigda, M.Tippett and R.H. Holloway. Inhibition of transient lower

esophageal sphincter relaxations by electrical acupoint stimulation, American Journal of Physiology-

Gastrointestinal and Liver Physiology, August 2006.

Patient #1 SP damp heat

Patient #2 ST yin def.

Patient #3 SP yang def.

Patient #4 SP/ST cold damp

Patient #5 LV invading Sp

Patient #6 ST blood stasis

Primary Hypertension

Flachskampf FA, Gallasch J, Gefeller O, Gan J, Mao J, Pfahlberg AB, Wortmann A,

Klinghammer L, Pflederer W, Werner GD. Randomized trial of acupuncture to lower blood

pressure. Circulation. 2007; 115: 3121–3129.

Patient #1 Liver fire

Patient #2 Phlegm obstructing spleen

Patient #3 Liv/Kid yin deficiency

Patient #4 Kid yang deficiency

Western Psychiatric Disease with Chinese Equivalents

Senile dementia - feeblemindedness, impaired memory

Major depressive disorder – depression-agitation, Lillium syndrome,

plum-pit syndrome

Bipolar Affective disorder – frequent sorrow/ frequent joy

Anxiety disorder – fear & palpitations, panic throbbing

Post-partum depression - Liver/Heart blood deficiency

Premenstrual dysphoric disorder - liver qi not discharging

Perimenopausal syndrome – liver/kidney yin deficiency heat flaring

Chinese Medical Psychiatry: A textbook and clinical manual. Blue Poppy Press, Boulder,

Colorado, 2001.

Hollifield, M and Hammerschlag R. Acupuncture for Posttraumatic Stress Disorder

a randomized controlled Pilot Trial, J Nerv and Mental Dis, Vol 195, Number 6, June 2007

Treatment with Chinese Medicine

TCM

Acupuncture

Herbs Qigong

Food Therapy

Moxa(moxibustion)

Moxibustion for correction of breech presentation: A randomized controlled trial. JAMA 280 (18): 1580–1584.

1998-11-11

tui na

Huang K-Y, Xia H-M. Massage for treatment of lumbar disc herniation in 371 cases of efficacy. J Clin Acupunct

Moxibustion. 2010;3:019

Ping, Chen (ed). Chinese Tuina and Therapeutic Applications: Advanced TCM Series, Volume 7. Beijing:

Science Press, 1998: 72-91

Qi Gong

A Comprehensive Review of Health Benefits of Qigong and Tai Chi : Jahnke R., Larkey, L, Rogers C.

and Lin F. Am J Health Promot, 2010 JUL-AUG; 24(6): e1-e25.

Traditional Chinese Acupuncture

gua sha

Melzack R, Katz J. The Gate Control Theory: Reaching for the Brain, in: Craig KD and

Hadjistavrapolous T. Pain: Physiological Perspectives; Mahwah NJ, Lawrence Erlbaum

Assoc, Publishing 2004.

Pricking / Bleeding

Yang Haixia, Clinical application of blood-letting therapy, Journal of Traditional

Chinese Medicine 2002; 22 (1): 26-28.

Cupping

Treatment of Pain in Shoulder Scapular Region and Back by Moving Cupping: A Report of 60 Cases, Li Guisong,

Yuan Minghua, Ju Lijing, TCM Shanghai Journal of Acupuncture and Moxibustion, 4th edition, 1999

Peng C-Z, How C-K. Bullae secondary to prolonged cupping. Am J Med Sci. 2013;346(1) (July):65.

Risk and Harms with Acu/Moxa Therapies

Soreness

Organ injury

Infections

Bleeding disorders

Broken needles

Pacemaker

Pregnancy

Silicone reaction

Burns

Hon KL, Luk D, Leong K, Leung A. Cupping therapy May be Harmful for Eczema: a PubMed Search.

Case Rep Pediatr. 2013;605829 (Oct 27).

Peng C-Z, How C-K. Bullae secondary to prolonged cupping. Am J Med Sci. 2013;346(1)

(July):65.

Saw A, Kwan M, Sengupta S. Necrotizing fascititis: a life-threatening complication of acupuncture

in a patient iwth diabetes mellitus. Singapore Med J. 2004;45(48):180-2.

Seeley E, Chambers H. Diabetic Ketoacidosis Precipitated by Stapylococcus aureus Absecss and

Baceriemia Due to Acupuncture: Case Report and Review of the Literature. Clin Infect Dis.

2006;43 (May 23):e6-8.

Seong MH, Kil H, Kim YS et al. Clinical and epidemiological features of hepatitis C virus infection

in South Korea: a prospective, multicenter cohort study. J Med Virol. 2013;85(10) (October):1724-

1733.

White A. A cumulative review of the range and incidence of significant adverse events associated with

acupuncture. Acupunct Med. 2004;22(3) (September):122-133.

Birch S, Alraek T, Norheim AJ. Acupuncture adverse events in China: a glimpse of historical and

contextual aspects. J Altern Complement Med. 2013;19(10) (October):845-850.

He W, Zhao X, Li Y, Xi Q, Guo Y. Adverse events following acupuncture: a systematic review of the

Chinese literature for the years 1956-2010. J Altern Complement Med. 2012;18(10) (October):892-

901.

Acupoint SelectionLocal points

Distant and peripheral points

Constitutional points

Empirical points

Arm pain = Large intestine 11

Lower abdominal region = Spleen 6

Scapular region = Small Intestine 11

Upper GI = Stomach 36

Back of head and neck = Lu7

Face and mouth = LI4

Low back pain (acute) = UB40

Extra points

Opposite Puncture (muci or jiuci)

Fang et al. Clinical and experimental studies on analgesic effects of ipsilateral and contralateral

stimulation with EA. Chung-kuo chung his chien ho tan chi 1994. 14 (10) 579-582.

Needle manipulation

Needle manipulation

WHO Conditions treated with Acupuncture

Acupuncture: Review and Analysis of Reports on Controlled Clinical Trials

• low back pain

• neck pain

• sciatica

• tennis elbow

• knee pain

• peri-arthritis of the shoulder

• sprains

• facial pain and tempromandibular (TMJ) dysfunction

• headache

• dental pain

• rheumatoid arthritis

• primary dysmenorrhea

• acute epigastralgia

• adverse reactions to radiation or chemotherapy

• Leucopenia

• induction of labor

• correction of malposition of fetus (breech presentation)

• morning sickness

• nausea and vomiting

• stroke

• Hypertension – essential

• allergic rhinitis, including hay fever

• depression (including depressive neurosis and depression following

stroke)

• peptic ulcer

• acute and chronic gastritis

WHO Conditions treated with Acupuncture

•Adult postoperative and chemotherapy nausea and

postoperative dental pain.

•Addiction, stroke rehabilitation

•headache, menstrual cramps, tennis elbow, fibromyalgia,

myofascial pain, osteoarthritis, low back pain, carpal

tunnel syndrome

• asthma

NIH Consensus Statement – Acupuncture. JAMA 998 Nov 4;280(17):1518-24.

Consensus statement