Acupuncture

Acupuncture is an ancient method of therapy that originated in China more than 2,000 years ago. It consists of inserting solid, hair-thin needles through the skin at very specific sites to achieve a cure of a disease or to relieve pain. Although it is not part of conventional medical treatment in most of the Western world, a 1998 consensus statement released by the National Institutes of Health (NIH) in the United States said evidence clearly shows acupuncture helps relieve many types of chronic and acute pain; nausea and vomiting associated chemotherapy, anesthesia, and pregnancy; and alters immune system functions. The World Health Organization, in conjunction with the International Acupuncture Training Center at Shanghai College of Traditional Chinese Medicine, declares acupuncture can be effective for dozens of problems—from bed wetting and allergies to chronic fatigue syndrome and anxiety disorders. Although many American physicians remain skeptical about its use as an anesthetic for surgery or cure for grave diseases, by 1999, approximately 10,000 acupuncturists held licenses in the United States, including some 3,000 physicians.

In the Far East, acupuncture is used extensively. It is considered one part of a total regimen that includes herbal medicine, closely guided dietetics, and psychological counseling. In ancient Chinese philosophy, good health depends A woman undergoing acupuncture. Photograph by Yoav Levy. Phototake NYC. Reproduced by permission.

on the uninterrupted flow of so-called "vital energy" called "qi" (sometimes written as chi but pronounced chee) throughout the body. When qi is interrupted, pain and disease follow. Qi flows through 12 pairs of pathways called meridians—one pair of each meridian lying on either side of the body. An additional two meridians run along the midline of the front and back. So-called extrameridians are scattered about and connect the 14 meridians on each side. Other points outside the meridians—on the hands, ears, and face—have specific reflex effects. Altogether, there are more than 1,000 acupuncture points. Inserting needles into points along appropriate meridians unblocks qi, restoring energy balance and health.

The concept of meridians developed as the ancient Chinese discovered that pain in a given area responded not only to pressure or puncture in its immediate vicinity, but also to pressure at distant points. Pain in one arm, for example, often responds to acupuncture in the opposite arm in the area corresponding to the painful arm. As the concept of acupuncture took shape, the ancient Chinese learned that points on the body, when stimulated, helped to ease pain or heal internal diseases. They also discovered other points that were distant from the affected area that could be stimulated to achieve pain relief in the affected area. As the number of points grew, they were connected by the imaginary meridians and were labeled by their function. The large intestine meridian, for example, originates at the root of the fingernail of the first finger. The channel courses along the thumb side of the arm, over the shoulder, up the neck to the face, ending at the nostril. The stomach meridian begins below the eye, courses across the face up to the forehead, then reverses direction to run down the throat, along the chest and abdomen, down the front of the thigh and lower leg, across the ankle and foot, ending at the lateral side of the root of the second toenail. The Conception Vessel is the name given to one of the midline meridians. Its route is from the genital area straight up the middle of the abdomen to end at the center of the lower lip. The posterior midline meridian, the Governor Vessel, starts at the tail-bone, courses up the spine, over the midline of the head and ends on the front of the upper gum.

During the acupuncture procedure, 1-20 hair-thin needles are inserted under the skin, some of which may be inserted as deep as 3 in (7.6 cm). Short needles are used for areas that are less fleshy and longer needles in areas of deep flesh and muscle. The needles will remain inserted from 15-30 minutes. Needles are always solid; nothing is ever injected through them into the body. When the needle enters the skin, the patient may feel minor transient pain. When the needle tip reaches the depth of the meridian, the patient will have a sensation of radiating warmth or fullness. The insertion points nearest the painful area are usually treated first, then the distant points. For acute conditions, the treatment may be given twice a day. For a long-lasting condition (chronic pain), the treatment can be given every second or third day for up to 20 treatments, after which no acupuncture should be given for several weeks.

Because acupuncture points are very specifically located, and because people are different sizes, the Chinese developed a special system of measuring the body called "cun," or "human inch." This term has since been modernized to the Acupuncture Unit of Measurement (AUM). The AUM divides a given distance on the human body into equal parts. For example, the AUM of the chest is the division of the distance between the nipples into eight AUM. The distance from the lower end of the breastbone (sternum) to the umbilicus also is eight AUM. Thus, a Acupuncture sites and meridians on the face and neck. Illustration by Hans & Cassidy. Courtesy of Gale Group. broad-chested man may have a distance of 12 in (30.48 cm) between the nipples and the smaller man may have only 10 in (25.4 cm). Nevertheless, the distance is divided into eight units because it is eight AUM across the thorax. The upper arm from crease of the elbow to armpit is nine AUM, the lower arm from crease of the elbow to crease of the wrist is 12 AUM, and so on until all the areas of the body have been given standard AUM dimensions.

When the appropriate points have been located and the needles inserted, the acupuncturist rotates the needles occasionally or, in some cases, a mild electric current is passed through them to stimulate the meridian. Another technique, known as moxibustion, uses heat stimulation. After the needle is inserted, a small piece of dried leaf from the Artemisia vulgaris plant is placed in a little cup on the needle's exposed end, and lighted. The heat passes through the needle to the area of pain. A few points on the body are not suited to needle insertion. In these instances, a small, smoldering cone of Artemisia vulgaris placed directly on the skin and the heat is allowed to penetrate.

What makes acupuncture effective remains a matter of scientific investigation. However, the meridians may be pathways of nerve fibers. Dr. Leonard Wisneski of the NIH said clinical evidence shows opioid peptides—the body's natural painkillers—are released by the brain during acupuncture. Also, a study conducted by Abass Alvi, M.D., chief of nuclear medicine at the University of Pennsylvania Medical Center, used single photon emission computer tomography (SPECT) to show that, after needles were inserted, every patient had increased blood flow to the thalamus, the portion of the brain that transmits pain and other sensory signals. Dr. Lee Nauss, emeritus anesthesiologist at the Mayo Clinic, Rochester, Minnesota, said they have used acupuncture in their pain clinic since 1974 and find it "quite beneficial" for patients who do not respond to traditional treatment such as medication and nerve blocks.

There are some adverse side effects of acupuncture, most of which result from lack of knowledge or unhygienic practices on the part of the acupuncturist. Treatment should be sought from a well-trained practitioner. The NIH panel concluded there is "sufficient evidence of acupuncture's value to expand its use into conventional medicine and to encourage study designs that can withstand rigorous scientific scrutiny." Some health insurance programs cover treatment.