Acupuncture is part of the ancient Traditional Chinese Medicine (TCM), a philosophy that developed into a medical system entailing examination, diagnosis, and treatment. Acupuncture uses very fine needles to stimulate points on the body’s surface to improve the physiological functioning of the body.

China’s Traditional Medical System

It was observed in ancient times that warriors wounded by arrows sometimes mysteriously recovered from chronic diseases unrelated to the areas of their wounds. Such observations involving the wounded parts and the recovery from particular diseases were systematised by the Chinese and the details given in The Yellow Emperor’s Classic of Internal Medicine, an ancient text. On the basis of these details, attempts were made to insert needles at specific points for recovery from particular diseases.

The details of the procedure spread from China to Japan in the sixth century. It was not, however, until the 17th century that French Jesuit missionaries in Japan brought it to the West. They gave the procedure its modern name ‘acupuncture’, from the Latin roots acus (needle) and punctura (puncture).

The West came to perceive acupuncture as a new procedure to help tackle various disease conditions. In the 1970s, the New York Times columnist James Reston wrote about his appendectomy, which was performed using acupuncture instead of a pharmaceutical anaesthetic. This article created tremendous interest and curiosity in medical circles. Thus started scientific research on acupuncture all over the world.

The Philosophy of Acupuncture

According to ancient Chinese philosophy, every one is born with a certain amount of energy called chi in the body. This energy circulates in our bodies through invisible channels called meridians. The channels constitute the main trunks which run longitudinally and deeply in the body and relate to each organ, while the collaterals which represent the branches of the channels, run transversely and superficially. The system of channels and collaterals includes the 12 regular channels, the 8 extra channels, and the 15 collaterals. This criss-cross network in which chi circulates, is spread over the body. Internally it connects over the viscera, and externally with the four extremities and the superficial tissues and organs. Its action is to regulate the function of different organs, transport vital energy, and connect the external with the internal organs, thus making the body an organic whole. Dysfunction of the channels and collaterals is an important cause of disease.

The chi flows from one meridian into the other, completing an energy cycle every 24 hours. The amount and quality of this energy is determined by heredity. It is also influenced by how we live our lives. We can enhance our store of energy by taking care of ourselves by eating the right food, taking proper physical exercise, and breathing clean air. We deplete it by inappropriate living habits such as intemperance in eating and drinking, anger, fears, anxiety, too much or too little sexual activity, or too much physical exertion. Any of these stresses and excesses can block the flow of chi in different parts of the body, or in the meridians. Illness is an excess or deficiency of this energy in the body or a part of the body.

Acupuncture stimulates points on the energy meridians to unblock stuck energy, speeding it up if it is flowing
too slowly, or slowing it down if it is racing too fast. Inserting and manipulating needles at the energy points corrects the imbalances that affect the functioning of our internal organs, which, in turn, affect our health.

An acupuncture point is the site where acupuncture is applied. These points may be either on the regular channels or on the extra channels. Over 360 points have been identified along these channels. The points which are not on these channels but have specific therapeutic properties are called extraordinary points and number several hundred. Every point has its own therapeutic property.

Selection of Points: Acupuncture points are selected on the following basis:

1. The points of some channels which are directly connected with the affected viscus, or have an interior or exterior relationship with the involved part named the distal points, are most frequently chosen.
2. The points which are at the site of the disease or adjacent to it and are termed local points are also selected.
3. The empirical points which are specific for certain diseases are also employed.

Needles: Acupuncture needles come in various shapes and sizes such as three-edged, plum-blossom, and ear needles, all generally made of stainless steel. The filiform needle is the main one used in ordinary clinics and has various lengths (1.0-15 cm) and diameters (0.27-0.46 mm). The filiform needle is selected according to the depth of the site of the disease, the thickness of the muscle and skin, and the required depth of insertion. The plum-blossom needle is used for tapping and exploring the skin of the affected area and its adjacent parts. The ear needle is employed for press acupuncture at the sensitive point of the corresponding region of the ear, which is then compressed and the needle fixed with adhesive plaster.

The needles are inserted into selected acupuncture points. They are usually left in place for 15 or 30 minutes or longer. They may be manipulated by hand in twirling or push-pull movements, and may be electrically activated by pulsatile electrical stimulation.

Moxibustion: The acupuncturist may employ more devices than just the needles. He may decide that moxibustion therapy will further alleviate the condition and build up chi or the life energy force.

Moxibustion represents a special form of point stimulation. The procedure involves burning a piece of the Chinese drug plant, Artemisia vulgaris, either on the head of the acupuncture needle so as to conduct heat into the body, or in some cases, on the surface of the skin. The importance of this procedure can be seen from the Chinese term for acupuncture, zhen diju, which literally means needling-moxibustion.

Another method employs a special needle with a cup at one end. The needle is inserted into the skin in the usual way. Then the herbal ball or stick (moxa) is placed in the cup and lit and the heat passes down the needle.

Modern science has extensively investigated the anaesthetic aspects of acupuncture. In 1975, research in Russia and America led to the discovery of endorphins and enkephalins, natural painkillers produced by the body. These biochemicals are also said to relieve allergies and depression, promote healing, and restore bodily functioning. Acupuncture has been found to increase significantly the levels of endorphins and enkephalins in the body.

According to another theory commonly called the Gate Theory, which is subscribed to both by Chinese and Western researchers, there are neuropathy gates to the brain along the spinal cord. Anaesthetic acupuncture is supposed to close these gates, blocking the pain message so that we do not feel it.

There are other theories too explaining how and why acupuncture works, particularly as an anaesthetic.

In the Placebo Effect, the conviction and faith of the patient in acupuncture stimulates the body’s own healing mechanisms.

Hypnosis dictates the control of mind over matter, thus stimulating physiological change.

The theory of Bioelectricity explains that bioelectricity flows through the meridians. Needling the meridians at accessible acupuncture points changes the electrical flow and increases energy.

How Acupuncture Works

Diagnosis of the condition is assessed on the basis of the patients’ complaints and symptoms. The practitioner uses four basic techniques for examination: to look, listen, ask, and feel. The acupuncturist looks at the colour of the face, the condition of the tongue, skin, eyes, fingernails, and hair. He may ask for a urine or stool sample to check its colour. He may also listen to the quality of the voice, its volume and force, and to the sound of breathing or gurgles in the abdomen. He may want to know about the appetite, and the body’s fluid secretions. He also enquires about the family’s medical history.

Finally, he examines the pulse, the main method for determining the condition of the body energy flow. This is similar to the pulse reading that the doctor or nurse performs, except that the acupuncturist checks three places from each wrist and three depths of flow at each place, that is, he takes a total of eighteen readings.

With the information gleaned from the interview and pulse reading, the doctor determines the specific imbalance and the point or points that will need puncture.

Uses of Acupuncture

Acupuncture is used as a treatment in three types of situations:
1. For promotion of health and prevention of disease: it is practised in conjunction with the full range of traditional Chinese medicine techniques involving the use of herbs, food, and exercise.

2. For symptomatic relief: it provides relief from pain or discomfort, without necessarily diagnosing the cause. ‘Barefoot doctors’ in rural China practise this type of acupuncture.

3. For anaesthesia: this involves the use of needles instead of, or in conjunction with anaesthesia during surgery.

Acupuncture is used clinically in several ways, as a primary treatment or in combination with other therapeutic methods, and as an adjunctive treatment in the following conditions:

4. Medical diseases: common cold, influenza, bronchitis, bronchial asthma, heat stroke, pain in the gastric region, spasm of the diaphragm, infectious hepatitis, acute enteritis, dysentery, cardiac diseases, hypertension, shock, strained neck, malaria, arthritis

5. Surgical disorders: lumbar pain, shoulder pain, elbow pain, sprain of the lower extremities, acute appendicitis, diseases of the biliary tract, mastitis, acute lymphangitis, simple goitre and hyperthyroidism, hemorrhoids, prolapse of rectum

6. Gynaecological and obstetrical disorders: irregular menstruation, amenorrhoea, pelvic inflammatory diseases, prolapse of the uterus, morning sickness, malposition of the foetus, prolonged labour, lactation deficiency

7. Pediatric diseases: whooping cough, infantile malnutrition, acute infantile convulsions, chronic infantile convulsions, parotitis, poliomyelitis

8. Diseases of the sense organs and neighbouring structures: acute conjunctivitis, myopia, atrophy of the optic nerve, tonsillitis, pharyngitis, chronic rhinitis, chronic sinusitis, toothache, deaf-mutism

9. Nervous and mental disorders: apoplexy, paraplegia, epilepsy, headache, facial neuralgia or paralysis, sciatica, neuritis, hysteria, schizophrenia, intercostal neuralgia

10. Urogenital disorders: enuresis, retention of urine, spermatorrhoea, impotence, and infections of the urinary tract

In the People’s Republic of China, 15-20 per cent of all surgical cases are said to be performed under acupuncture analgesia. In analgesia all other senses remain intact but pain is not felt. In some Western countries, acupuncture analgesia has been used in surgery with success. The overall success rate with acupuncture analgesia in diverse surgical procedures is said to be between 70 per cent and 80 per cent. Acupuncture analgesia is considered a valuable addition to the therapeutic armamentarium of the qualified anaesthesiologist.

Generally, acupuncture analgesia is thought to be more effective in head, neck, and chest surgery. It has also been used with satisfactory results in operations on the stomach, spleen, larynx, and in open-heart surgery. A large number of abdominal tubal ligations have been done in females under acupuncture analgesia, and over 80 per cent have been rated as very satisfactory in preventing conceptions.

Precautions and Prospects

Chinese scientists have succeeded in developing techniques for the isolation, extraction, and determination of internally secreted morphine-like substances, as well as for artificially synthesising the highly active substance encephalin and its derivatives. Experiments in both men and animals, have shown that the analgesic effect of acupuncture may be partially antagonised by the morphine antagonist now available as naloxone.

There are also certain specific contraindications to the use of acupuncture. These include pregnancy when associated with diseases otherwise amenable to acupuncture, needling of tumour sites, skin infections, presence of a cardiac pacemaker, and bleeding disorders such as haemophilia.
In spite of using acupuncture analgesia successfully in certain spheres, many problems concerning the mechanism of acupuncture and acupuncture analgesia have yet to be elucidated. The studies undertaken so far point to the need for further exploration, application, and research on acupuncture.

Now You Know

Part of the ancient Traditional Chinese Medicine (TCM), acupuncture is based on the scientific reasoning that physical and mental stresses and excesses block the flow of energy in the body.

Using needles to stimulate individual points, acupuncture unblocks the stuck energy, speeding it up or slowing it down as required. A diagnosis consisting of a general physical examination, pulse examination, and recording of the family’s medical history tell the doctor which points need acupuncture.

Acupuncture is used for promotion of health, prevention of disease, relieving pain, and for anaesthesia. It has proved its efficacy as an adjunct in several disease conditions. It is largely free of side-effects.