Dr Kie Pang David Tai
The mechanism of Acupuncture
Acupuncture needle is a tool acupuncturist is using this tool-inserted needle into the body walls tissues to treat the illness. Treating illnesses with acupuncture needle is a complex method.
The needle is applies or inserted into the body walls tissues requires special needle techniques in which is following the illness characteristic; Ling-Shu-Jing needle techniques are the original and fundamental needling methods, now-day still is great value in clinical practice.
The western medical sciences, especially, the pathophysiology and neurology are important in ACU treatment. In ACU treatment requires combination ACU needling methods and medical sciences, the treatment can achieve satisfactory out come.
The mechanism of ACU treatment is not only one single factor can be interpreted, initial LING-SHU stated the criteria of ACU treatment:
- Reinforcement of deficiency
- Reduction the overpower
- Releasing the obstruction
- Removal the blood congestion improve blood circulation
Following is common criteria in applied ACU needle for treatment:
- The needle is used as scalpel—doing operation:
- Such as the needle is inserted surrounding the scars tissues for removal the scars in which is interrupted the neurovascular pathway to released the pain symptom.
- Needling into the inflammation lump is similar using needle as a scalpel release the inflammation lump for example
- Acupuncture needle becomes a tool—needling techniques in which is used in the practitioners hand simplify as mechanical factors: the needle is inserted into the skin or connective tissues or into the obstructive tissues—the scars with in between two muscles for example: that interrupted the muscles movement causing the muscles contraction in which obstructed the neurovascular pathway pain symptom may occurred.
The lifting and thrusting needle techniques are applied the needle applies in this case is removed the scars for example. The gentle lifting and thrusting needle techniques the sharp tip of needle made several holes surrounding the scars and after needling gentle massages the point and stretching the muscles in which elongated the muscles length loosing up and soften the scars. Few treatments after the obstructive scars removed and the neurovascular pathway is return to normal path and pain symptom is released.
The needle technique more often is applies into the face and scalp region point, especially, in the case of obstructive tissues obstructed the neurovascular pathway and causing headache. The practitioner may discover the enlarge vein or palpated the artery pulses. The needle is gentle inserted into the skin on the side of the blood vessel can immediately released pain symptom.
When the temporal-mandible joint is lost balances may compress to the temporal artery just nearby the joint, causing headache or pulsation in the ear. Needle is inserted into the point TH21, which is on the side of the artery can immediately release headache and tinnitus; to cure the illness needs to balance both side joint function.
- Released inflammation lump
Tendinitis, bursitis, acute or chronic inflammations etc more often causing pain symptoms needle insertion accurately inserted into the inflame lump can rapidly released the inflammation.
The inflammation lump may locate on the superior of the tissue or interior of the periosteum; practitioners require carefully discovered and examination where the inflammation lump is located, the needle is accurately inserted into the lump.
Usually one needle is inserted into the centre of the lump perpendicularly and several needles are inserted obliquely into the surrounding lump. The needle is inserted into membrane of the inflame lump and made several holes surrounding the lump; after needling gentle massages the point allowing the inflammation fluid out of the lump.
Gentle stretching is required for healing process; avoid the heavy massages and strenuous stretched method.
In general clinical practice a superficial small lump one treatment is enough to release the inflammation, however, a large inflame lump requires few treatment.
The mechanism of the needling techniques is similar to the mechanical affect to release the inflammation fluid.
The inflammation may occur every-where in the body ACU treatment perception is: ‘Where the disorder is located where it is ACU point’ the disorder more often is occurred in extremities or/and causing of repeat over-used.
- Needle techniques activated body-healing powers
Following are three needling methods ‘activated body-healing powers’
- The needle is used as stimulus stimulated the sensory neuron
- The needle produced “low seal acute inflammation—reinforcement the deficiency”
- The needle is renewal the body tissue, improves nerve tissue regeneration,
- The sharp tip becomes the tool used to stimulate sensory neurons—the free nerve ending, which is located in the dermis papillary layer of the skin, or spindles are located in muscles or tendons.
A 0.20 diameter and 13mm length needle is perpendicularly inserted into the dermis papillary layer the needle is stimulated and fire the sensory neuron, activated the action potential regenerated the nerve impulses, and go with afferent transmit the impulses to the spinal cord gray column where the motor neuron is located. The nerve impulses may activate the motor neurons via efferent react to the motor end plate causing muscles contraction or released muscles tension.
In medical sciences define the needle is a stimulus the process is needle stimulated the sensory neurons via simple reflex arc activates the motor neuron causing excitation or inhibition the muscles activities, especially, this method is applies for lost skin sensation or muscles movement—SCI patient; in Chinese version is reinforced the deficiency or strengthen weakness part of the body tissues.
Needle insertion stimulates the point where the sensitive points are located: some points are hypersensitive such as K1 is located in plantar needling to K1 may produces large impulses, repetitive needling methods in the general ACU point also can produce stronger impulses. The larger impulses, especially, the impulses are produce initial the palm or the plantar may directly affect to the motor cortex such as needling into the points PC9 or K1. The extremities may automatically strong reflex: needling to the KI for a paraplegia patient may lifting the thigh up to the hip; if the peripheral nerve is remained intact for example.
In this case the reflex is through needle stimulated the hypersensitive point transmit the strong nerve impulses via the ascending tract activated the motor central nuclei function: through descending tract stimulated to the spinal cord gray column motor neurons via efferent activated the motor end plate excitation the muscles movement. In medical term may call ‘Flexor Withdraw Reflexes’.
Difference type of needling techniques may produce different type of nerve impulses, which in turn ignite reflex mechanisms to combat illness.
For example: After ACU treatment the patient feel ‘Relax’ because the Gentle needling method with small diameter needle and retention needle in the point may produce gentle and steady impulses to balances the ANS and sympathetic and parasympathetic nerve functions. After treatment the patients mentally and physically felt relax and release tension, particularly, for a stressful patient after ACU treatment felt calmer—ACU relaxation treatment.
- The needle is inserted into a specific point or region to produce low seal acute inflammation. ACU needle is inserted into BL 23 for example: the lifting and thrusting needle techniques initiated the skin the connective tissues and the side of the muscles and deep interior to the periosteum repeat needling several times in the point.
The acute inflammatory phenomenon is produce in the BL 23 the point felt warm after needle insertion. This acute inflammation phenomenon is the body’s own natural healing processes, especially, in treating trauma wounds and also may strengthen the Kidney—adrenal gland function, via the sympathetic nerve reflex activities. Thus, needling methods demonstrating how does acupuncture work, when used in conjunction with the knowledge of medical science, uses not some ‘magic’ or external force but instead ignites the body’s own healing powers to achieve results.
In Chinese version the Kidney is more concerns the function of the adrenal gland activities needling method: if the gland is over-active requires needle reduction method, if the gland is not produced enough hormone in which requires reinforcement method to increases the gland function. The needling method is via the sympathetic nerve reflex to the adrenal gland function.
In many instances, needle stimulation method and produces ‘low seal acute inflammation’ method are going together, especially, in treating the lesion nerves: the sharp stimulated and fire the sensory neurons and provided blood supplies nourish the lesion peripheral nerve; allowing the nerve recovery.
- ACU activated body-healing power
According medical sciences some of body walls structure such as the epidermis of the skin, the periosteum of the bone and the connective tissues are containing strong or powerful cellular regeneration activities—such as the simulation can produces adult stem cells, even is in the adult body. [Current new cellular treatment such as Stem cells treatment is the example.]
Derma hammer tap on the epidermis, needling into the connective tissues and the periosteum goes with the low seal acute inflammation phenomenon provided blood supplies to the tissues increase blood circulation improves cellular functions in which can renew the skin on the face, regenerated the lesion or degenerated nerve tissues maintaining and improved nerve function, especially, in treating SCI or/and for elderly patient.
The skin is the largest organ in body the environment change; trauma and many factors could lesion to skin. The illness attached to the body the first line is the skin, which lesions the skin and enter to the body. A healthy skin is demonstrated a healthy body wellbeing. Thus, protection of the skin, supporting the skin and exercises to maintaining and improve healthy skin is significance for body wellbeing.
Following is how does maintaining and strengthening the skin:
The skin contain large number of skin receptors in which received the environment stimulation provides the signal to the nervous system to adjust or adopt the environment changes such as temperature-heat or cold, trauma feel pain and gentle touch fell comfortable etc.
In this discussion is focused on the awareness and how to exercises the body to strengthen the skin. For example: When temperature is too hot or too cold requires clothing protection, however, over protection is weaken the body natural protection. From childhood requires adopting exercises to adjust the body following the environment change but not over protection and care for the limitation. Little pain is means nothing but big pain needs to pay attention. Fear of pain is requires medical psychological attention.
Stimulation skin receptors can produce nerve impulses and affected to CNS; the correlation of skin and CNS is directed and immediate. In childhood the skin is sensitive and the sensory neuron is growing and developing. In elderly the skin is degeneration most of the sensory neurons are decay. The face full of wrinkle body reaction slowing down memory is lost etc in which is natural ageing processes.
Many centuries are over and no body able to stop this phenomenon the ageing processes. Is that ACU treatment can be help?
The sharp of Acupuncture produced pain sensation, MOXA heat, derma hammer stimulation, hand slapping the skin and massages all of which may stimulate to the skin fire the receptors—sensory neuron activated the action potential regenerated nerve impulses through reflexes mechanism can strengthen the CNS and the skin.
In this sense regular ACU treatment can maintain body physical and mental wellbeing.
The healing powers come from practitioner’s hand manipulated the needling method, however, the practitioners require the knowledge of medical sciences, especially, the neurology sciences how to applies the needle to the points and activated the body healing potential—powers in which able to achieved the results.
ACU treatment assists correct medication usage
In clinical practice especially in chronic inflammation or chronic infection region the body may form adhesion scars tissues to limited the infection extended. In this instance may interrupt the medication or herb gets through to the lesion part tissues to improve the lesion wound to heal. Needling surrounding the wall-protective tissues the lifting and thrusting needling method break the obstruction increase blood supplies and allowing the medication and herb able get in to cure the illness, such as chronic tonsillitis medication limited the drag usage.
In clinical practice also requires observed the medication correctly conjunction with needling method: If the reason of medication is in used for inhibition nerve function that may interfere the acupuncture treatment, which is preferred not in this case combination both ACU treatment and medication usages: such as in the case of severely muscles spasm ACU treatment can stop the muscles spasm without using medication.
Diagnosis of illness is the first step. Here, Chinese and Western diagnostic practices vary. Sensible practice is to combine both to compliment each other to relieve the suffering of the patient and work towards the best possible outcome. It is wise to use pathophysiology to analysis the illness aetiology, prognosis and to decide on the treatment progression. The effectiveness of acupuncture has been subjected to much scrutiny over the past century and it continues to hold up.
In western medicine physical examination is important in diagnosis. Chinese medicine also has special physical examination method. If following ACU definition the physical examination may focus on observation palpation on body walls tissues such as observed and palpated the skin, the connective tissues, the muscles the tendons, the joint and correlation blood vessels and nerve tissues.
In the case of traumatic factors causing pain for example: the disorders, frequently, is the obstructive tissues obstructed the neurovascular pathway. Clinical finding: such as the blood vessels congestion, muscles contraction, joint restriction or malformation, and the patient felt stress and tied.
Relaxation is part of ACU treatment and can only temporally release stress, if requires to cure the illnesses require discovery where the original causes and released the causes.
Pain syndrome of the shoulder for example may observe shoulder joint malformation or joint restriction palpation the tendons attached to the joint is lumpy or tender and correlated muscles contraction. Clinical diagnosis such as rotator cuff tendinitis; ACU treatment requires observation where the inflammation is located, the capsules of the joint and the tendons in which attached to the joint is inflamed the rotator cuff muscles are in chronic contraction. Those clinical findings are where the illnesses located and the points for ACU needle insertion. The needle is inserted into the inflamed lump and the side of the tendons and the chronic spasm muscles to release the inflammation and the obstructive tissues to cure the illness. That is the meaning of combination of Western medical sciences and needle insertion techniques.
PREVENTATIVE MEDICINE
Traditional Chinese medicine is based on the principle of preventative medicine and is utilized in this context. Huang-Di Nei-Jing (The Yellow Emperor’s classic of internal medicine,
500-300 BC) states that:
“Hence, the sages did not treat those who were already ill; instead, they instructed those who were not yet ill. They did not wish to rule those who were already rebellious; instead, they guided those who were not yet rebellious. To administer medicine for illnesses, which have already developed is comparable to the behaviour of those who start to dig a well after they have become thirsty, or those who begin to cast weapons after they have already engaged in battle. Would not these actions then be too late?”
Acupuncture treatment is concerned with the prevention of both mental and physical illness. In traditional Chinese medicine, it was deemed vital to understand an illness before the symptoms occurred, rather than understanding symptoms that had already occurred.
Chinese Medicine is illuminated by the classic texts of Bian Que [c500 BC], ‘The Internal Classic of Bian Que’ and ‘The External Classic of Bian Que’ which opine that the best acupuncturist is, ‘He who can observe and cure illness before the symptoms occur’.
Take the example of body trauma, most commonly as the result of an accident. Lesion tissues may start forming before the patient feels any pain from these. In this stage of patho-physiology damage, there may not yet be signs of pathological change. Yet through physical observations garnered from the patient’s eyes, tongue, facial colour, postural position body language and body walls tissues, the practitioner can determine from the anatomy and physiology where damage is located and treat this before its symptoms are visible.
The focus of Western medicine is on treating symptoms that the patient presents for diagnosis, which point, damage may be advanced. In contrast, using the specific Chinese way to observe allows treatment to begin significantly earlier. Using the network of the body’s own meridians, Chinese practice links the body holistically. Early diagnosis and prompt treatment shorten the duration of illness and limit the degree of disability.
It is the norm today to advise people to maintain their physical and mental wellbeing to ward off sickness before it occurs. Similarly, in ancient China, acupuncturists encouraged the healthy to have regular treatment to maintain their wellbeing. Today, we are able to use medical testing techniques to demonstrate that what was deduced 1,000 years ago is indeed correct; that a person who has regular acupuncture treatment should enjoy a strong immune system while cellular function is well preserved. Those people can enjoy their wellbeing and happy life.
MEDICAL SCIENCES & NEEDLE TECHNIQUES
ACU treatment requires combination of western medical sciences and Chinese needle insertion techniques in which able to achieve good out come.
Following is the example; how to combination those two knowledge:
1. Illness diagnosis: ‘ Biceps tendinitis’
BICEPS BRACHIAL
- Pathophysiology:
Inflammation in the origin of the two heads of biceps is known as biceps brachii tendonitis. In the case of biceps tendonitis, tenderness and a mass can be palpated at the origin of the muscles. Hyperextension of the arm can result in immediate pain in the shoulder and arm, whereas flexing the forearm may reduce pain.
Causes of biceps brachii tendonitis include:
A direct impact injury or tearing of the muscle
Repeated overuse traumatic lesion
In many cases biceps tendonitis occurs during or after rotator cuff tendonitis or adhesive capsulitis.
The biceps brachii muscle is a powerful muscle, which is frequently used. Disorders of the biceps can cause inflammation in two heads of origin of the muscles and affected the coordinated muscles such as the triceps and posterior deltoid muscles. Powerful contraction of the biceps can overstretch the triceps and deltoid, particularly when the arm is involved in flexion or extension.
Biceps brachii tendonitis, triceps tendonitis and deltoid tendonitis often occur at the same time. In many cases the obvious symptoms are revealed in the triceps and deltoid rather than the biceps brachial. The pectoralis minor and coracobrachialis muscles will also be affected as they share the same muscle origin in the coracoid process of the scapula with the biceps.
In the case of biceps tendonitis the deltoid, triceps, pectoralis minor and coracobrachialis muscles should be examined and immediate treatment should be provided.
- CLINICAL EXAMINATION & POINTS LOCATION
The essential disorder is in Biceps origin of two heads. Clinical finding is tenderness in main two points: long head—supraglenoid tubercle of scapula and short head—coracoid process of scapula.
Actually clinical finding is show on LI15 and LU1 ACU points.
Where it is pain place that is a point. The needle is inserted into the skin and on the side of the tendon where it is inflammation lump is located. Needle technique is lifting and thrusting needle accurately into the inflammation lump and allowing the inflammation fluid escape from the lump; retention the needle 10minutes can reduce the tension of the skin and tendon.
To relax the biceps muscles and assist the healing process of the local tissue; two needles are inserted into the side of the belly of the biceps.
The practitioner should advise immobilization of the arm or the use of a sling. Healing of the local tissues may take a few weeks and no strenuous exercises during this period. The patient comes once weekly treatment may need three to four ACU treatments.
Following the same method can discovery at the triceps and deltoid:
NEEDLE INSERTION INTO THE DELTOID
The needle is inserted into the lower border of the crest of the spine of the scapula, at the origin of the posterior portion of the deltoid. This will relieve muscle spasm and inflammation at the side of the muscle. The needle is usually inserted into the insertion of the muscle (i.e. Point LI 14) and retention the needle for 15minutes to relax the deltoid muscle.
NEEDLE INSERTION INTO THE TRICEPS BRACHII
Pain symptoms revealed in triceps brachii tendonitis are more pronounced than those revealed in biceps or deltoid tendonitis. Severe pain is felt at the origin and insertion of the muscle. The following points are TH 10, TH 13, TH 14 and SI 9 commonly used.
The needle is inserted into the long head of the muscle at the infraglenoid tubercle of the scapula, the lateral head of the muscle in the upper half of the posterior surface of the shaft of the humerus and the medial head of the muscle, and at the posterior surface of the lower half of the shaft of the humerus.
The insertion of the triceps is on the posterior part of the olecranon process of the ulna. In this point a lump and pain can be palpate. Needle insertion into the insertion of the muscle can relieve muscle spasm and needle insertion into the lump can remove the inflammation.
- PROGNOSIS
If the disorder is being cured, the patient’s shoulder, elbow and wrist will form a straight line when the upper limb is extended.