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Acupuncture andTraditional ChineseMedicineMelissa Tornero-Bold, MDAssistant Professor - ClinicalDepartment of AnesthesiologyThe Ohio State University Wexner Medical CenteGoals Integrating Modern Medicine andTraditional Chinese Medicine Literature Review Essentials of Acupuncture: Theories,Concepts, and Practice Locations and Properties of ImportantAcupuncture PointsHuangdi NeijingThe Yellow Emperor's Classic Ancient Chinese medical textthat has been treated as thefundamental doctrinal source forTCM Dated by scholars around 400B.C. The work is composed of twotexts in a question-and-answerformat between the mythicalYellow Emperor and one of hisministers (physicians)“For example, a child three years old willrequire of the adult dose. Of powerfulnarcotics, children will require scarcelymore than one-half of this proportion.Children bear opiates poorly; while theystand comparatively large doses of arsenic,belladonna, ipecac, mercurials, pilocarpine,rhubarb and some other purgatives, andsquill.”Author: UnknownAuthor: Merck & Co.1
Acupuncture Modern Day Applications “ extraordinary claimsdemand extraordinaryproof.” - Dr. Steven Shafer “You must keep an openmind, but not so openthat your brains fall out”- James Oberg, NASAengineer and sciencewriterShafer SL. Did our brains fall out? Anesth Analg. 2007;104:247–8. – Source: Welcome CollectionsEffective Treatment of Animals is Usually CitedAs Proof that Acupuncture is Not Merely Placebo Veterinary medical journals cite many examples ofobjective clinical success Potentially lethal arthritis in horses Congenital hip dysplasia in dogs- Preventative Health-StressWeight managementFemale reproductive health- Behavioral health-DepressionAnxietyAddiction- Acute illness- Chronic medical conditions- Acute and Chronic painAuthor: Christopher Michel(CC BY 2.0)Acupuncture definition Acus meaning a sharp point Punctura meaning to pierce Technique of inserting and manipulatingfine filiform needles into specific points onthe body for various therapeutic purposes Original acupuncture technique: manipulateneedle in an up-and-down and rotatingmovement Attempt to reopen the meridian so that theobstructed Qi can resume its .php?hleda veterinary acupuncture2
Imaginary Words to a Western DoctorWith So Many Applications,Who Do You Trust? Meridians? The Government,of Course! Obstructed Qi?Source: https://nccih.nih.gov/The NIH is “the” National MedicalResearch Agency Includes 27 Institutes and Centers and is acomponent of the U.S. Department of Health andHuman Services The National Center for Complementary andIntegrative Health (NCCIH) is the FederalGovernment’s lead agency for scientific researchon complementary and integrativehealth hor: NASA / Neil A. ArmstrongWhat is Traditional ChineseMedicine to a Modern DayPhysician? https://www.nih.gov/ https://nccih.nih.gov/https://nccih.nih.gov/3
NCCIH’s Mission and Vision Mission Define Usefulness and Safety ofcomplementary and integrative healthinterventions and their roles in improving healthand health care Vision Scientific Evidence will inform decisionmaking by the public, by health careprofessionals, and by health policymakersregarding the use and integration ofcomplementary and integrativehealth -healthIntegrative Medicine Many definitions, but all involve bringing conventional andcomplementary approaches together in a coordinated wayResearchers are currently exploring the potential benefits ofintegrative health in a variety of situations, including:‒ Pain management for military personnel and veterans‒ Relief of symptoms in cancer patients and survivors‒ Programs to promote healthy health#cvsaNCCIH Quick Facts Established: by Congress 1992; laterrenamed 1999 Funding: FY 2020: 151.9 million; FY1992: 2.0 million Staff: Approximately 74 FTEs ntary versusAlternative When describing these approaches, peopleoften use “alternative” and “complementary”interchangeably, but the two terms refer todifferent concepts: If a non-mainstream practice is usedtogether with conventional medicine “complementary” If a non-mainstream practice is used in placeof conventional medicine grative-health#cvsa4
TCM DoctrineTCM encompasses manypractices, including: Diseases develop from natural effects of diet,lifestyle, emotions, environment, and age The universe is composed of various forces andprinciples, such as Yin and Yang, Qi and the FiveElements (or phases) Man can stay in balance or return to balance andhealth by understanding the laws of these naturalforces Herbal medicine Acupuncture Tai chi Food is medicineMoxibustionCuppingTui naQi med.htmThe Sign of Tai ChiThe Sign of Tai Chi also known as the Yin Yang symbol, which is theepitome of balanced Qi energy Yin and Yang are equal but opposite Yin and Yang are complementary to each other Cyclical rhythm of nature Yin and Yang are interdependent and cannotexist without each other‒ cannot have day without night‒ cannot have dark without light YINNegativeFemaleNightPassiveMoonIntuitiveColdSoft YANGPositiveMaleDayActiveSunLogicalHotHard Sympathetic NS?Catabolism?Author: Gregory Maxwell Parasympathetic NS? Anabolism?5
Yin and Yang Are in a State ofContinuous SupportBody Acupuncture Meridians and Acupoints Relative levels of yin and yang are continuouslychanging When yin or yang are out of balance, they affecteach other, and too much of one can eventuallyweaken (consume) the other leading to /commons/f/fc/Chinese meridians.JPGThe Elusive “Meridian” has not MaterializedYet Media nerves, blood vessels, lymphatic,connective tissues? In modern times, new methods of stimulatingthe acupuncture points (acupoints) have beenintroduced, including‒ Electroacupuncture (EA)‒ Transcutaneous Electrical AcupointStimulation (TEAS);‒ Injection of chemicals into the acupoints‒ AcupressureHow does Acupuncture work? Qi influenced and balanced by stimulating specificpoints on the body’s surface Recruits endogenous neurotransmitters andneuropeptides, such as endorphins, to suppresspain Interrupt the vicious cycle of pain mechanismsT.R. Deer et al. (eds.), Treatment of chronic pain by integrative approaches: theAmerican Academy of Pain Medicine textbook on patient management. 2015.ISBN 978-1-4939-1820-1 ISBN 978-1-4939-1821-8 (eBook)6
WHO Classification Systemof MeridiansMeridian Labeling Consensus Report reached by WHO ScientificGroup for standard international acupuncturenomenclature in 1989 Naming system: alphanumeric code as well asthe Han character names of meridians andacupuncture points, along with theirtransliterations into the Chinese phoneticalphabet (Pinyin) and their English translations Proposed standard nomenclature for the 14main meridians, the 361 classical acupuncturepoints, the 8 extra meridians and the 48extraordinary points, and for scalp acupuncturelines Each point has a specific function and meaningrelating to its internal organ and meridian Names often refer to flow on the surface of theearth: Well, Spring, Stream, River, Sea Valley, Marsh, 7e/https://en.wikipedia.org/wiki/List of acupuncture points#Large intestine meridianTheory of MeridiansMeridians are connected with each other inan endless cycle to nourish and adjust theenergy of the bodyBegin with the lungmeridian, connected tothe large intestine stomach spleen heart small intestine urinary bladder kidney pericardium San Jiao gallbladder liver finally returnsto the lung again Channels that transfer blood and Qi (vital energy)throughout the body Connected with the surface and all the internalorgans of the body Regulate yin and yang According to Chinese medical theory, illness ariseswhen the cyclical flow of Qi in the meridians isblocked or becomes unbalancedAuthor: Joe Haupt (CC BY-SA 2.0)Xu, J. (2014). Praeger handbook of acupuncture for pain management : A guide to how the'magic needles' work. Retrieved from https://ebookcentral.proquest.comXu, J. (2014). Praeger handbook of acupuncture for pain management : A guide to how the'magic needles' work. Retrieved from https://ebookcentral.proquest.com7
14 Common Meridians (6 pairs 2 unpaired) Relating to the Zang-Fu organsystemsMeridians Relate to the 5 elements Urinary bladder and Kidneymeridians (Water) Gallbladder and Liver (Wood) Heart and Small intestine (Fire) Stomach and Spleen (Earth) Lung and Large Intestine(Metal) Pericardium and San Jiaomeridians2 other meridians Du (GoverningVessel) and Ren (ConceptionVessel)2 other meridians Du (Governing Vessel)and Ren (Conception Vessel)Author Parnassus (CC BY-SA /d/d9/Collage of Nine Dogs.jpgCun Measurements of the BodyFive elements water, wood, fire, earth, metal symbolically represent all phenomena Includes stages of human life, and explain thefunctioning of the body and how it changesduring disease Since everyone's body is of a different size,use a person's inborn measurementsystemBased on five categories in nature: Water nourishes wood Wood provides the generative force for fire Fire enriches the earth Earth contains metal Metal produces water And so it med.htmXu, J. (2014). Praeger handbook of acupuncture for pain management : A guide tohow the 'magic needles' work. Retrieved from https://ebookcentral.proquest.com8
2012 National Health Interview Survey (NHIS)Provides Most Comprehensive Information onUse of Complementary Health Approaches in US This analysis is the first to provide data on children, on totalspending across age groups, and on mean spending per userfor any use of these approachesFive ElementTheory About 59 million Americans spend money out-of-pocket oncomplementary health approaches Total spending adds up to 30.2 billion a yearAuthor Parnassus (CC BY-SA 3.0)Health Care Approaches Outside of(Conventional) mainstream Western Medicine‒ More than 30%of adults‒ 12% of childrenClarke, TC et al. Trends in the use ofcomplementary health approaches amongadults: United States, 2002-2012. Natl HealthStat Report. 2015 Feb 10;(79):1-16.2012 National Health Interview Survey (NHIS) Data Published 2/2015 Conducted by the National Center forHealth Statistics (NCHS), part of theCDC Each year 35,000 and 40,000households to ask people questionsabout their health In 2002, 2007, 2012, and 2017 the NHISincluded a section, developed by NCHSand the National Center forComplementary and Integrative Health(NCCIH), on the use of complementaryhealth approachesSource: .nih.gov/research/statistics/NHIS/2012/about9
Acupuncture UseIs TCM safe? Improperly performed acupuncture serious side effects Reports of Chinese herbal products being contaminatedwith drugs, toxins, or heavy metals or not containing thelisted ingredients Some herbals can interact with drugs, have serious sideeffects, or be unsafe for people with certainmedical conditions 2002 – 2.136 million; 1.1% population (age adjusted) 2007 – 3.141 million; 1.4% population 2012 – 3.484 million; 1.5% emed.htmRisk AssessmentAuthor Acuhealth (CC BY-SA 3.0)Author BruceBlaus (CC BY 3.0)Author: Kyle HunterAuthor: William Rafti of the William Rafti Institute10
Chinese Herbal Medicine Chinese Materia Medica(the pharmacologicalreference book) describesthousands of medicinalsubstances ‒ primarily plants‒ some minerals‒ animal products Herbs are often combinedin formulasAuthor: WikidudemanFDA statement Cautioningagainst /Author: Iwansw (CC BY-SA 3.0)Source: Food and Drug Administration11
CuppingSource: Wellcome Collection gallery(2018-03-28) - (CC BY 4.0)MoxibusionAuthor: Alanna Ralph (CC BY ia/File:A Dose of Moxa.jpgThe Status of TCM Research In spite of the widespread use of TCM in China and itsuse in the West, rigorous scientific evidence of itseffectiveness is limited TCM can be difficult for researchers to study because itstreatments are often complex and are based on ideasvery different from those of modern Western medicine Most research studies on TCM have focused on specifictechniques, primarily acupuncture and Chinese herbalremedies, and there have been many systematic reviewsof studies of TCM approaches for various hinesemed.htmNIH Review Finds Nondrug ApproachesEffective for Painhttps://nccih.nih.gov/news/press/pain reviewNahin, Richard L et al. “Evidence-Based Evaluation of Complementary Health Approaches forPain Management in the United States.” Mayo Clinic proceedings vol. 91,9 (2016): 1292-306.doi:10.1016/j.mayocp.2016.06.00712
NIH Review Trial Evidence onComplementary Approaches forFive Painful Conditions Painful conditions are the most common reasonswhy American adults use complementary healthapproaches About 40 million American adults experiencesevere pain in any given year 5 conditions low back pain, osteoarthritis, neckpain, severe headaches and migraine, lts/spotlight/five-painful-conditionsNCCIH Review ArticleContinued Review conducted by a group of scientists from theNational Center for Complementary and IntegrativeHealth (NCCIH) at the National Institutes of Health To identify RCTs for each complementary approach,published from January 1, 1966, through March 31, 2016 Limited to RCTs in United States Found RCT-evidence for treating pain:‒ Acupuncture and yoga for back pain‒ Acupuncture and tai chi for osteoarthritis of the kneeNahin, Richard L et al. “Evidence-Based Evaluation of Complementary HealthApproaches for Pain Management in the United States.” Mayo Clinicproceedings vol. 91,9 (2016): 1292-306. doi:10.1016/j.mayocp.2016.06.007NIH Review Article: Low Back Pain 4 RCTs (total participants, 1092) Age range, 28-60 years‒ used primary study outcomes of self-report ofpain intensity (numeric rating scale or visualanalog scale [VAS]) and/or functional disability(Roland-Morris Disability Questionnaire,Oswestry Disability Index [ODI], or DisabilityRating Index) Cherkin et al reported modest improvement in painintensity and function compared with usual care In pregnant women using auricular acupuncture,Wang et al found a significant reduction in painintensity and improved functional les/MayoPainPaper social-graphics5-01.jpgNahin, Richard L et al. “Evidence-Based Evaluation of Complementary Health Approachesfor Pain Management in the United States.” Mayo Clinic proceedings vol. 91,9 (2016): 1292306. doi:10.1016/j.mayocp.2016.06.00713
NIH Review article: Knee OA 4 RCTs; Predominantly female, had mean ages 60–65years, and had knee pain for an average of 9 to 11years All used Western Ontario and McMaster UniversitiesOsteoarthritis Index (WOMAC) total score or theWOMAC pain subscore In 2 of the RCTs no difference was seen betweenverum acupuncture and sham acupuncture for eitherthe primary or secondary outcome measure The third trial, which used a sham control, foundsignificantly better improvement in both the WOMACpain subscale and function subscale after 14 weeks gov/files/MayoPainPaper social-graphics5-02.jpgNCCIH tips for finding a Provider If you need names of practitioners in your area, firstcheck with your doctor or other health care provide Unfortunately, the National Center for Complementaryand Integrative Health (NCCIH) cannot refer youto practitioners NCCIH is not involved in the clinical training,credentialing, or licensing of complementaryhealth practitioners Find out as much as you can about any potentialpractitioner, including education, training, licensing, andcertifications The credentials required for complementary healthpractitioners vary tremendously from state to state andfrom discipline to ingNahin, Richard L et al. “Evidence-Based Evaluation of Complementary Health Approachesfor Pain Management in the United States.” Mayo Clinic proceedings vol. 91,9 (2016): 1292306. doi:10.1016/j.mayocp.2016.06.007National Certification Commissionfor Acupuncture and OrientalMedicine (NCCAOM): National organization that validates entry-levelcompetency in the practice of acupuncture andOriental medicine through professionalcertification Provides patient-level information about thesepractices and a provider-finder linkhttps://www.nccaom.org/14
Acupuncture subsets edia/commons/a/a2/Archie McPhee acupuncture.jpgDemonstration of AcupunctureScalp ns/7/7f/Japanese vvtvy4k15
Ear AcupunctureAuthor: Wouterhagens at Dutch Wikipedia (CC BY-SA 3.0)Hand AcupunctureAuthor: National Institute of Korean Language (CC BY-SA 2.5)Acupuncture AnesthesiaDuring SurgeryHistory ofAcupuncture Research In the late 1950s up to 1970s, there was a large-scaleclinical practice in China of using acupuncture in lieuof anesthetics for surgical procedures In fact, in most hospitals, acupuncture was used incombination with anesthetics to form “acupunctureassisted anesthesia (AAA)” Almost all reports stressed the benefits‒‒‒‒less anesthetic requirementsearlier recoveryless postoperative pain and other complicationsshortened hospitalizationT.R. Deer et al. (eds.), Treatment of chronic pain by integrative approaches: theAmerican Academy of Pain Medicine textbook on patient management. 2015.ISBN 978-1-4939-1820-1 ISBN 978-1-4939-1821-8 (eBook)16
Acupuncture Raises Pain Thresholdin Humans and SuggestsNeurochemical Mechanisms Study to ascertain whether acupuncturestimulation would indeed lower pain sensitivity Skin potassium iontophoresis method was used,whereby the minimal intensity of an anode (5 mmdiameter) current needed to produce a clear painsensation was recorded, usually by 1 mA Following the continuous manipulation of theneedle (at Hegu point) for 50 min, a gradualincrease of the pain threshold was observed over30 min to increase from 1 to around 2 mA, andleveled off thereafterResearch Group of Acupuncture Analgesia, Beijing Medical College. The effect ofacupuncture on pain threshold of the skin on human volunteers.Chin Med J. 1973;3:151–7.LI-4 Hegu translated as Conjoining Valley Location: On the dorsum of the hand, between the 1stand 2nd metacarpal bones, in the middle of the 2ndmetacarpal bone on the radial side.Pain Threshold IncreasesAfter Acupuncture at LI-4 Eight representative skin points wereidentified for the measurement of painthreshold Slow rise of pain threshold during thestimulation period and the slow decayafter the removal of the needle suggestthe involvement of neurochemicalmechanismsT.R. Deer et al. (eds.), Treatment of chronic pain by integrative approaches: theAmerican Academy of Pain Medicine textbook on patient management. 2015.ISBN 978-1-4939-1820-1 ISBN 978-1-4939-1821-8 (eBook)Cerebrospinal Fluid Cross-perfusion StudyDetermines that Chemical Mediatorsproduced in Brain are Responsible forAnalgesia (BL-60)BL-60 translated as“Kunlun Mountains”Location: On the foot, behindthe external malleolus, in thedepression between the tip ofthe external malleolus andcalcaneal (Achilles) ns/0/05/Acupuncture point Hegu %28LI 4%29.jpgResearch Group of Acupuncture Anesthesia. Beijing Medical College: the role of someneurotransmitters of brain in acupuncture analgesia.Sci Sin. 1974;17:112–30.17
Neurochemical Mechanismsof AcupunctureAuthor: Gareth Rasberry (CC BY-SA 3.0)Research Group of Acupuncture Anesthesia. Beijing Medical College: the role of someneurotransmitters of brain in acupuncture analgesia. Sci Sin. 1974;17:112–30.Standard TEAS Device forResearch Studies Clinical trials demonstrated efficacy in treating pain andaddictions, autism, infertility, insomnia, depression, andurinary incontinence Gentle electrical stimulation at certain frequenciesmobilizes the body's own natural healing processes torestore biological ons/6/6b/Tens.jpgAcupuncture Analgesia found to beModulated through Opioidergic Pathways The analgesic effect of acupuncture for dental pain can beprevented by the subcutaneous injection of naloxone Suggests the involvement of endogenous ks/xy86ag9c/items?canvas 1&langCode freMayer DJ, Price DD, Raffi A. Antagonism of acupuncture analgesia in man by narcoticantagonist naloxone. Brain Res. 1977;121:368–72. Author: James Heilman, MD (CC BY-SA 4.0)Acupuncture is Modulated by Ascendingand Descending Pathways in the Brain andSpinal Cord From neurophysiological point of view, acupunctureanalgesia can be taken as a reflex action‒ Afferent (mostly Aᵦ fibers) innervating the acupoint‒ Efferent descending pathway modulating thesensitivity of the dorsal horn neurons not only in thesame segment but also in heterogeneous segments Rat studies revealed that 100-Hz stimulation of theacupoint would trigger the release of dynorphin in thespinal cord After destruction of the parabrachial nucleus of thebrainstem, high-frequency EA would no longer producean analgesic effectHan JS, Wang Q. Mobilization of specific neuropeptides by peripheral stimulation ofidentified frequencies. News Physiol Sci. 1992;7:176–80.18
Different ElectroacupunctureFrequencies Recruit DifferentOpioid Receptors Used a specific antagonist for the three types ofopioid receptors 2-Hz stimulation releases endorphins andenkephalins; mediated by mu and delta receptor 100-Hz stimulation releases dynorphins;mediated by kappa receptorsHan JS. Acupuncture: neuropeptide release produced by electricalstimulation of different frequencies. Trends Neurosci. 2003;26:17–22.Functional Magnetic ResonanceImaging (fMRI) shows EA-inducedAnalgesia by 2- or 100-Hz EA stim Magnitude of acupuncture-induced BOLDsignal change observed in identified brain areawith the magnitude of the analgesic effect The results showed that the analgesic effectinduced by low and high frequencies seems tobe mediated by different, though partiallyoverlapping brain networksZhang WT, Jin Z, Cui GH, et al. Relations between brain network activation and analgesiceffect induced by low versus high frequency electrical acupoint stimulation in differentsubjects: a functional magnetic resonance imaging study. Brain Res. 2003;982:168–78.Neuromodulation (continued) Conversely, 2-Hz EA induces the release of ᵦendorphin in the brain and enkephalin in thewhole central nervous system After the destruction of the arcuate nucleus ofthe hypothalamus (where ᵦ-endorphin neuronsaggregated), 2-Hz EA would no longer elicitanalgesia Neither low- nor high-frequency EA would workif a lesion is placed at the periaqueductal gray(PAG) of the midbrainHan JS, Wang Q. Mobilization of specific neuropeptides by peripheralstimulation of identified frequencies. News Physiol Sci. 1992;7:176–80.Serotonin in the CNS PlaysImportant Role inAcupuncture Analgesia The role played by central 5-hydroxytryptamine (5-HT)has been studied in rats with the tail-flick response Increase of availability of 5-HT in brain or spinal cordpotentiated acupuncture analgesia Whereas blockade of 5-HT synthesis or receptoractivation resulted in a significant decrease of theanalgesic effectHan JS, Chou PH, Lu CH, et al. The role of central 5-HT in acupuncture analgesia. Sci Sin.1979;22:91–104.19
Acupuncture is shown byEvidence-Based Medicine tobe Cost Effective Postoperative painNausea and vomitingAnxiolysisLack of clinical toxicityTEAS Device Decreases PostoperativePain Transcutaneous Electrical Acupoint Stimulation (TEAS)to assess if it can reduce the postoperative PCArequirement for hydromorphone (HM) Dr. Paul White’s group single-blind controlled study,first of many using specific device Compared to the blank control of “PCA only” group:‒ The HM used in the sham TEAS group showed a 22%reduction‒ For the real TEAS group, they used two levels ofintensity, the threshold level (4–5 mA) and doublethreshold level (9–12 mA), resulting in a 34% ( P 0.05) and 65% ( P 0.001)reduction, respectively Postoperative side effects significantly reducedWhite PF. Use of alternative medical therapies in the perioperative period: is ittime to get on board? Anesth Analg 2007;104:251–4.PC-6 Neiguan translated asInner Gate Location: On the palmar aspect of the forearm, 2 cunabove the transverse crease of the wrist, between thetendons of m. palmaris longus and m. flexor carpi radialisWang BG, Tang J, White PF, et al. Effect of the intensity of transcutaneousacupoint electrical stimulation on the postoperative analgesic requirement.Anesth Analg. 1997;85:406–13.Postoperative Nausea and Vomiting For 3,347 postoperative subjects in 26trials, acupuncture point PC-6 was found tobe very effective in reducing nausea andvomiting postoperatively Manipulating the needles, either manuallyor by electronic stimulation, can enhancethe effectsLee, A, Done, ML. “Stimulation of the wrist acupuncture point P6 for preventingpostoperative nausea and vomiting.” Cochrane Database System Review. 17. CD003281,2004. Update in: Cochrane Database System Review. (2): CD003281, 2009.20
Evidence Supports Ear AcupunctureEffectivenessAmelioratingWithdrawal andCravingSymptomsSAMHSA Publishes TIP 45 ManualRecommending Ear AcupunctureSAMHSA, of the U.S.Department of Health andHuman ServicesPublication Date: a/File:Papierosa 1 ubt 0069.jpeghttps://en.wikipedia.org/wiki/Fast food#/media/File:Fast food ia/File:Smoking mmons/3/34/Opioid Pills.svghttps://en.wikipedia.org/wiki/Alcoholic drink#/media/File:Common alcoholic 5-4131National Acupuncture Detoxification AssociationProtocol Summary (Lincoln Hospital, NY)(1) Clinicians use three to fiveear acupuncture points(2) Treatment is provided in agroup setting for 40–45 min(3) Acupuncture treatment isintegrated with conventionalelements of psychosocialrehabilitationAuthor: Genusfotografen (Tomas Gunnarsson) /Wikimedia Sverige (CC BY-SA 4.0)Source: Johnson, B. A. (Ed.). (2011). Addiction Medicine. doi:10.1007/978-1-4419-0338-921
Source: Source: How to Decide whichAcupoints? History and Physical‒ Tongue Diagnosis‒ Pulse Diagnosis Different combinations of points andmeridians can treat different diseases Acupuncture points are the locations alongeach of the specific meridians used forneedle insertionCategories of TCM Diagnosis Yin and YangHot and ColdExterior and InteriorDeficiency and CongestionComprehensive Training Course on Acupuncture for Physicians – Academy ofPain Research22
Tongue Areas Tongue related to bothmeridians and the internalorgans Important during inspection forconfirming TCM diagnosis Can present strong visualindicators of a person's overallhealthAuthor: Mahdiabbasinv (CC BY-SA 4.0)Source: https://wellcomecollection.orgPulse Diagnosis ( 28 types) on theLateral Wrist Detects the Energy andBlood of an Internal Organ Middle finger at eminent head ofradius and other 2 fingers areadjacent Separation of fingers depends onsize of the patient (greater iftaller), along the arteryAuthor: AcuMedic Ltd 2003 Fair UseAuthor: a Delhi painter. (Life time: Unknown)23
Pulse Quality- Choppy- Deep- Fast- Full- Hurried- Intermittent- Knotted- Short- Slippery- Slow- Superficial- Thin- Tight- Weak- WiryLimitations to Proving theEfficacy of Acupuncture Strict study protocol that cannot be variedfrom patient to patient Multiple cofounding medical problems Highly complex art Sham acupuncture that is effective Ineffective techniqueshttp://www.tcmstudent.com/study tools/Pulse%20Quality.htmlWhy is Acupuncture Able toTreat Different Disorders? Acupuncture RestoresHomeostasisAuthor: Pablo Carlos Budassi (CC BY-SA 4.0) Sophisticated regulatory mechanisms keep thebody in a biological balance in an everchanging environment Severe or prolonged deviation of the systembeyond the set points may lead the body intopathology Although the manifestations of diseases aredifferent, they often share similar hank YouSource: Needpix.com24
Channels that transfer blood and Qi (vital energy) throughout the body Connected with the surface and all the internal organs of the body Regulate yin and yang According to Chinese medical theory, illness arises when the cyclical flow of Qi in the
