Introduction to Medical Acupuncture

Medical acupuncture in the United States includes both our understanding of anatomy as well as the classical Chinese concepts of a circulating vital called Qi (pronounced chee). Musculoskeletal problems are the disorders most frequently and successfully treated with acupuncture.  Acupuncture can the primary therapy or in addition to western medicine.  Tiny needles are placed in various locations and patterns. The choice of needle patterns can be based on traditional principles, or upon modern concepts, or based upon a combination of these two principles.

History And Development

Acupuncture’s popularity in the U.S. increased rapidly following James Reston's landmark New York Times article in 1971.  Dr. Reston described his own experience managing post-appendectomy pain with acupuncture.¹  The enthusiasm was also fueled by reports from other physicians visiting China.  These  Western doctors witnessed surgical procedures performed using only needles for analgesia. By the end of the 1970’s, the scientific basis was established as release of endogenous opioids called endorphins.  These substances are similar to narcotics and control he body’s pain. It is now clear that acupuncture can increase endorphin levels.

The earliest major written account regarding the practice of acupuncture is the Huang Di Nei Jing (Yellow Emperor's Inner Classic).  The Nan Jing (a classic text discussing difficult issues) was written in the first and second centuries, during the Han dynasty. The Zhen Jiu Jia Yi Jing (a comprehensive manual of acupuncture and moxibustion), which is attributed to Huang-Fu Mi in 282 AD and is devoted entirely to acupuncture and moxibustion. 

Between the Han dynasty (from 206 B.C. to 200 A.D.) and the Ming Dynasty (from 1368 to 1644 A.D.), acupuncture practice was refined.  The Zhen Jiu Da Cheng and published in 1601. It eventually became the most influential text for generations of acupuncturists in Asia and Europe.

There was a flurry of experimentation Europe in the 17^th, 18^th and 19^th centuries. This accelerated in the last decades of the 19^th century as it was brought to the United States.  In the early 20^th George Soulie de Morant, published a series of articles and French translations 1901 and 1917.  On returning to France, he taught acupuncture to hundreds of Western physicians. He popularized the terms "meridian and "energy."²

Principal Classical Concepts

The models of health, disease, and treatment are seen in terms of a patients' harmony  with the universe.  They involve one's responses to the five elemental forces of wind, heat, damp, dryness, and cold.  They address the internal emotions of anger, excitement, worry, sadness, and fear. Illnesses characterized by their yin and yang components  (interior or exterior, cold or hot, deficient or excessive), by their elemental qualities (wood, fire, earth, metal, and water), and by their influences on each organ system. The principal meridians are named for each one of the organ systems.

The theory of acupuncture involves twelve internal organs that interact to produce basic energy and blood from food, then mix in the energy with air and propel the energy through the blood and all of the body's organs and tissues. The organs are divided into six parenchymal, energy-producing organs (solid, yin), and six visceral, substance-transporting organs (hollow, yang). These organs are coupled paired (one yin and one yang) to make the three plates.

Principal Modern Concepts

Since the late 1970’s, acupuncture has been demonstrated to activate the endogenous opioid system and the body's perception of pain. Two model systems of acupuncture analgesia have been advanced.  There is an endorphin-dependent system which can be stimulated with the low-frequency, high-intensity electrical stimulation of acupuncture needles (two to four cycles per second) at certain meridians.  There is also a monoamine-dependent system stimulated by high-frequency, low-intensity electrical stimulation (seventy cycles per second or greater).  By combining the two models with other observations about the mechanism of acupuncture's impact, needles are seen as simultaneously activating multiple pain suppression pathways.

Treatment Design

Treatment involves redirecting the energy of the body. A simple strain or sprain may need nothing more than “dispersion” with needles around the area of pain. Musculoskeletal pain of long-standing duration may need multiple needles placed along a principal meridian to encourage energy a more normal flow of energy. Psychosomatic may respond to the needling of several front or back mu or sho points.

Patient visits are usually scheduled once weekly, although two or three visits each week are not uncommon, especially during the initial stages of an acute problem. When a favorable response lasts for the full week between visits, the interval is increased to two weeks. As the response stabilizes for a two-week period, the interval is increased again to three weeks, then four weeks, and so on.  Maintenance treatment every six weeks or more is often recommended, especially for chronic pain problems.³

Organization

In the United States, including California, acupuncture is performed by physicians as well as non-physician practitioners.  Many doctors specialize in acupuncture in China, much as American medical students might specialize in internal medicine or general surgery.

No national standard exists for the third-party insurance reimbursement for acupuncture though many policies treat acupuncture as a legitimate and reimbursable procedure. Because of the popular and professional demand for acupuncture services, it is likely that insurance reimbursement will become more common with time.

Adverse Effects of Acupuncture

In the hands of a medically trained practitioner, acupuncture is a safe and forgiving discipline. Many patients report a sensation of well-being or relaxation following an acupuncture treatment, especially if electrical stimulation has been used.

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