Chinese Acupuncture
Mel Drisko, MSTCM, L.Ac.
Distinguish between western biological rationale for
medical acupuncture and Chinese acupuncture.
Compare and contrast diagnostics and treatment
approach from a medical acupuncture vs. TCM
perspective.
Identify medical conditions treated with
acupuncture, and resources for referral & further
learning.
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The contents of this document are provided for informational purposes
only, to scientists, health care professionals and academics. Neither the
statements in this document nor statements made by the presenter
should be interpreted as providing medical advice, a physician-tophysician consultation, professional diagnosis, a medical or healthrelated opinion, treatment, or services to you or any other individual;
nor should they be interpreted as recommending any product, therapy,
or course of treatment.
Health care professionals are responsible for their own independent
treatment decisions relative to their patients. Not responsible or liable
for any advice, course of treatment, or diagnosis made by a health care
professional, nor for any course of action taken by an individual.
Chinese Medicine
• Oracular / Demonic
• Religious / quasi-religious
• Buddhist, Ayurvedic
• Pragmatic drug therapy
• Systematic correspondence
• Western bio-medicine
Unschuld, P.U., Medicine in China, A History of ideas. Univ of Calif Press 1985
3500 year history
Xia
Shang
Zhou
Han
Song Yuan
Greece
Ancient
Rome
Medieval
Ming Qing
Renaissance
Reason
History
2000 BC
200 BC
200 CE
900
1850
1955
• Shamanism
• Ancestors
• feng shui
Tao, L. Achievements of Chinese medicine in the Qin and Han Dynasties. Chinese
Medicine Journal, Vol. 71, No.5, 300-386, Sept-Oct1953.
Confucianism
Taoism
Systematic correspondence
Confucianism
Taoism
Systematic Correspondence
Everything in Universe is connected with everything else
Human body
Parts of the body
Organs
Animals
Plants
Minerals
Natural phenomena
Climate/weather
Musical notes
Numbers
Systematic Correspondence
•Belief in unity of nature
•Finest particles of matter as basis of life
•Certain characteristics of a united empire
•Yin Yang and the Five Phase theories
Unschuld, P.U., Medicine in China, A History of ideas. Univ of Calif Press 1985
Sky
yang
Human
taiji
Earth
yin
Yin
Structure
Contraction
Responsive
Quiescent
Conservation
Earth
Female
Cold
Moist
Yang
Function
Expansion
Aggressive
Dynamic
Destruction
Sky
Male
Hot
Dry
Five Phase - wu xing
Legge, James. The Chinese Classics, 5:531, Hong Kong 1960
Yin Yang combined with five phases in a systematic correspondence
Yang/yin
Yang/Yang
Phase
Wood
Fire
Season
Spring
Summer
Viscera
Liver
Heart
Spleen
Bowels
GB
SI
Stomach
Color
green
Flavor
sour
Orifice
Emotion
eyes
anger
Earth
late
Yin/yang
Yin/Yin
Metal
Water
Autumn
Winter
Lung
Kidney
LI
red
yellow
white
bitter
sweet
pungent
ears
nose
mouth
joy
sympathy
grief
UB
black
salty
sluices
fear
Evil - xie
xie gui , xie mo– evil demons
xie qi – unnatural trend or influence
Unhealthy influences
Environmental
Emotional stresses
Dietary
Exercise/leisure/overexertion
Trauma
Parasites and poisons
Wrong treatment
Wiseman and Feng. A Practical Dictionary of Chinese Medicine. Brookline, Mass,
1998.( ISBN 0-912111-54-2).
Qi
or
Chi
“Rising vapors”
“Rice”
“breath”, “vapors”, “gas”, “pneuma”
Wiseman and Feng. A Practical Dictionary of Chinese Medicine. Brookline, Mass,
1998.( ISBN 0-912111-54-2).
Edelstein, Ludwig. Ancient Medicine, pg. 116, Baltimore Press, 1967
History
2000 BC
200 BC
200 CE
900
1850
Classical Period:
Nei Jing
Shang Han Lun
Nan Jing
Zhen jiu jia yi jing
Tao, L. Achievements of Chinese medicine in the Qin and Han Dynasties.
Chinese Medicine Journal, Vol. 71, No.5, 300-386, Sept-Oct1953.
1955
History
2000 BC
200 BC
200 CE
900
1300
1850
Song-Jin-Yuan
Tao, L. Achievements of Chinese medicine in the Sui and Tang Dynasties.
Chinese Medicine Journal, Vol. 71, No.4, 801-820, July-Aug 1953.
1955
History
2000 BC
200 BC
200 CE
900
1300
1800
Ming
Tao, L. Achievements of Chinese medicine in the Sui and Tang Dynasties.
Chinese Medicine Journal, Vol. 71, No.4, 801-820, July-Aug 1953.
1955
History
2000 BC
Pre-modern Period:
200 BC
200 CE
900
1800
1950
History
2000 BC
Traditional Chinese
Medicine ( TCM )
200 BC
200 CE
900
1800
1950
Acupuncture
Origins
•6000 BC
•168 BC Ma Huang Di tombs
• 90 BC
• 100 CE
White, A. & Ernst, E. A brief history of acupuncture. Rheum 2004; 43:662-663.
Acupuncture Channels (jingmai, luomai, sunmai)
•Occur between “skin and flesh”
•Carry qi and blood
• Well, spring, stream, river, sea
• Limits in analgesic effects
Acupuncture Channels
12 paired channels
8 single channels
Extra points
Then
Now
Electro-acupuncture
Amulets
Geomancy
Exorcism
Oral spells
Bleeding
Massage-tuina
Moxa-cautery
Bathing-fuimigation
13 acupoints
Stone needles
TENS
Filiform needle
3 edge needle
7 star hammer
Intradermal needle
Massage/acupressure
Cupping/Moxibustion
Point injection therapy
Infrared
Laser
Over 400 acupoints
Prioreschi, Plinio. History of Medicine: Primitive and Ancient Medicine, Vol.1, 1996
TCM - physiology
• Three treasures: qi, shen, jing
• Vital substances:
Jing
Kd
qi
Lu
blood
Lv
fluids
Sp
• Organ correspondences
Lungs
Spleen
GB
Liver
Kidney
Heart
Skin
Pancreas
acupoints
qi, tendons
bones, reproductive
emotions
shen
Ht
TCM – pathology
Many patterns for one disease
Many diseases with the same pattern
TCM Diagnosis
• History, interview
• Observation (laboratory tests)
• Palpation, physical exam
• Pulse
Tao, L. Achievements of Chinese medicine in Ming Dynasties. Chinese Medicine
Journal, Vol. 76, No.2, 178-198, Feb 1958a.
Tongue Inspection
Kim, HB. Handbook of Oriental Medicine 5th Edition,AcupunctureMedia, p30
Kim, HB. Handbook of Oriental Medicine 5th Edition,AcupunctureMedia, p33
TCM Diagnostic and Treatment Sequence
1. Synthesis of signs and symptoms
2. Eight Principles
yin-yang
Interior-Exterior
Hot-Cold
Deficient – Excess
3. Disease “pattern” (bian zheng)
- qi and blood patterns
- organ patterns
- channel patterns
Zaslawki, C. Clinical Reasoning in traditional Chinese medicine: implications for
clinical research. Clinical Acupuncture and Oriental Medicine. Vol.4, No.2-3, 94101, 2003
TCM Diagnostic and Treatment Sequence
4. Root (ben) or branch (biao) manifestation
5. Diagnosis
6. Treatment Principle
Hogeboom CJ, Sherman KJ, Cherkin DC. Variation in diagnosis and treatment of chronic low
back pain by traditional Chinese medicine acupuncturists. Compl Ther Med. 2001; 9(3): 15466.
Zaslawki, C. Clinical Reasoning in traditional Chinese medicine: implications for clinical
research. Clinical Acupuncture and Oriental Medicine. Vol.4, No.2-3, 94-101, 2003
Numerous correspondences
but little to no causation.
Chronic Gastritis
Patient #1
SP damp heat
Patient #2
ST yin def.
Patient #3
SP yang def.
Patient #4
SP/ST cold damp
Patient #5
LV invading Sp
Patient #6
ST blood stasis
DW Zou, WH Chen, K Iwakiri, R. Rigda, M.Tippett and R.H. Holloway. Inhibition of transient lower
esophageal sphincter relaxations by electrical acupoint stimulation, American Journal of PhysiologyGastrointestinal and Liver Physiology, August 2006.
Primary Hypertension
Patient #1
Liver fire
Patient #2
Phlegm obstructing spleen
Patient #3
Liv/Kid yin deficiency
Patient #4
Kid yang deficiency
Flachskampf FA, Gallasch J, Gefeller O, Gan J, Mao J, Pfahlberg AB, Wortmann A,
Klinghammer L, Pflederer W, Werner GD. Randomized trial of acupuncture to lower blood
pressure. Circulation. 2007; 115: 3121–3129.
Western Psychiatric Disease with Chinese Equivalents
Senile dementia - feeblemindedness, impaired memory
Major depressive disorder – depression-agitation, Lillium syndrome,
plum-pit syndrome
Bipolar Affective disorder – frequent sorrow/ frequent joy
Anxiety disorder – fear & palpitations, panic throbbing
Post-partum depression - Liver/Heart blood deficiency
Premenstrual dysphoric disorder - liver qi not discharging
Perimenopausal syndrome – liver/kidney yin deficiency heat flaring
Chinese Medical Psychiatry: A textbook and clinical manual. Blue Poppy Press, Boulder,
Colorado, 2001.
Hollifield, M and Hammerschlag R. Acupuncture for Posttraumatic Stress Disorder
a randomized controlled Pilot Trial, J Nerv and Mental Dis, Vol 195, Number 6, June 2007
Treatment with Chinese Medicine
Acupuncture
TCM
Herbs
Qigong
Food Therapy
Moxa
(moxibustion)
Moxibustion for correction of breech presentation: A randomized controlled trial. JAMA 280 (18): 1580–1584.
1998-11-11
tui na
Huang K-Y, Xia H-M. Massage for treatment of lumbar disc herniation in 371 cases of efficacy. J Clin Acupunct
Moxibustion. 2010;3:019
Ping, Chen (ed). Chinese Tuina and Therapeutic Applications: Advanced TCM Series, Volume 7. Beijing:
Science Press, 1998: 72-91
Qi Gong
A Comprehensive Review of Health Benefits of Qigong and Tai Chi : Jahnke R., Larkey, L, Rogers C.
and Lin F. Am J Health Promot, 2010 JUL-AUG; 24(6): e1-e25.
Traditional Chinese Acupuncture
gua sha
Melzack R, Katz J. The Gate Control Theory: Reaching for the Brain, in: Craig KD and
Hadjistavrapolous T. Pain: Physiological Perspectives; Mahwah NJ, Lawrence Erlbaum
Assoc, Publishing 2004.
Pricking / Bleeding
Yang Haixia, Clinical application of blood-letting therapy, Journal of Traditional
Chinese Medicine 2002; 22 (1): 26-28.
Cupping
Treatment of Pain in Shoulder Scapular Region and Back by Moving Cupping: A Report of 60 Cases, Li Guisong,
Yuan Minghua, Ju Lijing, TCM Shanghai Journal of Acupuncture and Moxibustion, 4th edition, 1999
Peng C-Z, How C-K. Bullae secondary to prolonged cupping. Am J Med Sci. 2013;346(1) (July):65.
Risk and Harms with Acu/Moxa Therapies
Soreness
Organ injury
Infections
Bleeding disorders
Broken needles
Pacemaker
Pregnancy
Silicone reaction
Burns
Birch S, Alraek T, Norheim AJ. Acupuncture adverse events in China: a glimpse of historical and
contextual aspects. J Altern Complement Med. 2013;19(10) (October):845-850.
He W, Zhao X, Li Y, Xi Q, Guo Y. Adverse events following acupuncture: a systematic review of the
Chinese literature for the years 1956-2010. J Altern Complement Med. 2012;18(10) (October):892901.
Hon KL, Luk D, Leong K, Leung A. Cupping therapy May be Harmful for Eczema: a PubMed Search.
Case Rep Pediatr. 2013;605829 (Oct 27).
Peng C-Z, How C-K. Bullae secondary to prolonged cupping. Am J Med Sci. 2013;346(1)
(July):65.
Saw A, Kwan M, Sengupta S. Necrotizing fascititis: a life-threatening complication of acupuncture
in a patient iwth diabetes mellitus. Singapore Med J. 2004;45(48):180-2.
Seeley E, Chambers H. Diabetic Ketoacidosis Precipitated by Stapylococcus aureus Absecss and
Baceriemia Due to Acupuncture: Case Report and Review of the Literature. Clin Infect Dis.
2006;43 (May 23):e6-8.
Seong MH, Kil H, Kim YS et al. Clinical and epidemiological features of hepatitis C virus infection
in South Korea: a prospective, multicenter cohort study. J Med Virol. 2013;85(10) (October):17241733.
White A. A cumulative review of the range and incidence of significant adverse events associated with
acupuncture. Acupunct Med. 2004;22(3) (September):122-133.
Acupoint Selection
Local points
Distant and peripheral points
Constitutional points
Empirical points
Arm pain = Large intestine 11
Lower abdominal region = Spleen 6
Scapular region = Small Intestine 11
Upper GI = Stomach 36
Back of head and neck = Lu7
Face and mouth = LI4
Low back pain (acute) = UB40
Extra points
Opposite Puncture (muci or jiuci)
Fang et al. Clinical and experimental studies on analgesic effects of ipsilateral and contralateral
stimulation with EA. Chung-kuo chung his chien ho tan chi 1994. 14 (10) 579-582.
Needle manipulation
Needle manipulation
WHO Conditions treated with Acupuncture
• low back pain
• neck pain
• sciatica
• tennis elbow
• knee pain
• peri-arthritis of the shoulder
• sprains
• facial pain and tempromandibular (TMJ) dysfunction
• headache
• dental pain
• rheumatoid arthritis
• primary dysmenorrhea
• acute epigastralgia
Acupuncture: Review and Analysis of Reports on Controlled Clinical Trials
WHO Conditions treated with Acupuncture
• adverse reactions to radiation or chemotherapy
• Leucopenia
• induction of labor
• correction of malposition of fetus (breech presentation)
• morning sickness
• nausea and vomiting
• stroke
• Hypertension – essential
• allergic rhinitis, including hay fever
• depression (including depressive neurosis and depression following
stroke)
• peptic ulcer
• acute and chronic gastritis
Consensus statement
•Adult postoperative and chemotherapy nausea and
postoperative dental pain.
•Addiction, stroke rehabilitation
•headache, menstrual cramps, tennis elbow, fibromyalgia,
myofascial pain, osteoarthritis, low back pain, carpal
tunnel syndrome
• asthma
NIH Consensus Statement – Acupuncture. JAMA 998 Nov 4;280(17):1518-24.