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Point prescription and frequency of treatment
Point prescription and frequency of treatment
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Point prescription When selecting points to control postoperative pain, the point prescription should be formed as concisely as possible; for example, 6–10 points are selected to treat mild pain or persons of weak constitution. However, to treat severe postoperative pain, or pain with a complicated pathology, a wider prescription containing a greater number of points (e.g. 10–14 points, usually bilateral) can be used to produce a strong, intensive and effective stimulation. After a few initial treatments, points may be modified as the condition requires. Among the points selected, the following should normally be included, in the order presented.
1. Puncture at the related Source point and Connecting point, or Source point and Sea point Generally speaking, postoperative pain can be caused either by disorder of the channels or by disorder of the internal Zang-Fu organs, or a mixture of channels and internal Zang-Fu organs due to various causes. When there is only disorder of the channel with no deep involvement of the internal Zang-Fu organs, then the Source point and Connecting point are often selected with the reducing method so as to harmonise the collaterals, regulate the channels and promote the Qi and Blood circulation. When there is only disorder of the internal Zang-Fu organs, the Source point and Sea point are often selected, with the reinforcing method for Deficiency and the reducing method for Excess.
2. Puncture at the related Accumulation point with the reducing method Traditionally speaking, this type of point is often used to treat acute pain due to various causes; however, the Accumulation point also has the ability to control postoperative pain, either acute or chronic. The reducing method should be applied on this point to sedate the pain and promote the Qi and Blood circulation. Ah Shi points also play an important role during treatment at this time. Ah Shi points near the painful spots are more often applied for chronic postoperative pain than for acute pain because of local swelling, wound formation and oversensitivity of the skin to pain.
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general introduction
3. Puncture at the points to calm the Shen and benefit the Heart In fact, it is possible that this procedure could be applied first, just before the above two procedures. When postoperative pain occurs, the patient usually suffers from restlessness, emotional stress and insomnia, which are caused by restlessness of the Shen due to failure of the Heart to house the Shen. The Shen denotes the totality of a person’s life capacity at any given moment, both in health and disease. When the Shen is strong, the body, psyche and personality are in harmony, reflected by an alertness of emotional expression, conscious identification, presence of mind, good memory, bright eyes and a lustrous complexion. The Heart governs the Blood and Blood Vessels of the entire body and propels the Blood through the body. This continuous flow of Blood through the Vessels nurtures both the body and the limbs, and serves as a vehicle for communication. The Blood communes with each and every part, pervading all regions of the whole body. The Blood propelled from the Heart enfolds the Shen in order to maintain awareness, serving as the material matrix of the psyche. When the Heart fails to maintain its physiological functions, insufficiency of Blood supply to the four limbs and internal Zang-Fu organs, or stagnation of Blood in the Blood Vessels, may occur. This may lead to postoperative pain. Furthermore, since the Heart is the governor of all the Zang-Fu organs, disturbance of the Heart may subsequently impair the functions of other organs, resulting in aggravation of pain.
4. Puncture at the points to eliminate the causative factors If only the above points are selected without choosing points to eliminate the causative factors, the pain will only be relieved temporarily and superficially, which is not the core of acupuncture treatment. In order to relieve postoperative pain as completely as possible, the above points are used followed by selecting other points to eliminate the causative factors in order to dispel the External pathogenic factors, smooth the emotions, regulate the internal Zang-Fu organs, balance Yin and Yang, and restore the physiological functions of the body. The Five Shu points, Mother–Son points, Back Transporting points, Front Collecting points, Gathering points and Confluence points, as well as
Ch10-F10361.indd 70
Inducing points, are considered to be the points most likely to eliminate the causative factors.
Retaining and withdrawing of the needles Retaining ‘Retaining’ means to hold the needles in the body after they are inserted to a given depth below the skin. Pathological conditions determine needle retention and its duration. In general, the needles are retained for 15–20 minutes after the arrival of Qi to treat postoperative pain due to incomplete disappearance or new invasion of External pathogenic factors. However, for most postoperative pain, the needles are retained for an appropriately prolonged interval after the arrival of Qi: ●
●
●
For pain immediately after the operation, most patients require retention of the needles for 30–45 minutes each time For pain months or years after the operation, most patients require retention of the needles for 20–30 minutes each time For patients with a dull needling sensation, retaining the needles serves as a method to wait for Qi to come, which could last for 1–2 hours.
Before the stage of retaining the needles, arrival of Qi is of prime importance. In order to keep maintaining the arrival of Qi, manipulation of the needles during the retention period may be applied at intervals, usually every 5–10 minutes, in order to enhance the therapeutic effects. It must be borne in mind that when there is no arrival of Qi after insertion of the needles, or when no manipulation is applied during the treatment, even if an accurate diagnosis is established and a good prescription of points is formed, it will be impossible to achieve a good therapeutic result.
Withdrawing On withdrawing the needle, press the skin around the point with the thumb and index finger of the pressing hand, rotate the needle gently with an even and steady force to prevent it sticking and lift it slowly to the subcutaneous level. Then withdraw it quickly and press the punctured point with a dry cotton ball to prevent bleeding and infection.
11/4/06 9:47:27 AM
point prescription and frequency of treatment On withdrawing the needle, an extra technique can be used to assist the reinforcing or reducing effect. Shake the needle to enlarge the acupuncture hole and allow the pathogenic factors to escape, then withdraw the needle slowly and leave the hole open; this is the reducing method. Conversely, withdraw the needle quickly and press the hole with a dry cotton ball to prevent the Qi from escaping; this is the reinforcing method. Withdrawing the needle forcefully is prohibited. If there is excessive bleeding, even during the reducing treatment, it is necessary to stop the bleeding at the point. When there is haematoma, cotton balls should be used to press it to stop bleeding into the muscle and diminish the swelling.
Frequency of treatment Recommended frequencies of treatment and rest intervals are different for patients with pain immediately after the operation and those with pain afterward. For pain immediately after the operation, most patients require treatment once a day, or more than one
Ch10-F10361.indd 71
71
treatment in a single day if this is possible. When the pain is stabilised, it can then be treated once every 3–4 days, or once a week. For pain months or years after the operation, most patients require treatment once a week. When the pain is stabilised or greatly diminished, it is then treated once every 1–4 weeks. Each acupuncture point has its own distinctive characteristics, yet those on the same channel or in the same locality have certain effects in common. It is not advisable to needle the same points too many times in the same treatment session as the efficacy of these points will diminish. Rather, other points with similar characteristics should be substituted, or a similar prescription made up of different points should be used instead. When treating the patient for the first time, especially a nervous one, the practitioner should needle fewer points, increasing the number in later treatments when the patient is more accustomed to acupuncture. After receiving acupuncture treatment for a period of weeks, treatment should be suspended temporarily, usually for 1–2 weeks, to rest the body.
11/4/06 9:47:28 AM
10
Point prescription When selecting points to control postoperative pain, the point prescription should be formed as concisely as possible; for example, 6–10 points are selected to treat mild pain or persons of weak constitution. However, to treat severe postoperative pain, or pain with a complicated pathology, a wider prescription containing a greater number of points (e.g. 10–14 points, usually bilateral) can be used to produce a strong, intensive and effective stimulation. After a few initial treatments, points may be modified as the condition requires. Among the points selected, the following should normally be included, in the order presented.
1. Puncture at the related Source point and Connecting point, or Source point and Sea point Generally speaking, postoperative pain can be caused either by disorder of the channels or by disorder of the internal Zang-Fu organs, or a mixture of channels and internal Zang-Fu organs due to various causes. When there is only disorder of the channel with no deep involvement of the internal Zang-Fu organs, then the Source point and Connecting point are often selected with the reducing method so as to harmonise the collaterals, regulate the channels and promote the Qi and Blood circulation. When there is only disorder of the internal Zang-Fu organs, the Source point and Sea point are often selected, with the reinforcing method for Deficiency and the reducing method for Excess.
2. Puncture at the related Accumulation point with the reducing method Traditionally speaking, this type of point is often used to treat acute pain due to various causes; however, the Accumulation point also has the ability to control postoperative pain, either acute or chronic. The reducing method should be applied on this point to sedate the pain and promote the Qi and Blood circulation. Ah Shi points also play an important role during treatment at this time. Ah Shi points near the painful spots are more often applied for chronic postoperative pain than for acute pain because of local swelling, wound formation and oversensitivity of the skin to pain.
69
Ch10-F10361.indd 69
11/4/06 9:47:26 AM
70
general introduction
3. Puncture at the points to calm the Shen and benefit the Heart In fact, it is possible that this procedure could be applied first, just before the above two procedures. When postoperative pain occurs, the patient usually suffers from restlessness, emotional stress and insomnia, which are caused by restlessness of the Shen due to failure of the Heart to house the Shen. The Shen denotes the totality of a person’s life capacity at any given moment, both in health and disease. When the Shen is strong, the body, psyche and personality are in harmony, reflected by an alertness of emotional expression, conscious identification, presence of mind, good memory, bright eyes and a lustrous complexion. The Heart governs the Blood and Blood Vessels of the entire body and propels the Blood through the body. This continuous flow of Blood through the Vessels nurtures both the body and the limbs, and serves as a vehicle for communication. The Blood communes with each and every part, pervading all regions of the whole body. The Blood propelled from the Heart enfolds the Shen in order to maintain awareness, serving as the material matrix of the psyche. When the Heart fails to maintain its physiological functions, insufficiency of Blood supply to the four limbs and internal Zang-Fu organs, or stagnation of Blood in the Blood Vessels, may occur. This may lead to postoperative pain. Furthermore, since the Heart is the governor of all the Zang-Fu organs, disturbance of the Heart may subsequently impair the functions of other organs, resulting in aggravation of pain.
4. Puncture at the points to eliminate the causative factors If only the above points are selected without choosing points to eliminate the causative factors, the pain will only be relieved temporarily and superficially, which is not the core of acupuncture treatment. In order to relieve postoperative pain as completely as possible, the above points are used followed by selecting other points to eliminate the causative factors in order to dispel the External pathogenic factors, smooth the emotions, regulate the internal Zang-Fu organs, balance Yin and Yang, and restore the physiological functions of the body. The Five Shu points, Mother–Son points, Back Transporting points, Front Collecting points, Gathering points and Confluence points, as well as
Ch10-F10361.indd 70
Inducing points, are considered to be the points most likely to eliminate the causative factors.
Retaining and withdrawing of the needles Retaining ‘Retaining’ means to hold the needles in the body after they are inserted to a given depth below the skin. Pathological conditions determine needle retention and its duration. In general, the needles are retained for 15–20 minutes after the arrival of Qi to treat postoperative pain due to incomplete disappearance or new invasion of External pathogenic factors. However, for most postoperative pain, the needles are retained for an appropriately prolonged interval after the arrival of Qi: ●
●
●
For pain immediately after the operation, most patients require retention of the needles for 30–45 minutes each time For pain months or years after the operation, most patients require retention of the needles for 20–30 minutes each time For patients with a dull needling sensation, retaining the needles serves as a method to wait for Qi to come, which could last for 1–2 hours.
Before the stage of retaining the needles, arrival of Qi is of prime importance. In order to keep maintaining the arrival of Qi, manipulation of the needles during the retention period may be applied at intervals, usually every 5–10 minutes, in order to enhance the therapeutic effects. It must be borne in mind that when there is no arrival of Qi after insertion of the needles, or when no manipulation is applied during the treatment, even if an accurate diagnosis is established and a good prescription of points is formed, it will be impossible to achieve a good therapeutic result.
Withdrawing On withdrawing the needle, press the skin around the point with the thumb and index finger of the pressing hand, rotate the needle gently with an even and steady force to prevent it sticking and lift it slowly to the subcutaneous level. Then withdraw it quickly and press the punctured point with a dry cotton ball to prevent bleeding and infection.
11/4/06 9:47:27 AM
point prescription and frequency of treatment On withdrawing the needle, an extra technique can be used to assist the reinforcing or reducing effect. Shake the needle to enlarge the acupuncture hole and allow the pathogenic factors to escape, then withdraw the needle slowly and leave the hole open; this is the reducing method. Conversely, withdraw the needle quickly and press the hole with a dry cotton ball to prevent the Qi from escaping; this is the reinforcing method. Withdrawing the needle forcefully is prohibited. If there is excessive bleeding, even during the reducing treatment, it is necessary to stop the bleeding at the point. When there is haematoma, cotton balls should be used to press it to stop bleeding into the muscle and diminish the swelling.
Frequency of treatment Recommended frequencies of treatment and rest intervals are different for patients with pain immediately after the operation and those with pain afterward. For pain immediately after the operation, most patients require treatment once a day, or more than one
Ch10-F10361.indd 71
71
treatment in a single day if this is possible. When the pain is stabilised, it can then be treated once every 3–4 days, or once a week. For pain months or years after the operation, most patients require treatment once a week. When the pain is stabilised or greatly diminished, it is then treated once every 1–4 weeks. Each acupuncture point has its own distinctive characteristics, yet those on the same channel or in the same locality have certain effects in common. It is not advisable to needle the same points too many times in the same treatment session as the efficacy of these points will diminish. Rather, other points with similar characteristics should be substituted, or a similar prescription made up of different points should be used instead. When treating the patient for the first time, especially a nervous one, the practitioner should needle fewer points, increasing the number in later treatments when the patient is more accustomed to acupuncture. After receiving acupuncture treatment for a period of weeks, treatment should be suspended temporarily, usually for 1–2 weeks, to rest the body.
11/4/06 9:47:28 AM