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What is acupuncture?
What is acupuncture? David Tai How acupuncture works is one of the unsolved mysteries of the world.This paper will explore two questions: what is acupuncture? What is important in training, practising, and evaluating the uses and benef|ts of acupuncture? # 2002 Elsevier Science Ltd. All rights reserved.
INTRODUCTION
David Tai 71 Arthur Street, Randwick, NSW 2031, Australia Tel.:+61 9398 8168 Correspondence to: Professor M. Colleen Stainton, Centre for Women’s Health Nursing, Royal Hospital for Women, Locked Bag 2000, Randwick, NSW 2031, Australia.Tel.: +61 9382 6740; Fax: +61 9382 6758; E-mail: [email protected]. gov.au
Acupuncture treatment involves the insertion of fine needles into specific points of the human body. The acupuncture needle is the tool used by the acupuncturist. The result is dependent upon knowledge of the human body and skill in using the tools. Over many centuries in history, alternative medicine has come and gone, yet acupuncture has always continued to grow and has extended from China into the world. The fascinating philosophy and magical results of the treatments have always surprised those who come into contact with it. In many instances, an acupuncturist uses fine needles the way a surgeon uses a scalpel. They enter the body in a specific place for a particular reason. The acupuncturist will examine an inflammatory lump, using one hand to locate and stabilise the lump, then insert the needle precisely into the tendon sheath of the lump and break the fluid out of it. The result of the ‘operation’ is only minor trauma to the body, allowing the body to recover rapidly without scar tissue forming in the local region. Acupuncture treatment is focused on the prevention of both mental and physical illness. In ancient Chinese medicine, it was deemed very important to understand an illness before symptoms occurred. If illness was evident, then early diagnosis and prompt treatment were important to shorten the duration of the illness and to limit the degree of disability. Acupuncture has been practised over many centuries, with clinical experiences proving that it can be used to treat a wide range of illness and disorders such as stress, lower back pain and spinal cord injuries. Repeat analysis and research, combined with history and past clinical experiences have allowed acupuncture to be reliable and easier to learn.
Acupuncture is a natural treatment which follows the laws of nature. In general, for acute and simple disorders, little treatment may be necessary. For chronic and more complicated disorders, extra treatment may be required. However, a person who receives regular acupuncture treatment for preventative medicine can attain and maintain good health. In recent years, ultrasonography, computer tomography and magnetic resonance imaging (MRI) have been used to diagnose pathological conditions in the muscular skeletal system, such as rotator cuff tendonitis and compressive neuropathies (Beltram 1999). These diagnostic methods provide possibilities for acupuncture research and education as the response to the insertion of a needle into pathological points can be viewed objectively. When a needle is inserted into these points, the pain syndrome caused by inflammation can be removed immediately, the disorders can be corrected, and the lump compression on the neurovascular pathway avoided. The acupuncture needle is a tool. In clinical practice, acupuncture treatment requires the practitioner to have knowledge of medicine combined with knowledge of several needle techniques in order to use the needle appropriately to cure various disorders. Research is needed to be able to describe the techniques for variation in disorders so that teaching can be more precise and skill developed more quickly than the long apprenticeship method of China and the tendency to westernise acupuncture into short courses. The knowledge of medicine is based on general anatomy, physiology, pathophysiology and skill in clinical diagnosis. The practitioner’s practice of acupuncture must combine this knowledge with the perspective of Chinese medicine. History must inform and influence contemporary acupuncture.
ComplementaryTherapies in Nursing & Midwifery (2002) 8, 155^159 # 2002 Elsevier Science Ltd. All rights reserved. doi:10.1054/ctnm.2002.0633, available online at http://www.idealibrary.com on
156
ComplementaryTherapies in Nursing & Midwifery
CHINESE MEDICINE In Chinese medicine, traditionally the texts and practitioners of acupuncture subscribe to the belief that an acupuncture needle inserted into the acupuncture point and manipulated to the correct depth and in the right direction can regulate the flow of ‘Qi’ within the meridian throughout the body. This technique is used to strengthen the body and treat disorders. Many centuries later, the questions that remain unanswered are the same: What is Qi? What is a meridian? The answers remain elusive and other schools of thought have emerged (McDonald, 2000).
ACUPUNCTURE POINTS AND BODY STRUCTURE Acupuncture as a treatment began with the discovery of acupuncture points. Skilled acupuncture practice, therefore, begins with learning the acupuncture points. In A Comprehensive Guide to Clinical Applications of Acupuncture, (Tai 1997), Tai uses the science of anatomy to locate 670 acupuncture points for both sides of the 14 meridians. It is important for practitioners to learn and become skilled in understanding the relationship of body structure and the use of acupuncture. There are important interrelationships between acupuncture points, body structure and the healing processes.
Traumatic lesions and body response
K
K
K
K
K
Traumatic factors can injure any part of the body. Any lesion point is always an acupuncture point. The following are several important considerations about acupuncture points and trauma to guide the understanding of this ancient practice. K All the acupuncture points are located on or connected to the skin and connective tissue. The needle is inserted through the skin and connective tissue to search for the desired point. The desired point is where the illness is located. K Most of the acupuncture points are located on the side of the muscles. Structurally, the muscles are the driving force of the body; thus they will have more risks of traumatic lesions. The traumatic lesion to the muscle frequently occurs at the origin, insertion and the belly of the muscle or at the point where two or three muscles meet. All of these points are acupuncture points. K The lesion of the musculature can cause acute or chronic inflammation, tissue adhesion, musculature contraction, poor
K
circulation into the muscle causing fatigue, etc. The needle technique is to break the inflammatory factor, remove the adhesive tissue, improve the blood circulation in muscles, etc. The main function of the joints is to provide a stable union and/or a free range of movement. A traumatic lesion of the joint, particularly when it restricts the movement of the joint causes severe disorder in the support and movement system of the body. There are several acupuncture points located where the tendons and ligaments are attached to the joint or the skin and connective tissue, including the tendon sheath, bursa and fascia. Disorders of the joints frequently cause inflammation such as bursitis or tendonitis, or restriction of the movement of the joint. The needle technique is designed to remove the inflammatory factor and the tissue adhesion, thus allowing the joint freedom of movement. The function of bone is to give support and protection. Bony tissue is normally organised into units of definite shape and form. In clinical practice, the deformity of bone structure is frequently used for diagnosis and/or observation of disorders, particularly, when incorrect body posture has compressed the spinal nerve or blood vessel causing a pain syndrome. After injury, in most cases incorrect body posture or deformity of the bone structure causes the pain syndrome. To relieve the pain syndrome in this condition, acupuncture should correct this condition of deformity. In this instance, the needle technique needed may be more complicated. It is involved with the relationship between muscles, joints and bone. In many cases, the acupuncture needle is inserted into the periosteum to correct this condition. The relationship between muscles, joints and bones is always carefully considered in acupuncture diagnosis and treatment. In acupuncture, the muscle is seen as a driving force, the joint as a fulcrum and the bone as a level. A disorder may be revealed in one of these three, and ultimately may involve all three. The obvious and final result may be the pain syndrome caused by compression of the neurovascular pathway.
Normal sensation spots in the body and sensation spots caused by neurological disorders According to the principles of ‘Nei-Jing’, ‘wherever there is a sensation spot, there is an
What is Acupuncture?
acupuncture point’ (500–300 BC). There are numerous normal sensation spots in the human body. Neurologists use sensation spots such as skin receptors, muscles spindle, Golgi tendon organ, reflex arcs, etc. for neurological tests. In acupuncture, a needle is directly inserted into these sensation spots to treat many neurological disorders. Most of the disorders of the support and movement system are frequently caused by neurological defects such as pain syndrome, loss of skin sensation and musculature movement. Thus, the diagnosis and treatment with acupuncture must follow this correlative neuroanatomy knowledge.
Example of dermatomes and re£exes When a sensory receptor is stimulated, a nerve impulse travels along an afferent neuron to the spinal cord. At the spinal cord, the associated neuron carries the impulse to a muscle, which contracts and moves a body part. The segmental spinal reflex involves the afferent neuron and a motor unit at the same level. The motor unit may become excited by one of the afferent neurons. When any one section of the simple reflex arc is damaged, there will be no response to external stimulation unless the reflex arc is rebuilt. It is important for a practitioner to have an understanding of a dermatome and the reflex arc: K A dermatome is a region of the body wall that is supplied by a single pair of dorsal root ganglia. The dermatome map is used for detecting the level and extent of sensory defects resulting from segmental nerve or spinal cord damage. K A reflex is an automatic stimulus–response mechanism known as the simple reflex arc. Traumatic force lesion to the body will, frequently, cause a lesion in the skin, muscle, tendon, ligament, joint and bone to include internal organs such as spinal nerves, blood vessels, spinal cord or lungs, etc. In many instances, inadequate healing wound will interrupt the function of the spinal nerves and cause the pain syndrome. In a severe case, a traumatic force may cause a lesion of the spinal cord resulting in loss of skin sensation or muscle movement. Neurological testing will properly diagnose the condition. Acupuncture can use neuroanatomical knowledge to rebuild the neurological defects. The following principles apply for using acupuncture in these conditions: K The brain, spinal cord and spinal nerves, all control skin sensation and muscle movement. Spinal cord injury causes
157
functional paralysis of the limbs. Without or with loss of regular stimulation and/or loss of active and passive functioning of the skin and muscles, the skin and muscles of the paralysed limb will atrophy rapidly. In addition, this can create more lesions to the spinal cord and spinal nerves. K Acupuncture treatment uses needle insertion into skin receptors and muscle effectors. This preserves the still surviving skin and muscle function and provides active and passive skin and muscle movement and blood to nourish the tissue and improve the wound healing process, allowing the spinal cord and spinal nerves to regenerate and function. K Rebuilding the pathway from the brain, spinal cord and spinal nerves is an essential part of acupuncture treatment for spinal cord injury.
EXAMPLES OF ACUPUNCTURE IN DIAGNOSIS AND TREATMENT One of the main effects of acupuncture is relief of pain and improved function of the body. The following examples provide a perspective of how acupuncture can be used in the diagnosis and treatment of painful conditions of the body that are not uncommon in those working in midwifery or other areas of the health-care system.
Example I: dermatitis Microbiological factors or a lesion to the skin such as caused by latex or other products may cause dermatitis. Primarily, the skin lesion may begin from traumatic factors that cause inflammation, haematoma, tear the tendon or sprain the joint. In the case of inadequate management of the wound while healing, tissue adhesions and chronic inflammation of the skin may develop. In this instance, the local skin will lose blood supply and sensation. The lesion tissues and blood congestion will allow the microbiological factors to continuously multiply causing chronic inflammation. The acupuncturist uses needles to remove any pus on the top of a lesion. Then needles are inserted to relieve blood congestion, which is supplying nutrition to microbes in the lesion. The needle insertion technique also improves blood circulation that will permit the lesion tissue to heal properly.
Example II: biceps brachii tendonitis With this condition, there is always inflammation on one side of the origin of the biceps and tissue
158 ComplementaryTherapies in Nursing & Midwifery
adhesion on the other side of the origin of the biceps muscle. The acupuncture needle technique is to insert the needle into the lump of the inflammation site, and use the needle to cut off the tissue adhesion on the other side of the biceps. At the same time, the coordinate movement between the biceps and triceps muscles must be observed; frequently, the head of triceps that attaches to the scapula is always in chronic contraction. Needle insertion precisely into the point can cure the condition rapidly.
Example III: sciatica Sciatica refers to pain symptoms in the area of sciatic nerve distribution. It is largely the result of compression of the nerve root in the vertebral column. In severe cases, prolapse of the intervertebral disc will result. Irritation of the sciatic nerve can be caused by compression of the fourth and fifth lumbar and first sacral nerve roots. This will cause pain, which extends from the posterior aspect of the thigh to the posterior and anterolateral aspects of the leg and into the foot. The perspective of acupuncture of the cause of sciatica may include intervertebral disc (joint), the column of vertebrae (bone) and the muscles that attach to the vertebral columns. The loss of equilibrium of the muscle will overstretch the vertebrae to an incorrect position. The result may cause disc prolapse and/or compress the sciatic nerve tissue; pain syndrome of the sciatic may also occur. The treatment of sciatica with acupuncture involves the following steps: first, to relieve the muscle spasm, and balance the coordinate muscle movement and next, to correct the position of the vertebrae. When the relationship between the muscle, joint and bone are in harmonious movement, the pain syndrome will be relieved.
Current acupuncture literature and general clinical practice focuses on providing treatment through external tissues. In modern clinical practice, there are only a few instances where needles are inserted into the internal organs. For example, if gallstones are present, needle insertion into the tube, which is in spasm, can release the spasm and the stones will drop down into the intestine. This will immediately relieve the pain symptoms. Another example is insertion of a needle into an inflamed tonsil, which will immediately relieve pain and remove the cause of the inflammation. Treatment can be very effective if needles are inserted into the points located on external tissues before pathological change of the internal organ has occurred. If pathological change of the internal organ has already occurred in the internal organ, the result of the treatment will be poor, unless the needle is inserted precisely into the point where damage is already apparent. Knowledge of anatomy and clinical diagnostic method is important, in order to use the needle correctly and be able to insert the needle accurately into the abnormal organ. Traditional Chinese medicine is based on the principle of preventative medicine and utilised in this context. The following passage has been translated from Huang-Di Nei-Jing (500–300 BC): 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. To administer medicines for diseases which had already developed is comparable to 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 be too late? (Veith, 1949).
Integrating acupuncture into health care Acupuncture and internal organs In general, an acupuncture point may reveal a local tissue disorder transferred from an internal organ or from the other side of the body or from a normal sensitive spot on the body tissue. When a needle is inserted into an acupuncture point, the result can be felt in the local tissue, the other side of the body or the internal organ. Needle insertion can correct disorders and strengthen the body. In ancient Chinese acupuncture practice, needle insertion was not limited only to the skin or external tissues. The needle was inserted through the skin and connective tissue until it reached the target point. The target is the original cause of the disorder and can be located either in the external tissue or in the internal organs. Practitioners who understood correct needle sterilisation and insertion techniques were able to treat the internal organs.
Acupuncture treatment is one form of managing illness or disorders of the body. Obviously, acupuncture treatment is largely dependent on knowledge of anatomy, physiology and pathophysiology. Acupuncture needle techniques have been practised for many centuries. Skilful needle technique will allow the practitioners to achieve good outcomes from the treatment. Many researchers and acupuncturists attempt to explain how acupuncture works with a single theory such as Qi or stimulating the nerve tissues. It is generally believed that the way the ancient Chinese explain the Qi condition is too complicated for the student and the clinical practice of acupuncture. In clinical practice, it is not necessary to follow the Qi explanation. A new textbook of acupuncture (Tai 2000) informs the student and the practitioners of the knowledge required, particularly, acupuncture treat-
What is Acupuncture?
ment of the disorders in the field of support and movement system. Modern acupuncture requires a change in understanding of acupuncture to get beyond the Chinese – only explanation of Qi. Modern acupuncture needs to incorporate scientific principles and rigorous research so that acupuncture can be properly incorporated into the treatment plan for appropriate conditions. In reviewing acupuncture history, McDonald (2000) refers to two schools of thought of acupuncture theory and practice that must be understood in integrating acupuncture into current health-care practices and systems. Integrating acupuncture appropriately is important so that people can be helped to heal more quickly and more completely. ACKNOWLEDGEMENTS
159 Women’s Health Nursing at the Royal Hospital for Women, Randwick in the preparation of this paper for publication is very much appreciated.
REFERENCES Beltram J 1999 Magnetic resonance imaging. In: Spirak JM, Di Cesare PE, Feldman DS, Koval KJ, Robete AS, Zuckerman JD (eds) Orthopaedics – a study guide. McGraw-Hill, Sydney (Chapter 32) Jing HDN 500–300 BC The Yellow Emperor’s classic of internal medicine. China McDonald J 2000 The relevance of acupuncture history to clinical practice and research. Pacific Journal of Oriental Medicine 16: 34–37 Tai D 1997 Acupuncture – a comprehensive guide to clinical applications of acupuncture. Hippo Books, Sydney Veith I 1949 The Yellow Emperor’s classic of internal medicine (translated). First University of California Press, USA
The assistance of University of Sydney Professor Colleen Stainton, Chair of Women’s Health Nursing, Centre for
David Tai is a well-known Sydney acupuncturist. He graduated from Beijing University Western Medical School in 1960 and continued post-graduate study. In 1961, he became an assistant lecturer of pathophysiology at the Tientsin University Medical School where in 1963, he was transferred to the Tientsin Pathology Research Centre to conduct research on the cardiovascular system. During this time, he also studied Chinese medicine, in particular, acupuncture. He moved to Hong Kong in 1972, where he lectured at the Hong Kong Acupuncturist’s Federation and began to practice acupuncture. He settled in Australia in 1976, where he initially lectured at the Acupuncture Colleges (Australia) and set up his private clinic in Sydney. In 1987, Dr Tai published his first book, and he is working on another. He continues to explore and expand his knowledge and skills as a healer who uses acupuncture.
INTRODUCTION
David Tai 71 Arthur Street, Randwick, NSW 2031, Australia Tel.:+61 9398 8168 Correspondence to: Professor M. Colleen Stainton, Centre for Women’s Health Nursing, Royal Hospital for Women, Locked Bag 2000, Randwick, NSW 2031, Australia.Tel.: +61 9382 6740; Fax: +61 9382 6758; E-mail: [email protected]. gov.au
Acupuncture treatment involves the insertion of fine needles into specific points of the human body. The acupuncture needle is the tool used by the acupuncturist. The result is dependent upon knowledge of the human body and skill in using the tools. Over many centuries in history, alternative medicine has come and gone, yet acupuncture has always continued to grow and has extended from China into the world. The fascinating philosophy and magical results of the treatments have always surprised those who come into contact with it. In many instances, an acupuncturist uses fine needles the way a surgeon uses a scalpel. They enter the body in a specific place for a particular reason. The acupuncturist will examine an inflammatory lump, using one hand to locate and stabilise the lump, then insert the needle precisely into the tendon sheath of the lump and break the fluid out of it. The result of the ‘operation’ is only minor trauma to the body, allowing the body to recover rapidly without scar tissue forming in the local region. Acupuncture treatment is focused on the prevention of both mental and physical illness. In ancient Chinese medicine, it was deemed very important to understand an illness before symptoms occurred. If illness was evident, then early diagnosis and prompt treatment were important to shorten the duration of the illness and to limit the degree of disability. Acupuncture has been practised over many centuries, with clinical experiences proving that it can be used to treat a wide range of illness and disorders such as stress, lower back pain and spinal cord injuries. Repeat analysis and research, combined with history and past clinical experiences have allowed acupuncture to be reliable and easier to learn.
Acupuncture is a natural treatment which follows the laws of nature. In general, for acute and simple disorders, little treatment may be necessary. For chronic and more complicated disorders, extra treatment may be required. However, a person who receives regular acupuncture treatment for preventative medicine can attain and maintain good health. In recent years, ultrasonography, computer tomography and magnetic resonance imaging (MRI) have been used to diagnose pathological conditions in the muscular skeletal system, such as rotator cuff tendonitis and compressive neuropathies (Beltram 1999). These diagnostic methods provide possibilities for acupuncture research and education as the response to the insertion of a needle into pathological points can be viewed objectively. When a needle is inserted into these points, the pain syndrome caused by inflammation can be removed immediately, the disorders can be corrected, and the lump compression on the neurovascular pathway avoided. The acupuncture needle is a tool. In clinical practice, acupuncture treatment requires the practitioner to have knowledge of medicine combined with knowledge of several needle techniques in order to use the needle appropriately to cure various disorders. Research is needed to be able to describe the techniques for variation in disorders so that teaching can be more precise and skill developed more quickly than the long apprenticeship method of China and the tendency to westernise acupuncture into short courses. The knowledge of medicine is based on general anatomy, physiology, pathophysiology and skill in clinical diagnosis. The practitioner’s practice of acupuncture must combine this knowledge with the perspective of Chinese medicine. History must inform and influence contemporary acupuncture.
ComplementaryTherapies in Nursing & Midwifery (2002) 8, 155^159 # 2002 Elsevier Science Ltd. All rights reserved. doi:10.1054/ctnm.2002.0633, available online at http://www.idealibrary.com on
156
ComplementaryTherapies in Nursing & Midwifery
CHINESE MEDICINE In Chinese medicine, traditionally the texts and practitioners of acupuncture subscribe to the belief that an acupuncture needle inserted into the acupuncture point and manipulated to the correct depth and in the right direction can regulate the flow of ‘Qi’ within the meridian throughout the body. This technique is used to strengthen the body and treat disorders. Many centuries later, the questions that remain unanswered are the same: What is Qi? What is a meridian? The answers remain elusive and other schools of thought have emerged (McDonald, 2000).
ACUPUNCTURE POINTS AND BODY STRUCTURE Acupuncture as a treatment began with the discovery of acupuncture points. Skilled acupuncture practice, therefore, begins with learning the acupuncture points. In A Comprehensive Guide to Clinical Applications of Acupuncture, (Tai 1997), Tai uses the science of anatomy to locate 670 acupuncture points for both sides of the 14 meridians. It is important for practitioners to learn and become skilled in understanding the relationship of body structure and the use of acupuncture. There are important interrelationships between acupuncture points, body structure and the healing processes.
Traumatic lesions and body response
K
K
K
K
K
Traumatic factors can injure any part of the body. Any lesion point is always an acupuncture point. The following are several important considerations about acupuncture points and trauma to guide the understanding of this ancient practice. K All the acupuncture points are located on or connected to the skin and connective tissue. The needle is inserted through the skin and connective tissue to search for the desired point. The desired point is where the illness is located. K Most of the acupuncture points are located on the side of the muscles. Structurally, the muscles are the driving force of the body; thus they will have more risks of traumatic lesions. The traumatic lesion to the muscle frequently occurs at the origin, insertion and the belly of the muscle or at the point where two or three muscles meet. All of these points are acupuncture points. K The lesion of the musculature can cause acute or chronic inflammation, tissue adhesion, musculature contraction, poor
K
circulation into the muscle causing fatigue, etc. The needle technique is to break the inflammatory factor, remove the adhesive tissue, improve the blood circulation in muscles, etc. The main function of the joints is to provide a stable union and/or a free range of movement. A traumatic lesion of the joint, particularly when it restricts the movement of the joint causes severe disorder in the support and movement system of the body. There are several acupuncture points located where the tendons and ligaments are attached to the joint or the skin and connective tissue, including the tendon sheath, bursa and fascia. Disorders of the joints frequently cause inflammation such as bursitis or tendonitis, or restriction of the movement of the joint. The needle technique is designed to remove the inflammatory factor and the tissue adhesion, thus allowing the joint freedom of movement. The function of bone is to give support and protection. Bony tissue is normally organised into units of definite shape and form. In clinical practice, the deformity of bone structure is frequently used for diagnosis and/or observation of disorders, particularly, when incorrect body posture has compressed the spinal nerve or blood vessel causing a pain syndrome. After injury, in most cases incorrect body posture or deformity of the bone structure causes the pain syndrome. To relieve the pain syndrome in this condition, acupuncture should correct this condition of deformity. In this instance, the needle technique needed may be more complicated. It is involved with the relationship between muscles, joints and bone. In many cases, the acupuncture needle is inserted into the periosteum to correct this condition. The relationship between muscles, joints and bones is always carefully considered in acupuncture diagnosis and treatment. In acupuncture, the muscle is seen as a driving force, the joint as a fulcrum and the bone as a level. A disorder may be revealed in one of these three, and ultimately may involve all three. The obvious and final result may be the pain syndrome caused by compression of the neurovascular pathway.
Normal sensation spots in the body and sensation spots caused by neurological disorders According to the principles of ‘Nei-Jing’, ‘wherever there is a sensation spot, there is an
What is Acupuncture?
acupuncture point’ (500–300 BC). There are numerous normal sensation spots in the human body. Neurologists use sensation spots such as skin receptors, muscles spindle, Golgi tendon organ, reflex arcs, etc. for neurological tests. In acupuncture, a needle is directly inserted into these sensation spots to treat many neurological disorders. Most of the disorders of the support and movement system are frequently caused by neurological defects such as pain syndrome, loss of skin sensation and musculature movement. Thus, the diagnosis and treatment with acupuncture must follow this correlative neuroanatomy knowledge.
Example of dermatomes and re£exes When a sensory receptor is stimulated, a nerve impulse travels along an afferent neuron to the spinal cord. At the spinal cord, the associated neuron carries the impulse to a muscle, which contracts and moves a body part. The segmental spinal reflex involves the afferent neuron and a motor unit at the same level. The motor unit may become excited by one of the afferent neurons. When any one section of the simple reflex arc is damaged, there will be no response to external stimulation unless the reflex arc is rebuilt. It is important for a practitioner to have an understanding of a dermatome and the reflex arc: K A dermatome is a region of the body wall that is supplied by a single pair of dorsal root ganglia. The dermatome map is used for detecting the level and extent of sensory defects resulting from segmental nerve or spinal cord damage. K A reflex is an automatic stimulus–response mechanism known as the simple reflex arc. Traumatic force lesion to the body will, frequently, cause a lesion in the skin, muscle, tendon, ligament, joint and bone to include internal organs such as spinal nerves, blood vessels, spinal cord or lungs, etc. In many instances, inadequate healing wound will interrupt the function of the spinal nerves and cause the pain syndrome. In a severe case, a traumatic force may cause a lesion of the spinal cord resulting in loss of skin sensation or muscle movement. Neurological testing will properly diagnose the condition. Acupuncture can use neuroanatomical knowledge to rebuild the neurological defects. The following principles apply for using acupuncture in these conditions: K The brain, spinal cord and spinal nerves, all control skin sensation and muscle movement. Spinal cord injury causes
157
functional paralysis of the limbs. Without or with loss of regular stimulation and/or loss of active and passive functioning of the skin and muscles, the skin and muscles of the paralysed limb will atrophy rapidly. In addition, this can create more lesions to the spinal cord and spinal nerves. K Acupuncture treatment uses needle insertion into skin receptors and muscle effectors. This preserves the still surviving skin and muscle function and provides active and passive skin and muscle movement and blood to nourish the tissue and improve the wound healing process, allowing the spinal cord and spinal nerves to regenerate and function. K Rebuilding the pathway from the brain, spinal cord and spinal nerves is an essential part of acupuncture treatment for spinal cord injury.
EXAMPLES OF ACUPUNCTURE IN DIAGNOSIS AND TREATMENT One of the main effects of acupuncture is relief of pain and improved function of the body. The following examples provide a perspective of how acupuncture can be used in the diagnosis and treatment of painful conditions of the body that are not uncommon in those working in midwifery or other areas of the health-care system.
Example I: dermatitis Microbiological factors or a lesion to the skin such as caused by latex or other products may cause dermatitis. Primarily, the skin lesion may begin from traumatic factors that cause inflammation, haematoma, tear the tendon or sprain the joint. In the case of inadequate management of the wound while healing, tissue adhesions and chronic inflammation of the skin may develop. In this instance, the local skin will lose blood supply and sensation. The lesion tissues and blood congestion will allow the microbiological factors to continuously multiply causing chronic inflammation. The acupuncturist uses needles to remove any pus on the top of a lesion. Then needles are inserted to relieve blood congestion, which is supplying nutrition to microbes in the lesion. The needle insertion technique also improves blood circulation that will permit the lesion tissue to heal properly.
Example II: biceps brachii tendonitis With this condition, there is always inflammation on one side of the origin of the biceps and tissue
158 ComplementaryTherapies in Nursing & Midwifery
adhesion on the other side of the origin of the biceps muscle. The acupuncture needle technique is to insert the needle into the lump of the inflammation site, and use the needle to cut off the tissue adhesion on the other side of the biceps. At the same time, the coordinate movement between the biceps and triceps muscles must be observed; frequently, the head of triceps that attaches to the scapula is always in chronic contraction. Needle insertion precisely into the point can cure the condition rapidly.
Example III: sciatica Sciatica refers to pain symptoms in the area of sciatic nerve distribution. It is largely the result of compression of the nerve root in the vertebral column. In severe cases, prolapse of the intervertebral disc will result. Irritation of the sciatic nerve can be caused by compression of the fourth and fifth lumbar and first sacral nerve roots. This will cause pain, which extends from the posterior aspect of the thigh to the posterior and anterolateral aspects of the leg and into the foot. The perspective of acupuncture of the cause of sciatica may include intervertebral disc (joint), the column of vertebrae (bone) and the muscles that attach to the vertebral columns. The loss of equilibrium of the muscle will overstretch the vertebrae to an incorrect position. The result may cause disc prolapse and/or compress the sciatic nerve tissue; pain syndrome of the sciatic may also occur. The treatment of sciatica with acupuncture involves the following steps: first, to relieve the muscle spasm, and balance the coordinate muscle movement and next, to correct the position of the vertebrae. When the relationship between the muscle, joint and bone are in harmonious movement, the pain syndrome will be relieved.
Current acupuncture literature and general clinical practice focuses on providing treatment through external tissues. In modern clinical practice, there are only a few instances where needles are inserted into the internal organs. For example, if gallstones are present, needle insertion into the tube, which is in spasm, can release the spasm and the stones will drop down into the intestine. This will immediately relieve the pain symptoms. Another example is insertion of a needle into an inflamed tonsil, which will immediately relieve pain and remove the cause of the inflammation. Treatment can be very effective if needles are inserted into the points located on external tissues before pathological change of the internal organ has occurred. If pathological change of the internal organ has already occurred in the internal organ, the result of the treatment will be poor, unless the needle is inserted precisely into the point where damage is already apparent. Knowledge of anatomy and clinical diagnostic method is important, in order to use the needle correctly and be able to insert the needle accurately into the abnormal organ. Traditional Chinese medicine is based on the principle of preventative medicine and utilised in this context. The following passage has been translated from Huang-Di Nei-Jing (500–300 BC): 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. To administer medicines for diseases which had already developed is comparable to 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 be too late? (Veith, 1949).
Integrating acupuncture into health care Acupuncture and internal organs In general, an acupuncture point may reveal a local tissue disorder transferred from an internal organ or from the other side of the body or from a normal sensitive spot on the body tissue. When a needle is inserted into an acupuncture point, the result can be felt in the local tissue, the other side of the body or the internal organ. Needle insertion can correct disorders and strengthen the body. In ancient Chinese acupuncture practice, needle insertion was not limited only to the skin or external tissues. The needle was inserted through the skin and connective tissue until it reached the target point. The target is the original cause of the disorder and can be located either in the external tissue or in the internal organs. Practitioners who understood correct needle sterilisation and insertion techniques were able to treat the internal organs.
Acupuncture treatment is one form of managing illness or disorders of the body. Obviously, acupuncture treatment is largely dependent on knowledge of anatomy, physiology and pathophysiology. Acupuncture needle techniques have been practised for many centuries. Skilful needle technique will allow the practitioners to achieve good outcomes from the treatment. Many researchers and acupuncturists attempt to explain how acupuncture works with a single theory such as Qi or stimulating the nerve tissues. It is generally believed that the way the ancient Chinese explain the Qi condition is too complicated for the student and the clinical practice of acupuncture. In clinical practice, it is not necessary to follow the Qi explanation. A new textbook of acupuncture (Tai 2000) informs the student and the practitioners of the knowledge required, particularly, acupuncture treat-
What is Acupuncture?
ment of the disorders in the field of support and movement system. Modern acupuncture requires a change in understanding of acupuncture to get beyond the Chinese – only explanation of Qi. Modern acupuncture needs to incorporate scientific principles and rigorous research so that acupuncture can be properly incorporated into the treatment plan for appropriate conditions. In reviewing acupuncture history, McDonald (2000) refers to two schools of thought of acupuncture theory and practice that must be understood in integrating acupuncture into current health-care practices and systems. Integrating acupuncture appropriately is important so that people can be helped to heal more quickly and more completely. ACKNOWLEDGEMENTS
159 Women’s Health Nursing at the Royal Hospital for Women, Randwick in the preparation of this paper for publication is very much appreciated.
REFERENCES Beltram J 1999 Magnetic resonance imaging. In: Spirak JM, Di Cesare PE, Feldman DS, Koval KJ, Robete AS, Zuckerman JD (eds) Orthopaedics – a study guide. McGraw-Hill, Sydney (Chapter 32) Jing HDN 500–300 BC The Yellow Emperor’s classic of internal medicine. China McDonald J 2000 The relevance of acupuncture history to clinical practice and research. Pacific Journal of Oriental Medicine 16: 34–37 Tai D 1997 Acupuncture – a comprehensive guide to clinical applications of acupuncture. Hippo Books, Sydney Veith I 1949 The Yellow Emperor’s classic of internal medicine (translated). First University of California Press, USA
The assistance of University of Sydney Professor Colleen Stainton, Chair of Women’s Health Nursing, Centre for
David Tai is a well-known Sydney acupuncturist. He graduated from Beijing University Western Medical School in 1960 and continued post-graduate study. In 1961, he became an assistant lecturer of pathophysiology at the Tientsin University Medical School where in 1963, he was transferred to the Tientsin Pathology Research Centre to conduct research on the cardiovascular system. During this time, he also studied Chinese medicine, in particular, acupuncture. He moved to Hong Kong in 1972, where he lectured at the Hong Kong Acupuncturist’s Federation and began to practice acupuncture. He settled in Australia in 1976, where he initially lectured at the Acupuncture Colleges (Australia) and set up his private clinic in Sydney. In 1987, Dr Tai published his first book, and he is working on another. He continues to explore and expand his knowledge and skills as a healer who uses acupuncture.