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Acupuncture for pain.

Chinese medicine is at least 2000 years old. Although it had even older roots, in systems of body work, moxibustion, martial arts, qi gong and bloodletting, it was largely developed into the form we recognise today during the Han dynasty, which ran from 200 BCE to 200 CE.

The foundation text was written in that time and is known as the Huang Di Nei Jing' - usually translated as the 'Yellow Emperor's Canon' or 'Classic of Internal Medicine'. The first part of the two books of the Neijing' (the Su Wen) covers the theoretical foundation of Chinese Medicine and its diagnostic methods. The second part (the'Ling Shu) discusses acupuncture therapy in great detail.

The physiology and pathology described in this text were probably an amalgamation of many older theories. These have, in turn, been synthesised and modernised several times since, most notably during the Ming Dynasty (1400 to 1600s) and the middle of the 20th century during the cultural revolution in the People's Republic of China. This is the form we are familiar with in the West.

The physiology and pathology reflected the way the Chinese viewed the world. A central concept was the theory of yin and yang. The main representatives of yin and yang in the body are the qi and the blood. Qi is yang and blood is yin. In simple terms, life is sustained by the interaction between qi and blood. Qi represents observable movement and activity and blood is the nutritive, more material, basis of that activity. Their inter-dependence is nicely expressed in the phrase: The qi leads the blood and the blood nourishes the qi. The qi and blood are produced by the internal organs (known as the zang-fu) and circulated through the rest of the body via the meridian system. Herbal medicine works directly on the zangfu and acupuncture works directly on the circulation of qi and blood in the meridians. So the meridian system tends to be more important to the acupuncturist.

There are twelve main meridians. Each one is either yin or yang, and each corresponds to one of the internal organs and has its own points. Two of the secondary meridians also have their own points. The main meridians form a circuit and have internal branches that connect with their related internal organ and other associated tissues. Collateral meridians branch off the main meridians, carrying the qi and blood to every part of the body.

Acupuncture points

In theory, acupuncture is a way of influencing the circulation of qi and blood in the meridians. Acupuncture points are supposed to be places where this can be done most effectively. The points between the fingers and elbows and the toes and knees are those with the strongest systemic and internal effects - traditionally because this is the area where the polarity changes from yin to yang or vice versa. These are often called distal points. The other set of points with a strong internal effect is found 1.5 inches lateral to the spine at the interspinous spaces. These can act as local points for the organs.

Pain

Pain is seen largely in terms of a stagnation or blockage of qi and blood in the meridians. There are two broad types of pain - qi stagnation and blood stagnation.

Qi stagnation occurs when the body's ability to regulate qi and blood circulation is impaired. This can be external (e.g. wind) or internal (e.g liver qi stagnation). Treatment relies on distal points to regulate the circulation. Qi stagnation pain is variable: it moves around the body, is affected by stress and emotion and is usually less intense.

Blood stagnation is more fixed. It is very localised, can be stronger and is more associated with particular movements. Blood stagnation can often be treated locally with acupuncture. This type of treatment often relies on ah shi, or locally tender points. An anatomically based diagnosis is often an important advantage, allowing a more precise selection and needling of ah shi points.

Acupuncture needling

Once the location of the point to be needled has been determined, the needle, in its guide tube, is placed on the skin and the end of the needle is forcefully tapped, pushing it through the sensitive dermal layers. The tube is then removed and the needle guided towards the desired depth and direction. An essential component of needling in Chinese acupuncture is a particular sensation felt by the patient. This is called de qi and is a dull, spreading sensation, which is poorly localised. It is probably produced by the distortion of polymodal receptors on the free ends of C (Type IV) sensory fibres in the deeper connective and muscle tissues. It is often accompanied by characteristic tissue reactions detected through the needle by the practitioner.

Types of acupuncture treatment for pain

Many presenting musculoskeletal disorders can be treated using ah shi and local acupuncture points. These are very old, simple and effective treatments. Another approach is to needle distant tender reflex points. Ear acupuncture and the balance method are two common approaches. More complex treatments involve needling a combination of distal, local and ah shi points to treat both the location of the disorder and the root cause.

How does acupuncture work?

This a question often asked by patients. My reply usually goes like this: You know the weird ache (de qi) that you feel when the needle is inserted? That is like a stimulus. That stimulus goes into the central nervous system and provokes a response. That response is what we're after.'

This answer acknowledges that acupuncture is largely working on and through the nervous system. It doesn't work when the nervous system is damaged or its action has been blocked by specific drugs such as procaine in the local area, or naloxone, an opioid blocker, in the CNS. Although the stimulus is more or less the same wherever it is generated, the nature of the response very much depends on where it is generated. The response can be mediated through the somatic, autonomic, hormonal and immune systems. The effects are many:

* Reducing strain

Muscle - trigger points and general muscle tone

Fascia - fascia can have tone and chemical properties altered

* Improving tissue repair

Regulating inflammation Affecting blood flow through vasoconstriction and vasodilation

* Neuroplastic changes in spinal cord and brain can switch off or override central sensitisation to help chronic pain.

David Legge

Osteopath, acupuncturist, lecture, Woy Osteopathic Clinic
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Title Annotation:ARTICLE
Author:Legge, David
Publication:Journal of the Australian Traditional-Medicine Society
Article Type:Report
Date:Sep 22, 2017
Words:1067
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