¡¡
by Subhuti
Dharmananda, Ph.D., Director, Institute for Traditional Medicine,
Portland, Oregon
There
are two very different ways of looking at acupuncture: from the
traditional Chinese perspective and from the modern international
perspective. Each of these will be briefly described.
TRADITIONAL VIEW
The understanding of how acupuncture
works has evolved with its practice, but the descriptions set down a
thousand years ago have largely been retained. The dominant function of
acupuncture is to regulate the circulation of qi (vital energy) and
blood. Approximately 2,000 years ago, the pre-eminent acupuncture text,
Huangdi Neijing (Yellow Emperor¡¯s Classic on Internal
Medicine), was written. In it, acupuncture was described as a means of
letting out excess qi or blood by making holes in the body along certain
pathways, called jingluo (meridians). For some of these meridians,
it was advised to acupuncture in such a way as to let out the blood but
not the qi; for others, to let out the qi, but not the blood. Many
diseases were thought to enter the body through the skin, and then
penetrate inward through muscle, internal organs, and, if not cured in
timely fashion, to the marrow of the bone. By inserting a needle to the
appropriate depth¡ªto correspond with the degree of disease penetration¡ªthe
disease could be let out.
Prior
to the time when there were microscopes by which people could envision
individual cells and before autopsies revealed the intricate structures
within the body, doctors and scholars projected the internal workings of
the body from what they could actually experience, which was the world
outside the body. On this basis, the workings of the body were described
in terms similar to those used to describe the visible world. One of the
critical aspects of nature for humans living a thousand years ago, when
Chinese civilization was well developed, was the system of water courses,
which included tiny streams, huge rivers, man-made canals and irrigation
systems, and the ocean. It was envisioned that the body had a similar
system of moving, life-giving fluid. This fluid was the qi, and the
pathways through which it flowed were the meridians.
Instead of discussing acupuncture in terms of letting something out of the
body, physicians began describing it in terms of regulating something
within the body. The flow of qi through the meridians, just like the flow
of water through a stream, could be blocked off by an obstruction¡ªa dam
across the waterway. In the streams, this might be a fallen tree or a mud
slide; in humans, it might be caused by something striking the body, the
influence of bad weather, or ingestion of improper foods. When a stream
is blocked, it floods above the blockage, and below the blockage it dries
up. If one goes to the point of blockage and clears it away, then the
stream can resume its natural course. In a like manner, if the qi in the
meridian becomes blocked, the condition of the body becomes disordered
like the flooding and dryness; if one could remove the blockage from the
flow of qi within a meridian, the natural flow could be restored.
In a
blocked stream, just cutting a small hole or crevice in the blockage will
often clear the entire stream path, because the force of the water that
penetrates the hole will widen it continuously until the normal course is
restored. In the human body, inserting a small needle into the blocked
meridian will have a similar effect. Just as a stream may have certain
points more easily accessed (or more easily blocked), the meridians have
certain points which, if treated by needling, will have a significant
impact on the flow pattern. Many acupuncture points are named for
geological structures: mountains, streams, ponds, and oceans.
Although this description of the basic acupuncture concept is somewhat
simplified, it conveys the approach that is taught today to students of
traditional acupuncture: locate the areas of disturbance, isolate the main
blockage points, and clear the blockage. Of course, many layers of
sophistication have been added to this model, so that the needling¡ªwhich
might be carried out in several different ways¡ªcan be seen to have subtle
and differing effects depending upon the site(s) needled, the depth and
direction of needling, and even the chemical composition of the needle
(such as gold, silver, or steel). For example, some needling techniques
are used for the primary purpose of increasing the flow of qi in a
meridian without necessarily removing any blockage; other techniques
reduce the flow of qi in the meridians. These tonifying and draining
methods, as well as transference methods that help move qi from one
meridian to another, are part of the more general aim of balancing the
flow of qi in the body.
Ultimately, all the descriptions of acupuncture that are based on the
traditional model involve rectifying a disturbance in the flow of qi. If
the qi circulation is corrected, the body can eliminate most symptoms and
eventually¡ªwith proper diet, exercise, and other habits¡ªovercome virtually
all disease.
MODERN VIEWS
When the human body was finally
described in terms of cells, biochemicals, and specific structures (most
of this accomplished less than 150 years ago), the Chinese method of
acupuncture and its underlying concepts were evaluated in these new
terms. As a first effort, researchers sought out physical pathways that
might correspond to the meridians, and even a fluid substance that might
correspond to qi. Neither of these were found. Nonetheless, the action
of performing acupuncture was shown to have effects on the body that
required some detailed explanation.
From
the modern perspective, diseases and injuries are resolved by a complex
set of responses; the responses are coordinated by several signaling
systems. The signaling systems mainly involve peptides and other small
biochemicals that are released at one site, travel to other sites,
interact with cells, and stimulate various biologically programmed
responses. Rather than blockages of circulation described in the old
Chinese dogma, diseases are understood to be caused by microorganisms,
metabolic failures, changes in DNA structure or signaling, or breakdown of
the immune system. Some of these disorders are resolved by the cellular
functions that are designed for healing, while others become chronic
diseases because the pathological factors involved have either defeated
the body¡¯s normalizing mechanisms or because something else has weakened
the body¡¯s responses to the point that they are ineffective. For example,
poor nutrition, unhealthy habits, and high stress can weaken the responses
to disease.
Modern
studies have revealed that acupuncture stimulates one or more of the
signaling systems, which can, under certain circumstances, increase the
rate of healing response. This may be sufficient to cure a disease, or it
might only reduce its impact (alleviate some symptoms). These findings
can explain most of the clinical effects of acupuncture therapy.
According to current understanding, the primary signaling system affected
by acupuncture is the nervous system, which not only transmits signals
along the nerves that comprise it, but also emits a variety of
biochemicals that influence other cells of the body. The nervous system,
with over 30 peptides involved in transmitting signals, is connected to
the hormonal system via the adrenal gland, and it makes connections to
every cell and system of the body.
In a
review article, Acupuncture and the Nervous System (American
Journal of Chinese Medicine 1992; 20(3¨C4): 331¨C337), Cai Wuying at the
Department of Neurology, Loyola University of Chicago, describes some of
the studies that implicate nervous system involvement. According to a
report of the Shanghai Medical University, cranial nerves, spinal nerves,
and their terminals were dispersed in the area surrounding the acupuncture
points for about 5 millimeters. They also found that the nervous
distribution of the Bladder Meridian points (which run along the spine)
was in the same area of the spine as that of the corresponding viscera.
In Japanese research, it was reported that when acupuncture points were
needled, certain neurotransmitters appeared at the site. In
laboratory-animal acupuncture studies, it was reported that two such
transmitters, substance P and calcitonin gene-related peptide, were
released from primary sensory neurons. Acupuncture analgesia appears to
be mediated by release of enkephalin and beta-endorphins, with regulation
of prostaglandin synthesis: all these have an effect on pain perception.
One of the dominant areas of research into acupuncture mechanisms has been
its effect on endorphins. Endorphins are one of several neuropeptides;
these have been shown to alleviate pain, and have been described as the
body¡¯s own ¡°opiates.¡± One reason for the focus on these biochemicals is
that they were identified in 1977, just as acupuncture was becoming
popular in the West, and they are involved in two areas that have been the
focus of acupuncture therapy in the West: treatment of chronic pain and
treatment of drug addiction.
According to traditional Chinese doctors, one of the key elements of a
successful acupuncture treatment is having the person who is being treated
experience what is called the ¡°needling sensation.¡± This sensation may
vary with the treatment, but it has been described as a numbness,
tingling, warmth, or other experience that is not simple pain (pain is not
an expected or desired response to acupuncture treatment, though it is
recognized that needling certain points may involve a painful response).
Sometimes the needling sensation is experienced as propagating from the
point of needling to another part of the body. The acupuncturist, while
handling the needle should experience a response called ¡°getting qi.¡± In
this case, the needle seems to get pulled by the body, and this may be
understood in modern terms as the result of muscle responses secondary to
the local nervous system interaction.
According to this interpretation, acupuncture is seen as a stimulus
directed to certain responsive parts of the nervous system, producing the
needling sensation and setting off a biochemical cascade which enhances
healing. Some acupuncture points are very frequently used and their
applications are quite varied: needling at these points may stimulate a
¡°global¡± healing response that can affect many diseases. Other points
have only limited applications; needling at those points may affect only
one of the signaling systems. It is common for acupuncturists to combine
the broad-spectrum points and the specific points for each treatment.
Some acupuncturists come to rely on a few of these broad-spectrum points
as treatments for virtually all common ailments.
This
modern explanation of how acupuncture works does not explain why the
acupuncture points are arrayed along the traditional meridian lines. At
this time, no one has identified¡ªfrom the modern viewpoint¡ªa clear series
of neural connections that would correspond to the meridians. However,
acupuncturists have identified other sets of points, such as those in the
outer ear, which seem to be mapped to the whole body. The description, in
the case of the ear, is of a layout of the body in the form of a
¡°homunculus¡± (a miniature humanoid form). Such patterns might be
understood more easily than the meridian lines, because the brain, which
is adjacent to the ear, also has a homunculus pattern of neurological
stimulus that has been identified by modern research. Similarly,
acupuncturists have identified zones of treatment (for example, on the
scalp or on the hand) that correspond to large areas of the body, and this
may also be more easily explained because there are connections from the
spinal column to various parts of the body which might have secondary
branches elsewhere. In fact, acupuncture by zones, homunculi, ¡°ashi¡±
points (places on the body that are tender and indicate a blockage of qi
circulation), and ¡°trigger¡± points (spots that are associated with muscle
groups) is becoming a dominant theme, as the emphasis on treating
meridians fades (for some practitioners). The new focus is on finding
effective points for various disorders and for getting biochemical
responses (rather than regulating qi, though there is no doubt some
overlap between the two concepts).
During this modern period (since the
1970¡¯s) an increasing number of ways to stimulate the healing response at
various body points have been advocated, confirming that needling is not a
unique method (the idea that the needle would produce a hole through which
pathogenic forces could escape has long been fading). In the past, the
main procedures for affecting acupuncture points were needling and
application of heat (moxibustion). Now, there is increasing reliance on
electrical stimulation (with or without needling), and laser stimulation.
Since the basic idea of acupuncture therapy is gaining popularity
throughout the world while the practice of needling is restricted to
certain health professions and is not always convenient, other methods are
also becoming widely used. Lay persons and practitioners with limited
training are applying finger pressure (acupressure), tiny metal balls held
to the to the skin by tape, magnets (with or without tiny needles
attached), piezoelectric stimulus (a brief electric discharge), and low
energy electrical pulsing (such as the TENS unit provides with electrical
stimulus applied to the skin surface by taped electrodes). Some of these
methods may have limited effectiveness, but it appears that if an
appropriate body site is stimulated properly, then the healing response is
generated.
For
many nervous system functions, timing is very important, and this is the
case for acupuncture. The duration of therapy usually needs to be kept
within certain limits (too short and no effect, too long and the person
may feel exhausted), and the stimulation of the point is often carried out
with a repetitive activity (maintained for a minute or two by manual
stimulation¡ªusually slight thrusting, slight withdrawing, or twirling¡ªor
throughout treatment with electrostimulation). It has been shown in
laboratory experiments that certain frequencies of stimulus work better
than others: this might be expected for nervous system responses, but is
not expected for simple chemical release from other cells.
TRADITIONAL AND MODERN VIEWS
COEXISTING
The traditional and modern
understandings of acupuncture arise from significantly different world
views and from application of different levels of technology. It is
difficult to directly correlate the two, though one can say that many of
the traditional observations and ideas have partial explanations by modern
mechanisms. Still, the modern practitioner can become aware of and
trained in the application of both approaches to acupuncture. A person to
be treated can be analyzed from both perspectives and the treatment
strategy can be devised according to the conclusions derived from each
perspective. Certain aspects of the case may be more amenable to
traditional analysis and corresponding treatment, while other aspects are
better suited to modern analysis and treatment approach.
An individual who is suffering from a
chronic pain syndrome might be analyzed in terms of which meridians are
blocked: through treatment of appropriate points on the meridian, the pain
might be alleviated. The same individual might be analyzed according to
which muscle groups are involved in the painful area and might be treated
by acupuncture at trigger points that specifically affect those muscles.
An individual suffering from an autoimmune disorder might be analyzed
according to which of the traditional organ systems are involved, with
treatment of the associated meridians. The same individual might be
analyzed in terms of the immune system disturbance and treated by
stimulating points that have been recently identified as immune
regulators.
Since
the traditional acupuncture approach has been shown to be effective in
clinical trials conducted in China (and elsewhere in the Orient), one can
rely on the traditional methods. However, many practitioners in the West,
with little or no prior exposure to Oriental philosophy but with
experience and training in Western modes of analysis, may feel
uncomfortable turning partly or completely to the traditional Chinese
view, and will, instead, focus on the modern understanding of this healing
technique.
Traditional Chinese medicine is not a static system, but an evolving one.
Thus, in the Orient and in the West there are many doctors and researchers
who are working on an integration of the earlier traditional approach and
the modern understanding.
A FEW COMMONLY USED ACUPUNCTURE POINTS
In ancient times, the number of acupuncture points was established to be
the same as the number of days in the year: 365. These points were mapped
to 14 major meridian lines, one meridian for each of the 12 inner organs,
one meridian along the spine (called the governing vessel), and another
along the midline of the abdomen (called the conception vessel). More
recently, the number of points identified by acupuncturists has exploded.
There are extra meridians (some of them outlined in ancient times, others
modern) with their own sets of points, there are special points (off
meridians), and there are complete mappings of body structures and
functions by points along the outer ears, on the nose, in the scalp, on
the hands, on the feet, and at the wrists and ankles. Despite the growing
number of treatment zones, most acupuncturists still utilize the
traditionally-identified points on the 14 main meridians. On each
meridian there are a small number of points used repeatedly, because of
their versatility, for a wide variety of patients and diseases. One such
point on each major meridian is mentioned below, sometimes with a second
point also briefly described, for a total of 21. It is important to
recognize that although a list of disorders and diseases treated by each
point can be given, sometimes the points are selected entirely or
primarily on the basis of the Chinese theory of balancing the flow in the
meridians, so that the point might be used for other kinds of disorders,
aside from those listed, because of its usefulness in this balancing
process. For points not on the central line of the body, each point has a
left and right side reflected location (the point is counted only once for
enumeration purposes). For each point in this presentation, the name of
the meridian, the number of the point, the number of standard points on
the meridian, its designation by one of the number-based classification
systems (two letters and the point number), and the Chinese name are
given.
Large Intestine Meridian, point #4 of
20: LI4, Hegu
This point is located on the back side
of the hand between the thumb and first finger. The dominant uses are to
relieve pain and to treat constipation or other bowel disorders. However,
this point is also utilized in the treatment of inflammatory and feverish
diseases which have symptoms in the throat and head, because the large
intestine meridian runs from the hand to the face. Another key point on
this meridian is LI11 (Quchi), located at the elbow. It is used
for many upper body disorders, such as sore throat, eye pain, lymphatic
swellings, rashes, and difficulty moving the arms, and for intestinal
disorders, such as diarrhea and intestinal cramping.
Lung Meridian, point #7 of 11: LU7,
Lieque
This point is located above the wrist
on the inside of the arm. It is used to treat several disorders of the
upper body, including headache, neck stiffness, cough, asthma, sore
throat, facial paralysis, and wrist problems.
Stomach Meridian, point #36 of 45:
ST36, Zusanli
This point is located on the front of
the leg, just below the knee. It is helpful for digestive disorders,
including nausea, vomiting, gastralgia, and abdominal distention, and also
for general weakness. Recently, numerous clinical trials have been
conducted with treatment of this point alone, demonstrating positive
effects in treating anemia, immune deficiency, fatigue, and numerous
diseases.
Spleen Meridian, point #6 of 21: SP6,
Sanyinjiao
This point is located on the inner
side of the leg just above the ankle. Although it is on the spleen
meridian, which generally influences the digestive system, this point is
also valuable for treating hormonal disorders (irregular menstruation,
impotence) and immune disorders. Another key point on this meridian is
SP9 (Yinlingquan), located just below the knee. It is used in the
treatment of urinary diseases, especially with fluid retention, abdominal
and back pain, and female reproductive system disorders.
Gallbladder Meridian, point #20 of 44:
GB20, Fengchi
This point is located at the base of
the skull where it joins the neck in back. It used in the treatment of
acute disorders, such as common cold, influenza, headache, neck pain, and
fever. In addition, it lowers blood pressure and relaxes tension in the
area of the eyes. Another key point on this meridian is GB34 (Yanglingquan),
located on the outer side of the knee, and used for treating a wide range
of injuries and disorders of the muscles and tendons.
Liver Meridian, point #3 of 14: LV3,
Taichong
The point is located on the top of the
foot, between the first and second toes. It is used to balance emotional
energy, to regulate menstruation, to reduce tension and pain in the chest,
treat eye disorders, alleviate headaches, and reduce high blood pressure.
The adjacent point in the meridian, LV2 (Xingjian), at the webbing
between the toes, is also considered quite important and is frequently
needled along with LV3; it has similar uses, but is also incorporated into
the treatment of lower abdominal disorders, such as urinary problems.
Pericardium Meridian, point #6 of 9:
PC6, Neiguan
This point is located on the inner
arm, just above the wrist. Like other points on this meridian, it is
useful for cardiac disorders, such as heart palpitation and angina
pectoris. It is also useful for nausea, vomiting, spasms, and
convulsions.
Heart Meridian, point #7 of 9: HT7,
Shenmen
This point is located on the outer
side of the wrist. It is used in the treatment of a variety of mental
disorders, such as absent mindedness, insomnia, disturbing dreams,
hysteria, depression, agitation, and mental illness. It is also used in
the treatment of heart disease and fatigue.
Urinary Bladder Meridian, point #40 of
67: BL40, Weizhong
This point is located at the back of
the knee. It is utilized in the treatment of back pain, hip impairment,
muscular atrophy, leg pain and immobility, abdominal pain, vomiting,
diarrhea, and a host of other symptoms. Another important point on the
bladder meridian is BL23 (Shenshu), in the lumbar area (hip level)
near the spine; it is used in treatment of a wide range of disorders,
including urinary problems, impotence, menstrual disorders, low back pain,
knee weakness, dizziness, ringing in the ears, blurred vision, edema,
asthma, and diarrhea. A large section of the bladder meridian is of
importance because, as it flows along either side of the spine (in two
parallel lines on each side), it associates with the internal organs in
the vicinity.
Kidney Meridian, point #3 of 27: KI3,
Taixi
This point is located just behind the
inner ankle. It is used for disorders in several areas of the body,
including sore throat and toothache, deafness and tinnitus, dizziness,
asthma, thirst, insomnia, impotence, frequency urination, pain in the
lower back, and menstrual irregularities.
Triple Burner Meridian, point #5 of
23: TB5, Waiguan
The triple burner is considered to be
a special type of organ system that spans the entire torso. This point on
the meridian is located on the outer side of the arm, above the wrist. It
is mainly used in treatment of disorders along the pathway of this
meridian, that is, of the fingers, hand, arms, neck, ears, cheek, and top
of the head.
Small Intestine Meridian, point #3 of
19: SI3, Houxi
This point is located on the side of
the hand, below the little finger. It is used for treating mental
disorders, stiffness and pain in the neck, chest, and lumbar region,
seizures, night sweats, and fevers.
Governing Vessel, point #20 of 28:
GV20, Baihui
This point is located at the top of the head. It is traditionally applied
in the treatment of various mental disorders, and for problems that occur
in the head: headache, vertigo, ringing in the ears, nasal obstruction,
difficulty with speech, etc. It is also used to treat prolapse, such as
that of the rectum and uterus. Another key point on this meridian is GV14
(Dazhui), located just below the seventh cervical vertebrae
(shoulder level); it is used for treating neck and upper back problems,
feverish diseases, convulsions, cough, asthma, and common cold.
Conception Vessel, point #4 of 24:
CV4, Guanyuan
This point is located a little below
the navel. It is used for all types of lower abdominal disorders,
including urination problems, hernia, menstrual disorders, gynecological
infections, postpartum bleeding, diarrhea, rectal prolapse, etc. Another
important point on this vessel is CV6 (Qihai), half way between CV4
and the navel. The applications are similar, but it is especially used in
cases of accompanying fatigue.
Examples of Combining These Points to
Produce an Effective Treatment
In the book Modern Clinic
Necessities for Acupuncture and Moxibustion (by Zhang Ren and Dong Zhi
Lin), several treatment strategies are outlined. For menopausal syndrome,
the main points recommended are GV20 and GV14, CV4, BL23, HT7, SP6 and
ST36; secondary points include PC6, LV3, and KI3. For bedwetting at night
among young children, recommended points include CV4, BL23 and SP6;
secondary points include LU7, KI3, CV6, and ST36. For hayfever,
recommended points include GB20, LI4, and ST36; secondary points include
GV14, LU7, LI11, and SP6. In her book Insights of a Senior
Acupuncturist, Miriam Lee describes a combination of points that have
wide application: ST36, SP6, LI4, LI11, and LU7. This set of points, with
slight adjustments (e.g., leaving out one or two, perhaps adding or
substituting one or two) is shown to be helpful for the majority of common
complaints seen in the Western acupuncture clinic. A popular treatment
for injury and stress is to needle the ¡°four gates,¡± the right and left
side points LV3 (feet) and LI4 (hands), which opens circulation throughout
the meridians.
November 1996
