An Introduction to Acupuncture It is only when we look to yesterday, today, that we can see tomorrow. AN INTRODUCTION TO ACUPUNCTURE A Practical Guide for GPs and other Medical Personnel Peter Pearson, MBBS, MRCGP, DRCOG The Medical Centre, Yateley, Cambedey, Surrey GU17 7LS Publisht;d in.the UK and Europe by MTP Press Limited Falcon House Lancaster, England British Library Cataloguing in Publication Data Pearson, Peter An introduction to acupuncture: a practical guide for GPs and other medical personnel. 1. Acupuncture I. Title 615.8'92 RM184 ISBN-13: 978-94-010-7935-8 e-ISBN-13: 978-94-009-3199-2 DOl: 10.1007/978-94-009-3199-2 Published in the USA by MTPPress A division of Kluwer Academic Publishers 101 Philip Drive Norwell, MA 02061, USA Copyright © 1987 MTP Press Limited Softcover reprint of the hardcover 1st edition 1987 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior permission from the publishers. CONTENTS Preface 7 Acknowledgements 8 1 What is acupuncture? 9 2 Local dysfunction of channels 13 3 The channels and points 15 4 Technique 37 5 Specific conditions 45 6 Systemic treatment 53 7 Other forms of acupuncture 65 8 Academic considerations 73 9 Further information 79 References 83 Index 87 PREFACE Several years ago, a patient consulted me, and requested 'aquapuncture'. This sounded more like an underwater sexual activity than anything else, but I confessed ignorance! Several more requests highlighted my complete lack of knowledge of this subject and stimulated me into activity. The public's increased interest in 'alternative medicine', together with a willing ness of our trainees to learn about complementary therapies 1 prompted me further. The purpose of this book is to introduce acupuncture as a practical proposition to busy GPs and related medical personnel. As a concept, acupuncture is understandably rejected by many doctors as being largely devoid of scientific basis and proven benefit. In the form that it is commonly presented, it is often found to be too enormous and un conventional to digest, and also to have too many differing 'schools'. Here the subject is described very basically, with enough information for the busy clinician to be able to grasp the essentials of traditional Chinese acupuncture and thence, and most important, to be able to practice simple acupuncture on common problems. This latter part is an essential requisite, as without the impetus to actually practise such a discipline at an early stage, many of us would lose interest and confidence, and lose out on feedback from the patients we treat. No dramatic claims are made, but by providing an 'easy opening' to this discipline more clinicians will be encouraged to try it, and then be in a better position to judge for themselves whether the subject is worthy of further study and practice. Most of this book is devoted to the practical techniques of treating common musculoskeletal problems, which have shown a 60-70% re sponse rate to acupuncture treatment2-4. Most of the evidence so far 7 Preface suggests that acupuncture is at least as effective as conventional treatment, but a lot safer. I have purposely dealt only very briefly with the more complex and specialized fonns of acupuncture, and take a much simplified approach which I have found effective and easy to learn. The purists will argue that to perfonn acupuncture at such a simple and local level is at best ineffective and, at worst, harmful. This is nonsense, and I hope to completely dispel this myth. To attempt to learn the whole of traditional acupuncture would in any case be totally impractical for the readers of this book. I have chosen these conditions not only because they are common, but also because they are suitable for this simplified approach. The suffer ers of these conditions are often disillusioned with conventional treat ments, whether because of poor results or potentially unsafe therapies. Also I feel that there is less 'credibility gap' to be crossed for both clinician and patient. This book is intended mainly for practising clinicians. A knowledge of conventional medicine is presumed, and indeed mandatory, otherwise the application of what is contained in this book would be impossible. I lay much emphasis on the time element in my approach to acupuncture. The treatment sessions need take no longer than the average GP consultation. Altogether I hope to inspire more clinicians to put into practice, at an early stage, this exciting, safe, and ancient branch of medicine. ACKNOWLEDGEMENlS I am indebted to G. Lewith and J. Kenyon who first inspired me, and who taught me most, if not all, I know of acupuncture. I would like to thank Ralph Davies for drawing the illustrations, and Louise for typing the manuscript (and mastering the physiology of a computer!) and for her many helpful suggestions. Most of all, I thank my patients, without whom I would never have been able to practice the art of acupuncture. 8 1 WHAT IS ACUPUNCTURE? Much of the following chapter will be devoted to the general principles of traditional Chinese medicine. There will be much mind-stretching to say the least! Thankfully, however, the actual amount of information that we need to learn, or even accept, to be able to practise simple acupuncture, is very small indeed. I feel that, despite this, it is necessary to have a grasp of the basic background to acupuncture. This will encompass ideas that are completely new to us, and unacceptable to many. I urge you to treat these as traditional concepts, not to be believed or disbelieved, but to be looked at with an open mind. The science may be wrong but the results may be right. Acupuncture is a form of therapy that has its origins in traditional Chinese medicine. Ithas been practised by the Chinese for over 2000 years and was introduced into Europe in 1683 by a Dutch doctor (Willem Ten Rhyme) after a trip to Japan. The earliest references to acupuncture are believed to be in the oldest medical textbook in the world - The Yellow Emperor's Classic ofI nternal Medicine, 300 BC! The first manuscript detailing the art was writtenabout200BC: Huangdi Nei Jing. Legend has it that acupuncture was first discovered by a soldier shot by an arrow, who found that when struck by a second arrow, this relieved the pain from the first. Acupuncture is therefore probably the oldest surviving medical discipline, and this surely begs the thought "there must be something in it". Traditional Chinese medicine described channels (or meridians) in the body, which, although internal, can be mapped out on the body surface for the purposes of identification. Along these channels flows 'qi' - otherwise known as 'vital energy'. At this stage, understand that qi is a concept, and not an identifiable substance. 9 An Introduction to Acupuncture In a similar vein (sorry about the pun), there is no anatomical or physiological basis for the channels. Another concept is the 'Yin-Yang balance'. The Yin forces are negative in nature and the Yang, positive. Good health exists when these forces are in equilibrium. Imbalance of Yin-Yang causes disease, and this is reflected by a disordered flow of qi in one or more channels. By inserting needles (or other stimuli) in certain points along these channels, the flow of qi can be corrected and so restore the body to a normal Yin-Yang balance. There are twenty-six channels in all, twelve pairs and two midline. Out of the twelve, six end in the upper limbs and six end in the lower limbs. These dozen channels are named after organs, whose functional activities are (partially) reflected in the corresponding channels. The organs de scribed in traditional Chinese medicine have functions very much wider than in conventional medicine. I will describe these functions briefly later in this chapter for the sake of completeness, although they have little bearing at this stage. However, if only for purposes of identification, the channels have been named in the traditional manner (Table 1). Table 1 The channels Channel YinNang Position Lung } Heart Yin } Pericardium Upper limb Large intestine } Small intestine Yang Sanjiao Spleen } Liver Yin } Kidney Lower limb Stomach } Urinary bladder Yang Gall bladder Du Midline posterior Ren Midline 10 What is Acupuncture? The reference to whether the channel is Ym or Yang in nature is, again, not vital to us. Each organ is described as either 'Zang' (the corresponding channel then being Yin) or 'Fu' (Yang channel). We are not finished yet! According to traditional Chinese medicine, there are certain 'pathogens' that can invade and become important in the causation of disease. The traditional pathogens are as follows: heat, cold, wind, damp, phlegm. We can certainly understand some of these (heat, cold, damp) when applied conventionally to certain rheumatological diseases, but on the whole our minds are stretched once more! Once again, this is not vital to us. Suffice it to say at this stage that there are various acupuncture points described which are supposed to disperse these patho gens (Chapter 6). The other types of pathogen, collectively known as the 'social pathogens', we can all understand: diet, exercise (lack of or excess), pollution, poisons, trauma. These are familiar enough to us in conven tional medicine. As promised earlier, I will now summarize the main functions of the organs, as described in traditional Chinese medicine: Heart: Dominates the circulation of blood. Keeps the mind healthy. Liver: Maintains the free flow of blood and qi through the body. Spleen: Governs digestion and blood. Maintains muscle bulk. Lung: Controls respiration and the passage of water. Dominates the hair and skin. Kidney: Dominates growth and reproduction. Produces marrow. Controls body water. Pericardium: As in conventional medicine Sanjiao: Otherwise known as the three cavities or the triple warmer organ. No apparent copnventional equivalent. Seems to encompass areas in the chest, epigastrium, and hypogastrium. Functionally controls body temperature. The following organs seem to have similar functions to their conventional equivalents: small intestine, gall bladder, stomach, large intestine, urinary bladder. Traditional Chinese diagnosis of systemic disease, caused by organ dysfunction and pathogen invasion, involves eliciting special signs that are completely foreign to conventional medicine. These include pulse 11