Chinese characters for acupuncture mean “Golden needle and moxibustion”. In ancient time, acupuncture was performed using golden needles and heat in the form of burning herbs which was applied to the needle to affect chi, the energy.

Acupuncture is derived from the latin “Acus” meaning needle and “Punctura” meaning to make a hole with a small pointed object.

The History of Acupuncture

China, one of the great cradles of ancient civilization, is still known to this day in the chinese language as the “Middle kingdom”. More than one billion people belonging to diverse cultures have dwelled and thrived in this great land. Recorded Chinese history of five thousand years demonstrated great advancement in arts, sciences such as the building of the great wall, nagivation, astronomy and well-known inventions such as printing, gunpowder and compass. Chinese traditional medicine such as the art and science of diagnosis and healing of diseases including the use of thin silver or gold metallic needles or pins to pierce the skin of patients known today in english as acupuncture.

Huang ti nei jing (approximately 500 – 300 b.C.), the medical treatise of the yellow emperor (huang ti) who was the first emperor of chinese history provided written record of practice of acupuncture in china. The nei jing not only chronicled the conversations between Huang ti and his court physicians on the use of acupuncture for treatment of illnesses based on the philosophy of holism but also delineated the basic chinese philosophy of holism, man, nature and heaven as one wholeness.

Archeological metallurgical needle artifacts from the han dynasty (208 b.C. – 220 a.D.) marked the time when acupuncture was being practiced in china for more than two thousand years. During this time acupuncture was used to treat people from great warriors who suffered from wounds inflicted during the battle to peasants with common ailments. More recently, bare-foot doctors of china in the time of chairman mao walked through the land of one billion people dispensing chinese medicine and acupuncture.

Acupuncture arrived in the west during the middle ages, after the missionary jesuit priests in china observed the practice of acupuncture by chinese practitioners. Documentation and translation of the classical chinese texts on acupuncture were undertaken and the acupuncture was brought across the oceans to europe where it flourished and was widely practiced. In the west, chinese medicine including acupuncture has been widely practiced in the immigrant community by traditional ethnic healers.

Acupuncture arrived in America from Europe including the effort of franklin bache, a philadelphia physician and great-grandson of benjamin franklin in the early 1800’s and, of course, with the chinese immigrants who arrived in the new world. Chinese medicine and acupuncture have been the mainstay of treatment of all kinds of ailments afflicting newly arrived immigrants within their ethnic communities. Over the course of one hundred years, acupuncture has flourished from the knowledge of few to the spectacular demonstration of the use of acupuncture on television during the historic visit of president richard m. Nixon to china in 1972 before the eyes of millions of american viewers. The popularity and power of acupuncture are attested to by its use within a small community many decades ago to the present day nation-wide use by millions of americans to revitalize and balance chi and maintain their harmony with the cosmos.

People throughout the world rely on acupuncture for relief of pain and treatment of a whole host of ailments from asthma to arthritis, anxiety to nervousness, from poor memory to infertility. Acupuncture is widely practiced today in clinics in the people’s republic of china including hong kong and taiwan. “In 1993, the fda reported that americans were spending…And making 9 – 12 million patient visits for acupuncture treatment” (daily news, oct 26, 1998). About $500 million a year was expended on about 9 – 12 million visits by americans on acupuncture treatment. Acupuncture has been used at lincoln hospital in the bronx, new york city, and at more than 100 substance-abuse programs in new york city to treat substance abuse and addiction. Pets such as dogs and cats receive acupuncture for whole host of ailments such as arthritis and ill health. Acupuncture has been used for a long time in treating various ailment and pain in thoroughbred horses.

National institutes of health (nih) of the government of the united states of america in bethesda, maryland, issued a nih consensus statments in november 1997 by an independent, non-federal consensus panel of prominent physicians and scientists in the fields of acupuncture, pain, psychology, psychiatry, physical medicine and rehabilitation, drug abuse, family practice, internal medicine, health poligy, epidemiolgoy, statistics, physiology, biophysics and representatives from the public. The three-day fact-finding meeting was also cosponsored by various leading scientific organizations in america. The finding is briefly reported here as follows: “Acupuncture has been used by millions of american patients and performed by thousands of physicians, dentists, acupuncturists, and other practitioners for relief of prevention of pain and for a variety of health conditions. It has been reported that more than 1 million americans currently receive acupuncture each year.” further the conclusions and recommendations: “However, promising results have emerged, for example, efficacy of acupuncture in adult post-operative and chemotherapy nausea and vomiting and in post-operative dental pain. There are other situations such as addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma where acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program.” (national institutes of health consensus development statement 15 (5) november 3 – 5, 1997).

Other condtions amenable to be relieved by acupuncture are various pain conditions of neck, arm, shoulder, elbow, wrist, hand, finger, leg, hip, knee, ankle and foot.

Every so often newspapers such as the new york times, daily news, journals or magazines publish articles on the healing power of acupuncture and how acupuncture is becoming more and more accepted as a standard treatment for diseases and illnesses.

Traditional chinese medicine not only used acupuncture but also incorporates diagnosis, herbology, dietary balance and the links between man, natural elements and the constellations. The chinese theories of medicine on health, illnesses and acupuncture were rooted in the relationship between man and the cosmos and the life force called “Chi”. In man, chi is constantly influenced by the cosmos and natural elements. Man is a small part of the universe and obeys the law of the universe and, therefore, is influenced by the events such as the hours of the day, days and seasons and is linked to changes in nature. The optimal times for treating various illnesses due to the disturbance in chi required that the time of day coincide with treatment due to the waxing and waning of chi in various organs.

Chi – the life force or energy. Tradintional chinese healing is based on the concept of a life foce or energy called “Chi” which is continuous generation, movement and transfer of chi within and among man, earth, natural elements and the cosmos. Chi is described to have two polarities, yin and yang. A healthy milieu in a person is maintained by the balance of chi and harmomy of yin and yang in the person and the cosmos. Conversely, diseases and illnesses in a person are caused by the imbalance of chi within the person or loss of harmony of a person’s chi with the cosmos. It is said that chi flowed throughout the body in 12 pairs of major channels (meridians) and in 2 extraordinary channels (or meridians) which linked and influenced various bodily organs.

An acupuncture doctor examines pulse, skin, tongue and bodily excretions determine chi of a man. Acupuncture is used to balance yin and yang to prevent and treat illnesses base on placement of acupuncture needles according to certain specific acupuncture points on the 32 channels. Each set of specific points is picked for balancing yin and yang affecting particular illness. Upon the acupuncture treatment the doctor can determine if the disease or illness is cured base on chi balance of bodily organs.

Yinyang was a concept of taoism preached by lao tzu (110 – 222 b.C.). In taoism, man is a micro-cosmic reflection of the universe. Like confucianism, yin yang is a way of life of the chinese people. The concept of chinese medicine and acupuncture are base on yin yang and is fundamental to chinese medicine. Yin yang is the universal doctrine of opposition but interdependence and continuity. Yin is negative, passive, weak, and destructive while yang is positive, active, strong, and constructive. Yin and yang governs the oppositeness in the universe – darkness and light, cold and hot, heaven and earth, fire and water, strength and weakness, woman and man. Yin and yang are dynamic and waxed and waned with moment of time.

Meridians or channels of energy flow are well illustrated as long lines on a human figurine in all acupuncture texts and mannequins. It is said that chi flowed throughout the body in 30 major channels (meridians) and in 2 extraordinary channels (or meridians) which linked and influenced various bodily organs. In chinese medicine, the bodily organs of import are small intestine, gall bladder, stomach, colon, urinary bladder, heart, liver, spleen, lungs, kidney, “Triple heater” and pericardium and chi flowed in the meridians interconnecting these organs which are nourished by chi. Deficiency or excess chi affects the function of the organs leading to diseases and illnesses. Tonification or strengthening when chi is deficient and dispersion or release of excess chi in a body leads to the restoration or balance of chi and, therefore, health.

A total of 32 meridians on both sides of a body are accounted as follows: six paired meridians are yang and they are large intestine, small intestine, triple burner, stomach, urinary bladder and gall bladder. Six paired meridians are yin and they are lung, spleen, heart, kidney, pericardium and liver. Eight auxil-iary channels of which six are connecting channels and two unpaired meridians which are “Tu mo” also known as governing vessel and “Jen mo” also known as the conception vessel.

Acupuncture points were described and shown to be points on the skin of a body in the texts or mannequin along the 32 meridians where chi was close to the body surface. At these points, therefore, chi could be influenced by the insertion and manipulation of acupuncture needles. There are approximately 671 acupuncture points, most of which are symmetrically located on these channels on both sides of the body.

Acupuncture points are described as a slight depression that is felt beneath the skin and can be felt by experienced fingers. The electrical impedance of acupuncture points is different from its surroundings. Some of the acupuncture points are tender to deep pressure from finger pressing on them and these tender points have been called “Pressure points.” some of the acupuncture points have a consistency of a cord or a nodule like a piece of unbaked dough

Each point has a chinese name describing its characteristic and/or function. Such named acupuncture points are shen men, hu ku. English translation of the named points and the use of abbreviation and meridians and numerical such as ki3, sp6, st36, li4, gb21, sp20, th10, b23 are more commonly known. By needling selected acupuncture points chi can be balanced by either tonification or strengthening when chi is deficient energy in a body or excess chi can be dispersed or released in the case of excess chi in a body.

Five-element concept was described by tzou yen (350 b.C. – 270 b.C.) and comprises the elements of fire, earth, metal, wood and water. The five elements are dynamic and wax and wane with time and are related to a pair of bodily organs. One set of organs was “Fu” or hollow organs comprising small intestine, gall bladder, stomach, colon and urinary bladder. The other set of organs was ‘tsang” or solid organs comprising heart, liver, spleen, lungs and kidney. In order to match the 24 meridians, “Triple heater” and ‘pericardium” were added making a total of 12 organs. The wood element relates to yin liver and yang gall bladder, fire element to yin heart and yang small intestine, earth element to yin spleen and yang stomach, metal element to yin lung and yang large intestine, water element to yin kidney and yang urinary bladder. The five elements linked the function and conditions of the organ systems of the body to nature, time and seasons and provided diagnosis, explanation of diseases and illnesses, treatment and forecast of cure. For example, fire element is associated with color red, southern direction, summer, arteries and small intestine and heart meridians. Earth element is associated with color yellow, central direction, indian summer, muscles and spleen and stomach meridians. Metal element is associated with white color, west direction, autumn, skin and body hair and lung and large intestine meridians. Water element is associated with black color, north direction, winter, bone and head hair and kidney and bladder meridians. Wood element is associated with green color, east direction, spring, muscle and tendon and gall bladder and liver meridians.

Application of acupuncture in dental and surgical procedures requiring anesthesia has been most commonly and extensively used throughout china. Other uses of acupuncture have been reported in china and the u.S.A. For the treatment of a long list of ailments. The world health organization has suggested the list of conditions amenable to acupuncture. These conditions are depression, anxiety, tension, nervousness, vertigo, migraine, headache, drug and cigarette addiction, tic, rhinitis, bell’s palsy, neuralgia, herpes zoster pain, conjunctivitis, neck pain, shoulder pain, bronchitis, asthma, coronary heart disease, hypertension, peptic ulcer, gastritis, appendicitis, tendonitis, joint sprain, spasmodic torticollis, arthitis, rheumatism, knee pain, low back pain, impotence, enuresis, dysmenorrhea, preeclampsia, strokes, insomnia and infertility.

Doctors of acupuncture are from diverse educational and training backgrounds and have received training in acupuncture either in the u.S. Or other countries where the practitioners may have been qualified physicians and certified to practice medicine. Today, there are approximately 3,000 physicians and 9,000 nonphysician practitioners in the u.S. And the number is fast increasing.

In the u.S., physicians with M.D. (doctor of medicine) degree and D.O. (doctor of osteopath) degree, generally, are medical internists, family physicians, neurologists, physiatrists (rehabilitation), psychiatrists, anesthesiologists, orthopaedists, rheumatologists and neurosurgeons.

Dentist with D.D.S. (doctor of dental surgery) or D.M.D.

Podiatrist, D.P. M. (doctor of podiatric medicine)

Veterinarian, D.V.M. (doctor of veterinarian medicine)

Chiropractor, D.C. (doctor of chiropratic)

In general, all american-trained physicians, dentists, oral surgeons, veterinarians and chiropractors are trained by various organizations affiliated with major leading universities in america or are certified by the states. Having completed the prescribed training, the physicians and clinicians would have to meet various certifications and requirements which vary from state to state in the union in order to practice acupuncture. In general, the certification for the practice of acupuncture for physicians, dentists or oral surgeons is part of their state licensing to practice medicine, surgery, dentistry and oral surgery. More information can be obtained from the board of education or medical and dental licensing bodies of the state governments.

Non-physician acupuncturists receive extensive clinical training in acupuncture, anatomy and physiology, chinese and oriental medicine, herbology in various state-certified institutions. The acupuncturists are granted “C.A.” or “Certified acupuncturist”, “L. Ac.” or “Licensed acupuncturist” and “Dipl. Ac.” or “Diplomate of acupuncture”. Other titles include “O.M.D.” or “Oriental medical doctor” and “Ph. D.” or “Doctor of philosophy”. The certification to practice using aforementioned titles varies from state to state in the union.

Many non-physician acupuncturists have received their extensive clinical training and clinical experience in other countries. They have taken qualifying examinations to be certified to practice acupuncture in america. In addition, several schools and colleges in u.S.A. Provide intensive training and course works. Extensive knowledge in oriental medicine, chinese medicine, herbology, history and physical examination, differential diagnosis (to come up with all the possible diagnoses of an illness) anatomy, physiology and acupuncture are taught to young american students to prepare them to be proficient acupuncturists. Today, an increasing number of students are enrolled in these rigorous programs.

Methods of acupuncture treatment comprise several techniques commonly used today in the u.S.A.

Electro-acupuncture: the most commonly used technique is the insertion of a few electricity-conducting needles to several needles varying from 4 – 10 needles each of which is very small (see dimensions below) through the skin of a person receiving acupuncture. The insertion of each needle almost always cause little discomfort or pain to no pain and no discomfort during the process of the insertion. After cleaning the skin, the needles are inserted into the selected acupuncture points along the meridians overlying muscles and various other tissues but never into the spinal cord, brain, chest, abdomen, various abdominal organs and blood vessels such as vein and artery. After all the needles are in place, a small, minute quantity of direct current usually supplied by a 9-volt battery from a small box stimulator is delivered to the electricity-conducting needles by small electrical cords with alligator clips at one end of each cord to attach to the needle. The patient usually feels the twitching of the muscles as the muscles are electrically stimulated. Some patients may feel different sensations such as warmth at the site being stimulated or adjacent sites to the stimulation sites. After about 5 – 20 minutes of stimulation, the entire contraption is removed from the patient. This is the most pleasant of all the techniques of acupuncture.

Manual acupuncture: follows similar insertion technique as electro-acupuncture except that no electrical stimulation is delivered and each needle is manually manipulated like twirling by the hands of the acupuncture practitioner. Twirling can cause pain and discomfort to patient.

Auricular acupuncture is the insertion of needles into the earlobes and uses the above methods of stimulation. It is reported and shown that there are about 168 acupuncture points on a human ear.

Other methods of acupuncture include scalp-needling in which acupuncture needles are inserted into acupuncture points on the scalp. Face and hand acupuncturists use the acupuncture points on the meridians on the face and hand, respectively.

Other means of delivering stimulation to the acupuncture points include moxibustion – a ball or cigar-like roll of herbs lit to deliver heat to the needle. Cupping is the application of cups heated by a small flame to create a vacuum on the skin when applied to the skin. Bloodletting uses a sharp lancet or needle to bleed a small quantity of blood from the skin. Laser is used to stimulate the acupuncture points on the skin. Magnets, staples or taped metal pellets are placed on the acupuncture points on the body, face, earlobes and tongue of the person. Acu-pressure uses fingers to deeply press on acupuncture points. Application of various types of electrical stimula-tion on the acupuncture points such as tens (transcutaneous electrical nerve stimulator).

Frequency and duration of treatment: varies among practitioners and disorders.

Needles

Three modern types of patented acupuncture needles will be introduced to ensure maximal sterility of the needles during application and to maximally reduce or even eliminate the transmission of diseases to patients receiving acupuncture and also to reduce the incidence of inadvertent sticking of the skin of the acupuncture practitioners. In addition, two patent-pending needle holder tubes will be introduced to achieve aforementioned objectives.

Modern acupuncture needle with fluorescence
Tandem acupuncture needle
Solid-state acupuncture needle
Bivalve tube holder
Conjoint tube holder

Commonly used traditional acupuncture needle in U.S.A. and the world.

The basic design of the acupuncture needles being used today has not changed much from that used some 2,000 years ago. Some ancient acupuncture needles were made from gold, silver and mixture of metals. Although gold and silver needles are available today, the most commonly use needles of the present day needles are single-use, sterile, stainless steel, metallic needles with plastic handle, stainless steel metallic shaft with a sharp tip contained in an individual blister package and sterilized with ethylene oxide gas.

Common acupuncture needle

Commonly, one sterile needle is contained in a transparent, holding plastic tube having a length slightly shorter than the needle in fig. 1. Both needle and holding plastic tube are individually packaged in a sterile blister package. Each needle is sterile, single-use, disposable, stainless steel, electricity-conducting needle. Each needle comprises a plastic handle 1, very thin (about the size of a strand of human hair or micron-thick diameter) flexible shaft and a tapered tip 3. The very thin, micron-thick shaft and tapered tip cause almost always no pain during the insertion and application of the needle through the skin and inflict minimal to no trauma and injury to the skin, nerve, veins and arteries and all other tissues underneath the skin.

Common length of acupuncture needles varies from 0.2 inch – 2.0 inches.

Common sizes of acupuncture needles:

  • Chinese gauge number 1 2 3 4 5 8 10
  • Japanese gauge number 40 38 36 34 32 30 28
  • Diameter of shaft in mm. 0.16 0.18 0.20 0.22 0.25 0.30 0.35

In february of 1996, after reviewing the existing body of knowledge, the U.S. Food and drug administration (fda) removed acupuncture needles from the category of “Experimental medical devices” and classified the needles as class ii medical device. Therefore, the needles are regulated just as other medical devices such as single-use surgical scalpels and hypodermic syringes.

How to find doctors

The recommended means of finding the best physicians and nonphysician acupuncturists is by referral from physicians, doctors, family members or friends who have personal knowledge of the acupuncturists who you will be seeing and from whom you will be receiving treatment. Other means include organization referral.

The best acupuncturists are practitioners who are good clinicians and well trained in the art and science of medicine including anatomy and physiology.

It is a paramount trait of a good clinical acupuncturist to have a thorough knowledge in anatomy of a human body so as to know exactly where to and where not to place and insert acupuncture needles. For example, where exactly is the chest cavity so that lung lining can be avoided so that accidental puncturing of the chest cavity is avoided, or to know where the major blood vessels are so that there is no accidental cause of bleeding into the body.

The understanding of physiology – what the human body is made of and how the human body functions are paramount skills and common science sense of a good clinician.

The clinician must also be good and thorough in taking your medical history and performing meaningful and goal-oriented examination. “Diagnostician is king”ô because correct diagnosis leads to proper and efficacious treatment and therefore either relieve or cure the illness or disorder of the patient and avoid stresses, injuries or even death to the patient.

The clinician’s ability to effectively communicate and explain the diseases and ailments affecting you, the treatment, options of treatments, expectation and goal of treatment is also crucial.

Of course, the practitioners must know how to treat, what to treat and know the limitation of the ability to treat and acupuncture and know when to and how to refer the patient for help.

Of equal importance is the skill of the practitioner, the use of sterile technique such as, but not limited to, vigorous washing of the hands prior to and after acupuncture treatment and between patients. In addition, sterile preparation of the acupuncture site, the use of gloves during acupuncture, use of clean treatment room and optimally maintaining the cleanliness of the treatment room and acupuncture sites are just as important. Strict observance of the sterility of the acupuncture needles from storage of the needles to the handling, application and the disposal of the sterile disposable, single-use, very thin acupuncture needle are equally important. Of course, application of sterile light dressing of the acupuncture sites is necessary.

Electro-acupuncture therapy is the preferred therapy. In this procedure, a miniscule amount of battery-provided electrical current is used to stimulate the tissues via the electricity-conducting needle. A minute quantity of electrical current, totally benign to the body, is being delivered from a small 9-volt-battery stimulus box. The size of the box is about that of six 3.5” diskettes. The procedure is gentle and not traumatic to the skin and tissues of the body. After the acupuncture needles are inserted into the body, direct current passes from the lead connecting the box to the needle into the tissues being stimulated. The amount of current used varies among practitioners.

Patient is relax and properly gowned and either lying down or sitting during the treatment. Patient may have various experiences during acupuncture. Some common experiences are pulsation at the stimulated sites due to the contraction of the electrical-stimulated muscles, tolerable transient but small amount of ache due to the presence of the needle in the skin and/or tissues which most likely quickly dissipate especially when the stimulus is turned on, warm sensation at the stimulus site or distant sites, sensations in other parts of the body which is not directly stimulated. Other pleasant experiences include tranquility, relaxation and sleepiness. Almost always, the treatment is pleasant and relaxing. Best of all, patient may sooner or later obtain relief from the ailment.

Availability of the practitioners after the treatment to answer questions, advise and follow-up.

How to prepare for acupuncture

  • Consult and inform your physicians prior to acupuncture.
  • Read about and understand acupuncture in reliable sources such as medical journals.
  • Drink adequate water prior to acupuncture to hydrate your body.
  • Ask your acupuncturists about ingestion of food and meal prior to the treatment.
  • Good skin and body hygiene such as shower or bathing prior to leaving the house for acupuncture.
  • Avoid perfume, oils, lotions and cosmetic on the sites intended for acupuncture – ask your doctor where are the intended sites.
  • Clothing which can be easily switched to disposable gown.
  • Ask your acupuncturist questions about treatment.
  • Do not hesitate to communicate your experience on acupuncture.
  • Inform the acupuncturist and your family physician if you have any question or problem.

Adverse effects

“The occurrence of adverse events in the practice of acupuncture has been documented to be extremely low. However, these events have occurred in rare occasions, some of which are life threatening (e.G. Pneumothorax).” (national institutes of health consensus development statement 15 (5) november 3 – 51997)

Like all other surgical procedures, although much lessened by the use of small, taper-tipped needles and the skill of the practitioners, the uncommon, if not rare, risks and complications are such as pain, bleeding, infection, dizziness and fainting, puncturing of the chest cavity leading to pneumothorax did occur. However, it needs to be emphasized again that good and careful acupuncture practitioners who observe sterile and proper technique can significantly, if not totally, reduce or eliminate the aforementioned risks and complications. That is the reason that the above section on how to find doctors should be observed.

The patient should be comfortable to ask the acupuncturist on his or her skill of handling emergency events or to contact patient’s family physician in case of necessity.

Do not hesitate to communicate your experience on acupuncture to and inform your acupuncturist and your family physician if you have any question or problem.

Future

Is extremely bright and promising for acupuncture. Beginning in the next millennium, almost all primary and family physicians and numerous specialists such as physiatrists, rheumatologists, neurologists, psychiatrists, dentists, oral surgeons, podiatrists, chiropractors and clinical acupuncturists in america and throughout the world will extensively use acupuncture in the treatment of many musculoskeletal, visceral and mental diseases and disorders on a daily basis.