Acupressure

Acupressure
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Acupressure is a technique derived from acupuncture. In acupressure physical pressure is applied to acupuncture points by the hand, elbow, or with various devices. Reviews of acupressure clinical trials have been conducted by the Cochrane Collaboration and according to the protocols of evidence-based medicine; for most conditions they have concluded a lack of effectiveness or lack of well-conducted clinical trials.

Traditional Chinese medicine's acupuncture theory predates use of the scientific method, and has received various criticisms based on scientific thinking. There is no known anatomical or histological basis for the existence of acupuncture points or . Acupuncturists tend to perceive TCM concepts in functional rather than structural terms, i.e. as being useful in guiding evaluation and care of patients. Neuroimaging research suggests that certain acupuncture points have distinct effects that are not otherwise predictable anatomically.

Background

Acupoints used in treatment may or may not be in the same area of the body as the targeted symptom. The TCM theory for the selection of such points and their effectiveness is that they work by stimulating the to bring about relief by rebalancing , and qi . This theory is based on the paradigm of TCM, not that of science.

Many East Asian martial arts also make extensive study and use of acupressure for self-defense and health purposes . The points or combinations of points are said to be used to manipulate or incapacitate an opponent. Also, martial artists regularly massage their own acupressure points in routines to remove blockages from their own meridians, claiming to thereby enhance their circulation and flexibility and keeping the points "soft" or less vulnerable to an attack.

Research

A preliminary randomized trial of Tapas Acupressure Technique found a possible weak correlation with weight loss maintenance using TAT versus Qigong or self-directed support, suggesting that TAT might outperform the other methods studied. The results were not , but a separation test indicated that further study is warranted. A full randomized trial of TAT versus standard weightloss management intervention is currently being conducted, funded by the .

An acupressure wristband that is claimed to relieve the symptoms of motion sickness and other forms of nausea is available. The band is designed to provide pressure to the P6 acupuncture point, a point that has been extensively investigated. The Cochrane Collaboration, a group of evidence-based medicine reviewers, reviewed the use of P6 for nausea and vomiting, and found it to be effective for reducing post-operative nausea, but not vomiting . The Cochrane review included various means of stimulating P6, including acupuncture, electro-acupuncture, transcutaneous nerve stimulation, laser stimulation, acustimulation device and acupressure; it did not comment on whether one or more forms of stimulation were more effective. EBM reviewer said that ''P6 acupressure in two studies showed 52% of patients with control having a success, compared with 75% with P6 acupressure''. One author of an article published in the Scientific Review of Alternative Medicine disagreed .

A Cochrane Collaboration review found that massage provided some long-term benefit for low back pain, and said: ''It seems that acupressure or pressure point massage techniques provide more relief than classic massage, although more research is needed to confirm this.''

Criticism of TCM theory

Clinical use of acupressure frequently relies on the conceptual framework of Traditional Chinese Medicine , which some scholars have characterized as . There is no physically verifiable anatomical or histological basis for the existence of acupuncture points or . Proponents reply that TCM is a prescientific system that continues to have practical relevance. Acupuncturists tend to perceive TCM concepts in functional rather than structural terms .


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Acupoint therapy

Acupoint Therapy is an extension of Willy Penzel's modern APM system , and it involves the stimulation of acupuncture or with a therapy stick. This differs from acupuncture which uses needles, acupressure or shiatsu which uses massage. Under the scientific standards of evidence-based medicine, there is insufficient evidence as to whether acupoint therapy is effective.

Sweden is one of the foremost countries using and developing this therapy.

Physiology

The starting point is traditional Chinese Medicine, which teaches that along the body runs a series of meridians. Each meridian is said to have a specific function, and each of the points along that meridian is claimed to have a different effect on that meridian and indeed on other parts of the body and the energy system.

Half the meridians are said by Acupoint therapists to be , which they say seems to correspond to the parasympathetic nervous system. In this theory stimulating these meridians leads to relaxation, a slower heart, reduced blood pressure, muscular release, etc. The other half of the meridians are therefore , which is said to produce increased sympathetic nervous system activity - tension, a faster heart beat, higher blood pressure, and more contraction in the muscles.

Acupoint Therapy focuses on bringing the yin and yang back into balance.

Treatment

The therapy stick looks a bit like something a dentist would put into your mouth, but at the end it has a small ball with a diameter of just a couple of millimeters.

One form of treatment involves the stimulation with the therapy stick along a meridian. This causes vasodilation, thereby stimulating the meridian.

Another treatment method involves stimulating individual points, rather than a length of the meridian.

Science and acupoint therapy

There is scientific agreement that health outcomes should be assessed via an evidence based medicine framework and that systematic reviews with strict protocols are needed.

Sixty-four patients in two trials have been studied to assess possible scientific support for acupoint therapy . As of July 2006, acupoint therapy has not been the subject of any peer-reviewed EBM review. Under EBM, there is insufficient evidence as to whether acupoint therapy is effective.

YNSA

YNSA, or Yamamoto New Scalp Acupuncture, is a separate form of acupuncture, developed by Japanese physician Dr. Toshikatsu Yamamoto in the 1960s.

YNSA is an acupuncture microsystem that works by needling of somatotopes located primarily on the scalp. Within each somatotope are zones associated with various parts of the body, physical functions and Chinese acupuncture .

The selection of points to be needled is determined by palpation and by neck and abdominal diagnosis.

YNSA is indicated above all for pain treatment and for neurological disorders. YNSA practitioners must undergo special training.

Shiatsu

Shiatsu is a traditional Japanese hands-on therapy based on anatomical and physiological theory and is regulated as a licensed medical therapy with the Ministry of Health and Welfare in Japan. Shiatsu is an evolving form. Various styles incorporate aspects of Japanese massage traditions, Chinese Medicine practice, and "Western" anatomy and physiology.

History of Shiatsu

Shiatsu, as well as ''Teate'', pronounced ''te-ah-te'' , originated in Japan. There were many hands-on therapies called Teate before traditional Chinese therapies such as Acupuncture and Tuina were introduced to Japan. The term shiatsu may have been first cited in a 1915 book, Tenpaku Tamai's ''Shiatsu Ryoho''.

Tokujiro Namikoshi founded the Japan Shiatsu College in 1940 and systematised a form of shiatsu therapy based on Western anatomy and physiology. In Japan, Namikoshi's system enjoys special legal status, and its adherents often credit him with the development of shiatsu; the story is told that at age seven, Tokujiro Namikoshi developed a technique of pressing with his thumbs and palms as he tried to nurse his mother who suffered from rheumatoid arthritis.

Namikoshi treated many high profile persons such as former Japanese Prime Minister Shigeru Yoshida and other successive prime ministers, the prosecutor for the International Military Tribunal for the Far East, Prosecutor Keenan, as well as celebrities like Marilyn Monroe and Muhammad Ali. In this way, shiatsu became known not only in Japan but also overseas.

Other styles of shiatsu exist; adherents of the Namikoshi system generally contend that these are derived from the work of Namikoshi and refer to them as Derivative Shiatsu.

*Tadashi Izawa established Meridian Shiatsu, incorporating Meridian Theory of Traditional Chinese Medicine into his shiatsu therapy.
*Shizuto Masunaga’s book, called Zen Shiatsu in English, popularised Zen Shiatsu in North America and Europe.
*Ryukyu Endo, a Buddhist priest, introduced , which involves concentrating the mind and making supplications to the Buddha.
*Kiyoshi Ikenaga, in his book Tsubo Shiatsu, elucidates from an anatomical and physiological point of view, how meridian points are useful in shiatsu therapy.
*Wataru Ohashi has developed a style called Ohashiatsu.
*Pauline Sasaki and Cliff Andrews have developed a form, derived from Zen Shiatsu, called Quantum Shiatsu, which aims to work with different levels of a person's energy: physical, emotional, mental, and spiritual.
*Bill Palmer and David Ventura have developed Movement Shiatsu, which specialises in working with chronic conditions through specific experiments and exercises.
*Shigeru Onoda, the founder of Spanish Shiatsu School in Madrid, has developed a style called Aze Shiatsu.
*Ted Saito has practised shiatsu in Toronto since 1971 and developed a style called Shinso Shiatsu.
* developed a form of Shiatsu derived from Zen, Ohashi and Macrobiotic Shiatsu called . Unique methods that address assessment, recommendations and shiatsu techniques for Body Mind Spirit are included in this form.

Since 1980 the evolution and development of shiatsu has largely taken place in Europe and North America.

Time Line

*1912: Tokujiro Namikoshi found his own therapy by treating his mother with only his thumbs and palms. He first named this therapy ''Appaku'' then later changed it to ''shiatsu''.
*1919: Tenpeki Tamai published his book . This is believed to be the first use of the term shiatsu.
*1925: Namikoshi opened his first clinic for shiatsu therapy.
*1940: Namikoshi opened the first school of shiatsu therapy in Tokyo.
*1940: Namikoshi established first association for shiatsu therapy.
*1945: After World War II, traditional Japanese forms of medicine were outlawed by the MacArthur occupation government, after returning POWs told stories about being stuck with needles and burned with moxa when they fell ill. The ban caused much protest. Because there were still many blind shiatsu/Anma practitioners, Helen Keller interceded with the American government. The ban was rescinded.
*1950: Toshiko Phipps becomes the first qualified shiatsu therapist to teach in the U.S.
*1953: Namikoshi and his son Toru invited to the Palmer College of Chiropractic to introduce shiatsu to the U.S.
*1955: Shiatsu therapy first recognised by Japanese government but only in conjunction with Anma and massage.
*1956: In a famous incident that greatly increased the reputation of shiatsu and of Namikoshi Tokujiro, Namikoshi treated Marilyn Monroe after she fell gravely ill while visiting Japan and failed to respond to conventional treatment.
*1957: Shiatsu officially recognised by Japan as a separate and distinct therapy.
*1964: Shiatsu officially defined by the Ministry of Health and Welfare in Japan.
*1980: Shiazuto Masunaga's students teaching in the U.S. and Britain, most notably Pauline Sasaki and Wataru Ohashi.
*1981: formed
*1989: AOBTA formed in United States
*1999: is established and 2200 hour educational standard is set.
*2000: Shiatsu occupational title Shiatsupractor is registered.

Definition of Shiatsu

:"Shiatsu technique refers to the use of fingers and palm of one's hand to apply pressure to particular sections on the surface of the body for the purpose of correcting the imbalances of the body, and for maintaining and promoting health. It is also a method contributing to the healing of specific illnesses."

—Japanese medical department of the Ministry of Welfare in December 1957.

Essence of Shiatsu

The characteristic of shiatsu as defined by Namikoshi is to practise using only the fingers, palms and especially the thumbs, but the essence of shiatsu is “Diagnosis and Therapy combined.”

“Diagnosis and Therapy combined” is the ability of the practitioner to use his sensory organs to detect irregularities, such as stiffness of the surface of the body, and to promptly correct or heal these problems. To acquire this skill takes considerable experience. The defining difference between shiatsu therapy and modern and Kampo medicine is this “Diagnosis and Therapy combined”; the fact that shiatsu does not always require previous diagnosis before commencing treatment.

In modern medicine, the course of treatment can only be decided after a diagnosis has been made. In TCM, it is also necessary to diagnose before treating. In shiatsu therapy, practitioners promote the prevention and recovery of illnesses by stimulating the immune system and natural healing power that people already possess. Therefore, even without a diagnosis or with a language barrier, practitioners can, to quote Tokujiro Namikoshi, treat patients with “thumbs and thin futon” at any time. Treating the body as a whole, so they say, helps to restore the physical functions of the nervous system, circulatory system, bone structure, muscles, and internal secretion and stimulates its alleged natural ability to heal illness. That being said, skilled practitioners can contribute considerably to regional health and medical treatment.

Shiatsu standardisation

In Japan, anyone who practices shiatsu therapy must be licensed with the Ministry of Health and Welfare. Shiatsupractors are required to study at least three years/2200-hour educational programme of shiatsu therapy in the universities or colleges which are authorised by the Ministry of Health and Welfare and pass the national exam to be licensed.

"Shiatsupractor" is the name given to a recently proposed international standardized shiatsu license. The name Shiatsupractor was first used in British Columbia, Canada in the 1990s. Presently, at the end of 2003, in the regions of North America , Europe , and Japan, the use of Shiatsupractor is officially protected as a registered trademark. In Japan, the educational standard for Shiatsupractor approval corresponds to that of the licenses for Anma, Massage, and shiatsu practitioners.

Shiatsu originated in Japan and has migrated to many corners of the Earth. As such, every nation and state has devised its own method of certification and licensure, often overlapping with the licences for massage.

In the U.S., one professional organisation for Asian Bodywork Therapy is the AOBTA . This organization is seeking statewide standardisation of Asian Bodywork licensure requirements. To date, the AOBTA has been named specifically in the licensure laws of Illinois and Washington, DC. The AOBTA is also working with the NCCAOM to introduce mandatory, standardized national board certification to the profession.

The AOBTA and NCCAOM require applicants to present a portfolio of training including anatomy and physiology, Chinese medicine, student clinic, primary discipline training, and elective coursework.

Bibliography

1. Internal jugular vein thrombosis associated with shiatsu massage of the neck. Wada Y - J Neurol Neurosurg Psychiatry - 01-JAN-2005; 76: 142-3

External downloads

* maps of the Shu points, Mu points, Circadian clock, every Meridian

Regulation of acupuncture

Regulation of acupuncture is done by various governmental bodies to ensure safe practice, and varies among and within countries.

Acupuncturists may also practice herbal medicine or massage , or may be medical acupuncturists, who are trained in modern, evidence-based medicine but also practice acupuncture in a simplified form. License is regulated by the or province in many countries, and often requires passage of a board exam.

United States

In the US, acupuncture is practiced by a variety of healthcare providers. Those who specialize in Acupuncture and Oriental Medicine are usually referred to as "licensed acupuncturists", or L.Ac.'s. Other healthcare providers such as physicians, dentists and chiropractors sometimes also practice acupuncture, though they may often receive less training than L.Ac.'s. L.Ac.'s generally receive from 2500 to 4000 hours of training in Chinese medical theory, acupuncture, and basic biosciences. The amount of training required for healthcare providers who are not L.Ac.'s varies from none to a few hundred hours, and in Hawaii the practice of acupuncture requires full training as a licensed acupuncturist. The National Certification Commission for Acupuncture and Oriental Medicine tests practitioners to ensure they are knowledgeable about Chinese medicine and appropriate sterile technique. Many states require this test for licensing, but each state has its own laws and requirements. Some states use titles besides L.Ac. for licensed practitioners specializing in acupuncture: "D.O.M." in New Mexico, "D.Ac." in Rhode Island, and "A.P." in Florida. Some states, such as California and Florida, legally treat acupuncturists as primary care providers. Most states allow acupuncturists to practice without a referral from another medical practitioner.

The abbreviation "Dipl. Ac." stands for "Diplomate of Acupuncture" and signifies that the holder is board-certified by the NCCAOM. Professional degrees are usually at the level of a Master's degree and include "M.Ac." , "M.S.Ac." , "M.S.O.M" , and "M.A.O.M." . As of 2007, the Accreditation Commission for Acupuncture and Oriental Medicine is beginning the process of accrediting the "Doctor of Acupuncture and Oriental Medicine" degree, and this new degree will represent the terminal degree in the field. The Oregon College of Oriental Medicine and Bastyr University were the first two institutions in the United States to offer the DAOM. The titles "O.M.D." and "C.M.D." are sometimes used by graduates of Chinese medical schools who have received the Bachelor of Medicine and Surgery degree. "O.M.D." may also signify a degree, granted by certain American schools, indicating a year or two of study beyond the Master's level. The O.M.D. and C.M.D. are not recognized by the ACAOM.

Acupuncturists are required to obtain continuing education credit to retain their licenses. There are three bodies that approve continuing education courses for re-licensure: the California Acupuncture Board, the Florida Board of Acupuncture, and the National Certification Commission for Acupuncture and Oriental Medicine . The NCCAOM awards PDA points towards re-licensure for approved courses and requires Diplomates to obtain 60 PDA points every four years to re-certify. The California Acupuncture Board governs the re-licensure of all California licensed acupuncturists and requires fifty continuing education units every two years. The Florida Board of Acupuncture governs all licensed acupuncturists in Florida and requires acupuncturists to complete 30 continuing education credit hours every two years. The NCCAOM and Florida Acupuncture Board calculate continuing education credit hours based on the calculation that sixty minutes of course time equals one continuing education point or unit. The California Acupuncture Board calculates that one continuing education unit is awarded for fifty minutes of course time and limits distance education to fifty percent of total CEU’s.

In 1996, the Food and Drug Administration changed the status of acupuncture needles from to medical devices, meaning that needles are regarded as safe and effective when used appropriately by licensed practitioners .

Canada

In the province of British Columbia the ''TCM practitioners and Acupuncturists Bylaws'' were approved by the provincial government on April 12, 2001. The governing body, College of Traditional Chinese Medicine Practitioners and Acupuncturists of British Columbia provides professional licensing. Acupuncturists began lobbying the B.C. government in the 1970s for regulation of the profession which was achieved in 2003.

In Ontario, the practice of acupuncture is now regulated by the Traditional Chinese Medicine Act, 2006, S.o. 2006, chapter 27. The government is in the process of establishing a College whose mandate will be to oversee the implementation of policies and regulations relating to the profession. Practitioners of Traditional Chinese medicine will be permitted to use the title 'Doctor of Traditional Chinese medicine'. In addition, they will be permitted to communicate a diagnosis to patients based on Traditional Chinese medicine techniques for diagnosis. Other regulated Health Care Professionals, such as naturopaths, physicians, physiotherapists, chiropractors, dentists, or massage therapists can perform acupuncture treatments when they fulfill educational requirements set up by their regulatory colleges. It is noteworthy, however, that the school and style of acupuncture differs depending on the training of the practitioner.

United Kingdom

Acupuncture practice is currently not regulated by law in the UK. Many practitioners belong voluntarily to acupuncture organisations which have rigorous codes of practice and educational requirements. An estimated 7,500 practitioners practise acupuncture to some extent and belong to a relevant professional or regulatory body. About 2,400 are traditional acupuncturists who mostly belong to the British Acupuncture Council, which requires its members to be trained in both traditional acupuncture and relevant biomedical sciences. Approximately 2,200 registered doctors belong to the British Medical Acupuncture Society. Some 2,650 physiotherapists belong to the Acupuncture Association of Chartered Physiotherapists and 250
nurses belong to the British Academy of Western Acupuncture. There are also practitioners of Traditional Chinese Medicine who belong to one or more associations.

Australia

In Australia, the legalities of practicing acupuncture also vary by state. In 2000, an independent government agency was established to oversee the practice of Chinese Herbal Medicine and Acupuncture in the state of Victoria. The Chinese Medicine Registration Board of Victoria aims to protect the public, ensuring that only appropriately experienced or qualified practitioners are registered to practice Chinese Medicine. The legislation put in place stipulates that only practitioners who are state registered may use the following titles: Acupuncture, Chinese Medicine, Chinese Herbal Medicine, Registered Acupuncturist, Registered Chinese Medicine Practitioner, and Registered Chinese Herbal Medicine Practitioner.

The Parliamentary Committee on the Health Care Complaints Commission in the Australian state of New South Wales commissioned a report investigating Traditional Chinese medicine practice. They recommended the introduction of a government appointed registration board that would regulate the profession by restricting use of the titles "acupuncturist", "Chinese herbal medicine practitioner" and "Chinese medicine practitioner". The aim of registration is to protect the public from the risks of acupuncture by ensuring a high baseline level of competency and education of registered acupuncturists, enforcing guidelines regarding continuing professional education and investigating complaints of practitioner conduct. The registration board will hold more power than local councils in respect to enforcing compliance with legal requirements and investigating and punishing misconduct. Victoria is the only state of Australia with an operational registration board. Currently acupuncturists in NSW are bound by the guidelines in the Public Health Regulation 2000 which is enforced at local council level. Other states of Australia have their own skin penetration acts. The act describes explicitly that single-use disposable needles should be used wherever possible, and that a needle labelled as "single-use" should be disposed of in a sharps container and never reused. Any other type of needle that penetrates the skin should be appropriately sterilised before reuse.

China

In China, acupuncture and other modalities of Traditional Chinese medicine are incorporated into standard medical education, and regulated accordingly; only doctors may practice.

Many other countries do not license acupuncturists or require them be trained.

Scientific theories regarding acupuncture

have been conducted concerning the hypothesized principles underlying the proposed mechanism of action of acupuncture.

Nerve-reflex theory

The nerve-reflex theory proposed the reflex interactions between the periphery and the autonomic nervous system. This theory states that the skin surface and internal organs are intimately connected by these reflexes — "viscera-cutaneous reflex" and "cutaneous-viscera reflex."

These reflexes can be related to the neuroendocrine-autonomic responses, which is mediated partly by the hypothalamic-pituitary-adrenal axis . HPA axis is a complex set of feedback interactions between the hypothalamus , the pituitary and the adrenal glands . The HPA axis is a major part of the neuroendocrine system that regulates stress responses and maintains the homeostatic condition of autonomic responses directly or indirectly, such as circulation regulation, breathing regulation, feeding behavior, weight control and digestion, immune responses, pain responses, es and stresses, states, sexual/reproductive responses, growth, fluid balance and metabolic energy balances.

In 2006, a broad sense hypothalamus-pituitary-adrenal model was proposed to explain the hypothesized analgesic effect of acupuncture based on observed neuroimaging results using fMRI technique. The model incorporated the stress-induced HPA axis model together with neuro-immune interaction including the cholinergic anti-inflammatory model.

Gate-control theory of pain

The "gate control theory of pain" proposed that pain perception is not simply a direct result of activating pain fibers, but modulated by interplay between excitation and inhibition of the pain pathways. According to the theory, the "gating of pain" is controlled by the inhibitory action on the pain pathways. That is, the perception of pain can be altered by a number of means physiologically, psychologically and pharmacologically. The gate-control theory was developed in neuroscience independent of acupuncture, which later was proposed as a mechanism to account for the hypothesized analgesic action of acupuncture in the brainstem reticular formation by a German neuroscientist in 1976.

This leads to the theory of central control of pain gating, i.e., pain blockade at the brain via the release of endogenous opioid neurohormones, such as endorphins and enkephalins .

Neurohormonal theory

Pain transmission can also be modulated at many other levels in the brain along the pain pathways, including the periaqueductal gray, thalamus, and the feedback pathways from the back to the thalamus. Pain blockade at these brain locations are often mediated by neurohormones, especially those that bind to the opioid receptors .

Analgesic action of acupuncture was demonstrated to be mediated by stimulating the release of natural endorphins in the brain. This effect can be inferred scientifically by blocking the action of endorphins using a drug called naloxone. When naloxone is administered to the patient, the analgesic effects of morphine can be reversed, causing the patient to feel pain again. When naloxone is administered to an acupunctured patient, the analgesic effect of acupuncture can also be reversed, leaving the patient with intense pain again. This demonstrates that the site of action of acupuncture is mediated through the natural release of endorphins by the brain, which can be reversed by naloxone. Such analgesic effect can also be shown to last more than an hour after acupuncture stimulation by recording the neural activity directly in the thalamus of the monkey's brain. It should be noted, however, that studies using similar methodological procedures, including the administration of naloxone, have suggested a role of endogenous opioids in the placebo response, demonstrating that this response is not unique to acupuncture. There is also a large overlap between the nervous system and acupuncture trigger points .

Research has also suggested that the sites of action of analgesia associated with acupuncture administration are mediated through the thalamus using fMRI and positron emission tomography brain imaging techniques, and via the feedback pathway from the cerebral cortex using electrophysiological recording of the nerve impulses of neurons directly in the cortex, which shows inhibitory action when acupuncture stimulus was applied. Similar effects have been observed in association with the placebo response. One study using fMRI found that placebo analgesia was associated with decreased activity in the thalamus, insula and anterior cingulate cortex .

Seattle Institute of Oriental Medicine

The Seattle Institute of Oriental Medicine is a single-purpose graduate college located in Seattle, Washington's neighborhood. It is accredited by the Accreditation Commission for Acupuncture and Oriental Medicine and authorized by the Washington Higher Education Coordinating Board to award the degree of Master of Acupuncture and Oriental Medicine. SIOM's clinic-based educational program trains future practitioners in acupuncture, tui na, traditional chinese medicine, Chinese herbal medicine, and Chinese language.

SIOM operates a teaching clinic and herbal dispensary where graduate students observe experienced practitioners or practice under their supervision. More than 50 patients are treated each week at SIOM's clinic.

Midwest College of Oriental Medicine

Midwest College of Oriental Medicine is a small school on the north side of Chicago. They helped in the founding of the Council of Colleges of Acupuncture and Oriental Medicine. This school was established in 1980 and has since expanded to a Racine, WI campus.

The school offers training in Acupuncture, Oriental Medicine including Chinese herbs, Tua Na massage, and Nutrition.

Medical acupuncture

Medical acupuncture is acupuncture performed by a or licensed health care professional who has training in the medical/health sciences who has also had training in acupuncture. Such a doctor or health professional may use one or the other approach, or a combination of both, to treat an dysfunction or illness.



Medical Acupuncture
Medicine:
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Culture:/

History of medical acupuncture

Medical acupuncture was created for Western practitioners such as medical doctors, physiotherapists, chiropractors and osteopaths who wish to use acupuncture based practices without the lengthy study of traditional Chinese Medicine theory that is usually required for acupuncturists. This version of medical acupuncture is lesser known than the traditional Chinese, but is increasing in popularity as otherwise mainstream medical practitioners in the West are seeing and taking more interest in alternative medicine. Medical acupuncture can also be seen as an attempt by conventional, evidence-based medicine to understand the effects of acupuncture from a Western, scientific perspective rather than within the paradigm of Chinese traditional medicine. The British Medical Acupuncture Society publishes a quarterly peer reviewed journal, ''Acupuncture in Medicine'', which is listed on Medline and Index Medicus.

The term "acupuncture" is a Western one, derived from Latin and meaning "puncturing with needles". It was first used by the Wilhelm Ten Rijn, who wrote a monograph in Latin on the subject at the end of the 17th century. Traditional Chinese medicine had an influence on Europe due to exchange via the Silk Road trade routes. Goods and ideas both travelled between cultures in this way.

Acupuncture continued to attract interest from physicians outside Asia in the 18th and 19th centuries, though generally without much reference to its Oriental roots. This interest has continued down to the present, receiving considerable interest after 's in 1972, when surgeons witnessed surgical operations being carried out using acupuncture analgesia instead of . As a result of this interest, traditional Chinese medicine has become a global phenomena. With this interest came a desire by medical professionals to learn acupuncture without the difficult theory. Some traditional Chinese medicine theories include reference to philosophies of Taoist cosmology and to some Westerners these philosophies border on shamanism and mysticism, which they reject. In the United Kingdom most practitioners of acupuncture are medical acupuncturists, either medical doctors or allied health professionals. The British Medical Acupuncture Society provides training for medical doctors and allied health professionals. Many countries have similar organisations, and the International Council of Medical Acupunturists represents medical acupuncturists from over 80 countries.

Battlefield acupuncture

The US Army trains medics in the use of acupuncture for pain relief for use in battle or major disasters. Forty doctors are licensed acupuncturists and provide training for hundreds of army medical specialists.

Differences between Classical Chinese Acupuncture, Traditional Chinese Medicine and Western Medical Acupuncture

The main differences between Classical Chinese Acupuncture, Traditional Chinese Medicine and Western Medical Acupuncture are as follows.

Classical Chinese Acupuncture is the form of acupuncture that has been practiced for thousands of years and is based on Taoist thought and elements of naturalism.

Traditional Chinese Medicine is the revised form of acupuncture and herbal medicine that was revived by Mao Zedong during the Cultural Revolution. Despite the misnomer, acupuncture based on Traditional Chinese Medicine is actually a modern form of acupuncture that has been well-integrated with western medical concepts of anatomy and physiology and has been used in hospitals alongside Medical Doctors in China for well over fifty years. This modern form of acupuncture is also situated in hospitals in Korea, Japan and parts of Europe.

Medical Acupuncture is a contemporary form of acupuncture that was developed by Medical Doctors in the United States and, recently, Great Britain over the last twenty years.

# The traditional theory of "points" and "meridians" is either ignored altogether or is radically reinterpreted because there is supposedly no physically verifiable anatomical or histological basis for the existence of acupuncture points or .
# The concepts of disease are derived from modern Western pathology instead of Oriental medical theory which predates use of the scientific method, and has received various criticisms based on western thinking.
# Medical acupuncture is understood to work via the western biomedical understanding of anatomy, physiology and biochemistry.

The principal differences between classical and medical acupuncture can be summarized as follows:

CLASSICAL	WESTERN MEDICAL
Follows procedures based on thousands of years' experience	Largely ignores the traditional theories and technique
Based on traditional observations and theory	Based on western concepts of anatomy and physiology
Often described with Taoist metaphor and everyday language	Based on western biomedicine

These differences are theoretical, but there are also practical
differences. Whereas traditional acupuncture practitioners, at least
today in the West, tend to work wholistically and address deficiencies
or overall energy imbalances (often inserting several or large numbers of needles
and maybe leaving them in place for 20 minutes or longer, some Western acupuncturists
use many fewer needles and practise brief insertion . Brief needling techniques are also used by
those traditionally trained, though they may be less common.

Medical acupuncture lends itself to use in a busy practice where
there is little time to spend on each patient. It also has the advantage
that it can be learned much more easily than traditional acupuncture by modern health
practitioners such as doctors, physiotherapists, osteopaths,
chiropractors, and podiatrists. Such people do not have to learn another system of thought or technique; rather, they see acupuncture as
an extension of what they are already doing .

Some traditionalists state that western medical acupuncture is a watered-down
version of "real" acupuncture, having at best a limited degree of
effectiveness in certain situations. In some jurisdictions, the practice of
needle insertion based on local physical symptoms, and without traditional
acupuncture training, is called 'dry needling' to distinguish it from
traditional acupuncture.

There is relatively little research to support the use of acupuncture, traditional or modern, and very little comparative
research comparing various approaches.

Choosing where to needle

The founding president of the American Academy of Medical Acupuncture has written that:

: "The choice of needle patterns can be based on traditional principles such as encouraging the flow of qi , a subtle vivifying energy, through classically described acupuncture channels, modern concepts such as recruiting neuroanatomical activities in segmental distributions, or a combination of these two principles."

The concept of trigger points is commonly used to decide on insertion points for the needles. These are tender areas, mostly in muscles, from which pain and other sensations may radiate to distant areas . In Traditional Chinese Medicine these are considered Ah Shi points, or spontaneously tender points, which are often appropriate for needling as part of a treatment.

Another idea is to base the needling on body segments. The spinal cord is arranged segmentally, with pairs of nerve roots emerging from it along its length. These nerve root pairs supply the skin in a series of stripes, so that it is possible to say which spinal segments supply sensation to different parts of the body. A similar arrangement exists at deeper levels, so that we may speak of myotomes and sclerotomes . In some versions of medical acupuncture the needles are inserted in segments that are related to the internal organs that one wishes to treat. This is very similar to the TCM approach of using tendino-muscular meridians or regions, which closely match the same areas.

Other simplified ways of choosing where to needle also exist. However, some medical acupuncturists think that it often makes relatively little difference where the needles are inserted, at least in quite broad terms. Certainly there seem to be some patients who react very strongly to needling and some in whom the actual site of treatment seems not very important . A traditionally-trained acupuncturist, however, might consider this belief heresy, and consider this
random approach potentially harmful or even dangerous.

There are also many techniques of electroacupuncture , one which uses only 24 points. Each meridian has a so-called test point, a tonification point, and a sedation point. A machine records the electrodermal current at the identified test point for each meridian. The values are placed into a chart. Based on the clustering of the values of the test points for each meridian - the practitioner is able to identify meridians which are hyperfunctioning and hypofunctioning. If the meridian is hypofunctioning - then the tonification point is needled to increase the electronic impulse flowing through said meridian. If the meridian is hyperfunctioning, then the sedation point is needled to decrease the electronic activity in the meridian. The process is called balancing the meridians. There are no complex points to remember, just 24 points on the bilateral meridians.

Mechanism

Two attempts at western medical explanation of analgesic and pain control action have been suggested:

# The gate theory of pain, first put forward some thirty years ago by Patrick Wall and Robert Melzack, postulates the existence of gates or filters in the spinal cord that can modulate transmission of pain information within the nervous system.
# The second explanation is based on the existence of natural opiates in the central nervous system and elsewhere in the body

Scientific research in recent decades have shown that these theories, although they support some of the possible partial mechanisms of pain relief from local and distal needling, are not quite accurate even on the pain control mechanism of acupuncture.

Jean-Baptiste Sarlandiere

Jean-Baptiste Sarlandière was a French anatomist and physiologist who was a native of Aix-la-Chapelle. At the age of 16 he began his medical studies at the local hospital in Noirmoutiers. In 1803 he was called to military service, and spent the next 11 years as part of the French Army. He resumed his studies in 1814, and was appointed physician at the military hospital in Paris. He received his medical degree in 1815.

Sarlandière was a colleague of Fran?ois Magendie , and the two physicians collaborated on several physiological experiments. Sarlandière is remembered for introducing electroacupuncture to European medicine. This therapeutic technique combined electricity with acupuncture. Unlike Oriental acupuncture, the needle was not the primary agent of treatment, but simply acted as a to apply the electricity subcutaneously. Reportedly he had success with electroacupuncture treating respiratory and rheumatic disorders, as well as some forms of paralysis, and his technique was soon adopted in French hospitals.

Sarlandière is also remembered for his written works. He died in 1838 while he was finishing one of his better works, ''Traité du système nerveux'' . Other well-known writings of his are:
* ''Memoires sur l’electropuncture''
* ''Anatomie méthodique, ou Organographie humaine'' ;
* ''Physiologie de l’action musculaire appliquée aux arts d’imitation''

James Tin Yau So

Dr. James Tin Yau So, N.D., LAc., also known as Dr. So, was one of the most influential individuals of the 20th Century in bringing acupuncture to the United States.

Dr. So’s teacher was Tsang Tien Chi who studied under Ching Tan An. He graduated from Dr. Tsang’s College of Scientific Acupuncture in , China, in 1939. During the same year Dr. So opened his medical office in Hong Kong. In 1941 he opened his own school, The Hong Kong College Acupuncture. For the next thirty years, Dr. So established himself as one of the most successful and well-respected acupuncturists throughout Asia. Practitioner came from all over Asia and Europe to study at his college.

Several acupuncturists from the National Acupuncture Association sought Dr. So’s assistance in 1972. At the time the NAA offered Dr. So a position as acupuncturist at the UCLA Acupuncture Pain Clinic, the only legal acupuncture clinic in California at that time. Dr. So accepted and joined the NAA staff of acupuncturists and the UCLA Acupuncture Pain Clinic in 1973.

In 1974, Dr. So was part of the NAA group that traveled to Massachusetts and opened the first acupuncture clinic in Boston and a second clinic in Worcester. In the fall of 1974, Dr. So founded the New England School of Acupuncture. Karen Freede and John V. Braga assisted Dr. So in the translation of his three books on the points of acupuncture, the techniques acupuncture and treatment of disease by acupuncture. . Dr. So, with the help of his students Arnie Freiman and Steven Breeker, founded the first school of acupuncture in the US, the New England School of Acupuncture , in 1974 With his approval Dr. Gene Bruno and Dr. Steven Rosenblatt founded a second school in the US, which became the California Acupuncture College, located in West Los Angeles.

A majority of the acupuncture schools in the U.S. were founded by students of Dr. So. This legacy of acupuncture in North America is unparalleled.

Dr. So was awarded the Acupuncturist of the Year in 2001 by the American Association of Oriental Medicine. In 2007, Dr. So Tin Yau was among the first four acupuncturists to be inscribed on the Founders of the Profession Honor Roll by the American Association of Oriental Medicine.

International Society of Acupuncture

The International Society of Acupuncture is an international acupuncture research society, based in Paris, France.

Building

It is a very large building housing many students and researchers as well as staff members and technicians.

Purpose

The society is well known for its research and development in alternative medicine. It has several wings in other countries, and is always available for complementary and alternative medicine work research. It has researched in veterinary medicine as well as other functions of complementary medicine.

Electroacupuncture according to Voll

Electroacupuncture according to Voll , also known as electrodermal screening , bioelectric functions diagnosis , bioresonance therapy , meridian stress assessment , or bio-energy regulatory technique , is a controversial alternative medicine method of using electrodiagnostic devices to diagnose and treat "energy imbalance" often using homeopathic products, first used by Reinhold Voll by combining acupuncture with a galvanometer in 1958. It is not used in treatments and has no scientific basis.

Functioning

The EAV diagnostic device measures electrical conductance of the human body through the skin by emitting a small nearly constant positive direct current from a thin metal probe having spherical contact surface at its tip to a conductive cylinder held in the subject's hand. The voltage drop on the patient is converted into indication using electronic amplifyer circuit, which operates as nonlinear amplifier in principle. The measurement device is calibrated such that a reading of 50% of the full scale corresponds to the conductance of 10 microSiemens, and the 100% reading corresponds to infinite conductance .

The probe is applied to various acupuncture points, and the measured conductance is assumed to have correlation with the functioning of the organ associated with the meridian being probed. The reading 50% of the full scale , is assumed to correspond to the state of no dysfunction, while higher ratings are assumed to indicate inflammation and lower readings should indicate stagnation.

As the procedure measures electrical conductance, readings slightly depend also on skin moisture and probe pressure, as well as on the positioning of the probe at the characteristic point.

Once an imbalance is established, remedies can be inserted into the procedure of EAV to bring a person's rating within the normal range.

These devices carry some pretty serious warnings. In addition to FDA warnings, there have been civil actions, lawsuits, professional board actions, and criminal prosecutions. The FDA has not approved the device for diagnosis, even though it continues to be promoted as a diagnostic tool.

Related devices

* Computron
*
*

Related methods

* acupressure
* acupuncture
* bioresonance therapy
* electricity therapy
* electroacupuncture
* galvanic skin response
* homeopathy
* iridology

Inventors of related devices and methods

* Albert Abrams
* Royal Raymond Rife

Doctor of Acupuncture & Oriental Medicine

The Doctor of Acupuncture & Oriental Medicine is the highest formal educational credential available in the field of acupuncture and Oriental medicine in the United States of America. Three schools are accredited by the Accreditation Commission for Acupuncture and Oriental Medicine to offer the D.A.O.M. degree. Bastyr University in Kenmore, WA, Oregon College of Oriental Medicine in Portland, OR and Pacific College of Oriental Medicine in San Diego, CA. All D.A.O.M. curricula require a Master's degree in the subject for admission. They are 2-2.5 calendar year programs, and involve advanced training that may include integration of western and eastern medical practices.

Currently, no state in the U.S.A. requires the D.A.O.M. degree in order to obtain a license to practice acupuncture.

Auriculotherapy

Auriculotherapy -also known as auricular therapy - is a form of alternative medicine based on the idea that the ear is a microsystem, meaning that the entire body is represented on the auricle in a similar fashion to and , and that the entire body can be treated by stimulation of the surface of the ear exclusively.

History

Exploiting the ear for the purpose of medical treatment began at the dawn of civilization. In ancient Egypt, the spirits of the dead were believed to cause pain and suffering to the living.
Evil spirits were thought to enter the body through the mouth, nose, or ears in order to devour their victims. Ancient Egyptian physicians sought to remove these spirits via the same portal through which they had entered. Hippocrates traveled to Egypt and spent four years learning the principles of ancient Egyptian medicine. Consequently, he wrote several books re?ecting on many Egyptian therapeutic techniques including utilizing the ear for the treatment of sexual and infertility problems.
In China the use of the ear for various medical purposes is widely recorded in the Chinese history of acupuncture. The ear was used sporadically, and treating diseases through the ear seriously lagged behind other ancient cultures such as those of Egypt and Persia. Before the exposure to Nogier’s discovery, ear acupuncture in China consisted only of treating three auricular points and lacked the recognition of any coherent somatotopic organization on the ear.
In the 1950s, Dr. Paul Nogier noticed that a local healer in Lyon, France was treating sciatica by an area of the ear, which prompted him to investigate the relationship between locations on the ear and human anatomy. Nogier said there was a somatotopic presentation of the inverted fetus in the ear, the anatomic regions of the fetus corresponding to specific zones of the ear. Nogier believed that pain in any part of the body could be relieved by needling, cauterizing, massaging or electrically stimulating the corresponding region of the ear. Nogier called this process auriculotherapy. It has been used as a treatment for pain and used in combined therapies to treat substance abuse .

Vascular Autonomic Response

"Dr Nogier noticed that there was a distinct change in the amplitude and dimension of the pulse when certain points on the auricle were stimulated. This occurs consistently and is both repeatable and measurable by modern equipment. Dr Nogier called it the Vascular Autonomic Signal but appropriately it is a response rather than a signal. Being able to detect the VAS on the radial pulse of the patients‘ left hand enables the practitioner to precisely determine the location of a point, whether there is a pathology in the region of the body that relates to specific points, and whether certain substances are indicated. Accurate employment of the VAS in diagnosis and treatment is essential to Auriculotherapy and Auriculomedicine."

Compared to acupuncture

* auriculotherapy considers the ear to be a localized reflex system connected to the central nervous system .

* auriculotherapy . Whilst some assert that auriculotherapy is a needle-less treatment it is in fact performed using either needles, laser, massage or electrical stimulation at points precisely detected by the VAS or electrical detection. .

Treatment is usually by means of an acupuncture needle, electrical probe, or sometimes .

Maps

Many widely differing auriculotherapy maps exist . Nogier first proposed a "somatotopic" map with the body appearing on the ear as an inverted fetus, with the head towards the lower lobule, the feet at the uppermost portion of the auricle, and the body in between; he subsequently produced three further "phase" diagrams providing additional and alternative sets of stimulation locations, in which the part or parts of the ear considered to represent a specific organ varies significantly depending on the "phase" of the ailment . Some French system practitioners now use a more distorted representation of the body in the ear, more similar to the somatotopic representation on the cerebal cortex . Chinese system diagrams place more emphasis on metaphorical names rather than anatomical locations.

Studies

* 1980: A double blind study by Dr. Terry Olson published in the Journal ''Pain'' found a 75.2 percent correlation between standard medical diagnosis and diagnosis from solely auricular examination. The study concluded that "these results thus support the hypothesis that there is a somatotopoic organization of the body represented upon the human auricle"

* 1984: A controlled crossover study involving 36 patients suffering from chronic pain found that "...auriculotherapy is not an effective therapeutic procedure for chronic pain"

* 1990: A study published in the ''Journal of the South African Veterinary Association'' involved auriculotherapy treatment of 30 canine subjects with . Complete recovery occurred in 50 percent of the subjects, and some improvement occurred in an additional 23 percent. Twelve of the recovered dogs were monitored for 26 weeks after the conclusion of treatment, and four of the twelve relapsed within that time.

* 1999: A study in the Journal ''Acupuncture in Medicine'' "...found no evidence to support the concept that the body is represented on the ear"

* 2006: A study published in the ''Oxford Journal of Human Reproduction'' involved 94 subjects and found that " significantly reduces pain intensity and analgesic consumption ... during oocyte aspiration in IVF treatment" and is additionally correlated with significantly reduced post-operative pain

* The work of David Alimi, Alfred Geissmann, and Denis Gardeur has immensely contributed to providing an evidence-based con?rmation of the existence of the auricular homunculus. Ten healthy volunteers were exposed to ?ve paradigms of stimulation and a recording of their fMRI in echo planar imaging sequences were made. In 9 out of 10 volunteers, the auricular acupuncture stimulation of the auricular site of projection of the thumb produced signi?cant fMRI signals superimposed on that obtained through the tactile stimulation of the thumb itself. This interesting work clearly proves the existence of speci?c neurophysiological connections between the auricular homunculus and that of the brain cortices.

Bibliography

* Soliman, N, "Soliman's Auricular Therapy Textbook, New Localizations and Evidence Based Therapeutic Approaches". Authorhouse, Bloomington, IN, 2008.

* Soliman, N, "Soliman's Auricular Therapy Atlas". Alternative Medicine Seminars, Rockville, Maryland. 2006.


* . 'Auriculotherapy: Modern ear acupuncture' Auriculotherapy.info

Acupuncture point

Acupuncture points (, also called acupoints are locations on the body that are the focus of acupuncture, acupressure, sonopuncture, and laser acupuncture treatments. There are several hundred acupuncture points that are distributed along as well as numerous other "extra points" that are not associated with a particular meridian.

Most of the current research into acupuncture point locations and mechanisms is taking place in China. Traditional Chinese medicine's acupuncture theory predates use of the scientific method, and has received various criticisms based on scientific thinking. There is no known anatomical or histological basis for the existence of acupuncture points or . Acupuncturists tend to perceive TCM concepts in functional rather than structural terms, i.e. as being useful in guiding evaluation and care of patients. Neuroimaging research suggests that certain acupuncture points have distinct effects that are not otherwise predictable anatomically.

Acupuncture point
This article is part of the branches of series.

Theory

Acupoints used in treatment may or may not be in the same area of the body as the targeted symptom. The Traditional Chinese Medicine theory for the selection of such points and their effectiveness is that they work by stimulating the to bring about relief by rebalancing , and qi . This theory is based on the paradigm of TCM and has no analogue in western medicine.

Body acupoints are generally located using a measurement unit, called the , that is calibrated according to their proportional distances from various landmark points on the body. Acupoint location usually depends on specific anatomical landmarks that can be palpated. There are nearly 400 basic acupoints recognized by the on the . Many of these basic points are rarely used. Some points are considered more therapeutically valuable than others, and are used very frequently for a wide array of health conditions.

Location by palpation for tenderness is also a common way of locating acupoints . Points may also be located by feeling for subtle differences in temperature on the skin surface or over the skin surface, as well as changes in the tension or "stickiness" of the skin and tissue. There is no scientific proof that this method works and some practitioners disagree with the method.

Body acupoints are referred to either by their traditional name, or by the name of the meridian on which they are located, followed by a number to indicate what order the point is in on the meridian. A common point on the hand, for example, is named ''Hegu'', and referred to as LI 4 which means that it is the fourth point on the Large Intestine meridian.

Categories of body acupuncture points

Certain acupuncture points are ascribed different functions according to different systems within the TCM framework.
:*Five Transporting Points system describes the flow of qi in the channels using a river analogy, and ascribes function to points along this flowline according to their location. This system describes qi bubbling up from a spring and gradually growing in depth and breadth like a river flowing down from a mountain to the sea horse.
::*Jing-well points represent the place where the qi "bubbles" up. These points are always the first points on the yang channels or last points on the yin channels and with exception of Kid-1 YongQuan all points are located on the tips of fingers and toes. The Nan Jing and Nei Jing described jing-well points as indicated for "fullness below the heart" and disorders of the zang organs .
::*Ying-spring points are where the qi "glides" down the channel. The Nan Jing and Nei Jing described ying-spring points as indicated for heat in the body and change in complexion.
::*Shu-stream points are where the qi "pours" down the channel. Shu-stream points are indicated for heaviness in the body and pain in the joints, and for intermittent diseases.
::*Jing-river points are where the qi "flows" down the channel. Jing-river points are indicated for cough and dyspnoea, chills and fever, diseases manifesting as changes in voice, and for diseases of the sinews and bones.
::*He-sea points are where the qi collects and begins to head deeper into the body. He-sea points are indicated for counterflow qi and diarrhea, and for disorders resulting from irregular eating and drinking.

:*Five Phase Points ascribe each of the five phases - wood, fire, earth, metal and water - to one of the Five Transporting points. On the yin channels, the jing-well points are wood points, the ying-spring points are fire, shu-stream points are earth, jing-river points are metal, he-sea points are water points. On the yang channels, the jing-well points are metal, ying-spring are water, shu-stream are wood, jing-river points are fire and he-sea points are earth points. These point categories are then implemented according to Five Phase theory in order to approach the treatment of disease.

:*Xi-cleft points are the point on the channel where the qi and blood gather and plunge more deeply. These points are indicated in acute situations and for painful conditions.

:*Yuan-source points are points on the channel from where the yuan qi can be accessed.

:*Luo-connecting points are located at the point on the channel where the luo meridian diverges. Each of the twelve meridians have a luo point that diverges from the main meridian. There are also three extra luo channels that diverge at Sp-21, Ren-15 and Du-1.

:*Back-shu points lie on the paraspinal muscles either side of the spine. Theory says that the qi of each organ is transported to and from these points, and can be influenced by them.

:*Front-mu points are located in close proximity to the respective organ. They have a direct effect on the organ itself but not on the associated channel.

:*Hui-meeting points are a category of points that are considered to have a "special effect" on certain tissues and organs. The hui-meeting points are:
::*zang organs - Liv-13 Zhang Men
::*fu organs - Ren-12 Zhong Fu
::*qi - Ren-17 Shang Fu
::*blood - Bl-17 Ge Shu
::*sinews - GB-34 Yang Ling Quan
::*vessels - Lu-9 Tai Yuan
::*bone - Bl11 Da Zhu
::*marrow - GB-39 Xuan Zhong

Listing of points

*Zusanli Three Mile Leg
::''Location'': outside of the lower leg, a few inches below the on the tibialis anterior muscle .
::''Effect'': Contributes to digestion and overall stamina.

Non-meridian points

Additionally, there are microsystems of acupoints that are typically not located on the meridians. For example, auriculotherapy uses the external ear microsystem exclusively, utilizing thousands of points that are not on a meridian, but located on the surface of the external ear. The Korean system of hand acupuncture is a microsystem that utilizes acupoints on the hand. There are other common and uncommon acupoints that are called ''extra points'', meaning that they are neither on a meridian nor part of a microsystem. Extra points are referred to more often by name, though some of the more commonly known have a letter/number combination for reference. A popular extra point is ''Yintang'', located at the midpoint between the eyebrows.

Scientific research

Evidence from neuroimaging studies

Acupuncture appears to have distinct effects on cortical activity, as demonstrated by MRI and PET . Researchers from the University of Southampton, UK and Purpan Hospital of Toulouse, France, summarize the literature:

*''Investigating Acupuncture Using Brain Imaging Techniques: The Current State of Play'': George T. Lewith, Peter J. White and Jeremie Pariente. "We have systematically researched and reviewed the literature looking at the effect of acupuncture on brain activation as measured by functional magnetic resonance imaging and positron emission tomography. These studies show that specific and largely predictable areas of brain activation and deactivation occur when considering the traditional Chinese functions attributable to certain specific acupuncture points. For example, points associated with hearing and vision stimulates the visual and auditory cerebral areas respectively."

Efficacy of specific ''distal points''

This section focuses on the efficacy of specific ''distal points'', i.e. body acupoints that according to TCM theory are indicated for treating conditions whose symptoms manifest in areas of the body that are distant from the acupoint's location. Current biomedical knowledge does not predict that such points should be efficacious. An example is P6, located near the wrist and used to treat nausea.

* Acupoint P6
The Cochrane Collaboration, a group of evidence-based medicine reviewers, reviewed the use of P6 for nausea and vomiting, and found it to be effective for reducing post-operative nausea, but not vomiting . The Cochrane review included various means of stimulating P6, including acupuncture, electro-acupuncture, transcutaneous nerve stimulation, laser stimulation, acustimulation device and acupressure; it did not comment on whether one or more forms of stimulation were more effective. EBM reviewer said that ''P6 acupressure in two studies showed 52% of patients with control having a success, compared with 75% with P6 acupressure''. One author of an article published in the Scientific Review of Alternative Medicine disagreed .

* Acupoint BL 67
One randomized controlled trial studied a classical TCM treatment for breech birth . The study showed that moxibustion at acupoint BL 67 , located at the tip of the fifth toe, was more effective than placebo at reducing the incidence of breech birth. An EBM review by Cochrane said that that more data were needed before recommendations on clinical effectiveness could be made.

Criticism of TCM theory

Clinical use of acupuncture points frequently relies on the conceptual framework of Traditional Chinese Medicine , which some scholars have characterized as . Proponents reply that TCM is a prescientific system that continues to have practical relevance.

Martial arts applications

There are several types of pressure points, each of which is applied differently, and each one creates different effects. Some of the principles are discussed below:

*Pain: Some points are painful, because of the prevalence of nerves in the area. For example, being prodded in the throat is painful. The body has a pain withdrawal reflex, whereby it reacts to pain by moving away from it. Martial artists make use of this, sometimes without being aware of it. Applying pressure next to the collar bone, from above, will cause the person to move downwards , whereas poking them in the gap between the jaw and neck will make their body want to move upwards. Pressure to the shoulder causes that side of the body to move back. A rub to the back down will cause the body to move forth. Some points react more violently to pain from changes in the pressure rather than constant pressure. All pressure points can cause pain but that may not be their true purpose.

*Muscular: Here a direct attack is made on a muscle, which will contract. Examples include: a punch to the , which impacts the diaphragm and thus affects the person's breathing ; and an attack to the outer thigh, which could cause the person to fall as their leg loses power .

*Pressure: The baroreceptor in the carotid artery is pressure-sensitive, allowing the body to control the bloodflow into the brain. Pressure against this region will 'trick' the body into thinking that blood pressure is too high, and thus will constrict and lower blood pressure - which can cause blackout. Striking veins and arteries can also cause them to shut or tear, both of which will definitely cause black-out and possible death if not treated immediately.

*Break: There are certain areas which are likely to lead to a break if struck properly. This includes the "loose rib", the philtrum and the top of the skull .

*Hyper-Extension There are joints that, when struck, can be hyper-extended and even completely torn apart. This is a technique which can cause permanent damage and disfiguration to one's opponent, usually focusing on the elbow and the knee. There are two types:
**brute force: This takes advantage of the vulnerability of the strike point, thereby causing the damage; and
**Golgi organs: A relatively gentle strike to the Golgi tendon at the back of the elbow, for example, causes a reflex which immediately relaxes that tendon, allowing the elbow to more easily bend in the wrong direction. If this is immediately followed by a solid strike to the elbow joint, the elbow can be broken with significantly less effort than through brute force.

*Brain shake: The brain is actually a very vulnerable , which is why it is encased in the skull. The brain floats in fluid and balances on a very flexible . Certain techniques can actually shake the brain in a way which causes black out. The most commonly taught technique involves a strike just below the occipital ridge, at the correct angle in the correct direction. Other areas that are susceptible to such techniques are the temples and the top of the skull.

*Energy: Some believe that there are energy channels which flow around the body through acupuncture , and an attack will impact the flows, and thus impact the body. This is called "chi", "ki" or "qi" in East Asian cultures. These techniques are said to be capable of causing blackout, serious injuries or death when used by a sufficiently skilled martial artist.

Acupuncture detoxification

Acupuncture detoxification is the use of auricular acupuncture to treat drug and alcohol addiction. Evidence supporting the use of auricular acupuncture to treat addictions is largely based on anecdotal and clinical reports. Reviews of randomized controlled studies have concluded that there is insufficient evidence and/or a lack of properly-designed trials.

A five-point Acupuncture auricular protocol was developed and taught by Michael Smith, MD, of Lincoln Memorial Hospital in the Bronx, NY, during a period of high heroin use in the 1970s. Dr. Smith says that auricular acupuncture should be considered an adjunctive therapy to standard treatments for addiction, not an alternative to them. The protocol is disseminated through the in the US and worldwide. Training and information is about acupuncture detoxification is available through NADA. According to ''Acupuncture Today'', a trade journal for acupuncturists, NADA was established in 1985 and since then has trained more than 10,000 "acupuncture detoxification specialists" in use of the five-point protocol.

The NADA protocol relies on concepts in Traditional Chinese Medicine , which some scholars have characterized as . Proponents reply that TCM is a prescientific system that continues to have practical relevance. See .

Acupuncture Association of America

The Acupuncture Association of America was established by acupuncturist Dr. Miriam Lee to provide education about acupuncture for the public, to advocate for legislation on acupuncture, to provide continuing education for licensed practitioners and to establish acupuncture research.

The Acupuncture Association of America was founded in 1980, and run by Dr. Lee until 1998 when she retired and passed the care of AAA over to her student, Susan Johnson, L.Ac.

For nearly a decade, AAA single-handedly supported California state lobbyist, Mr. Art Krause. Dr. Lee financed the lobbying by teaching Master Tung's Points classes to her students and licensed practitioners. Krause, well respected in Sacramento, was able to negotiate agreements with influential legislators including Senator Art Torres and Senator Herschel Rosenthal, both instrumental in getting many acupuncture bills made into law. It is directly through their efforts and a few others, that California has both licensure and the most comprehensive scope of practice which includes primary care physician status, primary insurance coverage and Medi-Cal.

In 1989, The Council of Acupuncture Organizations was formed to unite the profession statewide in the legislative process, and to share the financial support of the acupuncture lobbyist. This group was composed of nine different acupuncture organizations throughout California including, three Chinese, two Japanese, two Korean and two Caucasian groups. This was the first and only real attempt to date to bring these different acupuncture communities together. Unfortunately, the group only met for two years, but during that time, the CAO was able to procure acupuncture coverage through Worker's compensation.

The AAA continues to operate in California under Susan Johnson, L.Ac.