Acupressure

Acupressure
This article is part of the branches of series.

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 .


: ''See ''

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.