What is Acupuncture

The word “acupuncture” derived from two Latin words: “acus” which means needle and “puncture” means prick or penetrate. Thus, acupuncture procedure involves inserting tiny, hair-thin needles into specific points in the body, where they are gently stimulated with the intention to trigger the body’s natural healing response.

Many people are surprised to learn that acupuncture needles are extremely thin. They are not like hypodermic (injection) needles, which are big and hollow.  Japanese ultra-thin needles called moshin-hair needles (0.10 – 0.12mm in diameter) which are thinner than regular acupuncture needles (0.22-0.30mm in diameter) and even thinner than human hair!

Acupuncture Needle and Push Pin Push Pin and Japanese Acupuncture Needle (0.10 mm. Needle diameter)

Nine Classical Needles

Nine types of needles are described in Lingshu (Miraculous Pivot) , namely, filiform needle, shear needle,round-pointed needle, spoon needle, lance needle,round-sharp needle, stiletto needle, long needle and big needle.

Nine-Classical-Acupuncture-Needles

Ancient Acupuncture Needles

Filiform Needle

A type of fine needle of varying length most commonly used in performing acupuncture at present

Shear Needle

A pricking instrument like an arrowhead with a sharp tip, the same as a chisel needle or sagittal needle

Round-Pointed Needle

A cylindrical instrument with the shaft 1.6 cun long and an oval tip, used for massage on the body surface, the same as a rounded needle

Spoon Needle

An instrument with a thick shaft and a slightly sharp round tip used for pressing the meridians/channels

Lance Needle

Another name for a three-edged needle, the same as a lancing needle

Lance Needle

Another name for a three-edged needle, the same as a lancing needle

Round-Sharp Needle

A needle with a thin shaft and a somewhat enlarged and sharp round tip, the same as a sharp round needle

Stiletto Needle

An instrument like a double-edged sword used for drainage of pus, the same as a sword needle

Long Needle

7 cun in length, used for deep puncture

Big Needle

A needle with a long and thick shaft and a somewhat round tip, the same as a large needle

Ancient Needling Methods and Techniques

Five Needling Methods

a collective term for five ancient needling techniques used in accordance with the pathological changes of the five viscera, i.e., half needling, leopard-spot needling, joint needling, join valley needling and transport point needling.

1. Half needling

one of the five needling techniques characterized by shallow insertion and swift withdrawal of the needle, also called shallow needling

2. Leopard-spot needling

One of the five needling techniques characterized by pricking with a three-edged needle around the point

3. Joint needling

One of the five needling techniques by puncturing the tendon close to the joint

4. Join valley needling

One of the five needling techniques for treating numbness and pains of muscles by puncturing the muscles of the affected region directly with the needle going obliquely right and left just like the claws of a chicken, also called multi-direction needling

5. Transport point needling

an ancient needling method characterized by deep perpendicular puncture to the bone

Nine Needling Methods

a collective term for nine ancient techniques of needling used for treating nine types of syndrome, i.e., transport point needling, distant needling, meridian/channel needling, collateral/network needling, intermuscular needling, great drainage needling, skin needling, red-hot needling and contralateral meridian/channel needling

1. Transport point needling

an ancient needling method characterized by deep perpendicular puncture to the bone

2. Distant needling

an ancient needling method in which the needling point is selected at the lower body along the meridian/ channel distant from the disease site of the upper body

3. Meridian needling

an ancient needling method by puncturing the site of meridian/channel where nodulation or blood stasis appears

4. Collateral needling

an ancient needling method for bloodletting by pricking the small vessels with a three-edged needle

5. Intermuscular needling

an ancient needling method by puncturing directly into the muscle

6. Great drainage needling

an ancient needling method referring to incision and drainage of pus and blood

7. Skin needling

an ancient needling method characterized by shallow puncture of the skin

8. Red-hot needling

an ancient needling method involving the swift pricking with a red hot needle

9. Contralateral meridian needling

an ancient needling method by puncturing the point of the meridian/channel contralateral to the diseased side, also called opposing needling

Other Needling Methods

Contralateral collateral needling

an ancient needling method characterized by needling collateral/network contralateral to the diseased side, also called contralateral insertion

Paired needling

an ancient needling method by puncturing with a pair of needles, one anterior to and the other posterior to the disease site

Successive trigger needling

an ancient needling method: while needling directly at the tender point , searching for other tender points over the surrounding area and needling in succession

Relaxing needling

an ancient needling method: inserting the needle from the side and then puncturing the contracted muscle in different directions to induce relaxation

Triple needling

an ancient needling method involving one perpendicular needling with two more needling by its side

Shallow surround needling

an ancient needling method: needling the center of a point with additional needling anterior, posterior, right and left to the center of the point

Perpendicular needling

an ancient needling method by inserting the needle beneath the lifted skin

Short thrust needling

an ancient needling method: inserting the needle deep to the bone while gently shaking the handle, followed by short and swift lift and thrust

Superficial needling

an ancient needling method characterized by shallow oblique puncturing

Yin needling

an ancient needling method in which bilateral points are selected for puncture

Proximate needling

an ancient needling method involving a perpendicular needling followed by two oblique needling in the adjacent area

Repeated shallow needling

an ancient needling method characterized by multiple shallow needle insertions causing bleeding

NOTE: The terminologies and definitions of ancient needling methods are adapted from WHO International Standard Terminologies on Traditional Medicine in the Western Pacific Region, published by the World Health Organization in 2007.

MODERN NEEDLING METHODS

Electroacupuncture and other Acupuncture Techniques

Electro-acupuncture therapy

A therapy that applies pulses of electrical current to the needle to stimulate the acupuncture site

Laser acupuncture therapy

A therapy performed by laser irradiation on the acupuncture points

Herbal acupuncture therapy

Combined therapy of acupuncture and medication by which medicinal solution is injected into the acupuncture point

Electrothermic needle

An acupuncture instrument that produces a thermal effect by means of electricity

Microwave acupuncture therapy

Application of microwave radiation to the inserted needle to produce both acupuncture and moxibustion effects

Bee venom acupuncture

A special type of acupuncture performed by bee sting (or injection of episin) at a certain point or cutaneous region of the meridian/channel for therapeutic purposes, particularly for pain relief

Acupuncture point injection therapy

Combined therapy of acupuncture and medication by which liquid medicine is injected into the acupuncture point

Acupuncture anaesthesia

A method of inducing an anesthetic effect through needling for a surgical operation

Segmental needling

Needling to an area of a spinal segment that is associated with a disordered structure

Non-segmental needling

Needling to an area of a spinal segment that is not associated with a disordered structure

Trigger point needling

A type of acupuncture in which the trigger points are needled for therapeutic purposes. Trigger point is a sensitive area of the body which produces a reaction elsewhere in the body when stimulated.

Tender point needling

A type of acupuncture in which the tender points are needled for therapeutic purposes

Intramuscular stimulation needling

A needle stimulating treatment for muscle shortening in deep muscles, especially effective for chronic pain of neuropathic origin, also known as needling myofascial trigger points

Paraneural needling

A stimulating method in which practitioners insert acupuncture needles into the paraneural tissue

Muscle electroneedling

A stimulating method in which practitioners insert acupuncture needles into muscle and apply electrodes on the needles, thereby allowing electrical current to pass through needles

Nerve electroneedling

A stimulating method in which practitioners insert acupuncture needles close to the nerve and apply electrodes on the needles, thereby allowing electrical current to pass through needles

Subcutaneous electroneedling

A stimulating method in which practitioners insert acupuncture needles into the subcutaneous tissue and apply electrodes on the needles, thereby allowing electrical current to pass through needles

Facet joint electroneedling

A stimulating method in which practitioners insert the acupuncture needles on the facet joint of the vertebrae, and apply electrodes on the needles, thereby allowing electrical current to pass through needles

Sham acupuncture

(1) Mimic needling used as a placebo control in clinical research on the effect of acupuncture; (2) Devices to mimic needling

NOTE: The terminologies and definitions of modern needling methods are adapted from WHO International Standard Terminologies on Traditional Medicine in the Western Pacific Region, published by the World Health Organization in 2007.

Traditional Acupuncture Diagnosis and Assessment

As acupuncture and moxibustion are a part of Traditional East Asian Medicine, qualified practitioners typically utilize all of four traditional examinations: Inspection (includes tongue observation), Audio-olfactory assessment, Inquiry and Palpation (includes meridian points palpation, Pulse and Abdominal diagnosis).

Emphasis in the assessments however, may differ depending on each acupuncturist’s background. For example, many Chinese acupuncturists may heavily rely on tongue and pulse signs while Japanese acupuncturists tend to weigh more importance on pulse and abdominal findings.

It is important to note that typically, no single assessment is sufficient to deliver a proper diagnosis.  Experienced practitioners in modern age will gather all available information including Western systems of evaluation, such as orthopedic assessments, to best determine the nature of their patients’ illness. Only then, an effective strategy for acupuncture and moxibustion treatment can be developed.

Tongue-Diagnosis

Tongue Diagnosis

Tongue diagnosis has been an integral part of Chinese medical practice since the latter’s inception around the third century BCE  A description of general tongue characteristics in relation to diseases appears in the classic Chinese medicine texts Huangdi Neijing (Yellow Emperor’s Inner Classic) and Shang Han Lun (Discussion of Cold-Induced Disorders).

Tanaka, TH: Tongue diagnosis: relationship between sublingual tongue morphology in three tongue protrusion angles and menstrual clinical symptoms. Journal of Integrative Medicine. 13(4):248-56, 2015

Pulse Diagnosis

One of the commonly used methods is taking pulse at the radial artery of the
wrist. The three sections over the radial artery for feeling the pulse: The bar/guan is just central to the radial styloid at the wrist, where the tip of the physician’s middle finger is placed, the inch/cun is next to it on the distal
side where the tip of the physician’s index finger rests, and the cubit/chi is on the proximal side where the tip of the physician’s ring finger is placed.
fukushin

Abdominal Diagnosisi (fukushin)

Traditionally there are two main abdominal diagnosis systems based on famous ancient texts Shang Hun Lun (Discussion of Cold Damage written in around 3rd A.D.) and Nanjing (Classic of Difficulties, written in around 2nd A.D.). A page on Kampo site describes abdominal diagnosis based on Shang Hun Lun, which is commonly used by Kampo herbal medicine practitioners.  Many acupuncturists on the other hand, use Nanjing style abdominal diagnosis.

TCM AND JAPANESE ACUPUNCTURE STYLES

Difference between TCM and Japanese Acupuncture

Acupuncture has developed in the past few thousand years, through a rich tradition of trial and error, into an “empirical” medicine.

In the United States and Canada, many different styles and techniques of acupuncture, moxibustion, and acumoxa techniques have been adopted, including but not limited to traditional Chinese medicine acupuncture (TCM), Japanese acupuncture, classical acupuncture, medical acupuncture (neuro-anatomical acupuncture), electroacupuncture, auricular acupuncture, trigger point acupuncture, and Korean hand acupuncture. Increasing numbers of medical professionals such as physicians, chiropractors, and physiotherapists incorporate acupuncture as an adjunct modality into their treatment plan.

Acupuncture-Japanese-Chinese-Needles

Chinese (top) and Japanese (below) Acupuncture Needles

The most common system of acupuncture used in North America today is the Chinese system (or Traditional Chinese Medicine – TCM).  In general, TCM-trained acupuncturists use bigger and longer needles and almost always attempt to produce a de qi sensation (numbness, heaviness, twitching, or radiating ache around the needle insertion). TCM practitioners believe that the de qi sensation is essential for producing acupuncture’s benefits. In contrast, many Japanese-trained practitioners tend to use much finer needles and stimulate only the surface of the skin, and often do not consider the de-qi sensation of importance. It should be noted that not all Japanese practitioners treat their patients with the same technique. Chinese acupuncture was introduced into Japan about 1500 years ago. The basic principles remained similar to the Chinese meridian system, but the treatment style became quite different. This may be the result of social differences between mainland China and the island of Japan but it may also be a matter of simple economics.

In China, acupuncture is one of the cheapest medicines available whereas Western medical interventions and pharmaceuticals are expensive and less accessible. Acupuncture is so commonly practiced and the stream of patients is so voluminous that ensuring patient’s comfort has actually become secondary in this training and system.In Japan especially in the last 100 years, acupuncture has thrived in the private-practice sector. Western medicine has proved to be highly economical and is the central paradigm for Japanese government-supported healthcare. Practitioners of acupuncture in Japan have had to compete by developing traditional methods into highly effective and comfortable treatments.

There are many styles of acupuncture but which is best for you? This really depends on your condition and personal preference and may mean trying out a few practitioners before you find the right one. Every acupuncturist believes their treatment system is best but really, there is simply not enough evidence to conclude either way.

Chinese Acupuncture

Acupuncture in ancient China: How important was it really?

by Hanjo Lehmann

ABSTRACT: Although acupuncture theory is a fundamental part of the Huangdi Neijing, the clinical application of the needle therapy in ancient China was always a limited one. From early times there have been warnings that acupuncture might do harm. In books like Zhang Zhongjing’s Shanghanlun it plays only a marginal role. Among the 400 emperors in Chinese history, acupuncture was hardly ever applied. After Xu Dachun called acupuncture a “lost tradition” in 1757, the abolition of acupuncture and moxibustion from the Imperial Medical Academy in 1822 was a radical, but consequent act. When traditional Chinese medicine was revived after 1954, the “New Acupuncture” was completely different from what it had been in ancient China. The conclusion, however, is a positive one: The best time acupuncture ever had was not the Song dynasty or Yuan dynasty, but is now – and the future of acupuncture does not lie in old scripts, but in ourselves.

Journal of Integrative Medicine: Volume 11, 2013   Issue 1,  Pages: 45-53 Full Text Here

Japanese Acupuncture

Tokyo Declaration on Japanese Acupuncture

From 2011 Tokyo Declaration on Japanese Acupuncture (full text available on Japan Society of Acupuncture and Moxibustion website)

Japanese acupuncture and moxibustion are characterized by six distinctive features.

The first is that “touch” is the most important concept. Diagnostically, palpation is valued; especially pulse diagnosis has been emphasized. The typical example is “meridian treatment” that resulted from the development of a pulse diagnosis of six-position pulse diagnosis based on a unique interpretation of pulse diagnosis. Besides, a variety of palpatory techniques including abdominal diagnosis beyond the Chinese classic medical book “Nanjing(Classic of Difficult Issues)”, Chapter 16 have been newly developed and have evolved gradually. In clinical settings, emphasis has been placed on touching the skin and selecting acupuncture points on the basis of responses of the points as well as practicing treatments frequently on the sites of cutaneous and subcutaneous indications such as tenderness and in duration.

The second is that the development of acupuncture and moxibustion treatment along with diagnostic devices is advanced from the Western medicine perspective. Actually,tools for objective diagnoses ¾ such as meridian patterns of Ryodo-raku (Ryodomeridian therapy, Ryodoraku Medicine), electro-dermal points, and sadenten (potential difference point) ¾ and acupuncture point detector have been developed in parallel to the development of therapies. Particularly to the diagnosis oflocomotive disorders, manual test (physical examination) has been applied,suggesting the emphasis of objectivity. In addition, scientific clinical and basic researches have progressed into practical utilization in Japan.Given these facts and a very large number of patients with locomotive disorders, which are more likely to be treated with acupuncture and moxibustion(rather originated from Western medicine), valuable needle insertion method for local regions have evolved.

Third, promoted development of acupuncture and moxibustion treatment using less burdened and soft and tender stimulation has resulted in realization of kanshin-ho (needling method using a guide tube), thin and shallow tender needling, contact needling, infant needle,intradermal needle, thumbtack needle, laser acupuncture and electro-moxibustion.

Fourth, acupuncture and moxibustion practitioners in Japan are most commonly taking a middle course between Western medicine and classical medicine (based on the Chinese classic books “ Suwen ” and “Lingshu ”) in diagnosis, therapy, technique, and philosophy. The reason may be the flexibility of Japanese people. In fact,tool-assisted treatment such as hyperthermia and electrotherapy, massage,chiropractic, judo therapy, and combination therapy with Western medicine are very popular.

Fifth, moxibustion treatment is highly thriving. Particularly the practice of tonetsu-kyu (diathermic moxibustion) is quite unique technique in the world. This may be attributed to excellent moxa with low burning temperature that has been developed with delicate technology capability.

Finally, the treatment of the presymptomatic state referred to as ‘mibyo’ follows. At any acupuncture and moxibustion clinic,practitioners treat not only affected patients but also a considerable proportion of healthy or apparently healthy people with mibyo for health control and promotion, as is known by yojo no kyu (moxibustion for life nurturing) and sanri no kyu (moxibustion to legs, ST 36).