Connecting the interconnected systems of the body with acupuncture
Czechoslovakia was entombed in ice in January 1965 when Jitka Gunaratna, then twenty-one, left home for the tropical country of Ceylon (now Sri Lanka) to set up housekeeping with her husband, a native of that country.
Five years after arriving in Ceylon, Jitka became interested in studying acupuncture. “My husband, Piryasiri, had suffered with migraine headaches for many years,” Jitka said. “He had tried all sorts of treatments—medications such as vasodilators, analgesics, traction, physiotherapy. We learned about a doctor with the formidable title of Lord Pandit Raja-Guru Professor Doctor Sir Anton Jayasuriya, who practiced acupuncture with very good results. So Piyasiri went to him. He usually had a migraine at least once a week, and the attack was so severe that sometimes he could not work at all. After the initial acupuncture treatment, he had a migraine only once, and it was very mild. That encouraged him to continue. He was treated twice a week for three weeks and then once a week for a month, then once a fortnight for another two months. After that he went in for a treatment once a month if he felt a migraine coming on. After a year his migraine problem disappeared, and he has never had the problem again.”
Acupuncture is a Chinese medical technique that has been developed and refined for over three thousand years. Acupuncture consists of inserting a number of very fine steel needles into the skin at specific Meridian points. In ancient China needles were made of stone, animal bones and bamboo. Over the millennia, it was observed that stimulating certain points on the body's surface could have therapeutic effects. These observations and experiences accumu-lated through both trial and error and clinical experimentation, and eventually developed into the sophisticated and unique treatment system we know as acupuncture.
The majority of acupuncture points lie on the body surface along the thirteen Meridians. Eleven Meridians, each corresponding to a major or minor Energetic system (Liver, Heart, Spleen, Lung, Kidney, Gall Bladder, Small Intestine, Stomach, Large Intestine, Urinary Bladder and Triple Warmer), are distributed symmetrically on the body. There are two additional Meridians along the body's centerline, one along the front (called Ren) and the other along the back (called Du). Meridians form the network of channels or passageways by which Qi travels.
The thirteen major Meridians branch out to smaller channels. This branching out continues until the channels eventually become as minuscule as capillaries. This is how Meridians connect every part of the human body. In fact, Meridians, and the Qi that travels inside them, are the foundation for the wholeness of your body. For example, when you stimulate your Liver Meridian, it can affect all of the functions of the Energetic system to which the Liver is linked. The fourteen major Meridians and all the connecting channels have acupuncture points close to the body surface, for a total of 365 acupuncture points.
It is often of great interest to Westerners that an ailment on one part of the body requires needling in a distant site. For example, the treatment of many different types of headaches can be achieved by placing acupuncture needles in certain points in the feet and legs. Indigestion can be treated with acupuncture points on the bottom of your feet. Hemorrhoids are treated by needling a point on the head. The proven efficacy of acupuncture only further demonstrates that the body is indeed a whole interconnected system.
To understand how acupuncture works, think of a garden hose. Water can freely run through it unless there is an obstruction. If the obstruction is small then the water flow will be only slightly altered. If the obstruction is more severe, the water flow will be severely altered. If the hose is crimped, water pressure (Qi energy) builds up. When the crimp is straightened out, the water will burst forth, removing any obstruction (Qi stagnation). When the obstruction is removed, the water (Qi Energy) will once again be allowed to flow freely. This is the way acupuncture works. The obstruction in Meridians causes the Energy to flow slower, which results in a dysfunction in the Energy system that is associated with the Meridian. Acupuncture stimulates and regulates Qi flow, which removes the obstruction so that Energy can flow with regularity and the Energetic system can be made to resume its normal function.
Acupuncture points are Energetic junctures close to the surface of your skin that are access points to your internal Energy system. Think of these points as tiny valves where Qi is drawn in and out of your body's Energy flow. All acupuncture points are points on your body surface where there is lowered electrical resistance and a higher concentration of sensory and tiny nerve structures underneath the skin. These areas are more sensitive or more responsive to a physical stimulation. Acupuncture needles are inserted into these specific channels to influence your body's Energy flow, or Qi, thus allowing your body to balance and heal itself. Think of acupuncture needles as conduits through which we can strengthen deficient Qi or disperse stagnant Qi.
For the treatment of a chronic disease with a deficiency of Qi, needles are put into selected points to draw in or increase Qi. There are also cases where it is necessary to move excess Qi out of the body. For example, an infection from a toothache is an excess of Qi. Draining excess Qi from the imbalanced site can be accomplished through acupuncture. In the case of stagnation, Qi is dispersed or unblocked but not drained. Needles are inserted and then stimulated repeatedly for a longer time. The stimulation is provided by manually lifting and thrusting the needles, or by electrostimulation, which is explained below.
One cannot needle the body indiscriminately and hope to hit a specific acupuncture point along a Meridian channel. To know which Meridian point to needle, you must first identify which Meridian system is affected. This is where the in-depth diagnostic methods of Chinese medicine come into play. Each patient must be treated as an individual to determine the exact Energy system(s) affected.
Because acupuncture is used to reestablish harmony within your Energetic systems, it can be used for a vast range of illnesses and pain disorders and also to provide effective anesthesia during certain surgical procedures. In the case of chronic pain, acupuncture stimulates the release of endorphins, which are your body's internally produced substances similar to opiates (pain relievers). Research in the United States has focused on the use of acupuncture in pain relief and analgesia, to counteract the side effects of chemotherapy, and as an aid in reducing the cravings of former smokers and drug addicts.
The Acupuncture Clinic of Lord Pandit Raja-Guru Professor Doctor Sir Anton Jayasuriya in Kalubowila Colombo South General Hospital treated 150 to 200 patients every day. After Piyasiri Gunaratna's successful treatment for migraine headaches, Jitka became interested in acupuncture and enrolled to train under Jayasuriya at his institute, Medicina Alternative. Following graduation she stayed on at the clinic for the next twelve years, working as Jayasuriya's assistant.
“Professor Jayasuriya was constantly studying new ways of curing his patients without any harmful side effects by applying natural methods of holistic medicine,” Jitka said. “He made acupuncture anesthesia available in Sri Lanka and saved the lives of countless patients who were not candidates for traditional anesthesia.” In 1979 Columbo South General Hospital performed over seven hundred major surgical procedures using acupuncture anesthesia alone. Jitka assisted Jayasuriya on many such surgeries.
“After working at the clinic I was leaving the clinic quite exhausted,” Jitka said. “I started giving myself tonification treatments with acupuncture in the afternoon before I started to treat my private patients. Tonification points act as a pick-me-up. They are typically used after a long illness and for many other conditions, such as hypotension, loss of appetite, anorexia and anemia. I was using them to get a boost of energy during a long day—but suddenly I got pregnant! I was thirty-five years old, and after seventeen years of marriage it was a bit of a surprise.” (Acupuncture can improve ovarian function. See chapter 17 for a case history on infertility and acupuncture.)
Since it was Jitka's first baby and she was an older mother, her obstetrician decided it would be best delivered by Cesarian section. In 1977, Jayasuriya had performed the first acupuncture anesthesia during a Cesarian section in Sri Lanka; the infant girl was given the name Zusanli—the name of an acupuncture point. Jitka was found to be an appropriate candidate for acupuncture anesthesia. About 2 percent of the population is not suited to acupuncture analgesia. A patient is considered not suitable for acupuncture anesthesia if he or she does not feel the so-called acupuncture sensation—numbness, heaviness, slight pressure or tingles along the Meridian—when needled.
The difference between acupuncture as analgesia and acupuncture as anesthesia
An analgesic alters the perception of pain, such as acetaminophen or aspirin minimizing the pain of a headache. An anesthetic creates a total loss of the sen sation of pain, such as the drugs that are given during surgery to induce a deep sleep, or novocaine to numb and eliminate pain during dental procedures.
There are three key components to acupuncture as an analgesic and an anesthetic. First and foremost, acupuncture is extremely effective in killing pain. It is also somewhat effective in producing sedation. Although capable of effectively relaxing skeletal muscle, acupuncture is often unsatisfactory in its ability to relax smooth muscles, which line many organs. This is why the majority of acupuncture analgesia is utilized in neck, facial and skull operations, which do not require the stretching of large muscle organs. Acupuncture is often utilized in brain and neck surgery and dental procedures because the patient needs to be awake and conscious or because of the proximity of the surgery to the brain stem.
For surgery, acupuncture is also used in individuals that have a known history of allergy or intolerance to traditional anesthetics. However, because of the large smooth-muscle groups and organs found within the abdomen and pelvis, such surgeries rarely incorporate acupuncture as the sole anesthetic; rather, it is most often used as an adjunct to conventional anesthetics. The use of acupuncture as an adjunct allows for a lower dosage of chemical/conventional agents, thus providing a safer procedure for those patients with sensitivities to these agents. Acupuncture is also now used as anesthesia for childbirth. Unlike conventional anesthesia, acupuncture anesthesia does not lower blood pressure or depress breathing.
On her delivery day Jitka was taken to the operating room, where Jayasuria gave her ten needles—some were stimulated by high-frequency electric current.
A high-frequency stimulator is an electronic device designed for administering acupuncture anesthesia. It sends electronic pulsation with a very high frequency through electric wires connected to the acupuncture needles. The intensity and frequency required for acupuncture anesthesia are hard to sustain if they are to be provided manually.
Electrical stimulation is used during operations by way of a high-frequency stimulator, which makes the operated area numb when connected to selected needles. When using acupuncture anesthesia during surgery, it is essential to put some of the acupuncture needles alongside the incision. These needles are connected to the high-frequency stimulator. The other needles connected to the stimulator depend on the area operated upon—the head, chest, abdomen, pelvis—and of course the experience and knowledge of the acupuncturist.
Surgery is not the only condition in which electroacupuncture is utilized. Electroacupuncture can be used in nearly all situations in which traditional acupuncture is used. Most often it is used in the situation where the primary treatment focus is on dispersing Qi rather than tonifying. The flow of Qi is stimulated by connecting acupuncture needles to the small DC charge of an electroacupuncture stimulator. The needles are connected in pairs and several pairs can be connected at the same time. The frequency and strength of the electric pulse is monitored by the acupuncturist to achieve the desired effect without discomfort to the patient.
Using electroacupuncture for anesthesia, it takes about twenty minutes to achieve the induction state. Because the patient needs to get used to the stimulation and because he or she is fully conscious, it is necessary to work gently and to constantly adjust the stimulation. That is one reason why operations using acupuncture anesthesia are more demanding of the surgeon's skill. The surgeon must be gentle and quick, and the acupuncturist must constantly communicate with the patient and decide how to manage the stimulation as to not allow any discomfort. Such techniques, therefore, are not suitable for long operations, especially those where some force must be used, such as orthopedic operations where saws, hammers and chisels are used.
During Jitka's surgery, after a twenty-minute acupuncture induction period, at 8:30 A.M. the obstetrician started to work. “At 8:48 my son was born, and at 9:05 I was back in my bed,” Jitka said. “Five days later I attended a dinner organized by my husband at a restaurant in Colombo. There is nothing else I can say about my recovery. The whole affair was less stressful than a common cold.”
Jitka and her family fled Sri Lanka under death threats during the bloody civil war in 1989. They settled in the Czech Republic, where Jitka is a visiting lecturer at the Institute for Postgraduate Studies for medical doctors. There she has organized a successful postgraduate training course in acupuncture.
The Acupuncture Clinic of Lord Pandit Raja-Guru Professor Doctor Sir Anton Jayasuriya and the acupuncture institute he founded, Medicina Alternative, in Colombo, Sri Lanka, are among the most important acupuncture institutions in the world. Jayasuriya has never deviated from his philosophy that acupuncture treatments should be free. Rich and poor are always treated free of charge; students of acupuncture who attend Medicina Alternative are charged tuition. Most acupuncture clinics in the United States, unless funded by charitable organizations, charge between $25 and $125 per treatment.
When you go to a Chinese doctor for acupuncture treatment, your treatment will be no different than if you were being treated in China. Your treatment will begin with the Four Examinations, Inquiring, Looking, Listening/ Smelling and Touching, to determine your pattern of harmony and disharmony. This will give your doctor a comprehensive picture of your problem. Your doctor will then explain your imbalances and the treatment plan he or she advises.
You will be situated in such a way as to facilitate the effectiveness of the acupuncture treatment. Often this takes the form of lying or sitting on an acupuncture table. Other times you may be encouraged to walk around while the needles are in place. A caring acupuncturist will provide a tranquil atmosphere in a private room, with the temperature warm enough and with soothing music to enhance your relaxation. The acupuncturist will then dart needles into the acupuncture points that are appropriate for your treatment. This is mostly painless and can, in fact, be unnoticeable. Usually four to twenty needles will be inserted.
The insertion depth of the needle depends on two main factors: 1) Depth and needle insertion techniques are designed to engage Qi. This engagement is known as deqi. The patient experiences sensations of numbness, heaviness, distension or radiating tingles. The acupuncturist, on the other hand, experiences a subtle heaviness or pulling beneath the tip of the needle when deqi is achieved. 2) The thickness of the tissue at the acupuncture point. On thin muscles such as areas around the skull and close to the bones around the wrist the needles are inserted horizontally or obliquely to avoid the bone. On thick muscles and in areas where there is low risk of damage to underlying anatomical structures, needles are typically inserted at a depth of 1 to 1.5 cun (see Figure 7). Tiny needles (0.5 cun in depth) are utilized for areas such as fingers, toes, head, face and particularly the ears. On the other hand, an acupuncturist might use unusually long needles (up to 8 cun) for areas such as the hip.
Once a needle is inserted, the wire handle is twirled or the needle is lifted and thrusted until the feeling of deqi is achieved. It is necessary for the patient to feel the deqi when the needle is inserted. Since some patients are not as receptive, it is necessary to repeatedly stimulate the needles. For the sensitive person it is enough to leave the needles in place after insertion, without manip ulation, for fifteen to thirty minutes. In the treatment of chronic disorders it is often advisable to use less manipulation of the needles, as strong stimulation tends to disperse Qi.
At the end of an acupuncture treatment you may feel euphoric, relaxed and drowsy, or you may feel energized, with the relief of pain and other symptoms.
Although many conditions are improved by one acupuncture treatment, it usually takes a series or course of treatments to heal. Often herbal formulas are included in the treatment plan.
Hemophilia
Severe psychosis
Drug or alcohol intoxication
Also, certain points are contraindicated in pregnancy, as they can cause miscarriage.
It is important to note that acupuncture can be useful in treating the symptoms of AIDS as well as the side effects of drugs used to treat HIV and AIDS, and to strengthen the immune system.
Strict hygienic protocols including the use of sterile, disposable needles are practiced by reputable acupuncturists.
Just because you have tried acupuncture does not mean you had a quality experience with acupuncture. An acupuncturist may know the points, but that does not mean he or she can effectively treat you. Acupuncture is an art form that some people master and others do not—no matter how well intentioned. Moreover, the relationship between the acupuncturist and patient is extremely important. The right match between acupuncturist and patient is an important aspect of your healing process. A good rapport between you and your acupuncturist will ease any anxiety you may feel about your condition or about the actual acupuncture procedure. “A patient who has confidence and is relaxed is more likely to respond better to the treatment,” Jitka said. “Acupuncture is a very personal type of healing in which an acupuncturist and a patient exchange their own vital energy—Qi.” Because of the interaction of Qi during an acupuncture treatment, it is important that you experience a sense of rapport and safety with your practitioner. Feelings of tranquility, respect and confidence must be achieved. If you sense that your practitioner is rushed, distracted, upset or not fully present, postpone your treatment or look for another practitioner with whom you feel comfortable. Fortunately, there are now many excellent and compassionate acupuncturists to choose from.
By the same token, any practicing acupuncturist will tell you how very draining some patients can be. “I call them octopuses,” Jitka said. “As an acupuncturist, one feels like one is being wrapped and sucked by their tentacles.” Dr. Mao, who is the cofounder of the Tao of Wellness clinic in Santa Monica, California, said, “There is power in the exchange of Vital Energy or Qi. There is certainly Energy transference in clinical situations. When you are in practice you cannot avoid so-called toxic people. I practice and teach my students how to shield oneself from taking on a patient's anger and also how to cleanse oneself of negativity at the end of every working day. It is a mental, spiritual and Energetic practice of gathering protective Energy, so that one doesn't pick up negative Energy from patients.”
See page 425 for resources to find an acupuncture clinic in your area.
Moxabustion involves burning dried mugwort leaves directly over acupuncture points to allow the heat to penetrate the areas around acupuncture points along the channels that influence Qi and Blood flow. Moxa is made of the aromatic herb mugwort (Chinese: Ai Ye), a member of the Artemesia family of herbs, many of which have medicinal qualities.
Moxa is dehydrated mugwort leaves, which are treated, pulverized into a cotton-ball-like consistency—similar to the newsprint filling in padded mailing bags—then molded into a cone or stick that looks somewhat like a cigar. A moxa cone can be wrapped around the metal shaft or handle of the acupuncture needle or placed on a slice of dehydrated herb such as ginger, which is then placed directly on an acupuncture point and burned. A moxa stick is lit and the red glowing end held about one inch over specific acupuncture points, or over acupuncture needles that are inserted into points. The doctor of Chinese medicine will hold the moxa until your skin is warm, then draw it away, repeating this process for several minutes to half an hour.
Mugwort goes into Liver, Spleen and Kidney Energy Meridians. Moxa's basic function is as a warming agent that promotes Energy flow. It is used to treat Cold or deficient imbalances and alleviate certain types of pain. Moxa burns slowly, giving off a musty smoke. Some people find the smoke disagreeable because it lingers in hair and clothing. Smokeless moxa is avail able, and although hard to light, it is still often used. Moxa can be used on infants, children or adults who are afraid or cannot tolerate acupuncture needles.
Other forms of moxa include long thin sticks that resemble ordinary incense sticks, used as described above. Also, moxa can be burned in a box that is placed over an acupuncture area. Moxa can be wrapped around the metal handle of an acupuncture needle before the needle is inserted into a specific acupuncture point. The moxa is lit, warming the needle and penetrating the channel.
Moxa is suitable for use at home by the layperson. You can purchase moxa in various forms in many herbal stores, from your Chinese herbal clinic and online at ancientherbsmodernmedicine.com.
Acupressure is based on the same principles as acupuncture, though the pressure of touch is used instead of needles. The fingertip, not the pad, of the fin-ger(s) is used when exerting pressure. Whenever possible, the tip of the thumb is used because the thumbs are able to exert more and sustained pressure. The amount of pressure applied should be moderate, yet enough to create a significant sensation of Qi. If too little pressure is applied, you will only feel the sense of touch. If too much pressure is applied, you will feel notable pain. A little bit of soreness or tenderness actually is just about the right amount of pressure. Once the correct amount of pressure is being applied, while maintaining constant pressure one can make very small circular motions—so small they are hardly perceptible—with the applying finger(s), without lifting the finger(s). The duration of applied pressure should be maintained for at least one minute at a time, but no more than three minutes. This procedure can be repeated on the opposite side immediately. This process can be repeated back and forth between sides several times.
Headache
To treat a headache with acupressure, follow the two steps in the order presented: Cuan Zhu point and Tai Yang point. Alternate the two pairs of points several times by pressing each pair for about one minute at a time.
Figure 8 Cuan Zhu Point
Step One
Cuan Zhu point: Simultaneously using the tips of both thumbs, with the palms facing inward toward each other, press the points located at the very inner area (closest to the bridge of the nose) of the eyebrows.
Tai Yang point: Simultaneously using the tips of both thumbs with the palms over your forehead and the pads of the remaining fingers lightly touching the center of the forehead, apply pressure to the slightly concave and somewhat softer area of the temple located approximately one and a half to two inches on a line extending from the outer corner of your eyes toward your ears.
Figure 9 Tai Yang Point
To treat nausea (motion or morning sickness) with acupressure, follow the two steps in the order presented: Hegu point and Nei Guan point. Alternate the two pairs of points several times by pressing each pair for about one minute at a time.
Figure 10
Hegu Point
Step One
Hegu point: With one hand resting palm toward your stomach, use the tip of the thumb of the other hand to apply pressure at a point located between the base of the thumb and base of the index finger.
Figure 11 Nei Guan Poing
Step Two
Nei Guan point: With one arm bent and palm facing upward make a fist. You will notice two major tendons running alongside each other, from the base of your hand through the middle of your wrist. Using the tip of the thumb of the opposite hand, apply pressure to a point between these tendons approximately two finger widths down from the most distal (closest to the palm) crease line of the wrist.
To treat a stomachache or abdominal cramping with acupressure, use Zu San Li point. Press this point for about one minute, release, and repeat several times.
Figure 12 Zu San Li Point
Zu San Li point: Follow the ridge of the tibia (shinbone) all the way up to the top of the tibia, located just below the patella (kneecap). You will notice that the head of the tibia forms a T shape with the ridge of the shinbone. One index finger width toward the outside of the leg from the shinbone ridge and one index finger width down from the outer aspect of the top of the T is the acupressure point. Using the tip of either thumb, exert pressure on this point.
To treat eyestrain due to overuse (this is also good for preserving and promoting good eyesight) use the following four pairs as a group in the order presented: Jing Ming point, Cuan Zhu point, Chen Qi point and Tai Yang point. Maintain pressure on each pair of points for about one minute before moving on to the next pair. Repeat the steps once if necessary.
Figure 13 Jing Ming Point
Step One
Jing Ming point: Using the tips of the thumb and index finger, apply pressure to a pair of points located between the bridge of the nose and the inner corner of each eye, just above the eye itself. You will notice that you are applying pressure in such a way as to feel the bony upper part of the eye socket.
Cuan Zhu point: Simultaneously using the tips of both thumbs, with the palms facing inward toward each other, press the acupressure points located at the very inner area (closest to the bridge of the nose) of the eyebrows.
Figure 14 Cuan Zhu Point
Cheng Qi point: Apply pressure to a point located straight down from the pupils of your eyes and straight across from the top of each nostril where it flares out from the ridge of the nose. Use the tips of the index or middle fingers to apply pressure to both sides simultaneously.
Figure 15 Cheng Qi Point
Tai Yang point: Simultaneously using the tips of both thumbs with the palms over your forehead and the pads of the remaining fingers lightly touching the center of the forehead, apply pressure to the slightly concave and somewhat softer area of the temple located approximately one and a half to two inches on a line extending from the outer corner of your eyes toward your ears.
Figure 16 Tai Yang Point
To treat anxiety and tension with acupressure, follow the three steps in the order presented: Shen Men point, Nei Guan point and San Yin Jiao point. Maintain pressure on each pair of points for about one minute before moving on to the next pair.
Figure 17 Shen Men Point
Step One
Shen Men point: Using the tip of the thumb, apply pressure to a point on the opposite wrist located along the first wrist crease closest to your hand, approximately one and a half index finger widths from the outer edge (pinky side) of the hand.
Nei Guan point: With one arm bent and palm facing upward, make a fist. You will notice two major tendons running alongside each other from the base of your hand through the middle of your wrist. Using the tip of the thumb of the opposite hand, apply pressure to a point between these tendons approximately two finger widths down from the most distal (closest to the palm) crease line of the wrist.
Figure 18 Nei Guan Point
Figure 19 San Yin Jial Point
Step Three
San Yin Jiao point: This is where the Spleen, Liver and Kidney Meridians cross. This point is located on the inner aspect of the lower leg approximately three index finger widths above the inner bulge of the ankle bone, just beneath the tibia, in the soft area between the tibia and the lower part of the calf muscle.
The entire body is represented in acupuncture points on the ear. Auricular (ear) acupuncture is a branch of acupuncture that treats disharmonies or illnesses by needling exclusively acupuncture points on the ear. Some acupuncturists use seeds instead of needles. The seeds of the Wang Bu Liu Xing plant (Vaccaria) are often used, while others prefer to use stainless steel beads. Seeds are attached to surgical tape and adhered to certain specific acupuncture points on the ear. For example, certain points can be used when you feel anxious, stressed or experience cravings from withdrawal from cigarettes, sugar, caffeine or other stimulants; stimulating the seeds with the tips of your fingers can provide relief. The seeds are commercially available, but the application points have to be very precisely located. The seeds are best attached by a trained acupuncturist.