Even though acupuncture has been a practiced Chinese medical treatment for over 4,500 years, in most western cultures it is considered a "new alternative" medicine. Acupuncture is the oldest form of curing still practiced in the world today.
In Chinese medicine, and therefore in acupuncture, health is determined by a person's ability to maintain balanced and harmonious internal environment. Disease occurs when the internal environment is disturbed and the normal processes that act to restore balance and harmony are unable to cope (Mills & Finando, 1989, p. 8). Harmony and balance depend on the smooth and uninterrupted flow of Qi (pronounced ch'i). The Chinese ideogram for "energy" is called Qi. Acupuncture is based on the theory that Qi runs through the body as an energy force. The Qi consists of all vital activities including the spiritual, emotional, mental, and physical part of life that is within all living beings. Acupunctures premise is that nature is a part of all living beings rather than something outside them.
Qi is comprised of two parts, Yin and Yang. Yin and Yang are opposite forces, that when balanced, work together. Any upset in the balance will result in natural calamities, in nature, and disease in humans. It is the right balance of Yin and Yang that is responsible for the harmonious functioning of the universe, including mankind (Nightingale, 1987, p. 19).
An individuals' health is a reflection of the flow of Qi and the universal forces of the Yin and Yang. If the flow of Qi is unbalanced or interrupted, then the Yin and Yang will also be unbalanced. When these forces become unbalanced illness can surface (Singer, 1999).
The flow if Qi moves in the body along pathways called "meridians". Meridians are pathways along which energy is transmitted around the body by oscillation and vibration (Nightingale, 1987, p. 50). The meridians are paired, one on either side and run vertically up and down the surface of the body. The meridian system in the body could be thought of like our nervous system: It is a means of communication. Unlike our nervous system, though, the meridians are not a physical structure, but an energy structure (Sundarii, 1999).
Qi flows up and down these meridians and when these pathways become obstructed or stuck (unbalanced), Yin and Yang also become unbalanced and this is said to cause illness. Acupuncture is the practice of bringing balance back to the QI and the Yin and Yang.
The specific acupuncture points are where the meridians come to the surface of the skin. This makes it easy to access these points through needling that will restore circulation to the flow of Qi bringing back balance between Yin and Yang. Through the insertion of needles at specific acupuncture points on the Meridian, we are coaxing the energy to flow properly. When energy is flowing, the bodies own healing mechanisms are able to "kick in," and the process of healing begins (Sundarii, 1999).
Possible reasons cited for obstructing the flow of Qi include internal or emotional disturbances, external factors, imbalances in diet or lifestyle, and too much work and stress. Stimulation by acupuncture is said to remove these blockages by diffusing lactic acid and carbon monoxide that accumulates in muscle tissue. These accumulations are believed to cause stagnation of blood and stiffness throughout the body (iVillage, 2000).
Acupuncture relies on the body's own natural healing energy. Individuals are treated differently using acupuncture, as no two people are alike. As acupuncture treatment begins the body will access its own healing energy and the body will rebalance itself. Symptoms will begin to fade as the body begins to heal itself.
Millions of Americans have turned to acupuncture and other alternative medicines for relief or prevention of pain and for a variety of health conditions.
The National Institute of Health (NIH) gave their approval of acupuncture and in 1997, the NIH Consensus Panel examined all available research on acupuncture treatment. The NIH panel's consensus statement found that acupuncture (National Institute of Health, 1997):
* Is an effective treatment for a variety of health conditions including nausea from chemotherapy, surgery and pregnancy, and pain after surgery;
* May also be an effective adjunct therapy for a number of other conditions, including stroke rehabilitation, relieving addictions, headaches, menstrual cramps, a variety of muscle pains, carpal tunnel syndrome, tennis elbow, low back pain, osteoarthritis, and asthma;
* Adverse side effects are known to occur less often than with many drugs or other medical procedures used for the same conditions;
* Should be integrated into standard medical practice and be covered by Medicare, Medicaid and private insurance companies.
Moreover, the World Health Organization (WHO), the medical branch of the United Nations issued a provisional list of 41 diseases treatable by acupuncture. Some of those included in the list are respiratory ailments, pain and chronic pain conditions, PMS and other gynecological disorders, and gastrointestinal disorders (World Health Organization, 1979).
Today the practice of acupuncture has increased in the United States and there are over 50 schools of acupuncture nationwide, 21 of which are accredited by the U.S. Department of Education and over 40 states have laws or regulations governing the practice of acupuncture (http://www.thehealthpages.com/
articles/ar-acupn.html).
What is Acupuncture?
Acupuncture is comprised of a grouping of procedures that involve stimulating specific points on the skin using a variety of styles. Some of the acupuncture techniques practiced today have incorporated the traditions from China, Japan, Korea, and other countries (National Institute of Health, 1997).
For conditions that cannot be helped with Western medicine, acupuncture can be a viable source of treatment. Acupuncture deals with the physical body, the mental being and the spiritual being, whereas Western medicine only deals with the physical body. Therefore, it can help people on levels that go untouched by Western medicine (Sundarii, 1999). Not everyone is helped by acupuncture treatment however some people do experience relief after only one or two sessions. For others, relief could take up to ten to twelve sessions.
Acupuncture is a procedure that involves the penetration of specific locations on the skin using thin, solid, metallic needles in order to influence physiological functioning of the body. These specific points on the skin are called acupuncture points.
As many as nine different types of needles can be used in acupuncture, however only six are most commonly used today. The needles may vary in length, width of shaft, and shape of head. For health reasons, most needles are disposable and are only used once then discarded in accordance with medical biohazard regulations and guidelines (Singer, 1999).
Acupuncturists use a few types of methods when inserting needles. Techniques are carefully chosen based on the ailment and no two individuals are treated alike. Points can be needled anywhere in the range of 15 degrees to 90 degrees relative to the skin surface, depending on the treatment called for (Singer, 1999). The following techniques are sometimes used following insertion of needles: Raising and Thrusting, Twirling or Rotation, Combination of Raising/Thrusting and Rotation, Plucking, Scraping (vibrations sent through the needle), and Trembling (another vibration technique) (Singer, 1999).
These techniques are not painful, however there is a sensation felt by the patient. This sensation, which is not pain, is called deqi (pronounced dah-chee) and is desired by the acupuncturist (Singer, 1999).
How Does Acupuncture Work?
Scientists have no real answer to how acupuncture works, however there are many theories. What they do know is that acupuncture treatment can influences function rather than structure (Nightingale, 1987). What this means is that structural problems such as a broken bone, severed nerve, or irreversibly damaged internal organ cannot be helped by acupuncture. Functional problems, such as muscle spasms, joints pain or swelling, allergic reactions, and digestive disturbances, can be influenced by acupuncture (Rind, 1999). Pain, whether acute or chronic, often responds dramatically to acupuncture (Nightingale, 1987, p. 23).
A short answer to how acupuncture works is that acupuncture works by correcting disharmony within the body (Nightingale, 1987). The traditional Chinese describe this disharmony as either a deficiency or a blockage in the meridians. The meridians or pathways of energy that run through the body and over its surface flow through the body to irrigate and nourish the tissues. Any blockage or obstruction to this flow will cause a back up in the system and cause other parts to have deficiencies. These blockages and deficiencies of the flow of energy through the body will eventually lead to disease (Chinese Pain Center, 1999). Acupuncture or needling will unblock these dams of energy and bring back a regular flow of energy through the meridians. Acupuncture treatments can therefore help the body's internal organs to correct imbalances in their digestion, absorption, and energy production activities, and in the circulation of their energy through the meridians (Chinese Pain Center, 1999). This method of healing encourages the body to promote a natural self-healing process.
The western medical view of how acupuncture works is that the stimulation of needling the acupuncture points produces a controlled, sterile, and harmless stimulus to the nervous system. The body's defenses are triggered into responding with a desirable response, such as a release of chemicals in the muscles, spinal cord, and brain (Chinese Pain Center, 1999). These responses can increase endorphin production, improve circulation, improve immune response, or decrease inflammation changing the experience of pain or stimulating the body to use its own internal regulating system (Rind, 1999).
The Different Types of Acupuncture
There are different styles and schools of thought in acupuncture, ranging from traditional Chinese acupuncture to modern Western approaches. Within each of these different approaches there are many variations. No two practitioners will perform the same treatment techniques for the same problem. There are also different theoretical orientations (e.g., Chinese, Japanese, Korean) that a practitioner may use to approach treatment. There are many acupuncture techniques that may be used as treatment as well as many variations of these techniques. The following are brief descriptions of some of the most popular acupuncture techniques:
Traditional Chinese Acupuncture
Traditional Chinese acupuncture practitioners believe that Qi flows through the body through the meridians. Therefore, treatment from this view involves using needling to stimulate the acupuncture points that will promote the body's natural healing process. The purpose of the needling is to release any blockage of energy that may be causing pain or disease in the body. Traditional Chinese acupuncture healers focus on the unity of the body and mind, meaning that if a person is having pain or illness they are also in emotional turmoil, and vise versa (Rind, 1999).
Rvodoralru
Yoshio Nakatani, a Japanese physician, developed Rvodoralru an estimated 40 years ago (Rind, 1999). Ryodoraku is different from traditional Chinese acupuncture in that it doesn't attempt to increase the flow of Qi but instead attempts to balance the meridians.
Ryodoraku is a system of measuring skin resistance at the many different acupuncture points. This information is then used to balance the 12 main meridians. This method of acupuncture is based on the theory that good health comes from the balancing of the meridians (Rind, 1999).
Korvo Sooii Chim
Dr. Tae-Woo Yoo developed Korvo Sooii Chim (Korean hand acupuncture) in 1971 (Rind, 1999). This method of acupuncture used only points on the surface of the hands. The beliefs behind this method are that every acupuncture point on the body has a corresponding acupuncture point on the surface of the hand (Rind, 1999). Therefore, if an acupuncturist wanted to perform a treatment that would bring relief to a certain part of the leg, they would insert a needle in the corresponding part of the hand.
Modern Western Acupuncture
Modern Western acupuncture is similar to traditional Chinese acupuncture, however the difference lies in the underlying premise of each theory. Modern Western acupuncture is based on the premise that the insertion of an acupuncture needle will induce a controlled stimulation and have a measurable response. This stimulation will produce a reflex response from the body that may increase production of endorphins or create increased blood flow to a particular area of the body that will enable the body to initiate self-healing.
A traditional Chinese acupuncturist may insert a needle into the same point the Western acupuncturist inserted a needle but instead the premise would be that inserting a needle in that acupuncture point will stimulate the meridian and increase the flow of Qi which will bring balance and health (Rind, 1999).
Auricular Acupuncture
Auricular acupuncture is a commonly used treatment in the United States. This method of acupuncture involves placing needles into acupuncture points in the ear. This theory is based on the premise that the ear has a rich nerve and blood supply and therefore has connections all over the body. Much like the Korean method of Korvo Sooii Chim (Hand acupuncture), it is assumed that the ear has acupuncture points that correspond to the many different parts and organs of the body and therefore when these points are stimulated they will bring relief to the corresponding area of the body (Singer, 1999).
Acupuncture and Moxibustion
The method of acupuncture and moxibustion is the burning of the herb moxa (Chinese mugwort) over certain acupuncture points of the body to treat disease (Nightingale, 1987). This is method warms, tones, and stimulates the acupuncture points. Doing moxa regularly on specific acupuncture points is said to promote strength and longevity (Cohen, 1999). Acupuncture and moxibustion are considered complimentary forms of treatment, and are commonly used together. Moxibustion is used for ailments such as bronchial asthma, bronchitis, certain types of paralysis, and arthritic disorders (Singer, 1999).
Electro-Acupuncture
This method of acupuncture is used primarily in analgesia (pain relief). This form of acupuncture sends very small electrical impulses through the acupuncture needles. The amount of power used is only a few microamperes, but the frequency of the current can vary from 5 to 2,000 Hz (Singer, 1999). For surgical procedures the higher frequency is used. In China, this is a common form of surgical analgesia (Singer, 1999).
Cupping Acupuncture
Cupping is a method of stimulating acupuncture points by applying suction through a metal, wood or glass jar, in which a partial vacuum has been created (Singer, 1999). The cupping technique produces blood congestion at the acupuncture points creating stimulation. It involves taking small glass cups, burning a small amount of cotton wool impregnated with alcohol for a few seconds inside the cup, and then placing the cup over the area to be treated (Nightingale, 1987, p. 90). Cupping is used for low backache, sprains, soft tissue injuries, and helping relieve fluid from the lungs in chronic bronchitis (Singer, 1999).
How safe is Acupuncture?
Acupuncture is a very safe treatment when practiced by a trained, qualified acupuncturist using sterile, disposable needles and proper skin cleansing methods (Rind, 1999). One of the advantages of acupuncture is that the incidence of adverse effects is substantially lower than that of many drugs or other accepted medical procedures used for the same conditions (National Institute of Health, 1997).
However, it is important to consider the risks involved with any invasive procedure. Because needles are inserted into the skin during treatment, it is important to make sure the practitioner is using the most sterile techniques as to avoid infection or the transmission of diseases such as hepatitis or AIDS, even though the transmission of HIV through acupuncture is unlikely (Trachtenberg, 1989).
One way to reduce risk is to ask the practitioner if they use individually sealed, disposable needles (iVillage, 2000). Some acupuncturists use silver or gold needles, which must be sterilized after each use (Rind, 1999).
The individually sealed sterile, disposable needles are approximately the diameter of a human hair. The needle is solid, nothing is injected into the body, and the depth of the insertion is very shallow (Sundarii, 1999). When compared to the benefits of acupuncture, the risks and adverse side effects seem quite low.
Training and Healthcare Providers
Acupuncturists are licensed independently in most states. However, some states require you to be a Medical Doctor to practice acupuncture. Approximately 30 percent of the 10,000 practicing acupuncturists in the United States are physicians, according to the World Health Organization (World Health Organization, 1979). Thirty-four states license or otherwise regulate the practice of acupuncture by non-physicians, and have established training standards for certification to practice acupuncture (iVillage, 2000). Consistency among the States in regulating the qualifications of acupuncture practitioners will increase the confidence of the public and the health care community.
Some of the leading associations for acupuncture are the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM), the National Commission for the Certification of Acupuncturists (NCCA), and the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM).
Are there people who should not have acupuncture?
Even with acupunctures success rates there are some medical conditions that require extreme caution. For example bleeding disorders, taking prescribed blood-thinning medication, and pregnancy (Rind, 1999). Pregnant women should use extreme caution when being treated with acupuncture because acupuncture may stimulate production of hormones in pregnant women that help initiate labor and can be harmful to the fetus in early pregnancy (http://www.thehealthpages.com/articles/ar-acupn.html). Caution should also be used in cases of extreme susceptibility to infection or if the area to be treated is infected (Rind, 1999). Extremely weak and very old people and those who are unduly nervous as well as those who are particularly frightened of needles are better treated by some other method, such as laser (Nightingale, 1987, p. 25).
There are some conditions that do not respond as well to acupuncture. They include cancer, severe infections, heart disease, muscular dystrophy, venereal disease, motor neurone disease, and any cases where surgery is clearly indicated, such as appendicitis (Nightingale, 1987, p. 25).
How to Select an Acupuncturist?
When you are selecting an acupuncturist there are two important factors to consider, the doctor's training and your goals. There are two things that you want your acupuncture practitioner to have these are reputable training and a keen sense of the philosophical underpinning of Chinese medicine (Cohen, 1999). The best way to determine if a practitioner meets those standards is to ask a lot of questions about his or her training, length of practice, scope of practice, specializations, attitudes about wellness and disharmony and understanding of Chinese medicine philosophy (Cohen, 1999).
The acupuncturist you choose should be licensed (in states with licensing requirements) or certified. If you live in a state that does not require licensing, then you will want to make sure your acupuncturist is certified from the NCCA. There are about 10,000 licensed, registered, or certified acupuncturists in the U.S. and an additional 3,000 medical doctors (MDs) or doctors of osteopathy (DO's) who practice the technique (PDR, 1999).
The next thing to investigate is your goal of acupuncture treatment. Are you looking for a primary care physician or a short-term treatment? Are you more comfortable with a physician who practices acupuncture or with a non-physician practitioner? A physician will have a medical degree with training in acupuncture whereas a non-physician may have more faith in the body's natural healing process and the use of alternative medicines. More training is required of non-physician acupuncturists because of the importance of knowing what conditions can and cannot be safely treated with acupuncture, which locations on the body can be safely treated, and the importance of using safe, sterile technique (Rind, 1999). If a primary care physician is what you are looking for then you will want to select a practitioner that is knowledgeable about all aspects of Chinese medicine and Western medical procedures (Cohen, 1999). The following summarized what to look for in a primary care Chinese medicine practitioner (Cohen, 1999):
* Someone who does not make promises to cure disorders and diseases for which there is no cure.
* Someone who understands that there may be many different modalities that work for an individual and does not insist that his or her way is the only right or good way to go
* Someone who has a bedside manner that pleases you
* Someone who is able to explain what she or he is doing from both a Chinese and a Western viewpoint-or is at least willing to find out about the alter native perspective when necessary
* A practitioner who is not unconditionally opposed to any drug therapy in conjunction with acupuncture or herbal treatment, and who understands the interactions of drugs and herbs
* Someone who will work with medical doctors and other practitioners
* In cases of serious illnesses, you want to select a practitioner who understands Western medical terminology and concepts of the immune system, viruses and cancer, as well as Chinese concepts, if you are going for treatment of these problems.
* If you have HIV, chronic hepatitis, or CFIDS (chronic fatigue immune deficiency syndrome), be sure that the practitioner's attitude is that you can live with this chronic, manageable viral infection and that acupuncture and herbs may help you be more successful in that process.
Another factor to consider is whether or not your insurance will cover acupuncture treatment. Sometimes properly worded requests for acupuncture will be covered. Talk to your regular physician to see if he or she can prescribe acupuncture treatment (http://www.thehealthpages.com/articles/ar-acupn.html).
What can I expect at a first visit?
When you go to a Chinese medicine practitioner, the evaluation and diagnosis will be based on a system of observation and questioning. This system of evaluation and diagnosis follows the philosophy of the Tao. Diagnosis is a process of perceiving signs and symptoms and relating them to one another to reveal how they form patterns of harmony or disharmony; each symptom or sign has meaning only in relationship to other signs and symptoms and to the whole of your mind/body/ spirit (Cohen, 1999).
The first visit to an acupuncturist will include a questionnaire regarding health history, an interview, and a physical assessment. The acupuncturist will also observe how you walk, stand, sit and talk. Your face will be examined to note your complexion, and any odors will be noted that might lead to diagnosis. The tongue is especially important. Touching is also a very important part of the examination to see if there are any sensitive points on the body (Nightingale, 1987). For the most part the first visit will consist of the Four Examinations.
The Four Examinations are a traditional Chinese method of assessing an individuals needs. The Four Examinations include: inquiring, looking, listening/smelling, and touching. This process of examination reveals which of the Eight Fundamental Patterns of disharmony are at work and what type of disharmony of the Essential Substances, Organ Systems and channels you may have (Cohen, 1999).
After the Four Examinations the practitioner will decide on a course of treatment created uniquely for the individual based on their evaluation. The practitioner will rub alcohol on the acupuncture points and insert the needles about one inch into the points. Generally, the practitioner will use 10 to 12 needles and upon insertion may twist them to stimulate the points. The needle insertion reportedly does not hurt, however some say that they experience a tingling or tugging sensation. Some people find they are very relaxed and may even fall asleep. The needles are left in anywhere from 15 to 60 minutes. Some practitioners use an electrical pulse to stimulate the acupuncture points. Other practitioners may use heat and massage in addition.
Relevance to Marriage & Family Therapy
One of the great contributions of Chinese medicine is the ability to link physical and mental diseases, whereby it is often found that a physical disease has a mental cause, and a mental disease a physical cause (Mann, 1971, p. 90). In either case they may be treated with acupuncture. Therefore psychotherapy and acupuncture may work hand in hand to cure both physical and mental illness.
Social constructionism is a new outlook to intervention procedures that are currently influencing the field of marriage and family therapy today. Much like the social constructionist view of treatment Chinese alternative medicine also looks for the resources and strengths of the client. Chinese alternative medicine treatments are holistic approaches to illness that focus on using a person's inner healing resources to maintain health and fight illness. Research suggests that patients are attracted to Chinese alternative medicine because therapies are more in line with their philo-orientation toward health. A sense of self-control is helpful in healing and staying well. Chinese alternative medicine tends to allow a sense of control that aids healing, where illness and pain situations lower that sense (Astin, Shapiro, & Shapiro, 1999).
Chinese alternative medicine and social construction therapy have in common the belief that when diagnostic labels are used when referring to a client they may be creating a reality for them that gives the client a description of their identity in a social context that can be hurtful. The moment people become binge eaters, anorectics, obsessive-compulsive, depressed or what have you, much of their behavior gets swept into a category and is no longer available for alternate appraisals (Efran, Lukens, & Lukens, 1990, p. 90).
This process reduces uncertainty by telling the therapist what the therapist ought to do and suggesting how the client ought to change in order to get well (Gergen, Hoffman, & Anderson, 1996). These labels take the control away from the client and put it into the hands of physicians and therapists. The holistic approaches to treatment give back to the client a sense of control over their health.
Conclusion
Traditional Chinese medicine has been an effective treatment for a variety of ailments for over 5,000 years. The Western medical society has only recently considered acupuncture a valid form of treatment alongside other alternative forms of treatment, as well as Western medicine.
Many research studies have shown excellent response to acupuncture treatment for many different health conditions. However, if the Western medical society and health care providers are going to take alternative medicine seriously, research studies will need to have better controls over design, sample size, and other areas. Even with the current available research, more and more insurance companies are discovering the cost effectiveness of acupuncture and the benefits that acupuncture offers with only minor side effects.
Alternative medicine offers an option for individuals to take control over their health and give a sense of empowered. As opposed to the Western medical view of illness that uses labels and diagnostics, traditional medicine believes in the natural healing process of the individual.
Marriage and family therapy follows the same theoretical view as traditional medicine. In conjunction with therapeutic treatment, acupuncture can offer a holistic, client guided, self-healing treatment option.
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