2.

05A Oct 2016

Acupuncture and Complentary & Alternative Medicine
Dr. Mata
Department of Pharmacology & Toxicology

Outline  According to the ancient text Su Wen:

1. Introduction o The Tao of the Universe
2. Acupuncture – Origins & Philosophy  The principle of all matters
3. Definitions  The percentage of all change
a. Acupuncture  The origin of birth and death
b. TCM
4. Acupuncture Needles History of Acupuncture
5. Medical Acupuncture  Practiced in China for over 5000 years
a. Acupuncture Concepts:  Huang Di Nie Jing or Yellow Emperor’s Classic of Medicine
- Qi o One of the earliest books on the foundation of Traditional
- Yin and Yang Chinese Medicine (TCM) originating as early as 1000 B.C.
- Wu Xing  Developed as a part of the system of TCM
- Zang Fu  6th century- spread to Korea, Japan, and India
- Jing Lou  8th and 10th century - trade into Vietnam
- Eight Principles  16th century - Western France by Jesuit Missionaries
b. Steps in Medical Acupuncture  1700s - Practiced in Europe
c. Types of Acupuncture Treatment  1644 to 1911 - Suppression by Ching Dynasty
6. Medical Basis  1911 to 1949 - Suppression by Nationalist Regime
a. Evidence  1972- President Nixon visited China.
b. Acceptance o Member of US Press Corps had an emergency
7. Complications appendectomy and received acupuncture
8. Acupressure
9. Miscellaneous CAM Historical Developments: Global
 World Health Organization (WHO) in 1978 - Integration of
Italics / Texts in boxes were taken outside the lecture
Traditional Medicine in Primary Health Care (Alma-Ata
declaration on PHC)
OBJECTIVES  1999 - US Congress established the National Center for
 Comprehend history of acupuncture, underlying philosophies, its Complementary and Alternative Medicine (NCCAM) in the
spread globally and locally National Institutes of Health (NIH) in Bethesda, Maryland
 Understand the basic principles of acupuncture & moxibustion
 Assess the efficacy, acceptance, cost-effectiveness & future of
Historical Developments: Local
acupuncture
 Integrative Medicine - Philippines
 Apply the efficacy, acceptance, cost-effectiveness & future of
 Mid-70s- Filipino private physicians started training in
acupuncture
acupuncture in China
 Apply the fundamental knowledge gain, in the management of
o Sabi ni doc, na-hijack daw yung eroplano nitong mga
common disorders
physician na to during Martial Law tapos dinala sila sa China
para mag-train ng acupuncture
From 2D 2017
o One of the first Filipinos who trained is the brother of DSWD
INTRODUCTION Secretary Judy Taguiwalo (dami chismis ni doc)
 Complementary  Early 1980s - DOH physicians trained acupuncture in China;
o Using a non-mainstream approach together with herbal medicine production started
conventional medicine  1992 - Administrative Order Health No. 12, first came out with the
 Alternative Traditional Medicine Program
o Using a non-mainstream approach in place of o Traditional Medicine Program was tasked to promote and
conventional medicine advocate traditional medicine nationwide by Sec. Juan
 Integrative Medicine Flavier
o Array of non-mainstream health care approaches  1993 to 1995- DOH established the Traditional Medicine Unit
o Example: Cancer treatment with integrative health care which promoted the use of medicinal plants, acupuncture and
programs like acupuncture and meditation therapeutic massage
 1997- President Fidel V. Ramos, appreciated the potential of
ACUPUNCTURE – ORIGINS & PHILOSOPHY traditional medicine in the health economy and used this as one of
 Originates in Taoist tradition the administration’s pole vaulting strategies
 R.A. 8423 or The Traditional and Alternative Medicine Act
 Fu created the idea of yin and yang by observing a broken line and
(TAMA) of 1997- gave rose to the creation of the Philippine
an unbroken line.
Institute of Traditional and Alternative Health Care (PITAHC)
 According to the ancient text Tao Te Ching:
o PITAHC - Attached to DOH to answer the needs of people
o The Tao is The One (pero sa pag-ibig, di basta Tao, siya na
and health care through delivery of traditional and
ang THE ONE. SADNU?)
alternative health care
o From The One, comes Yin and Yang
 2008 - PITAHC started the accreditation of acupuncturists
o Yin and Yang gives creative energy
practicing the Philippines, both for medical and non-medical
o From energy, ten thousand things; the forms of all creation
o All life embodies the Yin and embraces the Yang. practitioners
o When Yin and Yang unites, harmony is achieved-  100 accdg to Doc Mata nung naging registered acupuncturist siya

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 Acupuncture & CAM

ACUPUNCTURE - DEFINITION Table 1. Eastern vs. Western Medicine

 Form of alternative medicine Eastern Western
 A key component of Traditional Chinese Medicine (TCM) or
Empirical observations over a Scientific method and case-based
Oriental Medicine
thousand of years medicine
Traditional Chinese Medicine Art of medicine Technology of medicine
 A systematized version of the many theories of Chinese Medicine Holistic View Molecular and Organ View
since the Cultural Revolution in China Circular Logic Linear Logic
 Consider the human being in the association with the rest of the
nature and the social setting Energetic Mechanistic

ACUPUNCTURE & NEEDLES

 Acus = “needle”
 Punctura = “puncture”
 Acupuncture = insertion of tiny needle to certain points of the body
to manipulate flow of Qi

Fig 3. Acupuncture needle.

Fig 1. Components of TCM. Ancient Needles

Benefits of TCM
 One of the most holistic medical systems available today
 Regards the body as a whole one, focuses on restoring and
maintaining the balance of the whole body.
o CM (Chinese medicine?) treats the root of the disease
 Has unique diagnostic and treatment techniques
 No side effects
 Emphasizes on prevention
 Long history of successful treatment for physical, mental, and
emotional disorders

Philosophies of TCM

Fig 4. The Ancient Nine Needles. *Sorry guys, di ko ma-translate yung

Chinese characters lol

Fig 2. Philosophies of TCM. Fig 5. (Left) Bian stone needle; (Right) Bone needle

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 Waichi Sugiyama – 17th century blind acupuncturist discovered a
device from bamboo reed known as kudabari – a needle insertion
guide tube, which is now a standard equipment for blind and
sighted acupuncturist
Fig 6. (A) Ancient variant of guide tube used in acupuncture; (B)
Modern needle guide tube.
Modern Needles
 1978 – AcuMedic designed the first disposable needles because
needles were not properly sterilized which cause transmission of
infectious disease
 1995 - US FDA classified acupuncture needles as medical
instruments
 Trivia: One box of acupuncture needles: Php300 
Fig 7. Modern acupuncture needles.
MEDICAL ACUPUNCTURE
 Therapeutic insertion of solid needles in various combinations and
patterns
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Acupuncture & CAM
 Traditional patterns based on principles of encouraging flow of Qi
in classical channels
 Medical acupuncture means that treatment is done by a physician;
traditional acupuncture is usually combined with nontraditional
methods to a minor or major degree
Acupuncture Concepts
 Vital energy called Qi is the life force that drives all living things. Qi
flows through meridians (also called channels) in the body similar
to water flowing in a river.
 Disease occurs with imbalance, resulting in excess of deficient
amounts of Qi in meridians.
 Acupuncture harmonizes the balance of whole body, Yin/Yang:
Qi/Blood: Zang/Fu
Qi
 An energy that, according to ancient Chinese beliefs, permeates all
things
 Must be able to flow freely throughout the body in order for
person to maintain overall health
 Flows along the meridians of the body
 The most fundamental entity making up the world
 Everything in the universe resulted from the movement and change
of Qi.
 Chinese character for “Qi” is the same word used for air or gas, and
it is thought to have the same properties as these substances.
Fig 8. Gas + Rice = Qi (for some reason)
o Can be interpreted as the “life energy” or “life force”.
Sometimes, it is known as the “vital energy” of the body.
o Cited ni doc yung formula ni Einstein na E= mc2 (Theory of
Relativity). Di detailed out kung bakit. Pero sabi nga ni
Einstein:
Yin & Yang
 Two stages of cyclical movements, one constantly changing into
the other, such as day giving way to night and vice versa
 Acupuncture & CAM

Table 3. Wu Xing Elemental Principles

Promoting Controlling
Wood promotes Fire Wood controls Earth
Fire promotes Earth Earth controls Water
Earth promotes Metal Water controls Fire
Metal promotes Water Fire controls Metal
Water promotes Wood Metal controls Wood
Table 2. Yin vs Yang
Yin Yang
Wet Dry
Moon Sun
Front Back
Female Male
Darkness Bright
Rest Activity
Matter Energy
Cold Heat
Chronic Acute
Body Head
Fig 9. Diagrammatic representation of the promotion/control aspect of
Interior Exterior Wu Xing.
Below the Waist Above the Waist
 In Traditional Chinese Medicine, each of the major organ system is
Posterolateral Surface of the
Anteromedial surface of Limbs assigned an element.
Limbs
o Wood = Liver
Zang Organs Fu Organs o Fire = Heart
Organ Structure Organ Function o Earth = Spleen
o Metal = Lungs
Blood & Body Fluids Qi
o Water = Kidneys
Nutritive Qi Defensive Qi

 Five basic characteristics of Yin and Yang:

1. That they are opposite to each other
2. That neither can exist without the other (interdependent)
3. That each is constantly consuming the other
(interconsuming)
4. That they are in a constant state of transforming into each
other
5. That because each contains the other within it, each can be
divided infinitely
 Yin & Yang in Acupuncture
o Acupuncture needles are inserted in an attempt to balance
the opposing forces of yin and yang
o Yin and Yang are balanced when a person is healthy and Qi is
therefore able to flow freely
o Injury or illness cause yin and yang to become distressed and
unbalanced

Wu Xing
 Concept of Five Elements/Phases
 The 5 elements are arranged in the circle in a particular order. Fig 10. Disturbances in the Wu Xing organs (Negative cycle; pansin
o Wood promotes Fire nyo counter clockwise yung arrows? Pag positive/good flow, dapat
o Fire promotes Earth clockwise)
o Earth promotes Metal
o Metal promotes Water Zang Fu / Zang Xiang
o Water promotes Wood  Linked to the concept of Qi, vital substances and the theory of five
 In nature, one can see how wood is the fuel for fire, how burned phases of transformation (Wu Xing).
wood returns to the earth, how metal comes from the earth, how  Each zang-fu organ system is associated with a particular phase of
metal promotes condensation and how water promotes the growth the transformation and transportation of the various vital
of wood. substances
 There are 6 zang-fu organ systems, each system consisting of one
zang organ and one fu organ.

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 Acupuncture & CAM

Table 4. Zang Fu  Meridians & Collaterals

 Paths which transport Qi & Blood and the network connecting the
Zang Fu
whole body
Yin Yang o Jing – Meridians, path which are the main trunks running
Solid Hollow longitudinally and exteriorly–internally within the body
o Luo - Collaterals, networks, thinner and smaller than the
Processing products Storage meridians, they are the branches running crisscross over the
Heart (Xin) Small intestine (Xiao Chang) body
Lungs (Fei) Large intestine (Da Chang)  Stimulating certain points on the body reached by needles, the Qi
can flow and the body diseases are treated
Liver (Gan) Gallbladder (Dan)  These stimulation points are called acupuncture points
Spleen (Pi) Stomach (Wei)  Originally there were 365 acupuncture points, but through the
years this number has increased to over 2000
Kidney (Shen) Urinary Bladder (Pang Guang)
 Each point is believed to correspond with a particular illness or
Pericardium (Xin Bao) “Triple burner” (Sanjiao) injury
 Major Meridians:
o Lung: LU
o Heart: HT
o Pericardium: PC
o Spleen: SP
o Liver: LIV
o Kidney: KID
o Large Intestine: LI
o Small intestine: SI
o Triple Heater: TH
o Stomach: ST
o Gallbladder: GB
o Bladder: BL
o Conception vessels: CV
o Governing vessels: GV

Fig 11. Zang Fu Organs,

Jing Luo

Fig 13. Flow of meridians. I-memorize mo pag marami kang time.

Eight Principles
 ‘8 principles’ are the basic categories acupuncturists traditionally
use to decide how to treat a disease:
o Yang
 Exterior – Skin, hair, flesh & meridians
 Excess (shi) – Disease preventing forces (-),
Pathogenic factors increase
 Heat – Yin deficiency or excess heat
Fig 12. There are twelve main meridians in the body – 6 Yin and 6 o Yin
Yang. A meridian has strong impact on blood flow and nervous  Interior – Organs, bone marrow, qi & blood
impulses. Known as Circadian rhythm, the energy flow in the meridians  Deficiency (xu) – Disease preventing forces decrease,
is constant and changes from one to the next every 2 hrs. Pathogenic factors (-)
 Cold – Yang deficiency or excess cold

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 Acupuncture & CAM

(L) Classic acupuncture; (R) Electroacupuncture

Fig 14. Eight principles as a way of differentiating the causes of

disease.

Steps in Acupuncture Treatment

 Diagnosis
o Interrogation
o Observation (L) Laser acupuncture; (R) Cupping
o Olfaction
o Pulse Diagnosis
o Tongue Diagnosis
o Ear Diagnosis
 Treatment
o Acupuncture
o Moxibustion
o Cupping ʖ °)
o Bleeding

Diagnostic Techniques
1. Observation – Inspection of the patients’s general well-being, (L) Acupoint Injection; (R) Moxibustion
colour of complexion etc.
2. Auscultation and olfaction – The patient’s voice, breathing MEDICAL BASIS OF ACUPUNCTURE
patterns and breath are analysed  Acupuncture is NOT based on modern medical science
3. Interrogation – Checking with the patient his illness, the  There is no obvious correlation between the 14 identified
symptoms and sensations experienced etc. meridians and the actual location of organs and nerves within the
4. Taking the pulse – the changes in the patient’s pulse is used to body
determine his qi and blood circulation  Some proponents of acupuncture have attempted to explain its
medical function
Types of Acupuncture Treatment
 Classic acupuncture Medical Acupuncture: Effects
 Electroacupuncture  Local effects
o Acupuncture in which the needles used carry a mild electric o Blood flow; increased circulation; temperature
current o Muscle relaxation
 Laser acupuncture  Remote effects
o Same as normal acupuncture except that laser light is used o Neurohumoral changes (endorphins and others)
instead of traditional penetrating needles o Brain activation (limbic, thalamic, cortical)
 Cupping o Sympathetic and parasympathetic effects
o Heated glass cups are applied to the skin along the meridians  Long-term Effects
of the body, creating suction as a way of stimulating the flow of o Pain threshold; nervous system “plasticity”
energy o Improved autonomic function
 Acupoint injection  Possible Explanations:
o Injection of natural therapeutic substances, such as o Stimulation of release of endorphins
homeopathic remedies into acupuncture points o Blockage of nerve transmission (Gateway theory)
 Moxibustion
o Burning of moxa (dried mugwort) on or near a person's skin as See Appendix 1 for the list of conditions which the WHO recognizes to
a counterirritant. benefit from acupuncture.

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Evidences Locating Acupressure Points

 fMRI study
o Needle placed in foot acupuncture point associated with
stimulation of brain’s visual cortex
o Auditory complex stimulated by needle placed in acupoint on
the leg associated with hearing
 Anxiety & Insomnia
o Adults suffering from anxiety & insomnia were treated with
acupuncture 2x a week for 5 weeks
o ↓ Anxiety levels were lower (86.0% to 76.1%)
o ↑ Sleep efficiency & nighttime melatonin (66.0% to 88.6%)
 Delivery of Breech Babies
o Pregnant women with babies in fetal breech position were
randomized to receive manual acupuncture at UB67 point
o ↑ likelihood for the fetus to move to the proper delivery
position (76.4%) versus control group (45.4%)
 Kansas Hospital Study with Stroke Patients
o Patients who had suffered their first stroke were randomly
assigned to receive wither acupuncture or traditional speech,
occupational & physical therapy
o 90% of the acupuncture group “improved so much that they
were able to go home rather than to another facility” vs 33%
of patients in the traditional therapy group ﴾๏๏﴿ O'RLY?
o Patients in the acupuncture group also showed improvement
in the ability to carry out tasks eg, dressing, bathing,
grooming.
 Medical & Surgical Expenses & Effectiveness
o Patients with severe angina pectoris received 12
acupuncture treatments in 4 weeks
o 2-year follow-up: 30 out of 49 patients who were candidates
for surgery were postponed due to clinical improvement
o Cost savings of $13,000 per patient
o ↓ in-hospital days & outpatient visits
 Fertility Treatment
o ↑ Success rate (50%) in women undergoing in vitro
fertilization
 Low Back Pain
o Patients at a workers’ compensation clinic were randomized
to receive either acupuncture or standard PT/OT/exercise
o 62% returned to normal employment in the acupuncture
group vs 14.8% in the standard therapy group
 Most of the acupressure points on the body:
o Lie underneath major muscle groups
o Follow the bone structure, residing in the joints or in the
hollows of bone
 In order to find an acupressure point with your hands, concentrate
on feeling for a muscular cord or a hollow in the bone structure
o Feel for a slight indentation or depression between the
tendons and muscles at each point
o Once you have found a muscular cord, press directly on it; or
if you feel a bony hollow, slowly press directly into it
Tsun or Cun Measurements
 “Measurements need to be taken from the patient’s hand.”
 Thumb measurement
o The width of the interphalangeal joint of the patient’s thumb
is taken as 1 cun
 Two Finger measurement
o The width of the index and middle finger is taken as 1.5 cun
 Four Finger measurement
o When the four fingers (index, middle, ring, and little fingers)
keep closely together, their width on the level of the proximal
interphalangeal crease of the middle finger is taken as 3 cun
Fig 15. Cun measurements (L) Thumb measurement (C) Two-finger
(R) Four-finger measurement
Acupressure Points
Neiguan, “inner pass”

Acceptance of Acupuncture & TCM

 More Western medicine MDs believed in the effectiveness of
acupuncture (62% efficacy) and Chinese herbal medicine (51.6%)
than any other CAM therapy
o Compared to (3rd highest to lowest):
 Massage
 Chiropractic care
 Herbal therapy  Located three fingerbreadths below the wrist in between the two
 Homeopathy tendons
 Stops nausea/ sea sickness/ morning sickness
ACUPUNCTURE - COMPLICATIONS  Calming
 Rarely and in inexperienced hands more serious side effects (e.g.  Chest pain
organ puncture) have been reported but almost never by properly  Insomnia
trained acupuncturists.
 Occasional bruising Hegu, “Joining Valley”
 Needle fainting

ACUPUNCTURE VS ACUPRESSURE
 Acupressure - alternative medicine technique derived from
acupuncture but instead of needles, physical pressure is applied by
using the fingers, hands, elbow or other devices to press key points
on the surface of the skin
 Stimulates the body’s natural self-curative abilities

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 Acupuncture & CAM

 For colds  Difficult labor (expel fetus)

 Headache (esp. one-sided)  Primary dysmenorrhea
 Toothache  Bleeding disorders
 Sore throat
 Sore back Liver 3 / Tai Chong
 Hypertension

Zusanli, “Three Leg Mile”

 Lower back pain

 High blood pressure
 Menstrual cramps
 Limb pain
 Strengthen stomach  Stress, insomnia, and anxiety
 Strengthen immunity
 Builds qi and blood Large Intestine 11 / Pool at the Bend / Quchi
 Painkiller

Luo Zhen, “Stiff Neck”

 Allergy
 Hives
 Vomiting and Diarrhea
 Fever
 Sore throat
 For painful neck
 Pain in the elbow and arm
 Press the point while you bend, flex, and extend your neck

Yao Tong Xue, “Lumbar Pain Point” From 2D 2017

MISCELLANEOUS ALTERNATIVE MODALITIES
Massage Therapy
 Includes many different techniques in which practitioners
manually manipulate the soft tissues of the body

Swedish Massage

 Long, sweeping strokes

(effleurage), usually used at the
start and end of a massage
 Muscle kneading and rolling
 Slightly proximal on hand vs luo zhen, and add the space between (petrissage), where the muscles
4th-5th metacarpal are worked on just like
 For back pain kneading dough
 Bend and twist while pressing  It is also a rhythmic tapping
(tapotement), a fast percussion
Sanyinjiao (3 Yin Meeting) movements like dropping and
chopping

Hot Stone Massage

 Stone is placed in the back after

heating either in microwave or
open fire
 “Centering” yourself, releasing
very tense muscles, for relaxation

 On the medial side (inside) of the lower leg, 1 handbreadth

superior to the prominence of the medial malleolus bone

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 Acupuncture & CAM

Deep Tissue Massage Chinese CAM

 Applies deep pressure onto specific trouble points  Are practices from traditional Chinese Medicine that combine
specific movements of postures, coordinated breathing and
Shiatsu Massage mental focus

Tai Chi

Left: Shiatsu (massage), Right: Shih Tzu (not a massage)

 Literally means finger pressure

 Japanese massage that combines gentle stretches with finger Left: Tai Chi (free), Right: Chai Tea (expensive)
pressure to work on different pressure points  Is an ancient Chinese “internal” or “soft” martial art often
 The idea is to fix imbalances in the flow of energy in your body practice for its health giving and spiritual benefits

Thai Massage Qi Gong

 A form of gentle exercise composed of:
o Movements that are repeated a
 System of massage and manipulation number of times often stretching the
 Developed in Thailand body
o Increasing fluid movement (blood,
synovial and lymph)
o Building awareness of how the body
moves through space
Meditation Techniques
 Mindfulness meditation or transcendental meditation
Yoga
 Involves ways in which a person learns to focus attention
 Used for health purposes; typically combine
physical postures or movement, breathing
Movement Therapies techniques and meditation
Feldenkrais Method  Physical, mental and spiritual practices or
discipline that aim to transform body and
mind
 Focuses on the relationship between
movement and thought, increased mental
awareness and creativity accompany
physical movements
Healing Touch
 Gentle touch assist in balancing your physical, mental, emotional
and spiritual well being
Pilates  Works with your energy field to support your natural ability to
heal

 An exercise which emphasizes the balanced

and development of the body through core END OF TRANS
strength, flexibility and awareness in order
to support efficient, graceful movement

Rolfing Structural Integration

 Holistic system of soft tissue manipulation

and movement education that organizes the
whole body in gravity

Movement Therapies
 Designed to produce the body’s natural relaxation response
 Examples:
o Breathing exercise
o Guided imagery
o Progressive muscle relaxation

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Appendix 1. World Health Organization (WHO) on Acupuncture  Musculo-skeletal Conditions

o Muscle pain, swelling, stiffness, weakness
 Psychological Conditions o Localized traumatic injuries, sprains, strains, tendinitis,
o Depression contractures
o Anxiety o Arthritis
o OCD (Obsessive Compulsive Disorder) o Fibromyalgia
o PTSD (Post Traumatic Stress Disorder) o Work- & sports-related injury
o Somatization disorder o Low back and/or neck strain
o Hypersomnia o Osteoarthritis
o Insomnia o “Frozen shoulder” or “tennis elbow”
 Neurologic conditions o Sciatica
o Headache and migraine
o Trigeminal neuralgia
o Facial palsy (early stage, within three to six months)
o Paresis following stroke
o Peripheral neuropathies
o Meniere’s Disease
o Nocturnal enuresis
o Cervicobrachial syndrome
o Neurogenic bladder dysfunction
o Intercostal neuralgia
o Disc problems
 Gastrointestinal conditions
o Spasms of esophagus and cardiac
o Irritable bowel and colitis
o Gastroptosis
o Acute and chronic gastritis
o Gastric hyperacidity (i.e. acid reflux)
o Chronic duodenal ulcer (pain relief)
o Acute duodenal ulcer (without complication)
o Acute chronic colitis
o Constipation
o Diarrhea
o Acute bacillary dysentery
o Paralytic ileus
 Gynaecological conditions
o Infertility
o PMS
o Dysmenorrhea
o Menopause syndrome
o Benign irregular menstruation
o Benign amenorrhea
 Cardiovascular Conditions
o Essential hypertension
 Other Conditions
o Withdrawal from street and pharmacological drugs
o Appetite Suppression
 Respiratory System Conditions
o Acute sinusitis
o Acute rhinitis
o Common cold & allergies
o Acute tonsillitis
o Acute bronchitis
o Bronchial asthma
 Conditions of the Eye, Ear, Nose & Mouth
o Acute conjunctivitis
o Central retinitis
o Myopia (in children)
o Cataract (w/o complications)
o Toothaches, post-extraction pain
o Gingivitis
o Acute & chronic pharyngitis

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