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Acupuncture, Part I: An Overview

I know I’ve talked about this series on acupuncture with several readers and friends. It was first postponed because we went off-line for one week, and now is further delayed because last week I remembered to bring the medical releases to the clinic, but...forgot the camera. *smacking forehead* My next opportunity to take photos of the test subject is next week. Yes, I should ask the acupuncturist whether forgetfulness can be treated with needles, too.

So begging your indulgence for this dense post, I’m going to go ahead with a quick overview of acupuncture. The next post will cover the clinic experience — what to expect and what it feels like. A third post will look at the homework you can anticipate when you’re back from the clinic (yes, there’s homework).



CHI

When you think of acupuncture, you probably think of needles. Lots of them. And while this is certainly a defining aspect of acupuncture — versus say, acupressure or massage — it really isn’t the heart of it. Instead, to understand how acupuncture works, we have to re-visit the concept of Chi (chee), also spelled Qi, or Ki (kee) in Japanese (as in Rei-ki).

“Chi” is probably one of the most difficult concepts for the Western mind to wrap itself around. It is defined here by a physician trained in Traditional Chinese Medicine (TCM), identified only as Dr. Fang, in Dr. David Eisenberg’s (MD) seminal book on TCM, Encounters with Qi (W.W. Norton & Co., 1985):

‘Qi means that which differentiates life from death, animate from inanimate. To live is to have Qi in every part of your body. To die is to be a body without Qi. For health to be maintained, there must be a balance of Qi, neither too much nor too little.’ (page 43)


In English, it is most often translated as "universal life force," or "vital essence." TCM understands Chi as existing not only within the body, but also in the environment — we take in nutritional Chi by the foods we eat, and breathe in air Chi by respiration.

TCM envisions the body’s Chi as existing in and running through channels, or meridians, that are interconnected and that affect each other in different relationships. Each meridian is linked to a major organ in the body, and is often named after the organ with which it is associated (e.g., the Lung Meridian). Through the meridians, Chi circulates through the healthy body in a defined pattern, delivering needed nutrition to organs and removing wastes and toxins. When there is an imbalance in one meridian, it can cause a domino effect in the other meridians, both behind and forward of the unbalanced or blocked channel. If left untreated, the body’s Chi becomes weak and leaves the body susceptible to both internal and external factors that can precipitate disease and illness.

It is the role of the TCM physician not to diagnosis the disease or condition (pneumonia, migraine, back pain, etc.), but rather the underlying root of the imbalance in the body’s Chi. The condition is merely a symptom of a deeper issue — the physician is interested in
Why the pneumonia, migraine, etc., has been able to overcome the body’s protective Chi. In every case the answer will be different because each patient will have different circumstances that bring on their health crisis. Therefore, two people who enter a TCM physician’s office with the same complaint (e.g., migraines) are likely to have completely different treatment regimes.

For we who are accustomed to the treatment model, “You have this condition, take this pill” this takes a moment to sink in. It is the meaning of “Holistic” — that individuals require treatments tailored for their individual circumstance. Wow, what a concept. And that is the feel-good side of holistic practices: you’re not just a condition, you’re an individual. The flip-side of holistic practices (acupuncture included) is that these treatments are not magic bullets, and they often don’t provide immediate relief of the symptoms that bring us to the TCM physician’s clinic. Sometimes symptoms will even get worse for awhile, before they get better.

The thing to keep in mind is this: the series of circumstances that finally brings on physical symptoms in the form of disease or illness are often the result of years, even decades, of accumulated poor practices (lousy diet, poor sleep habits, lack of exercise) and environmental influences (stress, weather, trauma). It won’t be undone in a day, a week, or even a month. As for worsening symptoms, this is also something recognized in Western medicine. My father suffers with large tophi (uric acid crystallizations) that leave his hands and knees deformed and painful. His internist warned him that the low-purine diet he was prescribed should slowly dissolve the acid crystals, but that as the crystals dissolved they would re-enter the blood stream before being eliminated through the kidneys. The sudden influx of uric acid in the blood could trigger a painful gout attack, in which case his medication dosages would be adjusted. Eventually the tophi should be eliminated; and if he maintains a sensible diet, the gout attacks also minimized.

DIAGNOSIS

In TCM, diagnoses are made in terms of Chi: Is there enough Chi? Is it active (Yang) or stagnant (Yin)? What channels/meridians are affected? What internal and external factors are affecting the meridians?

To reach a diagnosis, the physician will use carefully defined techniques, some of which have been chronicled, practiced, and adapted for 2000 years. These include pulse-taking, examining the tongue, specific questioning, and observation of the patient's speech, smell, color and appearance. We will touch on those more in the next part in the series,
The Clinic Visit.

ACUPUNCTURE

So how does acupuncture work? The theory behind TCM is simple enough: restore balance to the body’s Chi and the body can begin to heal itself. A primary use for acupuncture is the stimulation of points along affected meridians to allow Chi to travel as it should on its appointed route.

TCM teaches that there are 12 meridian pairs running symmetrically along the left and right sides of the body, 2 non-paired meridians that run along the midline of the torso and head, and collateral meridians which are points that connect meridians to one another. Each meridian has a defined number of points; some have as few 9, others over 60; for a total of over 300 points.

In acupuncture, meridian points are influenced with the insertion of long, thin needles, which may also be used to conduct a mild electric current. The needles can release accumulated Chi in a blocked meridian (in much the same way accumulated water is released when a pipe is cleaned), or stimulate slow-moving or stagnant Chi to circulate more freely (imagine fresh water coming in to a tidepool), or divert Chi from one meridian to another. In each case, the goal is to restore the open circulation of Chi.

Another use for acupuncture is pain management and anesthesia. Even non-TCM physicians can use acupuncture to manage pain in chronic illnesses such as fibromyalgia or diabetes. In these cases, needles are inserted at meridian points which are thought to release endorphins into the body to lessen pain. This can be used in conjunction with meridian points that also support body functions that contribute to the patient’s comfort and well-being in managing his overall condition (e.g., blood cell production, elimination of toxins by the liver and kidneys, etc.). Acupuncture has also been used in lieu of or with local anesthetics to control pain during surgery or painful treatments.

FURTHER READING

This is a bare-bones description of acupuncture. I've purposefully left out naming meridians, and descriptions of how they influence each other because: one, it gets confusing and I am not the authority to explain it; and two, it isn't necessary to know in order to seek treatment. One can get a consultation and treatment from a TCM physician without knowing a thing about anything written here.

Although we were familiar with the concept of Chi in our practice with Reiki, when we started acupuncture this year most concepts were in the category: “I’ve heard of that, not exactly sure what it means.” T is happy with the results he feels and sees with his treatments, and leaves well enough alone. That’s great, but if you’re like me and would like to read more about acupuncture, I recommend Dr. Ruth Kidson’s book, Acupuncture for Everyone: What It Is, Why It Works, and How It Can Help You (Healing Arts Press, 2000). Dr. Kidson is a licensed physician in the U.K., and I found her book immensely helpful in getting a grasp of the fundamentals of acupuncture. Her writing is clear, straightforward, and easy for a lay person to follow. I was already on my third treatment before I got to the heart of her book, where she discusses the symptomology associated with imbalances in different meridians, and I was fascinated with how the descriptions in her book matched my own doctor's diagnosis and treatment. I found this book at the public library, but it's soon going to become a part of our home library.

The book quoted from at the top is an exploration of the phenomenon of Chi, or Qi, by medical doctor and researcher, Dr. David Eisenberg. Dr. Eisenberg was one of the first U.S.-trained doctors to study and train in TCM in Beijing in the late 1970s. Fluent in Mandarin, and a graduate of Harvard Medical School, Dr. Eisenberg brought an empiricist’s eye to his studies in Beijing. His quest to quantify the results he saw in his practice there is enlightening whether you would want to prove or disprove his findings. Most of the book is anecdotal — accounts of his experiences learning acupuncture, herbology, and massage at one of the top TCM universities in Beijing. Since writing this book in the mid-1980s, Dr. Eisenberg has gone on to found a research center at his alma mater to further the empirical study of TCM and other alternative, complementary — the Center calls them “integrative” — therapies. Read more about the
Harvard Medical School Osher Research Center and its current research agenda.

FINDING A PRACTITIONER

Finally, if you're considering acupuncture for yourself, Dr. Kidson offers some practical advice about choosing a practitioner and what to expect. First, she cautions that most governing bodies of complementary medicine do not allow their registered members to advertise (Yellow pages listing or "Accepting new patients" notices in newspapers are allowed), so be wary of flyers that promote acupuncture for specific illnesses; in fact, your best bet may be to seek personal recommendations. Second, consider whether you are interested in pain management only or a more holistic approach, then check whether the acupuncturist you are interested in has earned a degree (a longer more comprehensive program with an holistic approach) or taken course work in treating symptomatic pain. During your first appointment, describe your condition and ask whether the practitioner can treat it, what the limitations of treatment are, and how long you might expect treatment to continue; the practitioner should be willing to recommend other treatment options if you don't show improvement over time. To these I would add, familiarize yourself with the licensing requirements in your jurisdiction; every country — and in the U.S., every state — has different requirements and allows different titles to be used. You can read Hawaii's regulations regarding acupuncture in full: H.R.S. §436E: Acupuncture Practice (I could no longer find these readable on-line, this link will download a PDF file to your computer).

I didn't pick up Dr. Kidson's book until after my second treatment, so it was sheer good fortune that we found the TCM practitioner we did. Although she limits her practice in Hawaii to acupuncture and herbology, she also trained as a medical doctor specializing in acupuncture in her home country. Her training allows us to talk to her about our medical conditions, and she has advised us when to seek further Western medical diagnoses too. In the
next part of this series, you'll meet the charming Dr. Wong, D.Ac., in her clinic.

Acupuncture, Part II: The Clinic Visit
Acupuncture, Part III: Brewing Teas at Home