Acupuncture Explained

Commonly treated conditions with Acupuncture

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What is Acupuncture?

Acupuncture explainedAcupuncture is based upon the ancient Chinese form of needle therapy, practiced for over 1000 years in China. It is popular for its use in the treatment of acute and chronic pain, as well as many internal illnesses.

 

During treatment, very thin, solid, hair-like needles are inserted into specific points in the body. In Chinese these points are called “neural nodes” (jie) and the stimulation of these nodes affects both the central and peripheral nervous systems. It triggers the release of the body’s internal chemicals such as endorphins and encephalin, which have pain-relieving properties. If you have pain that is lingering or is not being treated by other modalities, then acupuncture offers a time-tested, very reliable method of pain relief.

How does Acupuncture work?

Mistranslations of Chinese Acupuncture textbooks into the English language, has created some misinformation about acupuncture and what it really is in the west. Acupuncture is not an energy medicine, Acupuncture is not voodoo, religion or magic and there are no visible energy meridians!

 

Acupuncture in fact is a real physical medicine, based on real human anatomy not energy, developed via dissection similarly to allopathic western medicine practiced by your doctor that we are familiar within Australia. Acupuncture actually improves the flow of oxygen (or as we call it Qi), nutrients (Ying Qi) and blood (Xue) through the blood vessel system.

 

The theory is that Acupuncture benefits blood flow – An Acupuncturists believes that many ailments within the body are caused by impaired blood flow in the body (or as we call it blood stagnation)! When there is impaired blood flow to any area of the body, it cannot function properly or heal. Acupuncture can cause blood vessels to dilate (expand) and increases the blood flow to specific areas of the body to relieve pain. 

 

Acupuncture also stimulates the nervous system by activating nociceptors, sensory nerves and proprioceptor fibers that travel from the skin to the spine and from the spine to the brain. Acupuncture actually improves the nerve signals to the brain and forces your brain to release opioids (natural painkillers) to shut of pain signals and eliminate your pain.

 

Acupuncturists believe that 5 main factors that influence your health:

 

·    The flow of oxygen in your body (Qi)

·    The flow of blood in your body (Xue)

·    The health of your blood vessels (Xue Mai)

·    The health of your organs (Zang Fu)

·    The health of your nervous system (Jing Mai)

 

In short, Acupuncture aims to stimulate the body’s natural ability to heal itself!

 

Acupuncture treats an endless number of conditions (see below) on its own or in conjunction with Chinese Herbal medicine or other therapies. So if you are looking for a natural solution to your health problems, without drugs or side effects then Acupuncture is defiantly worth a try!

Main benefits of Acupuncture

The main three benefits of acupuncture are:

 

  • Relieves pain
  • Decreases inflammation
  • Restores homeostasis
Acupuncture explained, what is the mechanism of action?

How Acupuncture works is a very complex matter and to understand how Acupuncture works it is best to understand the basic mechanisms of pain and physiology in relation to injuries.

 

Any time there is pain in the body, there are sensory nerves, which are firing; these may or may not be related to a structural problem causing the sensory dysfunction. It is suggested 90-95%[v] of the time with chronic pain; particularly lower back pain there is no major structural reason/cause for the pain (nothing pushing on a nerve, no bulging disc, nothing leaning on a spinal nerve) but the person still has pain!

 

In most of our minds is the assumption is that if you have pain, there must be a structural reason for it. In other words, there must be some form of structure, being bone, soft tissue, disc or some object actually pushing on the sensory nerve, causing it to continuously fire. This assumption is not always true. So why is the pain still there?

 

This is because the patient is caught in a sensory motor loop, meaning their body has literally forgotten how to shut the pain down. This is due to a neuropathic problem where the nerve itself is swollen, firing continuously, sending incorrect information to the brain; hence creating a major problem for the patient where they are stuck in a pain cycle.

 

The second problem involves a survival mechanism that the brain evolved a very long time ago. Let’s take a knee injury as an example. When we bang our knee into something, the brain immediately takes measures to protect it. The brain doesn’t know what happened to the knee, but it assumes a worst-case scenario, that you are losing a lot of blood and thus the injury becomes in your brain life threatening.

 

What the brain does in this situation is restrict the blood supply going into the knee and the blood return coming out of the knee. This is actually a very intelligent choice. If a venomous snake bit you, reducing blood flow around the knee will lessen the chance that the poison will spread. And if you were cut badly, reducing the blood flow will lessen your chances of bleeding to death.

 

This phenomenon is known as “guarding”. One of the results of reducing blood flow to the knee is that it becomes stiff and weak. This was a great strategy before the advent of western emergency medicine. Almost everyone would prefer to lose function in his or her knee rather than death. But this isn’t a choice most of us have to make anymore, because when we cut our knee or get bitten by a snake we can go to the hospital and it can save our lives. And the problem is that cutting off blood flow to the knee – while it may have saved our lives in times past – dramatically limits the knee’s ability to heal.

 

So how does Acupuncture help? Well by inserting needles into the skin at neurovascular nodes we create a series of events within the body;

 

Firstly it is believed that acupuncture insertion causes “jumps” at the neural threshold on the position nerve pathway, so that the signal can reach the brain. Once the signal reaches the brain a whole series of events occur including vasodilation (increased blood flow), release of enkephalins (the bodies own pain killers), and immune stimulation. However what isn’t quite understood is Acupuncture’s unique ability to stimulate areas that are not being touched by the needle (see above what is an Acupuncture point for more information).

 

Most pain relief from Acupuncture is very fast. However after needling the pain will come back, the old habits of the nerve chronically firing re-establishes itself. The body, just like the mind, has a hard time breaking bad habits.

 

But if the patient returns in a couple of days to get another treatment, the neural threshold will be jumped again. And if you keep jumping the neural threshold, eventually the central and peripheral nervous system figure out that it’s better to operate in the non-pain state than in the pain state. The technical term for this is re-establishment of neurological homeostasis.

 

Once this happens, the brain is no longer receiving pain signals from the knee. It no longer thinks the knee is injured or threatening the survival of the body.

The Science of Acupuncture

The mechanisms underlying how acupuncture relieves pain have been extensively researched for over 60 years. In basic science animal studies, Acupuncture has been observed to activate all four types of afferent nerve fibers. These fibers include the thick myelinated Aα and Aβ fibers, the thin myelinated Aδ fibers, and the thin unmyelinated C-fibers, all of which innervate skin and muscle. The innervation of fascia is less well known but is thought to include abundant nociceptors. Single afferent fiber recordings found predominantly C and A fiber activation in to Acupuncture (1). Manual manipulation of the needle, typically including lifting and thrusting to elicit de qi, dynamically alters the extracellular milieu, resulting in rotational deformation of fascia tissue, which may affect the physiology and gene expression of fibroblasts.

 

Numerous biochemicals have been identified including opioid and non-opioid neuropeptides, and neurotransmitters such as serotonin, norepinephrine, dopamine, cytokines, glutamate, nitric oxide, and gamma-amino-butyric-acid (GABA). Acupuncture analgesia has been shown to involve several classes of naturally produced opioid neuropeptides including enkephalins, endorphins, dynorphins, endomorphins, and nociceptin (also known as Orphanin FQ). Among the non-opioid neuropeptides, substance P (SP), vasoactive intestinal peptide (VIP) and calcitonin gene-related peptide (CGRP), which plays a central role in the pathogenesis of migraine, have been investigated for their roles in both the analgesic and anti-inflammatory effects of acupuncture.

 

Many biochemical and signaling pathways have been identified as playing a direct role in how acupuncture achieves its clinical effects, but perhaps the most central pathway that acupuncture uses, one that helps explain how it is effective in such a diverse array of clinical areas, is that acupuncture has been demonstrated to directly initiate a process called purinergic signaling, a primitive and ubiquitous system in the body using adenosine and ATP for signaling and regulation in all tissues and organ systems. It is now understood that all nerve transmission requires ATP as a co-factor and the that the body uses purine levels as a primary background signal of both healthy function and tissue damage. Studies on mice demonstrate that those that were bred to be unable to bind to adenosine did not have pain relief from acupuncture nor any of the chemical changes associated with acupuncture pain relief, while the normal mice did and this effect was repeated in humans.

 

Purinergic signaling has been demonstrated to play a central role in such diverse linical areas as migraines and headaches, immune dysfunction and inflammation, cancer, autism, Alzheimer’s, cardiovascular disease, endocrine function , embryological development While pharmaceutical companies are currently attempting to develop drugs in all of these areas to inhibit or enhance purinergic signaling, safety is an issue as the balance of these compounds at the cellular level is delicate, and both too much and too little adenosine and ATP are associated with disease. However, stimulating improved self-regulation of purinergic signaling through acupuncture treatment is likely both effective and safe.

 

In addition to biochemical actions, studies also demonstrate direct effects of acupuncture on the central nervous system. These include spinal reflex effects, where acupuncture stimulates muscle relaxation and changes in visceral organs. In the brain, acupuncture has been shown to change functional connectivity, decreasing activity in limbic structures associated with stress and illness while improving the regulation of the hypothalamus, pituitary, adrenal axis, the primary system that the body uses for regulating hormones and the physiological stress response. Additionally, acupuncture modulates parasympathetic activity, the branch of the nervous system associated with rest, relaxation, digestion and tissue healing. (11)

Acupuncture Research

Research into acupuncture as a medical treatment has grown exponenti ally in the past 20 years, increasing at twice the rate of research into conventional biomedicine. Over this period, there have been over 13,000 studies conducted in 60 countries, including hundreds of meta-analyses summarising the results of thousands of human and animal studies. With nearly 1,000 systematic reviews of acupuncture, getting a sense of what the evidence shows can be a challenge. Fortunately, the entire literature base was summarized in 2010 by the Australian Department of Veteran Aairs. This review was updated in 2014 by the US Department of Veteran Affairs and then again in 2017 by John McDonald and Stephen Janz, the authors of the Acupuncture Evidence Project.

 

“It is no longer possible to say that the effectiveness of acupuncture can be attributed to the placebo effect or that it is useful only for musculoskeletal pain.”

STEPHEN JANZ

The Acupuncture Evidence Project reviewed the eectiveness of acupuncture for 122 treatments over 14 clinical areas. They found some evidence of eect for 117 conditions. “Our study found evidence for the eectiveness of acupuncture for 117 conditions, with stronger evidence for acupuncture’s eectiveness for some conditions than others. Acupuncture is considered safe in the hands of a well-trained practitioner and has been found to be cost-eective for some conditions. The quality and quantity of research into acupuncture’s eectiveness is increasing.” Acupuncture Evidence Project, pg 55 (10).

While acupuncture enjoys high-level clinical evidence for dozens of conditions, translating trial research into official medical guidelines can take time. However, a recent review examined clinical guideline recommendations from around the world made by a variety of groups including government health institutions, national guidelines, and medical specialty groups. Over a 27 year period, they found 2189 positive recommendations for acupuncture for 204 health problems, mainly in guidelines published in North America, Europe and Australasia. (11)

How will I know if the Acupuncture is helping?

If you present with pain, you will often know that Acupuncture is working by the reduction of pain. By this occurring, it is proof that your body will listen to the Acupuncture treatments, and that the issue (pain/injury) will be able to make a complete recovery with repeat sessions. On the other hand, if no change is felt after a series of treatments then this could be an indication of a major structural problem (ie broken bone), which is out of our scope of practice and will most likely require some form of surgery.

 

For other ailments your practitioner will set a measurable goal, you will know if the treatment is helping by reaching this goal. This could be no symptoms, or a reduction in symptoms.

What is an Acupuncture point?

Modern research suggests that Acupuncture points that have been used to treat countless conditions in thousands of people are so powerful because these sites are actually neurovascular nodes (Neuro meaning nerve, and Vascular meaning veins, lymph vessels and arteries). That is, that Acupuncture points are areas within the tissue that have greater concentration of sensory fibres, fine blood vessels, fine lymphatic vessels and mast cells[ii], thus pressure or needle penetration at these points will cause greater reaction within the body compared with surrounding areas. We also know that the corneum stratum above acupuncture points is slightly thinner than the surrounding area with a lower electrical resistance.

 

So simply put by gentle needle penetration into these areas within the body will cause complex electrical and chemical messages to be conducted through the body via the nervous system, hormonal system, lymphatic and immune system. In clinic I like to refer to Acupuncture points as reactionary points, meaning that needling this point will create a reaction within the body.

 

A great example of this is the famous Acupuncture point which in the west we term Liver 3 (Tai Chong) which among its many uses can be used to treat eye pain or eye headaches. And guess what, it is nowhere near the eye!

 

As you can see Liver 3 is located on the foot in the depression proximal to the first metatarsal space. Interestingly enough needling this point increases blood flow to the choroid of the eye[iii]. Although more research is needed on each individual Acupuncture point, in clinic we are constantly amazed at how brilliantly these Acupuncture points work, and even more stumped at how the Chinese Acupuncturists discovered these amazing functions of these neurovascular nodes over 1000 years ago.

What is Distal Acupucture?

At Balanced Life Health Care we now offer Distal Acupuncture, which is a particular acupuncture method over 2,500 years old, popular in Hong Kong and Taiwan. This method varies widely from the typical treatments one can receive in Australia, with the results being far more effective and sustainable, particularly for pain relief.

 

Distal Acupuncture produces instantaneous pain relief, which is likened to “turning on a light switch”, enabling pain to be treated instantly and effectively. The Acupuncture points used involve areas of the scalp and ears; elbows to the fingers; and from knees to the toes. Consequently, the patient does not need to remove any clothing, and can lie comfortably while receiving an efficient and effective treatment. This style of Acupuncture also helps to create a treatment matrix for some of the more difficult conditions which are resistant to other types of treatment, as not only can pain be eradicated, but internal disorders also corrected.

Distal Acupuncture VS Local Acupuncture treatment

At Balanced Life Health Care we practise Distal Acupuncture, which can be known under several different names; “Tan Style Acupuncture”, ” Balance method Acupuncture”, or ” Advanced Neurological Acupuncture”. Despite the different names the technique is very similar and is practised around the world. Simple put Acupuncture needles are placed in areas of the body that are not in pain but have a neurological relationship to the area of pain. The benefits of this technique over local needling is that;

  • The area of pain will not be aggregated or further damage through treatment
  • Pain can be reduced anywhere from 50-100% immediately after the session
  • Receiver of distal Acupuncture can remain fully clothed as most points are located from the knees to the toes and elbows to fingers
  • Better treatment outcomes
  • Longer lasting results or total resolution of problem once a course of treatments is followed

Distal Acupuncture is one of the most advanced treatment methods for chronic pain and rarely mastered in the west. It is highly suited to chronic pain conditions that have neurological involvement because it is one of the only treatment methods that addresses midbrain involvement in pain.

Are there any risks involved?

Acupuncture is a very safe treatment when performed by a qualified Acupuncturist. It takes 4-5 years to study Acupuncture in Australia and all qualified Acupuncturists are recognized by AHPRA; the same governing body of all registered health practitioners. Only Acupuncturists that hold a minimum of a bachelor qualification are recognized by AHPRA. All Acupuncturists at Balanced Life Health Care hold a bachelor degree or higher qualification.

 

The needles used by an Acupuncturist are single-use, sterile needles and the risk of contamination is virtually nil. When performed by a qualified Acupuncturist – Acupuncture is side effect free

Does Acupuncture hurt?

This is the most common question asked about Acupuncture because many people associate needles with pain. Acupuncture needles are about the thickness of a cat’s whisker, so they are virtually painless when inserted. After insertion, the practitioner will bring the needle to the appropriate depth. You will then usually feel a very unique sensation that can vary from tingling, to heaviness, to warmth, or nothing at all; this is the body basically starting its “work”. Each person’s experience is different, so if you ask your practitioner they will explain to you what is going on. Should you experience any discomfort, inform the practitioner, and they will adjust the needles accordingly.

Will Acupuncture bruise or mark the skin?

In some cases, the needle will cause a small and mild bruise, which typically disappears in a few days. This is a very individualised occurrence and depends on the issue, health and medical history of the patient. For example those on blood thinners such as warfarin and aspirin may bruise easier than clients not taking these medications.

 

However, if cupping therapy is part of your treatment, it will leave bruises or marks on most skin types. This treatment is not painful. If you are receiving cupping therapy your acupuncturist will explain the process and bruising prior to treatment.

Can you use Acupuncture while pregnant?

Yes. Because there are some points, which are contraindicated during pregnancy, make sure you inform your practitioner if you are pregnant, become pregnant during the treatment, or trying to become pregnant. Acupuncture can be used safely during pregnancy, and poses no threat to you pregnancy if used by a qualified practitioner.

What is the duration of each session?

The initial consultation goes for 60 minutes; this is where a complete history and detailed evaluation of your condition will be completed, as well as the required treatment. With repeat sessions, patients will be in-and-out within 45 minutes.

How many sessions will I need?

This depends on the severity, duration and nature of the complaint. Generally 15 to 20 treatments are ample for the majority of chronic issues to be dealt with. In saying that, some acute conditions will be corrected in 1 treatment, where as some degenerative conditions may require as many as 40 treatments. Each individual is different, and results depend upon the health and vitality of the patient. However, the patient has the right to expect their major complaint to be addressed and treated in a direct and timely manner.

How often should I have Acupuncture?

Treatments are performed on a anywhere between twice-weekly to a fortnightly basis. Initially, for optimal results, treatment is one to two times a week, which will then be decreased to once a week, and eventually once a fortnight and so on. Once the condition has been controlled and you are symptom free, the treatments are performed less frequently to the point that you will no longer need treatment on that “old” issue. Problems that have been around for a long time generally take more treatments to resolve in comparison to ones that have come about recently.

How can I prepare for my session, and what can I do to make treatments more successful?

A light meal should be eaten before Acupuncture so that the body has some energy to work with, as sometimes a person who has not eaten could feel lightheaded or weak when receiving an Acupuncture treatment. It is best to wear loose clothing, which is comfortable, with the knees, elbows, and stomach region easily accessible. Do not perform any strenuous activity, drink alcohol, smoke excessively, or ingest heavy meals before or after your treatment. One of the most important things to do both before and after your treatment is to DRINK WATER. If an adequate amount of water is not put into the body, then optimal results will not be reached in the optimal time.

Am I able to claim my Acupuncture treatments with my Health Fund?

Yes, Balanced Life Health Care is partnered up with all Health Funds. We have a HICAPS terminal on site so eligible health funds can be claimed back instantaneously. However herbal medicine is currently not covered by most health funds. Please contact your health funds for full details on coverage levels as these can vary from policy to policy.

Do you reuse needles?

Never. All of our Acupuncturists use sterile, single use needles. We strictly follow infectious control guidelines in our clinic as per Chinese Medicine board of Australia guidelines

Your first visit

Your first visit starts with a consultation and history taking. Questions may be asked about your medical history, chief complaint, other aspects of your health and lifestyle that may affect your treatment and recovery. Our practitioners will also take a measurement of your pulse and check your tongue. Both of these are unique to Chinese medicine and are invaluable in our diagnosis.

 

Treatment will be given in the first session. Your treatment may include Acupuncture, cupping, moxibusion and/or herbal medicine. You may also be given lifestyle advice, exercises or dietary changes that are necessary for a swift recovery.

References

  1. Helene M. Langevin, MD, CM & Et Al (2015)Manual and Electrical Needle Stimulation in Acupuncture Research: Pitfalls and Challenges of Heterogeneity; Journal of Alternative and Complementary Medicine; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4855731/
  2. Kavoussi B, Ross BE. (2007) The neuroimmune basis of anti-inflammatory acupuncture. Integr Cancer Ther;  6:  251-7.
  3. Zijlstra FJ et al. (2003) Anti-inflammatory actions of acupuncture. Mediators Inflamm; 12: 59-69.
  4. Stux G, Pomeranz B, eds. (1987) Acupuncture Textbook and Atlas. Heidelberg: Springer-Verlag; 1-18.
  5. Zhao ZQ.  (2008) Neural mechanism underlying acupuncture analgesia. Prog Neurobiol.;  85: 355-75.
  6. Zhou Q et al. (2008) The effect of electro-acupuncture on the imbalance between monoamine neurotransmitters and GABA in the CNS of rats with chronic emotional stress-induced anxiety. Int J Clin Acupunct;17: 79-84.
  7. Lee B et al. (2009) Effects of acupuncture on chronic corticosterone-induced depression-like behavior and expression of neuropeptide Y in the rats. Neuroscience Letters; 453: 151-6.
  8. Cheng CH et al. (2009) Endogenous Opiates in the Nucleus Tractus Solitarius Mediate Electroacupuncture-induced Sleep Activities in Rats. Evid Based Complement Alternat Med; Sep 3.
  9.  Goldman N  et al. (2010) Adenosine A1 receptors mediate local anti-nociceptive effects of acupuncture. Nat Neurosci; May 30.
    Han JS. Acupuncture and endorphins. Neurosci Lett 2004; 361: 258-61.
  10. McDonald, John & Janz, Stephen. (2016). The Acupuncture Evidence Project : A Comparative Literature Review (Revised). Australian Acupuncture & Chinese Medicine Association Ltd, Coorparoo
  11. Website; https://www.evidencebasedacupuncture.org/present-research/acupuncture-scientific-evidence
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