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Flashcards in Chapter 23 Acupuncture Deck (28):

Acupuncture (Jin jiu)

consists of mechanical stimulation via needle insertion and thermal input by moxibustion. AP on the body surface is known as external therapy in
contrast to internal therapy by intake of medication


Taoist philosophy

Tao is the source of all creation and acts through
two opposing but balancing forces: the yin and the yang.


the yin and the yang

Yin implies dark, cold, rest, passivity, inward, decrease, wet, and female. Yang means bright, hot, activity, outward, increase, dry, and male. People exist within the tensions created by these two forces in a dynamic interaction with nature. Illness occurs when yin and yang fall out of balance and harmony. AP restores the balance by promoting yin and yang energy within organ systems.


qi (vital energy)

is fundamental to the
practice of classic AP. Qi is the energy that flows through different “meridians” or channels that connect the internal
body with the external environment


different types of qi that serve functions such as

hereditary, protective,
and nourishing energy



The network of meridians
runs around the body while each meridian is associated
with an organ system. There are 12 paired principal, 2 unpaired, and 8 extra meridians


Obstruction of qi may
result in

disequilibrium of yin and yang that may manifest as pain or illness


The meridians emerge at the surface of body via

acupuncture points (acupoints) where external stimulation may modulate the qi


six pathologic factors that cause disease in TCM (traditional Chinese medicine)

including wind, cold, heat, dampness, dryness, and fire


The four steps in assessing a patient’s symptoms are

observation; listening and smelling; palpation; history taking. The goal is to assess balance of yin and yang, and to gain insight into other symptoms


Eight diagnostic principles for symptom classification including

yin or yang, external or internal, cold or hot, and deficiency or excess



The skin is wiped
with an alcohol pad and stretched prior to needle insertion to minimize discomfort. Tubular guides can assist needle
insertion. The usual angle of insertion is perpendicular
or oblique



sites of low skin resistance and accessible for stimulation


An acupoint is identified by its

meridian, a Chinese name and number


Acupoints are located

through anatomic landmarks such as
bony structures, muscles, and external features


The cun

a defined unit of measurement to locate acupoints via specific
landmarks, is the distance between the joint creases of
interphalangeal joints of a patient’s flexed middle finger or equivalent to the width of patient’s thumb


The insertion of the needle is usually accompanied by

“deqi” (obtaining qi) described as soreness, heaviness, and
numbness around the site


The disposable stainless
steel needle

consists of a body or shaft with a handle. Common sizes are 30 to 32 gauge with lengths ranging
from 20 to 125 mm. Manipulation of needle depends on either an excess or deficiency state of the qi


Proposed Mechanism of AP

cause release of various endorphins and monoamine neurotransmitters in both the peripheral nervous system and central nervous system (CNS). AP activates sensory nerve fibers in muscles and sends signals to the spinal cord. This activates other centers in the midbrain and hypothalamic–pituitary axis that cause the release of neuropeptides.


Effect of the neuropeptides and neurotransmitters

Enkephalin and dynorphin are released at the level of the spinal cord and may block afferent pathways. Enkephalin produced at midbrain may stimulate
the inhibitory raphe descending system and release monoamines
serotonin and norepinephrine. These neurotransmitters
may further block pain transmission in the spinal
cord. Beta-endorphin released from the hypothalamic– pituitary axis may result in analgesia through both the systemic circulation and CSF


Functional MRI (fMRI)

a noninvasive technique that depends on differences in the relative concentration of oxygenated to deoxygenated hemoglobin within the brain in response to stimuli


Hypothesizes on how AP works

Fang and colleagues hypothesized that AP mediates analgesia,
anxiolysis, and other therapeutic effects via an
intrinsic neural circuit that plays a central role in the affective and cognitive dimensions of pain as well as in the regulation and integration of emotion and memory processing and autonomic, endocrine, immunologic, and sensorimotor functions.

Kim and colleagues proposed that needle manipulation enhanced analgesia by suppression of the transcription of pain-related genes


Indications of AP

AP and stimulation were effective in the short-term management of low back pain (LBP), neck pain, and osteoarthritis of the knee


Common adverse effects of AP

bleeding or hematoma, pain, and vegetative
symptoms. pneumothorax and injury to the CNS.



Pregnancy is a relative contraindication due to potential induction of premature labor. Bleeding diathesis and anticoagulant
therapy may result in bleeding and hematoma
formation. Steroids should be discontinued prior to therapy if possible due to attenuation of AP effects. Heavy meals and alcohol prior to AP is imprudent due to risk of vasovagal symptoms. Caution should be exercised when
performing AP over the thoracic region in compromised patients. Care should be taken to avoid electromagnetic interference associated with EA and pacemakers


AP is most likely to benefit patients with

back pain, neck pain, tension headache, migraine, and knee
osteoarthritis (OA), acute migraine attacks


AP-like TENS is superior to conventional TENS because

it produces prolonged
analgesia and thus does not have to be used continuously.
One 30-min treatment session a day (or twice a week) is sufficient therapy using AP-like TENS for chronic pain


Relationship between trigger points and acupuncture

trigger points and acupuncture points for pain, although discovered independently and labeled differently, represent the same phenomenon and can be explained in terms of the same underlying neural mechanisms

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