The insertion and manipulation of fine metal needles to bring about a therapeutic effect is unique to Chinese medicine. Needling (acupuncture) tends to restore homeostasis by normalizing sympathetic and parasympathetic outflow, which has an influence on restoring visceral function and blood circulation. Typically, sympathetic activities are reduced. Homeostasis is promoted by reducing pain, restoring blood flow, normalizing immune system balance, and restoring visceral balance. Needling therapy is a complex treatment approach that requires knowledge of the nodes (acupoints) and their selection, as well as how to manipulate the tissue reactions to enhance either the inflammatory or anti-inflammatory phase of the process. Factors considered by the practitioner include selection of appropriate nodes (acupoints), strength of stimulation, methods of manipulation, depth and duration of insertion, basic constitution of the patient, presenting exterior and interior conditions, and the therapeutic method to be employed. The defensive and reflex mechanisms activated by needling intervention are also activated by the application of other therapies including moxibustion, massage, pressure, cupping, and additional modalities. Needling manipulation techniques are applied consistent with the node (acupoint) function and desired tissue reaction.
Although inserting needles may be relatively simple, great skill is required to bring about a controlled response. Most contemporary treatments use the fine filiform needle. The Huang Di Nei Jing Ling Shu Chapter 3 (Understanding the Fine Needle) goes so far as to judge the competency of practitioners based on their skill in applying the fine needle:
To say it is easy to apply the fine needle means that it is easy to talk about it. To say it is difficult to apply the fine needle means it is difficult to actually insert needles into a person. An unskilled practitioner is someone who is restricted to needling techniques based on observing or watching.
A highly skilled physician observes the patient’s vitality (spirit) and is able to observe the conditions of blood and vital substances to determine excess and deficiency, and apply reinforcing or reduction as needed.
Unskilled practitioners attend to the critical junctures, they restrict their application to nodes (acupoints) on the four extremities, and they have no understanding of the flow of blood and vital substances, or the dynamic interaction of homeostatic balance and pathogenic factors.
Use of Nodes (Acupoints) in Treatment Strategies
The application of specific nodes (acupoints) in clinical strategies derived by the early Chinese physicians is consistent with the physiological mechanisms that mediate reactions to needling the superficial body, including manipulating needle insertion in terms of both strength and duration to produce specific tissue reactions. The anatomical location of nodes (acupoints) and their influence on local, proximal, or distal regions, neuroanatomical relationships, internal organ relationships, affected vessel, or muscle distribution are all considered in the selection and use of nodes (acupoints). The two most important features taken into account are the spinal segmental relationships between certain body regions and the internal organs, and the contribution of propriospinal pathways to activate centrally mediated effects. Segmental relationships are considered when influencing a particular internal organ, vascular structure, or muscle distribution through the selection of local and adjacent nodes (acupoints). Propriospinal influence is considered in the case of spreading the centrally mediated descending control over a wider course of the spinal cord and body through the use of nodes (acupoints) that are proximal and distal to the problem area.
The ancient Chinese physicians established the relationships between the internal organs, distribution vessels, and the muscle pathways. Once a diagnosis indicates the involvement of a particular internal organ, vessel pathway, or muscle distribution, nodes (acupoints) are selected on the distribution vessel that supplies the affected area. Nodes (acupoints) that have indications for visceral problems show definite somatovisceral relationships over particular body regions that are generally consistent with the same spinal segmental levels of autonomic nerves serving the internal organs. This information provides a guide to selecting the local and adjacent candidate nodes (acupoints) for treatment. Selection of appropriate proximal and distal nodes (acupoints) on the target distribution vessel then completes a typical treatment protocol. The term proximal refers to nodes (acupoints) that are closest to the spinal cord, such as nodes (acupoints) located on the back, or those located at highest spinal segment level. Distal locations are usually on the arms or hands, or the legs and feet. The therapeutic method employed dictates how the nodes (acupoints) are to be manipulated. Additional nodes (acupoints) may also be included in the treatment plan, selected for certain special relationships as exhibited by recruitment, communication, confluent, and five-phase nodes (acupoints), as well as those chosen for their known special effects or special meeting locations.
This article is an excerpt from the Dao of Chinese Medicine [2] by Donald Kendall
About the Author
Dr. Donald Kendall, author of Dao of Chinese Medicine, first became involved with Chinese medicine after graduating from the University of Illinois with a degree in engineering, when he adopted the use of Chinese herbs as his primary health care strategy. This led to the study of physiology and Chinese medicine, culminating in a degree from the California Acupuncture College as Doctor of Oriental Medicine. Dr. Kendall has more than twenty years of private clinical experience, including acupuncture research at the UCLA dental school and as a staff member at UCLAs Center for East-West Medicine. Dr. Kendall has also served on the boards of several state and national professional organizations for acupuncture and Oriental medicine. He has developed and taught acupuncture orthopedics and dental acupuncture certification courses, and has participated in veterinary medical acupuncture training programs. He lectures extensively around the United States, as well as internationally, and has published a number of articles on various aspects of Chinese medicine, with an emphasis on how acupuncture works.