Chapter 23 Acupuncture

Question 1

Acupuncture (Jin jiu)

Answer 1

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

Question 2

Taoist philosophy

Answer 2

Tao is the source of all creation and acts through

two opposing but balancing forces: the yin and the yang.

Question 3

the yin and the yang

Answer 3

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.

Question 4

qi (vital energy)

Answer 4

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

Question 5

different types of qi that serve functions such as

Answer 5

hereditary, protective,

and nourishing energy

Question 6

Meridians

Answer 6

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

Question 7

Obstruction of qi may

result in

Answer 7

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

Question 8

The meridians emerge at the surface of body via

Answer 8

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

Question 9

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

Answer 9

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

Question 10

The four steps in assessing a patient’s symptoms are

Answer 10

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

Question 11

Eight diagnostic principles for symptom classification including

Answer 11

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

Question 12

TECHNIQUE

Answer 12

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

Question 13

Acupoints

Answer 13

sites of low skin resistance and accessible for stimulation

Question 14

An acupoint is identified by its

Answer 14

meridian, a Chinese name and number

Question 15

Acupoints are located

Answer 15

through anatomic landmarks such as

bony structures, muscles, and external features

Question 16

The cun

Answer 16

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

Question 17

The insertion of the needle is usually accompanied by

Answer 17

“deqi” (obtaining qi) described as soreness, heaviness, and

numbness around the site

Question 18

The disposable stainless

steel needle

Answer 18

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

Question 19

Proposed Mechanism of AP

Answer 19

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.

Question 20

Effect of the neuropeptides and neurotransmitters

Answer 20

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

Question 21

Functional MRI (fMRI)

Answer 21

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

Question 22

Hypothesizes on how AP works

Answer 22

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

Question 23

Indications of AP

Answer 23

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

Question 24

Common adverse effects of AP

Answer 24

bleeding or hematoma, pain, and vegetative

symptoms. pneumothorax and injury to the CNS.

Question 25

PRECAUTIONS AND RELATIVE

CONTRAINDICATIONS

Answer 25

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

Question 26

AP is most likely to benefit patients with

Answer 26

back pain, neck pain, tension headache, migraine, and knee

osteoarthritis (OA), acute migraine attacks

Question 27

AP-like TENS is superior to conventional TENS because

Answer 27

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

Question 28

Relationship between trigger points and acupuncture

Answer 28

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