MedAku
HOW ACUPUNCTURE WORKS
© 2010 Nature America, Inc. All rights reserved.

Acupuncture is a procedure in which fine needles are inserted into an individual at discrete points and then manipulated, with the intent of relieving pain. Since its development in China around 2,000 B.C., acupuncture has become worldwide in its practice1. Although Western medicine has treated acupuncture with considerable skepticism2, a broader worldwide population has granted it acceptance. For instance, the World Health Organization endorses acupuncture for at least two dozen conditions3 and the US National Institutes of Health issued a consensus statement proposing acupuncture as a therapeutic intervention for complementary medicine. Perhaps most tellingly, the U.S. Internal Revenue Service approved acupuncture as a deductible medical expense in 1973.

Although the analgesic effect of acupuncture is well documented, little is understood about its biological basis. Insertion of the acupuncture needles in itself is not sufficient to relieve pain4. An acupuncture session typically lasts for 30 min, during which the needles are intermittently rotated, electrically stimulated or, in some cases, heated. The pain threshold is reported to slowly increase and to outlast the treatment4. The primary mechanism implicated in the anti-nociceptive effect of acupuncture involves release of opioid peptides in the CNS in response to the long-lasting activation of ascending sensory tracks during the intermittent stimulation4–6. However, a centrally acting agent cannot explain why acupuncture is conventionally applied in close proximity to the locus of pain and why the analgesic effects of acupuncture are restricted to the ipsilateral side7,8.

RESULTS
Acupuncture triggers adenosine and ATP metabolites release
ATP is released in response to either mechanical and electrical stimulation or heat. Once released, ATP acts as a transmitter that binds to purinergic receptors, including P2X and P2Y receptors9,10. ATP cannot be transported back into the cell but is rapidly degraded to adenosine by several ectonucleotidases before re-uptake10. Thus, adenosine acts as an analgesic agent that suppresses pain through Gi-coupled A1-adenosine receptors11–13. To determine whether adenosine is involved in the anti-nociceptive effects of acupuncture, we first asked whether the extracellular concentration of adenosine increases during acupuncture.

We collected samples of interstitial fluid by a microdialysis probe implanted in the tibialis anterior muscle/subcutis of adult mice at a distance of 0.4–0.6 mm from the ‘Zusanli point’, which is located 3–4 mm below and 1–2 mm lateral for the midline of the knee4. Adenine nucleotides and adenosine were quantified using high-performance liquid chromatography (HPLC) with ultraviolet absorbance before, during and after acupuncture (Fig. 1a)14,15. At baseline, the concentrations of ATP, ADP, AMP and adenosine were in the low nanomolar range (Fig. 1b), consistent with previous reports16,17. Acupuncture applied by gentle manual rotation of the acupuncture needle every 5 min for a total of 30 min sharply increased the extracellular concentrations of all purines detected (Fig. 1b). Adenosine concentration increased ~24-fold (253.5 ± 81.1 nM from a baseline of 10.6 ± 6.7 nM) during the 30-min
acupuncture session (Fig. 1c). The extracellular concentration of ATP returned to baseline after acupuncture, whereas adenosine, AMP and ADP remained significantly elevated (adenosine and AMP, P < 0.01; ADP, P < 0.05, paired t test compared to 0 min) at 60 min (Fig. 1c). Notably, previous studies have shown that deep brain stimulation is also associated with a severalfold increase in extracellular ATP and adenosine. Similar to electroacupuncture and transcutaneous electrical nerve stimulation, deep brain stimulation delivers electrical stimulation that triggers an increase in extracellular adenosine concentration18.

1Center for Translational Neuromedicine, University of Rochester Medical Center, Rochester, New York, USA. 2Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA. 3National Institute of Diabetes and Digestive and Kidney Diseases, US National Institutes of Health, Bethesda, Maryland, USA. 4These authors contributed equally to this work. Correspondence should be addressed to M.N. (nedergaard@urmc.rochester.edu).
Received 16 March; accepted 27 April; published online 30 May 2010; doi:10.1038/nn.2562
Adenosine A1 receptors mediate local anti-nociceptive effects of acupuncture
Nanna Goldman1,4, Michael Chen1,4, Takumi Fujita1,4, Qiwu Xu1, Weiguo Peng1, Wei Liu1, Tina K Jensen1,
Yong Pei1, Fushun Wang1, Xiaoning Han1, Jiang-Fan Chen2, Jurgen Schnermann3, Takahiro Takano1,
Lane Bekar1, Kim Tieu1 & Maiken Nedergaard1

Acupuncture's painkilling secret revealed: it's all in the twist action




Acupuncture 'meridians' match main nerve pathways, scientists 
believe
Acupuncture 'meridians' match main nerve pathways, scientists believe. Photograph: Getty Images/Getty

Ever since Chinese doctors first poked their patients with sharp objects 4,000 years ago, and charged them for the pleasure, acupuncture has been shrouded in mystery.

Tradition has it that the procedure works by improving the flow of "qi" along invisible energy channels called meridians, but research published today points to a less mystical explanation for the painkilling claims of acupuncture.

The answer, according to a team of scientists in New York, follows an extraordinary study in which researchers gave regular acupuncture sessions to mice with sore paws.

After each half-hour session the mice felt less discomfort in their paws because the needles triggered the release of a natural painkiller, the researchers say. The needles caused tissue damage that stimulated cells to produce adenosine, an anti-inflammatory chemical, that was effective for up to an hour after the therapy was over.

Modern acupuncture involves inserting fine needles into the skin at specific points around the body. The needles are pushed in a few centimetres, and then heated, twisted or even electrified to produce their claimed medical effects.

Acupuncture has spread around the world since originating in China but conventional western medicine has remained steadfastly sceptical. Although there is now good evidence that acupuncture can relieve pain, many of the other health benefits acupuncturists claim are on shakier ground.

The latest research gives doctors a sound explanation of how sticking needles into the skin can alleviate, rather than exacerbate, pain. The discovery will challenge the view , widely held among scientists, that any benefits a patient feels after acupuncture are due purely to the placebo effect.

"The view that acupuncture has little benefit beyond the placebo effect has really hampered research into the technique," said Maiken Nedergaard, a neuroscientist at the University of Rochester medical centre in New York state, who led the study.

"Some people think any work in this area is junk research, but I think that's wrong. I was really surprised at the arrogance of some of my colleagues. We can benefit from what has been learned over many thousands of years," Nedergaard said.

"I believe we've found the main mechanism by which acupuncture relieves pain. Adenosine is a very potent anti-inflammatory compound and most chronic pain is caused by inflammation."

The scientists gave each mouse a sore paw by injecting it with an inflammatory chemical. Half of the mice lacked a gene that is needed to make adenosine receptors, which are found on major nerves.

The therapy session involved inserting a fine needle into an acupuncture point in the knee above each mouse's sore foot. In keeping with traditional practice, the needles were rotated periodically throughout the half-hour session.

To measure how effective the acupuncture was, the researchers recorded how quickly each mouse pulled its sore paw away from a small bristly brush. The more pain the mice were in, the faster they pulled away.

Writing in the journal, Nature Neuroscience, Nedergaard's team describe how acupuncture reduced pain by two-thirds in normal mice, but had no effect on the discomfort of mice that lacked the adenosine receptor gene. Without adenosine receptors, the mice were unable to respond to the adenosine released when cells were damaged by acupuncture needles.

Acupuncture had no effect in either group of mice if the needles were not rotated, suggesting that the tissues had to be physically damaged to release adenosine.

Nedergaard said that twisting the needles seems to cause enough damage to make cells release the painkilling chemical. This is then picked up by adenosine receptors on nearby nerves, which react by damping down pain. Further tests on the mice revealed that levels of adenosine surged 24-fold in the tissues around the acupuncture needles during and immediately after each session.

One of the longstanding mysteries surrounding acupuncture is why the technique only seems to alleviate pain if needles are inserted at specific points. Nedergaard believes that most of these acupuncture points are along major nerve tracks, and as such are parts of the body that have plenty of adenosine receptors.

In a final experiment, Nedergaard's team injected mice with a cancer drug that made it harder to remove adenosine from their tissues. The drug, called deoxycoformycin, boosted the effects of acupuncture dramatically, more than tripling how long the pain relief lasted.

"There is an attitude among some researchers that studying alternative medicine is unfashionable," said Nedergaard. "Because it has not been understood completely, many people have remained sceptical."

Although the study explains how acupuncture can alleviate pain, it sheds no light on the other health benefits that some practitioners believe the procedure can achieve.

Josephine Briggs, the director of the national centre for complementary and alternative medicine at the US National Institutes of Health, said: "It's clear that acupuncture may activate a number of different mechanisms … It's an interesting contribution to our growing understanding of the complex intervention which is acupuncture."


http://www.guardian.co.uk/lifeandstyle/2010/may/30/acupuncture-pain-relief-adenosine-mice
Published: February 24, 2010

Up to a quarter of all women suffer from depression during pregnancy, and many are

reluctant to take antidepressants. Now a new study suggests that acupuncture may

provide some relief during pregnancy, even though it has not been found to be an

effective treatment against depression in general.


The Stanford University study recruited 150 depressed women who were 12 to 30

weeks pregnant, and randomly assigned 52 to receive acupuncture specifically designed

for depressive symptoms, 49 to regular acupuncture and 49 to Swedish massage.


Each woman received 12 sessions of 25 minutes each; those given acupuncture did not

know which type they were getting. (In the depression-specific treatment, needles are

inserted at body points that are said to correspond to symptoms like anxiety, withdrawal

and apathy.)


After eight weeks, almost two-thirds of the women who had depression-specific acupuncture experienced

a reduction in at least 50 percent of their symptoms, compared with just under half of the women treated with either

massage or regular acupuncture.


There was no significant difference in the rates of complete remission — about a third in each group. The findings appear in the March issue of Obstetrics & Gynecology.


The lead author, Rachel Manber, a professor of psychiatry and behavioral sciences at Stanford, said the results suggested that some symptoms of depression during pregnancy might be related to physical discomfort that is alleviated by acupuncture.

Still, the results were striking, she said, adding, “It’s quite remarkable, especially since the prevalence of depression is highest in the third trimester of pregnancy, so it goes against the course of how you would expect depression to go.”


You can access this article at - http://www.nytimes.com/2010/03/02/health/research/02preg.html?ref=health
Free Research Paper at - http://journals.lww.com/greenjournal/Fulltext/2010/03000/Acupuncture_for_Depression_During_Pregnancy__A.7.aspx

Obstetrics & Gynecology: March 2010 - Volume 115 - Issue 3 - pp 511-520, doi: 10.1097/AOG.0b013e3181cc0816, Original Research
Acupuncture for Depression During Pregnancy: A Randomized Controlled Trial


 

Acupuncture HELPS Brain's Ability To Regulate Pain, UM Study Shows

ScienceDaily (Aug. 11, 2009) — Acupuncture has been used in East-Asian medicine for thousands of years to treat pain, possibly by activating the body's natural painkillers. But how it works at the cellular level is largely unknown.

Using brain imaging, a University of Michigan study provides novel evidence that traditional Chinese acupuncture affects the brain's long-term ability to regulate pain.

The results appear online ahead of print in the September Journal of NeuroImage.

In the study, researchers at the U-M Chronic Pain and Fatigue Research Center showed acupuncture increased the binding availability of mu-opoid receptors (MOR) in regions of the brain that process and dampen pain signals – specifically the cingulate, insula, caudate, thalamus and amygdala.

Opioid painkillers, such as morphine, codeine and other medications, are thought to work by binding to these opioid receptors in the brain and spinal cord.

"The increased binding availability of these receptors was associated with reductions in pain," says Richard E. Harris, Ph.D., researcher at the U-M Chronic Pain and Fatigue Research Center and a research assistant professor of anesthesiology at the U-M Medical School.

One implication of this research is that patients with chronic pain treated with acupuncture might be more responsive to opioid medications since the receptors seem to have more binding availability, Harris says.

These findings could spur a new direction in the field of acupuncture research following recent controversy over large studies showing that sham acupuncture is as effective as real acupuncture in reducing chronic pain.

"Interestingly both acupuncture and sham acupuncture groups had similar reductions in clinical pain," Harris says. "But the mechanisms leading to pain relief are distinctly different."

The study participants included 20 women who had been diagnosed with fibromyalgia, a chronic pain condition, for at least a year, and experienced pain at least 50 percent of the time. During the study they agreed not to take any new medications for their fibromyalgia pain.

Patients had position emission tomography, or PET, scans of the brain during the first treatment and then repeated a month later after the eighth treatment.

Additional authors were Jon-Kar Zubieta, M.D., Ph.D., David J. Scott, Vitaly Napadow, Richard H. Gracely, Ph.D, Daniel J. Clauw, M.D.

Funding was provided by the Department of Army, and the National Institutes of Health.

Source:

Adapted from materials provided by University of Michigan Health System. Original article written by Shantell M. Kirkendoll.


Journal Reference:

1.                       Richard E. Harris, Jon-Kar Zubieta, David J. Scott, Vitaly Napadow, Richard H. Gracely, Daniel J. Clauw. Traditional Chinese acupuncture and placebo (sham) acupuncture are differentiated by their effects on μ-opioid receptors (MORs). Journal of NeuroImage, 2009; 47 (3): 1077-1085 DOI: 10.1016/j.neuroimage.2009.05.083

 


Study Maps Effects of Acupuncture on the Brain

ScienceDaily (Feb. 5, 2010) — Important new research about the effects of acupuncture on the brain may provide an understanding of the complex mechanisms of acupuncture and could lead to a wider acceptability of the treatment.


The study, by researchers at the University of York and the Hull York Medical School published in Brain Research, indicates that acupuncture has a significant effect on specific neural structures. When a patient receives acupuncture treatment, a sensation called deqi can be obtained; scientific analysis shows that this deactivates areas within the brain that are associated with the processing of pain.

Dr Hugh MacPherson, of the Complementary Medicine Research Group in the University's Department of Health Sciences, says: "These results provide objective scientific evidence that acupuncture has specific effects within the brain which hopefully will lead to a better understanding of how acupuncture works."

Neuroscientist Dr Aziz Asghar, of the York Neuroimaging Centre and the Hull York Medical School, adds: "The results are fascinating. Whether such brain deactivations constitute a mechanism which underlies or contributes to the therapeutic effect of acupuncture is an intriguing possibility which requires further research."

Last summer, following research conducted in York, acupuncture was recommended for the first time by the National Institute for Health and Clinical Excellence (NICE) as a treatment option for NHS patients with lower back pain. NICE guidelines now state that GPs should 'consider offering a course of acupuncture comprising a maximum of 10 sessions over a period of up to 12 weeks' for patients with this common condition.

Current clinical trials at the University of York are investigating the effectiveness and cost-effectiveness of acupuncture for Irritable Bowel Syndrome (IBS) and for depression. Recent studies in the US have also shown that acupuncture can be an effective treatment for migraines and osteoarthritis of the knee.

The York team believe that the new research could help to clear the way for acupuncture to be more broadly accepted as a treatment option on the NHS for a number of medical conditions.


Source:

Adapted from materials provided by University of York, via EurekAlert!, a service of AAAS.


Journal Reference:

1.                       Asghar et al. Acupuncture needling sensation: The neural correlates of deqi using fMRI. Brain Research, 2010; 1315111 DOI: 10.1016/j.brainres.2009.12.019

http://www.sciencedaily.com/releases/2010/02/100204101736.htm

alt="ScienceDaily: Your source for the latest research news and science breakthroughs -- updated daily" v:shapes="_x0000_i1032">


Acupuncture Reduces Side Effects Of Breast Cancer Treatment As Much As Conventional Drug Therapy, Study Suggests

ScienceDaily (Sep. 23, 2008) — Acupuncture is as effective and longer-lasting in managing the common debilitating side effects of hot flashes, night sweats, and excessive sweating (vasomotor symptoms) associated with breast cancer treatment and has no treatment side effects compared to conventional drug therapy, according to a first-of-its-kind study presented September 24, 2008, at the American Society for Therapeutic Radiology and Oncology's 50th Annual Meeting in Boston.


Findings also show there were additional benefits to acupuncture treatment for breast cancer patients, such as an increased sense of well being, more energy, and in some cases, a higher sex drive, that were not experienced in those patients who underwent drug treatment for their hot flashes.

"Our study shows that physicians and patients have an additional therapy for something that affects the majority of breast cancer survivors and actually has benefits, as opposed to more side effects. The effect is more durable than a drug commonly used to treat these vasomotor symptoms and, ultimately, is more cost-effective for insurance companies," Eleanor Walker, M.D., lead author of the study and a radiation oncologist at the Henry Ford Hospital Department of Radiation Oncology in Detroit, said.

The reduction in hot flashes lasted longer for those breast cancer patients after completing their acupuncture treatment, compared to patients after stopping their drug therapy plan.

Eighty percent of women treated for breast cancer suffer from hot flashes after being treated with chemotherapy and/or anti-estrogen hormones, such as Tamoxifen and Arimidex. Although hormone replacement therapy is typically used to relieve these symptoms, breast cancer patients cannot use this therapy because it may increase the risk of the cancer coming back.

As a treatment alternative, patients are generally treated with steroids and/or antidepressant drugs. These drugs, however, have additional side effects, such as weight gain, nausea, constipation and fatigue. The antidepressant, venlafaxine (Effexor), a selective serotonin reuptake inhibitor, is one of the most common drugs used to treat these hot flashes. However, many women decide against this treatment choice because of potential side effects, including decreased libido, insomnia, dizziness and nausea, or because they simply do not want to take any more medications.

The randomized clinical trial compared acupuncture treatment to venlafixine for 12 weeks to find out if acupuncture reduced vasomotor symptoms in breast cancer patients receiving hormonal therapy and produced fewer side effects than venlafaxine. The study involved 47 breast cancer patients who received either Tamoxifen or Arimidex and had at least 14 hot flashes per week. Results show that acupuncture reduces hot flashes as effectively as venlafaxine, with no side effects, and also provides additional health benefits to patients.

The abstract is entitled, "Acupuncture for the Treatment of Vasomotor Symptoms in Breast Cancer Patients Receiving Hormone Suppression Treatment."

Source:

Adapted from materials provided by American Society for Therapeutic Radiology and Oncology, via EurekAlert!, a service of AAAS.

 

 


Acupuncture Cuts Tension Headache Rates By Almost Half

ScienceDaily (Aug. 1, 2005) — Acupuncture is an effective treatment for tension headache, cutting rates for sufferers by almost half, shows a study on bmj.com this week.


And a minimal acupuncture course works almost as well as traditional Chinese therapy, say the researchers.

In a randomised controlled trial - the gold standard of clinical trials - researchers in Germany divided 270 patients with a similar severity of tension headache into three groups.

Over an eight week period one set were treated with traditional acupuncture, one with minimal acupuncture (needles inserted only superficially into the skin, at non-acupuncture points), and one group had neither treatment ('control' group).

Those receiving traditional acupuncture care saw their headache rates drop by almost half - suffering 7 days less headaches over the four weeks following the treatment. Those receiving minimal acupuncture had 6.6 less days of headaches. While the control group experienced 1.5 less days of headaches - a drop of just a tenth.

Improvements to headache rates continued for months after the acupuncture treatment, though they began to rise slightly as time went on.

Those in the 'no treatment' group were subsequently given acupuncture for eight weeks after the main study period. These patients also improved significantly after the treatment, though not to the same level as those given acupuncture initially.

Of the 195 patients in the acupuncture groups, 37 reported some side effects - the most common being dizziness, other headaches and bruising.

Such a small difference in results between traditional and minimal acupuncture treatments seems to indicate that the location of acupuncture points and other aspects of traditional Chinese acupuncture do not make a major difference for tension headache, say the authors.

Acupuncture treatments are sometimes associated with strong placebo effects, caution the authors. But these findings show that acupuncture produces just as good improvements for tension headache sufferers as treatments already accepted, they conclude.

Story

Adapted from materials provided by British Medical Journal, via EurekAlert!, a service of AAAS.

 

Acupuncture May Relieve Joint Pain Caused by Some Breast Cancer Treatments

ScienceDaily (Mar. 5, 2010) — A new study, led by researchers at the Herbert Irving Comprehensive Cancer Center at NewYork-Presbyterian Hospital/Columbia University Medical Center, demonstrates that acupuncture may be an effective therapy for joint pain and stiffness in breast cancer patients who are being treated with commonly used hormonal therapies.


Results were published in the Journal of Clinical Oncology.

Joint pain and stiffness are common side effects of aromatase inhibitor therapy, in which the synthesis of estrogen is blocked. The therapy, which is a common and effective treatment for early-stage, hormone-receptor-positive breast cancer in post-menopausal women, has been shown in previous research to cause some joint pain and stiffness in half of women being treated.

"Since aromatase inhibitors have become an increasingly popular treatment option for some breast cancer patients, we aimed to find a non-drug option to manage the joint issues they often create, thereby improving quality of life and reducing the likelihood that patients would discontinue this potentially life-saving treatment," said Dawn Hershman, M.D, M.S., senior author of the paper, and co-director of the breast cancer program at the Herbert Irving Comprehensive Cancer Center at NewYork-Presbyterian Hospital/Columbia University Medical Center, and an assistant professor of medicine (hematology/oncology) and epidemiology at Columbia University Medical Center.

To explore the effects of acupuncture on aromatase inhibitor-associated joint pain, the research team randomly assigned 43 women to receive either true acupuncture or sham acupuncture twice a week for six weeks. Sham acupuncture, which was used to control for a potential placebo effect, involved superficial needle insertion at body points not recognized as true acupuncture points. All participants were receiving an aromatase inhibitor for early breast cancer, and all had reported musculoskeletal pain.

Among the women treated with true acupuncture, findings demonstrated that they experienced significant improvement in joint pain and stiffness over the course of the study. Pain severity declined, and overall physical well-being improved. Additionally, 20 percent of the patients who had reported taking pain relief medications reported that they no longer needed to take these medications following acupuncture treatment. No such improvements were reported by the women who were treated with the sham acupuncture.

"This study suggests that acupuncture may help women manage the joint pain and stiffness that can accompany aromatase inhibitor treatment," said Katherine D. Crew, M.D., M.S., first author of the paper, and the Florence Irving Assistant Professor of Medicine (hematology/oncology) and Epidemiology at Columbia University Medical Center and a hematological oncologist at NewYork-Presbyterian Hospital/Columbia University Medical Center. "To our knowledge, this is the first randomized, placebo-controlled trial establishing that acupuncture may be an effective method to relieve joint problems caused by these medications. However, results still need to be confirmed in larger, multicenter studies."

Source:

Adapted from materials provided by Columbia University Medical Center, via EurekAlert!, a service of AAAS.


Journal Reference:

1.                       Katherine D. Crew, Jillian L. Capodice, Heather Greenlee, Lois Brafman, Deborah Fuentes, Danielle Awad, Wei Yann Tsai, and Dawn L. Hershman. Randomized, Blinded, Sham-Controlled Trial of Acupuncture for the Management of Aromatase Inhibitor-Associated Joint Symptoms in Women With Early-Stage Breast Cancer. Journal of Clinical Oncology, 2010; 28 (7): 1154 DOI: 10.1200/JCO.2009.23.4708

 

 

_________________________________________________________________________________________


A-Z Guide to the Year in Medicine

TIME MAGAZINE Sunday, Nov. 27, 2005

'A' FOR ACUPUNCTURE

acupuncture

ACUPUNCTURE There is growing scientific evidence that acupuncture, a pillar of Chinese medicine, can relieve many kinds of pain, but there's no clear agreement about how it works. That was underscored by a German study of migraines: it found that inserting needles at various acupuncture points in the body relieved pain just as effectively as inserting them in the points that are supposed to affect migraines. Both therapies cut the number of episodes more than 50% over a 12-week period; a control group that did not receive either treatment continued to suffer as before.

http://www.time.com/time/magazine/article/0,9171,1134763-1,00.html

NATIONAL INSTITUTE OF HEALTH - USA

Acupuncture as a therapeutic intervention is widely practiced
in the United States. There have been many studies
of its potential usefulness. However, many of these studies
provide equivocal results because of design, sample size,
and other factors. The issue is further complicated by
inherent difficulties in the use of appropriate controls,
such as placebo and sham acupuncture groups.

However, promising results have emerged, for example,
efficacy of acupuncture in adult post-operative and chemotherapy
nausea and vomiting and in post-operative dental
pain. There are other situations such as addiction, stroke
rehabilitation, headache, menstrual cramps, tennis elbow,
fibromyalgia, myofascial pain, osteoarthritis, low back pain,
carpal tunnel syndrome, and asthma for which acupuncture
may be useful as an adjunct treatment or an acceptable
alternative or be included in a comprehensive management
program. Further research is likely to uncover additional
areas where acupuncture interventions will be useful.

Findings from basic research have begun to elucidate the
mechanisms of action of acupuncture, including the release
of opioids and other peptides in the central nervous system
and the periphery and changes in neuroendocrine function.
Although much needs to be accomplished, the emergence
of plausible mechanisms for the therapeutic effects of
acupuncture is encouraging.

The introduction of acupuncture into the choice of treatment
modalities readily available to the public is in its early
stages. Issues of training, licensure, and reimbursement
remain to be clarified. There is sufficient evidence, however,
of its potential value to conventional medicine to encourage
further studies.

There is sufficient evidence of acupuncture's value to expand
its use into conventional medicine and to encourage further
studies of its physiology and clinical value.

http://consensus.nih.gov/1997/1997Acupuncture107PDF.pdf


Acupuncture Today
June, 2000, Vol. 01, Issue 06

Ice Age Acupuncture?

Study of Mummified Body Raises Questions about Practice's Origin

By Editorial Staff

In 1991, the scientific world was rocked by the discovery of Otzi, a 5,000-year-old mummified man found in the mountains along the border between Austria and Italy. Named after the Otz valley in which it was discovered, the mummy's body was remarkably well preserved, as were most of his clothing, tools and weapons.

For the past nine years, scientists have examined the mummy's remains thoroughly, learning much about the everyday life of ancient Europeans. One of the most remarkable discoveries was a complicated system of bluish-black tattoos running along Otzi's back, right knee and left ankle.

While most tattoos are ornamental in nature, the tattoos found on Otzi's body were in the form of simple stripes or crosses. They were also found in places that would normally be covered by hair or clothing. Since such non-ornamental tattoos had previously been found in similar locations on mummies in Siberia and South America, some researchers speculated that the lines on Otzi's body were of therapeutic importance.

What, if any, significance did the ice man's tattoos have beyond ornamentation? A group of scientists from the University of Graz in Austria attempted to answer that question by theorizing a possible relationship between the tattoos and traditional acupuncture points. Their findings, first published in The Lancet in 1999 and updated in Discover magazine earlier this year,1,2 purport to show that acupuncture  or a system of healing quite similar to it  may have been in use in central Europe more than 2,000 years earlier than previously believed.

The research team, led by Drs. Leopold Dorfer and Max Moser, first calculated the mummy's cun by measuring its femur, tibia and radius. They then converted the measurements of the tattoos to cun and overlaid the locations of the tattoos to topographical representations of Chinese acupuncture points.

Experts from three acupuncture societies then examined the locations of the tattoos. In their opinion, nine tattoos could be identified as being located directly on, or within six millimeters of, traditional acupuncture points. Two more were located on an acupuncture meridian. One tattoo was used as a local point. The remaining three tattoos were situated between 6-13mm from the closest acupuncture point.

Table I: Location of tattoo groups on the Tyrolean ice man ("Otzi") and their relation to classical acupuncture points.

Tattoo location and shapeAcunpuncture pointDistance between tattoo & acupuncture point (mm)
Left back  
Upper four lines 
Upper three lines 
Lower three lines 
Lower four lines
UB21 
UB22 
UB23 
UB25



0
Right back  
Four linesUB2413
Right leg  
Cross on knee, medial 
Three lines, medial 
Three lines, frontal 
Upper three lines, lateral 
Two lines, lateral 
Lower three lines, lateral
Li8 
Ki7, SP6 
Local pt between GB40 and ST41 
On GB meridan 
GB37, dorsal to fibula 
GB38, dorsal to fibula


N/A 
N/A 

6
Left leg  
Seven lines, dorsal 
Three lines, dorsal 
One line dorsal 
Dorsal cross at lateral malleolus
Ub56 
On UB, Between UB58 and UB59 
UB59 
UB60

N/A 

4

X-rays of the ice man's body revealed evidence of arthritis in the hip joints, knees, ankles and lumbar spine. Nine of the mummy's 15 tattoos are located on the urinary bladder meridian, a meridian commonly associated with treating back pain. In fact, one of the mummy's two cross-shaped tattoos is located near the left ankle on point UB60, which is considered by several texts a "master point for back pain."3-5

"The fact that not randomly selected points, but rather corresponding groups of points were marked by tattoos, seems especially intriguing," the researchers noted. "From an acupuncturist's viewpoint, the combination of points selected represents a meaningful therapeutic regimen."

Forensic analysis of the mummy also revealed that his intestines were filled with whipworm eggs, which can cause severe abdominal pain. Five other tattoos located on the body corresponded with points located on the gall bladder, spleen and liver meridians  points that are traditionally used to treat stomach disorders.

"Taken together," the scientists added, "the tattoos could be viewed as a medical report from the stone age, or possibly as a guide to self-treatment marking where to puncture when pains occur."

Admittedly, not all of the tattoos matched up precisely with known acupuncture sites; one tattoo, in fact, was located more than half an inch from the nearest acupuncture point. The scientists theorized that these differences in location "might be explained by twisting of the Iceman's skin relative to underlying structures that may have occurred during 5,000 years in the ice." They also acknowledged that some tattoos "are partly shifted today out of symmetry according to their location on the twisted body."

Despite these small variations, the discovery of therapeutic tattoos on a mummy who died more than 2,000 years before the appearance of acupuncture as it is known today raises some interesting questions as to where this form of care originated and how long it has been practiced.

"The locations of the tattoos are similar to points used for specific disease states in the traditional Chinese and modern acupuncture treatment," the scientists concluded. "É This raises the possibility of acupuncture having originated in the Eurasian continent at least 2000 years earlier than previously recognized."

"At the time when Otzi was around, I'm sure that many shamanistic cultures worldwide might have practiced it," added Dr. Moser. "But only the Chinese formalized it and saved it into modern times."

References

  1. Dorfer L, et al. A medical report from the stone age? Lancet Sep 18, 1999;354:1023-5. 
  2. Glausiusz J. The ice man healeth. Discover February 2000. 
  3. Essentials of Chinese Acupuncture. Compiled by Beijing, Shanghai and Nanjing College of TCM. Beijing: Foreign Language Press, 1980. 
  4. O'Connor J, Bansky D (eds.) Acupuncture: A Comprehensive Text. Seatle: Eastlan, 1996. 
  5. Maciocia G. The Foundations of Chinese Medicine. A Comprehensive Text for Acupuncturists and Herbalists. New York: Churchill Livingstone, 1989.



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Micro-Acupuncture Systems
As Fractals Of The Human Body
Vadim Bouevitch, MD

ABSTRACT
Microacupuncture systems may be based on the principle of fractalization found in nature (living and non-living), including the wave-like nature of acupuncture channels. Such a theory accommodates the perspective of physics as well as Traditional Chinese Medicine concepts of meridians, microacupuncture systems, acupuncture points, Qi energy, pathogenic factors, etc. The number of projections of microacupuncture systems onto the skin surface and mucous membranes is potentially unlimited. The need exists for scientific exploration and elaboration of the physiologic mechanisms involved in microsystems to gauge treatment effects.
KEY WORDS
Acupuncture, Microacupuncture Systems, Fractal, Su Jok, Embryo Microsystems Formation, Yamamoto New Scalp Acupuncture

INTRODUCTION
A characteristic feature of modern acupuncture is the rapid development of the doctrine of microacupuncture systems. A variety of microsystems is in use: auriculotherapy, su jok therapy, ECIWO (embryo containing the information of the whole organism) therapy, oral acupuncture, iridodiagnostics, nasal therapy, different modifications of scalp therapy (including Yamamoto New Scalp Acupuncture [YNSA]), vaginal acupuncture, clavicle needle injection, and more.

These systems are united by one general property; each is a projection of all parts of the body and its internal organs onto a limited section of the skin, mucous membrane, and periosteum. The organs are extrapolated not only morphologically but also functionally. It is impossible to explain such a reflection on so varied and removed surfaces simply by means of neurohormonal connections. Nevertheless, the clinical efficacy of the microsystems is irrefutable; one of the modern theories of the influence of acupuncture pertains to the fractal-field model of the structure of the organism. This accounts precisely for the appearance and structure of microacupuncture systems and their activity.

The Fractal Model
In the field of nonlinear equations and complex numbers, Benoit Mandelbrot is the originator of fractal geometry.1 Mandelbrot's set (Z [Z2-C]), solved for Z and C, provides particular parameters that can be represented pictorially via computer graphics. This visual display illustrates the sheer variety of forms that arise, coupled with the self-similarity of the figures. This quality of self-similarity is independent of size or scale.1 The very peculiarity is in the primary (mother) figure giving rise to smaller figures, which are still similar in form and content (Figure 1). This self-similarity is mathematically endless in principle, but the real size of the smallest figure is necessarily restricted by atom size. Apart from the principle of self-organization, one can see the dialectical unity of order and chaos within the same process. The central symmetrical figure at the beginning of the process gradually turns into the chaotic "fractal dust" on the periphery.

Recently, the fractalization (self-similarity) principle has been recognized as the basic principle behind nature's self-organization. This is illustrated aptly by the classic irregular coastline viewed on different scales (e.g., 1:100 m, 1:100 km) whereby the shape remains constant, irrespective of the scale of measurement. Similarly, this pattern can be noted in the branching of a tree or in the divisions in the veins of a leaf.

Many fractal-like structures have also been discovered in the human organism. Certainly, they are not as identical as mathematical sets, but the principle of fractalization is nevertheless observed in the bronchial dichotic division of the 1st, 2nd, 3rd, 4th, and 5th and additional levels (Figure 2). This also occurs in the branching of blood vessels and nerves, and in intestinal villi and microvilli.

In addition to structural fractals, functional fractals exist in organisms. For example, for electrocardiographic (ECG) Holter monitoring data, the graph that depicts the variations in the healthy heart rhythm over a 24-hour period is identical to the R-R interval on ECG for a 1-minute period (Figure 3).

Wave Theory of Meridians
Many attempts have been made to explain the nature of the classic acupuncture meridians. To date, there are approximately 20 theories, none of which account for microsystems. A more recent interpretation is the fractal-field model of the structure of the organism, which describes the meridians as the final wave cycle in the coherent field of an organism with projections onto the body surface at the level of the acupuncture points. According to this concept, the main function of the meridians is to provide an informational exchange between an organism (microspace) and its environment (macrospace). The goal of this exchange is the adaptation of an organism to the changeable conditions of its environment.2

Fractal electromagnetic (or torsion) fields, which transmit information without transferring energy, probably play a part in the material substratum which facilitates the exchange.3 The advantage of this model is that it allows the modern view of the structure of matter to be united with the ancient East's conception of acupuncture to prove the physical reality of such concepts as meridians, Qi energy, internal and external pathogens, and more.

Thus, the channels of acupuncture are wave formations that transmit information about the internal environment of an organism and facilitate the exchange of this information with the external environment via the acupuncture points. Indeed, the meridian system is an informational cast of the human body on the wave level. In addition, according to the principle of fractalization, an organism creates many quantum copies of itself with projections on the skin, mucous membranes, etc. The biological reason for these multiple copies is to create a bigger "durability reserve" for the informational structure, i.e., the body codes its anatomical structure, the structure and functions of its internal organs and systems, and the development of the organism in space and time.4

Formation and Application to Microsystems
A large central image analogous to the system of 12 Principal, and 8 Extra Meridians, is shown in Figure 1; many other images are created around it. These images are self-similar in form and content but different in size, from the largest to the smallest "fractal dust." These images can be used to represent the microacupuncture systems, which also vary in size and in their resolving ability. The su jok, ECIWO, and YNSA microsystems have the greatest resolving ability. Su jok describes the microcopies of the meridians as bel meridians. Generally, this system provides the most comprehensive description of the principle of fractalization, particularly with regard to the basic and minisystems of conformity.

Figure 1.
The Mandelbrot Set (Z [Z2-C]) Depicted at Different Scales via Computer Graphics7
(A) Primary "Mother Figure" acupuncture channels; (B) Amounts of different microsystems




Park Jae Woo had no need to prove the principle of self-similarity, which has long been known in the East. He simply used this principle as the basis of his doctrine and at the same time, transferred the philosophical concepts of traditional Eastern medicine to this microsystem. He did not try to substantiate it physiologically. Recently, there have been attempts to describe the meridians in other acupuncture systems.

Since the DNA molecule is the smallest information carrier and wave copy of an organism, a theoretically possible number of microsystems must be at least 103 (the number of cells in the living organism). The Chinese say, "Each object can be divided 10,000 times." In principle, it is possible to describe many other microsystems, but they are all smaller and less significant than more recently discovered systems.

How should we regard the Extra Meridian and purported new acupuncture points belonging to the microacupuncture systems that have yet to be described? Accepting the multitude of microacupuncture systems necessitates dealing with their interrelationships. This problem can be solved via cybernetic and homeostatic laws.

Figure 2. Dichotomic Branching as a Fractal of the Bronchial Tree


In cybernetics, any microacupuncture system is a homeostat that provides an informational exchange between the inner medium of the human organism and the environment, and that which keeps internal stability. The body's lower-order homeostats, being informational fractals, join to form a hierarchical net resulting in a homeostat of a higher order.5 According to cybernetic laws, the higher-order homeostat controls all the lower-order ones included in its circuit. In the human organism, the system of classic Chinese meridians is an acupuncture homeostat of the highest order. It includes and rules all the smaller systems.

The size of the organism is a factor that results in different resolutions in the multitude of acupuncture systems. This directly impacts the clinical efficacy during a treatment period. This conclusion is borne out by the holographic principle as follows: if only a small portion of the hologram is illuminated, the whole image of the object still appears, but in less detail from fewer angles."6

Figure 3. Fractalization of the Cardiac Rhythm During a 24-Hour Period and a 1-Minute Interval



The pathology of an internal organ, of a system within the organism, or of a traumatic injury is momentarily reflected in all acupuncture systems on the field level. The main task of a clinician is to find the core of pathology and be able to influence it directly or indirectly. It is sometimes easier to do this by using a microsystem, where all the information about an individual is concentrated on a limited surface. The possibilities are limited by the respective resolving ability of a particular microsystem and, as a result, its influence on an organism. The most effective diagnostics and treatment are possible when performed with Classic and Extra Meridians. In some cases, lack of success (with these) is the result of a lack of knowledge and not due to a defect in the system.

This hypothesis of the formation of microacupuncture systems is somewhat abstract. It only models the process mathematically and physically, without the participation of the nervous, humoral, and other systems. Important to remember is that demonstrating mathematical laws in nature, including living nature, is universal. Concrete physiologic substantiation will perhaps be carried out in the future, probably in some unusual form, taking knowledge of this to the next level.

The fractal theory of the microsystems is a component of a more general fractal-field model of the organism. By using this model, it is possible to explain the mechanism of interaction between the living organism and a low-energy laser beam.

Additionally, the above-mentioned model is the theoretical basis of the electronic marker of acupuncture points (EMAP) therapy, a new trend in acupuncture actively being developed in Russia. The core of this method is the noninvasive informational influence on the organism by means of fractal electromagnetic fields, by means of the acupuncture points.

Confirming and explaining concepts in traditional Eastern acupuncture from the perspective of the laws of physics gives rise to new possibilities for diagnostics and treatment. Instruments and tests for specific diagnostics and EMAP therapy have been formulated. Their high level of efficacy have been proven for treating pain syndromes, strong arterial hypertension, chronic obstructive lung diseases with pulmonary hypertension, and eye diseases, as well as in pediatric practice.

CONCLUSION
Microacupuncture systems are one of the manifestations of fractalization, the universal principle of self-organization in nature. The number of possible microsystems is unlimited. Resolution of a microsystem and its influence on the organism depends on the size of its projection on the surface of the skin, mucous membrane, and periosteum. This influence is most effective at the points of the classic acupuncture meridians. The new and Extra Meridian points belong to microsystems that have yet to be described.

The medical effects of the microacupuncture systems need to be accepted fully. To do this, it is necessary to thoroughly explore the physiologic mechanisms of fractal-field theory as they apply to microacupuncture systems.

ACKNOWLEDGEMENT

I express my gratitude to Sue Marriott for helping me with the English translation.

REFERENCES

  1. Peitgen H-O, Richter PH. Beauty of Fractals: Images of Complex Dynamical Systems. Berlin, Germany: Springer-Verlag; 1988:175.
  2. Nebrat V. The physical model of the low energy electromagnetic field influence
    on the human body through the acupuncture points. Poster presented at 2nd European Congress "Acupuncture White Nights-97." St Petersburg, Russia; 1997.
  3. Shipov G. The Theory of Physical Vacuum. Moscow, Russia: Nauka; 1993.
  4. Gariaev P. Wave genome. Public Profit. 1994.
  5. Stepanov A. The fundamental principle of the medical homeostatics. Voronezh, MODEC. 1994.
  6. Jarrett LS. The holographic paradigm and acupuncture. J Tradit Acupuncture. 1985;8:36-41.
  7. Fractal explorer. Link: http://www.eclectasy.com/fractal-explorer/index.html. Accessibility verified September 14, 2002.

AUTHOR INFORMATION

Dr Vadim Bouevitch is a Medical Doctor and Licensed Medical Acupuncturist at the Hospital of Medical Rehabilitation, Amur Medical Academy, Russia. Dr Bouevitch is interested in classic acupuncture theories and their evidence with regard to physics.

Vadim Bouevitch, MD, MAc*
Hospital of Medical Rehabilitation
Krasnoflotskaya St 189
Blagoveschensk, 675000 Russia
Phone (office): +7-4162-421457; Home: +7-4162-356745  Fax: +7-4162-350018  
E-mail:
moxa@amur.ru

http://www.medicalacupuncture.org/aama_marf/journal/vol14_2/article1.html


PAIN MANAGEMENT IN ACUPUNCTURE

At present, acupuncture has been used to treat chronic pain has been widely accepted [9]. Acupuncture clinical trials have also proved effective in the treatment of fibromyalgia, chronic headache and primary dysmenorrhea, through stimulation of free nerve endings and increase blood flow velocity of cerebral blood vessels, the release of endorphin, prostaglandin to achieve analgesic effects [1].

 

Chronic pain syndrome with sympathetic hyperactivity, but also including the different divisions forebrain cortex and can inhibit the promotion of pain and function with a degree of autonomy. Acupuncture arising on the relationship between sensory, sympathetic and parasympathetic function of the effects of self-government as well as the electroencephalogram (EEGs) changes in research, results showed that acupuncture can significantly reduce the heart rate (HR), increased systolic blood pressure (SBP) . Spectral analysis pointed out that acupuncture can significantly reduce the HR variability (HRV) and SBP variability (SBPV) in low-frequency component (LF), a significant reduction in HRV low-frequency and high frequency (HF) ratio (LF / HF index for sympathetic nerve activity), HRV and the LF / HF ratio and the reported number of sensory-specific acupuncture was negatively correlated, HRV and the HF between the number of acupuncture felt was a significant positive correlation.

 

EEG data analysis showed that non-specific acupuncture makes waves in addition to γ, the increase in the intensity of all bands. And HF (parasympathetic activity index) changes and the overall strength of HRV (autonomic nervous system activity of the total) and θ, α and γ-wave intensity was positively correlated, while the LF and HRV of SBPV the LF / HF change with all changes in the intensity of bands was a negative correlation. The study results suggest that acupuncture-induced sensory changes caused by the autonomy of the central nervous system through the forebrain in particular (such as changes in EEG)-mediated, which is inhibited through the sympathetic nerve activity to alleviate chronic pain and is useful [10] ... ...

 

PD is also called paralysis agitans, is a regular middle-aged and older occurred in the central nervous system degenerative diseases, mainly for static tremor, muscle rigidity, bradykinesia, ataxia, postural reflex impairment, patients with severe memory impairment and symptoms of dementia, PD prevalence rate second only to AD, mainly in middle-aged and older people, people over the age of 65 the prevalence rate of about 2%. Acupuncture treatment of PD in order to study the physiological mechanisms, the use of methyl-phenyl-tetrahydropyridine (MPTP) to deal with C57BL / 6 mice, for making PD model, and select points "Yanglingquan" and "Taichong" to carry out acupuncture, testing whether acupuncture inhibition of nerve cells of microglial activation and inflammatory response,

 

results showed that acupuncture could reduce tyrosine hydroxylase immunoreactivity in the striatum and substantia nigra have a neuroprotective effect, attenuation nerve cells of microglial markers that macrophage antigen complex 1 (MAC-1) increase, decrease COX-2 (COX-2) and inducible nitric oxide synthase (iNOS) expression increased. In the MPTP group, dopamine in the striatum 7 days was 46%, while the acupuncture group compared with 78% of dopamine. The study results show that acupuncture may be by inhibiting the nerve cells of microglial activation and inflammatory response to play a neuroprotective effect, suggesting that acupuncture can be used as a means of neuroprotective intervention for patients with PD neurons inhibit microglia activation and the inflammatory response [25].

MECHANISM OF ACUPUNCTURE EFFECT

"Thorn to the gas to and effective", a gas is caused by sensory stimulation of acupuncture, and is closely related to clinical efficacy. Study indicated that the hypothalamus is the air conditioning was an important site, the use of acupuncture and the feeling of scale can predict the activation of the hypothalamus and a feeling of relevance gas. To study the results of acupuncture treatment as an example, the forbidden drugaddiction, the changes in the function of the hypothalamus persists, through functional magnetic resonance imaging (fMRI) studies have shown that in healthy volunteers and heroin addicts and the activation of the hypothalamus to stimulate acupuncture related to corticosterone levels and physiological responses, including a gas feeling sharp pain to anxiety and findings of the study showed that acupuncture stimulation, the addicts of the activation of the hypothalamus better than healthy, acupuncture treatment of heroin addicts have gas score was significantly higher than the healthy group [4].

Acupuncture is usually the body by regulating cell signaling molecules play a role of substance, like nitric oxide (NO), norepinephrine (NE) and so on. NO is an important signaling molecule, such as neurotransmitters, like with a variety of functions, may in some cells such as neurons and have a skin. Epidermis, outer root sheath and sebaceous glands with neuronal nitric oxide synthase (nNOS) immunoreactivity and NADPH diaphorase Ⅱ activity. Human skin in NO concentration can be micro-dialysis method of skin in vivo monitoring [5]. Research has shown that acupuncture points in the rat skin, the meridian on the NO concentration and relatively high expression of nNOS [6].

Skin surface in order to collect points of nitrate and nitrite quantitative, revealed by a bacterial enzyme nitrate reduction of non-acupuncture points on whether or not to participate in NO synthesis, at both ends with a length of 0.5 ~ 0.7 cm of small plastic tubes tied tube 50 healthy volunteers in the forearm or leg. The NO scavenger, hemoglobin, or 2 - benzene -4,4,5,5 - tetramethyl-imidazoline -1 - O -3 - oxide (PTIO) Add tube under the skin 20 min, the use of chemiluminescence to collect samples of nitrate and nitrite quantitatively. The results show that regional and non-meridian control samples collected compared to nitrate and nitrite concentration on the Pericardium Meridian Point 4, the bladder through two points on the significantly increased. Nitrate and nitrite concentration in the first a 20 min sample collection points were significantly increased, and in 20 ~ 40 min, 40 ~ 60 min and 60 ~ 80 min of the research team collected samples of similar concentration. Water treatment and the skin surface compared to the skin with sodium hypochlorite to deal with the surface nitrate and nitrite concentration and the number of bacteria significantly reduced cloning. This study shows that with non-points compared to the skin, NO in the points to a very high level of physical release, by the bacterial reduction of nitrate to participate in non-enzymatic chemical skin acupoint produced NO, and L-arginine for NO synthesis [7].

With α-methyl tyrosine methyl ester pretreatment and intravenous injection of rat L-(2,3,5,6-3H) - tyrosine, blood, stripped lower limbs, upper limbs and trunk on the acupuncture points, non-acupuncture points and non-meridian skin regions were observed in skin tissue levels of NE and the determination of NO update on the acupuncture points and meridians on the NE effect, results showed that the NE concentration of the skin points and the release of 3H-NE was significantly higher than non-acupoints and non-meridian area. When the intravenous injection of NO donor DEA-NO-pro-nuclear complex, the points in the release of 3H-NE increase, when the injection of neuronal NO synthesis inhibitor NG-propyl-L-arginine, the points in the 3H - decline in NE release. NE Acupoints NO update rate in the treatment group for the lower body, and in the NO synthesis inhibitor group the opposite trend. In contrast, the NO donor and NO synthesis inhibitors both organizations to deal with non-acupuncture points or non-meridian control organization of the update rate of NE were not affected. NE of the study to prove the first update rate is always lower in the acupuncture points, NO donor points to the promotion of increased NE synthesis or release, NO synthesis inhibitor, can inhibit NE synthesis or release points, tips and non-acupuncture points, meridians compared to skin tissue, in acupuncture points, meridians NE skin is to increase the synthesis or release, and in the sympathetic nervous system can be derived from L-arginine by NO synthesis regulation [8].


The Mechanism of Acupuncture - Beyond Neurohumoral Theory

By Charles Shang, MD HARVARD


Abstract:


Objectives:
The gold standard in testing scientific theory requires multiple independent prospective tests. This standard is applied to basic acupuncture research. This article reviews the key results of basic acupuncture research which meet the gold standards and discusses their implications.

Method:
Literature search and review of publications in medline and Chinese medical literature databases are combined with discussion with many experts to identify and analyze the models in basic acupuncture research which have predictions. These predictions are further checked for independent confirmation by multiple research groups.

Results:
Initial literature screen identified more than 400 related articles. Further analysis and discussion showed that the growth control model is the only published model in basic acupuncture research which has met the gold standard. It encompasses the neurophysiology model and suggests that a macroscopic growth control system originates from a network of organizers in embryogenesis. The activity of the growth control system is important in the formation, maintenance and regulation of all the physiological systems. Several phenomena of acupuncture such as the distribution of auricular acupuncture points, the long term effects of acupuncture and the effect of multimodal nonspecific stimulation at acupuncture points are consistent with the growth control model. The following predictions of the growth control model have been independently confirmed by research results in both acupuncture and conventional biomedical sciences: 1. Acupuncture has extensive growth control effects. 2. Singular point and separatrix exist in morphogenesis. 3. Organizers have high electric conductance, high current density and high density of gap junctions. 4. A high density of gap junctions is distributed as separatrices or boundaries at body surface after early embryogenesis. 5. Many acupuncture points are located at transition points or boundaries between different body domains or muscles, coinciding with the connective tissue planes. 6. Some morphogens and organizers continue to function after embryogenesis.

Conclusion: Current acupuncture research suggests a convergence of the neurophysiology model, the connective tissue model and the growth control model. The growth control model of acupuncture set the first example of a biological model in integrative medicine with significant prediction power across multiple disciplines. Basic acupuncture research has met the gold standard of science with multiple independently confirmed predictions.


Introduction

According to the World Health Organization (WHO), a broad definition of acupuncture is the stimulation of certain points on the body (acupuncture points) using needling, moxibustion, electricity, laser, or acupressure for therapeutic purposes.1 The Standard Acupuncture Nomenclature published by the WHO listed about 400 acupuncture points and 20 meridians connecting most of the points.2 Results from randomized controlled trials (RCTs) have shown that acupuncture is effective in treating dozens of disorders1 such as osteoarthritis 3, 4, 5 pelvic and back pain 6 neck pain 7 migraine and tension headache 8,9 nausea/vomiting 10 and inflammatory bowel disease.11 Mixed results widely exist in acupuncture research12 for various reasons. Many neurohumoral 13, 14, 15, 16 mechanical and growth control effects of acupuncture18 have been observed. Several models of acupuncture mechanism have been proposed. The focus of this article is on the biological models of acupuncture which can meet the gold standard of science with multiple independently confirmed predictions.

The Observations from Acupuncture Research

In the mid-70s, the discovery of endorphin induction in acupuncture analgesia and its blockade by naloxone was instrumental in establishing the validity of acupuncture in modern science.19, 20 In acupuncture analgesia, the peripheral nervous system has been shown to be crucial in mediating the effect. The analgesia can be abolished if the acupuncture site is affected by postherpetic neuralgia21 or injection of local anesthetics.22 Different frequencies of electric stimulation in electroacupuncture lead to release of different neuropeptides.13 Electroacupuncture has been shown to release nociceptin and inhibit the reflex-induced increases in blood pressure16 and increased the synthesis of nitric oxide in mediating the protective effect on gastric mucosa.23

Since the 1950s, it has been discovered and confirmed with refined techniques14 that many acupuncture points and meridians have high electrical conductance24, 25, 26 though the results are sometimes mixed.27 High electric conductance of acupuncture points have been successfully used for locating acupuncture points in acupuncture therapy.28 The high electric conductance at acupuncture points is further supported by preliminary finding of high density of gap junctions at the epithelia of the acupuncture points.29, 30, 31, 32 Gap junctions are hexagonal protein complexes that form channels between adjacent cells. It is well established in cell biology that gap junctions facilitate intercellular communication and increase electric conductance. High concentrations of nitric oxide and nitric oxide synthase have also been observed at acupuncture points and meridians.33

Modern Biological Models of Acupuncture

In the 1970's, the relation between the nervous system and acupuncture alteration of visceral function was explored by examining the cortical evoked potentials, single unit discharges and neurochemistry associated with acupuncture. These studies brought forth the Meridian-Cortex-Viscera correlation hypothesis which states that: 1. The meridian system is an independent system connected via the nervous system to the cerebral cortex. 2. It acts through neurohumoral mechanisms.34 A contending model claimed that the meridian system as described in the classic acupuncture literature does not exist and that all the effects of acupuncture are mediated through nervous system.35, 36

Another hypothesis suggested that the network of acupuncture points and meridians is a signal transduction network formed by interstitial connective tissue. Mapping of acupuncture points on human arm showed an 80% correspondence between the sites of acupuncture points and the location of intermuscular or intramuscular connective tissue planes in postmortem tissue sections.37

Modern biological models of acupuncture are confronted with the following puzzling facts:

  1. The distribution of acupuncture points: The distribution of acupuncture points is different from the distribution of nerves, blood vessels, lymphatics or connective tissue. For example, an auricle has no important nerves or blood vessels or lymphatics or complex connective tissue planes and no significant physiological function other than sound collection. While the vagus nerve has an auricular branch, this branch has no known important function in modern neuroscience. A search of Medline did not yield any article on the function of the auricular branch of vagus nerve in the past 50 years. The auricle nevertheless has the highest density of acupuncture points. According to the WHO, 43 auricular points have proven therapeutic value,2 which consist of more than 10% of the acupuncture points of the entire human body. Numerous RCTs have demonstrated the efficacy of auricular acupuncture38, 39, 40, 41, 42, 43 while some results are mixed.12
     
  2. The non-specific activation of acupuncture points: Therapeutic effect of acupuncture has been achieved by a variety of stimuli10,1 including needling, injection of nonspecific chemicals, electricity, temperature variation, laser, and pressure. No conventional nerve stimulation technique has such diverse modalities of stimulation. Non-noxious stimuli such as non-thermal low intensity laser irradiation, which does not cause local nerve excitation44 or collagen fiber reorganization at acupuncture points, can cause extensive systemic effects45 and stimulate local cellular calcium oscillation,45 cell proliferation, release of basic fibroblast growth factor, interleukins as well as other growth control effects.46 This suggests that another system other than nervous system mediates the initial signal transduction in acupuncture.
     
  3. Transient acupuncture stimulation often causes long lasting effect over weeks or months. For example, two RCTs9,8 have shown that the relief of migraine headache lasted 1 year after acupuncture treatment – thousands of times longer than the physiological half life of endorphin47 and other common neurotransmitters. Similar long-term benefits of acupuncture have been shown by RCTs on the treatment of shoulder pain,48 chronic low back pain,49, 50 primary dysmenorrhea,51 spinal cord injuries,42 urinary urgency41 and osteoarthritis.5, 52, 53 This long lasting effect is almost non-existent in conventional therapy using transient mild peripheral nerve stimulation. In conventional nerve stimulation, long lasting effects require long term stimulation as observed in the effects of opioids, serotonin reuptake inhibitors, sacral nerve stimulation,54 and vagal nerve stimulation.55
     
  4. The existence of acupuncture points. i.e. why do stimuli at many acupuncture points cause diverse systemic effects without obvious benefit of survival for normal animals? For example, stimulation at acupuncture points PC6 and ST36 which are at the extremities increases the gastric motility in dogs.56 This is contrary to the fight or flight response and seems to offer no survival benefit to animals. What is the intrinsic function of acupuncture points? How did these acupuncture points come into existence over the course of evolution?

In science, models or hypotheses capable of successful prospective predictions are considered more convincing than models solely based on retrospective explanations or accommodations.57, 58 The gold standard in testing a scientific theory is multiple independent confirmations of its predictions. It is therefore important to assess which theory in basic acupuncture research has met this gold standard. A literature research in PubMed with full text (Medline) using keywords acupuncture AND (predict* OR corollary) identified 101 articles. Similar search strategy in Chinese medical/scientific literature databases including http://www.wanfangdata.com.cn/, http://engine.cqvip.com/,and http://www.chinainfobank.com/ identified over 300 articles. Further review of the literature and discussion with more than a dozen experts in this field narrowed down to two biological models59,18 which have independently confirmed prediction(s): The neurophysiology model on the long term effects of acupuncture59 suggests: 1. The trophic and anti-inflammatory effects of acupuncture are important in mediating its long term effects. 2. Long term potentiation and long term depression are likely involved in acupuncture signal transduction. Its corollary on the peripheral anti-inflammatory effect of endorphin in acupuncture has been confirmed.60 The growth control model first published in the 1980s61 correctly predicted multiple research results not only in acupuncture, but also in conventional biomedical sciences. It also has shed light on the puzzling observations mentioned above.62,18 This model encompasses the neurophysiology of acupuncture18 and is supported by the research results on connective tissue at acupuncture points.17,37 It is the only published model which has met the gold standard of the multiple independent prospective tests.

The Origin and Function of Acupuncture Points

It is well known that all the physiological systems, including nervous system, are derived from a system of embryogenesis - a growth control system.63[Figure 1] In growth control, the fate of a larger region is frequently controlled by a small group of cells, which is termed an organizing center or organizer.64 A gradient of messenger molecules called morphogens forms around organizers. Organizers have highest (sources) or lowest (sinks) local concentration of morphogens64, 65 and therefore are macroscopic singular points of morphogen gradient field. A singular point is a point of discontinuity. It indicates abrupt transition from one state to another. Small, nonspecific perturbations around singular points - organizers can have important systemic effect.66, 67 Several lines of evidence suggests that the bioelectric field interacts with morphogens and growth factors, and guides morphogenesis.68, 69 The growth and migration of a variety of cells are sensitive to electric fields of physiological strength.70, 71 Organizers and acupuncture points share several common features: Both commonly distribute at the extreme points of surface curvature18,61,62 and are activated by non-specific stimuli.67,61 Both are associated with bioelectric field.18 The growth control model therefore suggested that acupuncture points originate from organizers.18,61

Confirmed Predictions on Organizers and Morphogens

Based on the connection between acupuncture points and organizers, the growth control model predicted that organizers have high electric conductance, high electric current density and high density of gap junctions.18,61 These predictions on organizers have been independently confirmed: Organizers such as blastopore and zone of polarizing activity have high electric conductance, high current density72 and high density of gap junctions.73, 74, 75, 76 Multi-cellular organisms maintain regular form and function despite constant replacement of cells, intra-cellular components and extracellular matrix. Without growth control, this constant regeneration is prone to structural disintegration and degeneration into various tumors. The growth control model predicted that organizers and morphogens partially retain their regulatory function after embryogenesis.18,61 This prediction has also been independently confirmed: Morphogens such as retinoic acid, Wnt, bone morphogenetic protein and Hedgehog as well as some organizers continue to exist and function in adult after embryogenesis.77, 78, 79, 80, 81

Confirmed Predictions on Acupuncture

One corollary from the growth control model is that acupuncture has extensive growth control effects which have been confirmed: Acupuncture has been shown to regulate various growth factors and growth control genes. It can induce vascular endothelial growth factor82 and basic fibroblast growth factor83 during brain ischemia. It also induces glial cell line-derived neurotrophic factor84 and expression of the c-fos proto-oncogene.85, 86 Acupuncture regulates the expression of Bcl-2,87 Bax, fas and FasL proteins which are involved in apoptosis signaling. Acupuncture inhibits the apoptosis of intestinal epithelial cells in inflammatory bowel disease of rats88 and enhances proliferation of CD8+ lymphocytes,89 reduces nerve growth factor in polycystic ovaries,90, 91reduces IL-6 expression and proliferation of osteoclasts.92 The neuro-humoral factors induced by acupuncture such as endorphins, nitric oxide and serotonin also have growth-control effects.92, 98, 94 In RCTs, acupuncture has shown efficacy in treating growth control related disorders including spinal cord injuries38 and low sperm quality.95, 96

Growth Control System as Foundation of Pathophysiology

A growth control system originates from a network of organizers.97 In embryogenesis, the development of organizers precedes the development of other physiological systems.18,64 The formation, maintenance and regulation of all the physiological systems are dependent on the activity of the growth control system. Growth control is a primary function of all multi-cellular organisms. The evolutionary origin of the growth control system likely preceded all the other physiological systems. Its genetic blueprint served as a template from which the newer systems evolved. Consequently, it overlaps and interacts with other systems but is not merely part of the nervous system, immune system or circulatory system. The growth control signal transduction is embedded in the activity of the function-based physiological systems: The regulation of many neural, circulatory, immune processes and related disorders are mediated through growth control mechanisms such as hypertrophy, hyperplasia, atrophy, apoptosis with shared messenger molecules including morphogens98, 99, 77,81 and common signal transduction pathways involving growth control genes such as proto-oncogenes.100, 101, 102

The Nonspecific Stimulation and the Long Term Effects of Acupuncture

Based on the growth control model, acupuncture points and organizers are singular points and therefore prone to nonspecific perturbation. The long lasting systemic effects of acupuncture can be achieved by nonspecific stimuli as mentioned above. Similarly, long lasting growth control activities of organizers have been induced by various stimuli such as mechanical injury and injection of nonspecific chemicals.67 Based on the growth control model, acupuncture effect is a byproduct of the growth control network. Stimulating organizers – acupuncture points can not only cause transient modulation of neurotransmission, but also alter the growth control signal transduction in various systems - leading to long term effects.18

The Distribution of Acupuncture Points and Organizers

Organizers are at the extreme points of curvature on the body surface such as the locally most convex points (e.g., apical ectodermal ridge and other growth tips) or concave or saddle points (e.g., zone of polarizing activity).103, 18 Similarly, almost all the extreme points of the body surface curvature are acupuncture points. For example, the convex points include EX-UE11 Shixuan (finger tips), EX-LE12 Qiduan (toe tips), ST17 Ruzhong (tip of nipple), ST42 Chongyang, (the convex, palpable point of arteria dorsalis pedis), GV25 Suliao (nose tip) ... The concave points include TE3 Zhongzhu (the concave point between the 4th and 5th metacarpal), KI1 Yongquan (at the concave point of the sole), GB20 Fengchi (the concave point below occipital bone, between upper ends of sternocleidomastoid and trapezius), BL40 Weizhong (midpoint of the transverse crease of the popliteal fossa), HT1 Jiquan (the most concave point of axilla), BL1 Jingming (at the concave point above medial canthus), CV8 Shenque (navel)... Based on growth control model, the extreme points of surface curvature are associated with organizers – acupuncture points. The auricle obviously has the most convoluted surface morphology of the human body. Therefore it has the highest density of extreme points of surface curvature and is expected to have the highest density of organizers - acupuncture points. Auricle exemplifies the interconnection of growth control: Auricular morphology is a sentinel of malformation in other organs. Auricular malformation has been observed in numerous malformation syndromes. It is recommended in a standard textbook of pediatrics that any auricular anomaly should initiate a search for malformations in other parts of the body.104

The Origin of Meridians

The growth control model suggests that the discontinuity or abrupt transition in growth control not only exists at organizers but also along boundaries.18,61 The growth control boundaries or folds between different structures are also called separatrices in mathematics and often connect singular points - organizers. The model predicted that growth control boundaries have high electric conductance and high density of gap junctions – just as the meridians in acupuncture which likely originate from growth control boundaries. These predictions have been confirmed: As embryogenesis progresses, high density gap junctions become restricted at discrete boundaries, leading to the subdivision of the embryo into communication compartment domains.105, 106 Increasing or decreasing the gap junctions can cause various developmental defects107 such as spina bifida.108 These high electric conductance boundaries are likely major pathways of bioelectric currents. Organizers are known to locate at boundaries between different structures.109 The growth control model suggests that meridians originate from separatrices – boundaries in growth control and form an undifferentiated,18,61 interconnected cellular network that regulates growth and physiology. In consistence with the prediction of under-differentiation of the meridian system and growth control system, it has been observed that the most apical part of folds of embryo remain undifferentiated in morphogenesis,110 including organizers such as apical ectodermal ridge.111 As predicted by the growth control model, singular point and separatrix have important roles in morphogenesis.112, 113 Growth control boundaries/separatrices are similar to organizers in controlling growth and pattern formation with morphogen gradient.114 Many acupuncture points are located at boundaries between different body domains or muscles, coinciding with the connective tissue planes which connect adjacent body domains or muscles.17, 37, 115

Summary

Current acupuncture research suggests a convergence of the neurophysiology model, the connective tissue model and the growth control model. The growth control model of acupuncture set the first example of a biological model in integrative medicine with significant prediction power across multiple disciplines. It is the first theory in basic acupuncture research which has met the gold standard in testing scientific theory. The following predictions of the growth control model have been independently confirmed by research results in both acupuncture and conventional biomedical sciences: 1. Acupuncture has extensive growth control effects. 2. Singular point and separatrix have important roles in morphogenesis. 3. Organizers have high electric conductance, high current density and high density of gap junctions. 4. A high density of gap junctions is distributed as separatrices or boundaries at body surface after early embryogenesis. 5. Many acupuncture points are located at transition points or boundaries between different body domains or muscles, coinciding with the connective tissue planes. 6. Some morphogens and organizers continue to function after embryogenesis. The growth control model has also shed light on several puzzling phenomena of acupuncture such as the distribution of auricular acupuncture points, the long term effects of acupuncture and the effect of multimodal nonspecific stimulation at acupuncture points.

Future Directions

  1. The structure and cell differentiation at acupuncture points as well as the neurophysiology and growth control signal transduction involved in different modalities of acupuncture should be further delineated.
     
  2. Manipulating the singular points - organizers of the growth control system may be a convenient way of activating intrinsic stem cells as evident from the improvement of sperm quality after acupuncture.95, 96
     
  3. As the growth control model predicts the growth control activity at acupuncture points/extreme points of surface (or interface) curvature after embryogenesis, residual morphogen gradient may still exist at these points and may be detectable by probing morphogen candidates such as Hedgehog, Wnt and TGF-beta families. Certain morphogen gradient distributes along boundaries.116 This pattern may persist after embryogenesis into adulthood and coincides with meridians.
     
  4. Mapping of the growth control system and the dynamics of its electromagnetic field with high resolution techniques such as the superconducting quantum interference device (SQUID) and atomic magnetometer :117 The growth control model predicts that the singular points and separatrices of the bioelectric field in growth control correlate with the acupuncture points and meridians respectively.
     
  5. The growth control model suggests that techniques involving the stimulation of the growth control system such as acupuncture can activate the growth control activity of an organism and improve its structure and function at a more fundamental level than symptomatic relief.18 In growth control, the change in electric field precedes morphologic change and manipulation of the electric field can affect the change.70, 118 Development of the techniques of detecting and manipulating the electric field may enable the diagnosis and treatment of a pathologic process at the early signal transduction stage prior to the anatomical or morphological change.
     
  6. The growth control model suggests that apparently unrelated acupuncture points are not exactly ‘placebo’ points. The more acupuncture points are used as placebo points in a RCT, the more likely that some systemic effects will be resulted from the ‘placebo’ treatment. The self-regulatory effect of acupuncture will be difficult to predict when the patients have multiple comorbidities and many acupuncture points are used. Subtle, ‘sham’ stimulation at acupuncture points can be effective due to the response of the acupuncture points to nonspecific stimuli. These reasons may contribute to the mixed results in RCTs on acupuncture. This model also suggests that acupuncture is mostly likely to demonstrate its efficacy and advantage in a patient population with few comorbidities, relatively good general health and vitality and a regimen with efficient use of acupoints.
     
  7. The growth control model suggests that the distribution of growth control system is related to both internal and external structures. Acupuncture points which are not at obvious extreme points of surface curvature or meridians which are not at obvious surface boundaries may be vestigial or related to interface between internal structures such as muscles and bones. Intrinsic stem cells are likely part of the undifferentiated growth control network. The germ cell is one of the least differentiated cells and also a type of stem cell – similar to the embryonic stem cell in its ability to differentiate into all three germ layers. The distribution pattern of intrinsic germ cells can be deduced based on the fact that the distribution pattern of primary tumors reflects the distribution of their normal counterpart. The primary germ cell tumors119 have a midline and para-axial distribution pattern which spans from the sacrococcygeal region to pineal gland. It appears to concentrate at 7 locations: sacrococcygeal region, gonads, retroperitoneum, thymus, thyroid,120 suprasellar region, and pineal gland. This pattern reflects the distribution pattern of intrinsic germ cells which are likely to be highly inter-connected in a normal state (e.g. via gap junctions121 ) and provide important regulatory functions.122, 56 This also suggests a hierarchy in the degree of cell differentiation and function in the growth control system.

Acknowledgments

I thank Steven K.H. Aung, Zang-Hee Cho, Yuenan Cui, Li Dingzhong, Maria do Desterro Leiros, Michael Levin, Vitaly Napadow, Richard Nuccitelli, Stig Ollmar, Rosa N. Schnyer, San Wan, Peter Wayne, Raimond Wong, Seung-Schik Yoo for their input.

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Charles Shang, MD
Department of Medicine
New England Baptist Hospital
Harvard Medical School
125 Parker Hill Ave.
Boston, MA 02120
Tel: 617-754-5248
Email: cshang@caregroup.harvard.edu

Xin and Yi: Two Minds

by Dr. Yang, Jwing-Ming, January 1, 2008
The Yi Leads the Qi

Emotional Thinking (Limbic System)

If you are interested in learning Taijiquan, you must understand Yin and Yang, and their relationship with Taiji. Without knowing the theory and the Dao, your Taijiquan practice will be limited to the external forms and movements. In this case, you will have lost the real meaning of practicing Taijiquan. Before the action of Taijiquan movement, the Xin (emotional mind) is peaceful and the Qi is harmonious, the Xin and Yi (wisdom mind) are at the Real Dan Tian and the Qi stays in its residence. This is the state of extreme calmness and is the state of Wuji. However, when the Xin and Yi begin to act, the Qi circulation begins, the physical body?s movement is thus initiated, and the Yin and Yang accordingly divides. From this we can see that Xin and Yi are what is called Taiji in Taijiquan. That means the Dao of Taijiquan is the Dao of Xin and Yi, our two minds.

The Wuji state exists inside each of us. It is the state from which all creative impulses grow. Taiji is generated out of Wuji and is the mother of Yin and Yang. Thus, Taiji is the cause of the Yin and Yang division, and is itself neither Wuji nor Yin and Yang, but the cause of the separation of Yin and Yang. In this sense it is a part of the divine aspect of the Dao. All things can be classified as either Yin or Yang. Taijiquan was created according to this theory. In the beginning posture of the Taijiquan sequence, the mind is calm and empty, and the weight is evenly distributed on both feet. This state is Wuji. When your mind starts to lead the body into the posture of Grasp Sparrow?s Tail , internal (Yin) and external (Yang) aspects of Taijiquan features start to be discriminated. Moreover, the hands and feet are differentiated into insubstantial (Yin) and substantial (Yang). This is the state of Two Polarities. Through interaction of substantial (Yang) and insubstantial (Yin), all of Taijiquan?s fighting strategies and techniques are generated. From this, you can see that the Taiji (i.e., the Dao) in Taijiquan is actually the mind. It is the mind that makes the body move and divides the Wuji state into Yin and Yang two polarities. We can conclude from this that Taijiquan is actually a martial art of the mind. Taiji means "grand ultimate". In the body, the mind is the grand ultimate that initiates movement, Qi circulation, and discrimination between yin and yang.

Xin and Yi are able to reach anywhere in the universe without being restricted by time and space. From Xin and Yi, the Yin and Yang are initiated and continue to move into unlimited variations. This is the theory of millions of divisions and creations of Taiji. Therefore, those who practice Taijiquan must begin from the training of Xin and Yi. Though our physical bodies are restricted by our three-dimensional reality, our minds are free to travel and reach anywhere in the universe, unrestricted by time, or even beyond this universe. All human creations, from shovels to airplanes, arose first in our imaginations. From our thoughts, new ideas are created. It is the same for Taijiquan. It was created from the mind, and its creation will continue without an end. Since it is an active, living, and creative art, Taijiquan is a product of spiritual enlightenment and an understanding of life.

The emotional mind and wisdom mind are contained internally, which belongs to Yin. The movements (actions) of Taijiquan are manifested externally, which belongs to Yang. When the functions of Xin and Yi are applied to our spiritual feeling, they direct us into the correct Dao of cultivating our human nature, through efforts toward strengthening the mind, raise up the spirit, and comprehend the real meaning of human life, and from this, further to comprehend the meaning and relationship among humans, between humans and objects around us, and also to search for the truth of nature in heaven and earth. When the function of Xin and Yi is applied to our physical body, it is the great Dao of cultivating the physical life for self-defense, nourishing the physical life, and strengthening the physical body. This is the foundation for extending our lives and establishing a firm root of health.

When Xin and Yi are acting on internal spiritual feeling, it serves to cultivate our human temperaments and helps us to understand the meaning of our lives. When Xin and Yi are acting and manifested externally, it promotes physical health and self-defense. Therefore, when we practice Taijiquan, we should cultivate both our spiritual beings (Yin) and train our physical bodies (Yang). Taijiquan originated from the Daoist family. Its ultimate goal is to reach enlightenment and so as to achieve the Dao of unification between heaven and human. Therefore, the final goal of practicing Taijiquan is to reach the unified harmonious Wuji state of heaven and human. From practicing Taijiquan, we are able to further comprehend the meaning of human life and the universe.

This subject is discussed in the book "Taijiquan Theory of Dr. Yang, Jwing-Ming"

A Modern Definition of Qi

by Dr. Yang, Jwing-Ming, November 30, 2007
Healthy Blood Cells Transporting Qi

Healthy Blood Cells Transporting Qi

It is important that you know about the progress that has been made by modern science in the study of Qi. This will keep you from getting stuck in the ancient concepts and level of understanding.

In ancient China, people had very little knowledge of electricity. They only knew from acupuncture that when a needle was inserted into the acupuncture cavities, some kind of energy other than heat was produced which often caused a shocking or a tickling sensation. It was not until the last few decades, when the Chinese people were more acquainted with electromagnetic science, that they began to recognize that this energy circulating in the body, which they called Qi, might be the same thing as what today's science calls "bioelectricity."

We must look at what modern Western science has discovered about bioelectromagnetic energy. Many bioelectricity related reports have been published, and frequently the results are closely related to what is experienced in Chinese Qigong training and medical science. For example, during the electrophysiological research of the 1960's, several investigators discovered that bones are piezoelectric; that is, when they are stressed, mechanical energy is converted to electrical energy in the form of electric current. This might explain one of the practices of Marrow Washing Qigong in which the stress on the bones and muscles is increased in certain ways to increase the Qi circulation.

It is understood now that the human body is constructed of many different electrically conductive materials, and that it forms a living electromagnetic field and circuit. Electromagnetic energy is continuously being generated in the human body through the biochemical reaction in food and air assimilation, and circulated by the electromotive forces (EMF) generated within the body.

In addition, you are constantly being affected by external electromagnetic fields such as that of the earth, or the electrical fields generated by clouds. When you practice Chinese medicine or Qigong, you need to be aware of these outside factors and take them into account.

Countless experiments have been conducted in China, Japan, and other countries to study how external magnetic or electrical fields can affect and adjust the body's Qi field. Many acupuncturists use magnets and electricity in their treatments. They attach a magnet to the skin over a cavity and leave it there for a period of time. The magnetic field gradually affects the Qi circulation in that channel. Alternatively, they insert needles into cavities and then run an electric current through the needle to reach the Qi channels directly. Although many researchers have claimed a degree of success in their experiments, none has been able to publish any detailed and convincing proof of the results, or give a good explanation of the theory behind the experiment. As with many other attempts to explain the How and Why of acupuncture, conclusive proof is elusive, and many unanswered questions remain. Of course, this theory is quite new, and it will take more study and research before it is verified and completely understood.

Much of the research on the body's electrical field relates to acupuncture. For example, Dr. Robert O. Becker, author of The Body Electric1, 2, reports that the conductivity of the skin is much higher at acupuncture cavities, and that it is now possible to locate them precisely by measuring the skin's conductivity. Many of these reports prove that the acupuncture which has been done in China for thousands of years is reasonable and scientific.

Although the link between the theory of "the Body Electric" and the Chinese theory of Qi is becoming more accepted and better proven, there are still many questions to be answered. For example, how can the mind lead Qi (electricity)? How actually does the mind generate an EMF (electromotive force) to circulate the electricity in the body? How is the human electromagnetic field affected by the multitude of other electric fields which surround us, such as radio wiring or electrical appliances? How can we readjust our electromagnetic fields and survive in outer space or on other planets where the magnetic field is completely different from the earth's? You can see that the future of Qigong and bioelectric science is a challenging and exciting one. It is about time that we started to use modern technology to understand the inner energy world which has been for the most part ignored by Western society.

This article was originally written by Dr. Yang in the 1980's. The subject of Qi as bioelectromagnetic energy has been explored in much greater detail since that time, by many researchers in both the East and West. This topic is discussed in the DVD Understanding Qigong 1.

REFERENCES


1. Robert Becker, The Body Electric: Electromagnetism and the Foundation of Life, Harper Paperbacks, 1998 (second edition)

2. Robert Becker, Cross Currents, Tarcher, 1990

A Brief History of Qigong

by Dr. Yang, Jwing-Ming, February 28, 2008
Bodhidharma, the 28th patriarch of Buddhism

Bodhidharma, Da Mo

It is known that the Chinese art of Qigong has a history that goes back over 5,000 years, though only a few historical documents exist today. Qigong can be roughly divided into four periods. We know little about the first period, which started when the "Yi Jing" (Book of Changes) was introduced, sometime before 1122 B.C., and to have extended until the Han dynasty when Buddhism and its meditation methods were imported from India. This infusion brought Qigong practice and meditation into the second period, the religious Qigong era, which lasted until the Liang dynasty, when it was discovered that Qigong could be used for martial purposes. This was the beginning of the third period, that of martial Qigong. Many different martial Qigong styles were created based on the theories and principles of Buddhist and Daoist Qigong. This period lasted until the overthrow of the Qing dynasty in 1911; from that point Chinese Qigong training was mixed with Qigong practices from India, Japan, and many other countries.

Before the Han Dynasty


The Book of Changes was probably the first Chinese book related to Qi. It introduced the concept of the three natural energies or powers (San Cai): Tian (Heaven), Di (Earth), and Ren (Man). Studying the relationship of these three natural powers was the first step in the development of Qigong.

In 1766-1154 B.C. (the Shang dynasty), the Chinese capital was located in today's An Yang in Henan province. An archeological dig there at a late Shang dynasty burial ground called Yin Xu discovered more than 160,000 pieces of turtle shell and animal bone which were covered with written characters. This writing, called "Jia Gu Wen" (Oracle-Bone Scripture), was the earliest evidence of the Chinese use of the written word. Most of the information recorded was of a religious nature. There was no mention of acupuncture or other medical knowledge, even though it was recorded in the Nei Jing that during the reign of the Yellow emperor (2690-2590 B.C.) Bian Shi (stone probes) were already being used to adjust people's Qi circulation.

During the Zhou dynasty (1122-934 B.C.), Lao Zi mentioned certain breathing techniques in his classic "Dao De Jing" (Tao Te Ching) (Classic on the Virtue of the Dao). He stressed that the way to obtain health was to "concentrate on Qi and achieve softness". Later, "Shi Ji" (Historical Record) in the Spring and Autumn and Warring States Periods (770-221 B.C.) also described more complete methods of breath training.

About 300 B.C. the Daoist philosopher Zhuang Zi described the relationship between health and the breath in his book "Nan Hua Jing." It states: "The men of old breathed clear down to their heels..." This was not merely a figure of speech, and confirms that a breathing method for Qi circulation was being used by some Daoists at that time. During the Qin and Han dynasties (221 B.C.-220 A.D.) there are several medical references to Qigong in the literature, such as the "Nan Jing" (Classic on Disorders) by the famous physician Bian Que, which describes using the breathing to increase Qi circulation. "Jin Kui Yao Lue" (Prescriptions from the Golden Chamber) by Zhang Zhong-Jing discusses the use of breathing and acupuncture to maintain good Qi flow. "Zhou Yi Can Tong Qi" (A Comparative Study of the Zhou (dynasty) Book of Changes) by Wei Bo-Yang explains the relationship of human beings to nature's forces and Qi. Up to this time, almost all of the Qigong publications were written by scholars such as Lao Zi and Zhuang Zi, or physicians such as Bian Que and Wei Bo-Yang.

From the Han Dynasty to the Beginning of the Liang Dynasty (206 B.C.-502 A.D.)


Because many Han emperors were intelligent and wise, the Han dynasty was a glorious and peaceful period. It was during the Eastern Han dynasty that Buddhism was imported to China from India. The Han emperor became a sincere Buddhist; Buddhism soon spread and became very popular. Many Buddhist meditation and Qigong practices, which had been practiced in India for thousands of years, were absorbed into the Chinese culture. The Buddhist temples taught many Qigong practices, especially the still meditation of Chan (Zen), which marked a new era of Chinese Qigong. Much of the deeper Qigong theory and practices that had been developed in India were brought to China. These training practices were kept within the temple, not taught to laypersons, and only during this century has it slowly become available to the general populace.

Not long after Buddhism had been imported into China, a Daoist by the name of Zhang Dao-Ling combined the traditional Daoist principles with Buddhism and created a religion called Dao Jiao. Many of the meditation methods were a combination of the principles and training methods of both sources. Since Tibet had developed its own branch of Buddhism with its own training system and methods of attaining Buddhahood, Tibetan Buddhists were also invited to China to preach. In time, their practices were also absorbed.

It was in this period that the traditional Chinese Qigong practitioners finally had a chance to compare their arts with the religious Qigong practices imported mainly from India. While the scholarly and medical Qigong had been concerned with maintaining and improving health, the newly imported religious Qigong was concerned with far more. Contemporary documents and Qigong styles show clearly that the religious practitioners trained their Qi to a much deeper level, working with many internal functions of the body, and strove to obtain control of their bodies, minds, and spirits with the goal of escaping from the cycle of reincarnation and attaining enlightenment.

While the Qigong practices and meditations were being passed down secretly within the monasteries, traditional scholars and physicians continued their Qigong research. During the Jin dynasty in the 3rd century A.D., a famous physician named Hua Tuo used acupuncture for anesthesia in surgery. The Daoist Jun Qian used the movements of animals to create the Wu Qin Xi (Five Animal Sports), which taught people how to increase their Qi circulation through specific movements. Also, in this period a physician named Ge Hong mentioned in his book Bao Pu Zi using the mind to lead and increase Qi. Sometime in the period of 420 to 581 A.D. Tao Hong-Jing compiled the "Yang Shen Yan Ming Lu" (Records of Nourishing the Body and Extending Life), which showed many Qigong techniques.

From the Liang Dynasty to the End of the Qing Dynasty (502-1911 A.D.)


During the Liang dynasty (502-557 A.D.) the emperor invited a Buddhist monk named Da Mo (Bodhidharma), who was once an Indian prince, to preach Buddhism in China. Da Mo was the 28th ?patriarch? to carry on the lineage after the original Buddha, Siddhartha gautama, who lived in India during the 5th century B.C. However, the emperor decided he did not like Da Mo's Buddhist theory, which was based on ?internal cultivation? rather than simply doing good deeds and such to attain enlightenment, so Da Mo eventually withdrew to the Shaolin Temple. When Da Mo arrived, he saw that the priests were weak and sickly from focusing only on their minds and not their bodies, so he shut himself away to ponder the problem. He emerged after nine years of seclusion and wrote two classics: "Yi Jin Jing" (or Yi Gin Ching) (Muscle/Tendon Changing Classic) and "Xi Sui Jing" (or Shii Soei Ching) (Marrow/Brain Washing Classic). The Muscle/Tendon Changing Classic taught the priests how to gain health and change their physical bodies from weak to strong. The Marrow/Brain Washing Classic taught the priests how to use Qi to clean the bone marrow and strengthen the blood and immune system, as well as how to energize the brain and attain enlightenment. Because the Marrow/Brain Washing Classic was harder to understand and practice, the training methods were passed down secretly to only a very few disciples in each generation. 

After the priests practiced the Muscle/Tendon Changing exercises, they found that not only did they improve their health, but they also greatly increased their strength. The monks were often attacked by bandits, and so they had developed some self defense techniques. When this Qigong training was integrated into their martial arts forms, it increased the effectiveness of their techniques. In addition to this martial Qigong training, the Shaolin priests also created five animal styles of Gongfu (kung fu) which imitated the way different animals fight. The animals imitated were the tiger, leopard, dragon, snake, and crane.

Outside of the monastery, the development of Qigong continued during the Sui and Tang dynasties (581-907 A.D.). Chao Yuan-Fang compiled the "Zhu Bing Yuan Hou Lun" (Thesis on the Origins and Symptoms of Various Diseases), which is a veritable encyclopedia of Qigong methods listing 260 different ways of increasing the Qi flow. The "Qian Jin Fang" (Thousand Gold Prescriptions) by Sun Si-Mao described the method of leading Qi, and also described the use of the Six Sounds. The Buddhists and Daoists had already been using the Six Sounds to regulate Qi in the internal organs for some time. Sun Si-Mao also introduced a massage system called Lao Zi's 49 Massage Techniques. "Wai Tai Mi Yao" (The Extra Important Secret) by Wang Tao discussed the use of breathing and herbal therapies for disorders of Qi circulation.

During the Song, Jin, and Yuan dynasties (960-1368 A.D.), "Yang Shen Jue" (Life Nourishing Secrets) by Zhang An-Dao discussed several Qigong practices. "Ru Men Shi Shi" (The Confucian Point of View) by Zhang Zi-He describes the use of Qigong to cure external injuries such as cuts and sprains. "Lan Shi Mi Cang" (Secret Library of the Orchid Room) by Li Guo describes using Qigong and herbal remedies for internal disorders. "Ge Zhi Yu Lun" (A Further Thesis of Complete Study) by Zhu Dan-Xi provided a theoretical explanation for the use of Qigong in curing disease.

During the Song dynasty (960-1279 A.D.), a Daoist named Chang San-Feng is believed to have created Taijiquan (Tai Chi Chuan), which means ?grand ultimate fist?. Tai;ji followed a different approach in its use of Qigong than did Shaolin. While Shaolin Gongfu emphasizes Wai Dan (External Elixir) Qigong exercises, Taiji, and the other internal arts that followed, emphasize Nei Dan (Internal Elixir) Qigong training.

In 1026 A.D. the famous brass man of acupuncture was designed and built by Dr. Wang Wei-Yi. Before that time, the many publications which discussed acupuncture theory, principles, and treatment techniques disagreed with each other, and left many points unclear. When Dr. Wang built his brass man, he also wrote a book called "Tong Ren Yu Xue Zhen Jiu Tu" (Illustration of the Brass Man Acupuncture and Moxibustion). He explained the relationship of the 12 organs and the 12 Qi channels, clarified many of the points of confusion, and, for the first time, systematically organized acupuncture theory and principles.

In 1034 A.D. Dr. Wang used acupuncture to cure the emperor Ren Zong. With the support of the emperor, acupuncture flourished. In order to encourage acupuncture medical research, the emperor built a temple to Bian Que, who wrote the Nan Jing, and worshiped him as the ancestor of acupuncture. Acupuncture technology developed so much that even the Jin race in the distant North requested the brass man and other acupuncture technology as a condition for peace. Between 1102 to 1106 A.D. Dr. Wang dissected the bodies of prisoners and added more information to the Nan Jing. His work contributed greatly to the advancement of Qigong and Chinese medicine by giving a clear and systematic idea of the circulation of Qi in the human body.

Later, in the Southern Song dynasty (1127-1279 A.D.), Marshal Yue Fei was credited with creating several internal Qigong exercises and martial arts. It is said that he created the Eight Pieces of Brocade to improve the health of his soldiers. He is also known as the creator of the internal martial style Xing Yi. Eagle style martial artists also claim that Yue Fei was the creator of their style.

From then until the end of the Qing dynasty (1911 A.D.), many other Qigong styles were founded. The well-known ones include Hu Bu Gong (Tiger Step Gong), Shi Er Zhuang (Twelve Postures) and Jiao Hua Gong (Beggar Gong). Also in this period, many documents related to Qigong were published, such as "Bao Shen Mi Yao" (The Secret Important Document of Body Protection) by Cao Yuan-Bai, which described moving and stationary Qigong practices; and "Yang Shen Fu Yu" (Brief Introduction to Nourishing the Body) by Chen Ji Ru, about the three treasures: Jing (essence), Qi (internal energy), and Shen (spirit). Also, "Yi Fan Ji Jie" (The Total Introduction to Medical Prescriptions) by Wang Fan-An reviewed and summarized the previously published materials; and "Nei Gong Tu Shuo" (Illustrated Explanation of Nei Gong) by Wang Zu-Yuan presented the Twelve Pieces of Brocade and explained the idea of combining both moving and stationary Qigong.

In the late Ming dynasty (around 1640 A.D.), a martial Qigong style, Huo Long Gong (Fire Dragon Gong), was created by the Taiyang martial stylists. The well-known internal martial art style Ba Gua Zhang (or Ba Kua Chang)(Eight Trigrams Palm) is believed to have been created by Dong Hai-Chuan late in the Qing dynasty (1644-1911 A.D.). This style is now gaining in popularity throughout the world. During the Qing dynasty, Tibetan meditation and martial techniques became widespread in China for the first time. This was due to the encouragement and interest of the Manchurian Emperors in the royal palace, as well as others of high rank in society.

From the End of Qing Dynasty to the Present


Before 1911 A.D., Chinese society was very conservative and old-fashioned. Even though China had been expanding its contact with the outside world for the previous hundred years, the outside world had little influence beyond the coastal regions. With the overthrow of the Qing dynasty in 1911 and the founding of the Chinese Republic, the nation began changing as never before. Since this time Qigong practice has entered a new era. Because of the ease of communication in the modern world, Western culture now has great influence on the Orient. Many Chinese have opened their minds and changed their traditional ideas, especially in Taiwan and Hong Kong. Various Qigong styles are now being taught openly, and many formerly secret documents are being published. Modern methods of communication have opened up Qigong to a much wider audience than ever before, and people now have the opportunity to study and understand many different styles. In addition, people are now able to compare Chinese Qigong to similar arts from other countries such as India, Japan, Korea, and the Middle East.

I believe that in the near future Qigong will be considered the most exciting and challenging field of research. It is an ancient science just waiting to be investigated with the help of the new technologies now being developed at an almost explosive rate. Anything we can do to accelerate this research will greatly help humanity to understand and improve itself.

Source: http://www.ymaa.com/articles/history/history-qigong

Find Your Teacher and Practice Humbly

by Dr. Yang, Jwing-Ming, January 7, 2008
Chinese Teapot

Empty Your Cup

There is a Chinese story about six blind men who touch an elephant to know what it looks like. The first one touches the elephant's ear and says, "An elephant is like a large fan." The second one touches the side of its body and says, "No, it is like a wall." The third one describes the leg, "No, the elephant is a pillar." The fourth one touches the nose and shouts, "The elephant is like a big, hanging branch of a tree!" The fifth one touches the ivory, and says, "it is a large horn sticking out of a huge mouth". The sixth one who touches the tail says loudly, "No, an elephant is a large swinging broom sticking out of the wall". If they were to put all of the information together, they would have a reasonable description of the elephant. This story shows we should not stubbornly insist there is only one viewpoint, as we often see only part of the story. There is always more to learn.

Don't waste time in only theoretical research. Practice and theory should go together. From practice, you gain experience, and from theory, you have a clear guideline for practice. Some people hesitate due to the danger involved in martial arts, qigong, or meditation, accomplishing nothing and simply wasting time. Be cautious but determined, and learn from the experience of others, and you will find the right path. Study the Classics passed down in the lineage of your art. Find a teacher, and practice, practice, practice.

Buddha traveled the countryside one day and came to a river. An old Qigong master lived there, who asked him, "You are the Buddha? If so, can you do the same thing I can? I cross the river by walking on top of the water!" Buddha said, "That is very impressive. But how long have you practiced it?" The old man replied proudly, "It took me nearly forty years to achieve it." The Buddha looked at him and said, "It took you forty years! It takes me only a few coins to cross the river on the ferryboat."

Often we spend too much time on unimportant things. Treat your time preciously and use it efficiently. Get rid of your dignity. If you take your dignity too seriously, you will not find a sincere teacher willing to teach from the heart.

A young Samurai swordsman entered the house of a famous Zen master. He looked at the master, bowed and said, "Master! I have reached a deep level of Zen, both in theory and practice. I have heard you are great so I come here to bow to you and hope you can teach me something." The Zen master looked at this proud young man. Without a word, he went into the back room and brought out a teapot and a teacup. He placed the cup in front of the young man and started to pour the tea into the cup. The tea filled the cup quickly and soon began to overflow. The young man looked at the old man with a confused expression. He said, "Stop, master! The teacup is overflowing". The old Zen master put the teapot down and smiled at him. He said, "This is you. You are too full already. I cannot teach you. If you wish to learn, you must first empty your cup." Can you be humble?

When you find a good qualified teacher or source of learning, treat it preciously, so you don't miss the opportunity of learning. This chance may not come again.

Traditionally, it was very difficult to find a qualified teacher. Even if you found one, you would not necessarily be accepted. Today, it is easier to collect information since there are so many books, and DVDs available. But the guidance of an experienced teacher is crucial to reach the final goal. Subtle advice can save you a great deal of time and effort. When you are lost in a big city, even though you have read the map, guidance from a passerby could save a lot of effort.

A young man had already spent more than seven years searching for a good master. He came to where a great teacher lived deep in the remote mountains with a few students. He was received kindly and expressed his intention of learning from the master. The master looked at him for a while, then brought out a teapot and a teacup.

He poured tea into the cup, stopping when the tea reached the brim. He put the teapot down with a smile, hinting to the young man that the place was already full. He could not accept another student. The young man looked at the cup and realized what it meant. He lowered his head in sadness. Noticing a rice straw on the floor, he picked it up and carefully stuck it into the tea. The tea did not overflow. He looked at the master's face with hope, showing him, Look, there is still space for me. The tea did not overflow. Through this silent communication, the old master realized that the young man was one of those rare intelligent ones who could comprehend the profound feeling of the art. He accepted him with delight. It is very difficult to find a humble and intelligent student able to comprehend the art deeply and to develop it. When a teacher finds this kind of student, it will be like a precious pearl in his hands.

 Breathing Technique Offers Help for People With Asthma - 

BUTEYKO BREATHING METHOD - MedAku offers this treatment

Published: November 2, 2009
NEW YORK TIMES

I don?t often write about alternative remedies for serious medical conditions. Most have little more than anecdotal support, and few have been found effective in well-designed clinical trials. Such trials randomly assign patients to one of two or more treatments and, wherever possible, assess the results without telling either the patients or evaluators who received which treatment.

Related

Health Guide: Asthma

Now, however, in describing an alternative treatment for asthma that does not yet have top clinical ratings in this country (although it is taught in Russian medical schools and covered by insurance in Australia), I am going beyond my usually stringent research criteria for three reasons:

?The treatment, a breathing technique discovered half a century ago, is harmless if practiced as directed with a well-trained therapist.

?It has the potential to improve the health and quality of life of many people with asthma, while saving health care dollars.

?I?ve seen it work miraculously well for a friend who had little choice but to stop using thesteroid medications that were keeping him alive.

My friend, David Wiebe, 58, of Woodstock, N.Y., is a well-known maker of violins and cellos, with a 48-year history of severe asthma that was treated with bronchodilators and steroids for two decades. Ten years ago, Mr. Wiebe noticed gradually worsening vision problems, eventually diagnosed as a form of macular degeneration caused by the steroids. Two leading retina specialists told him to stop using the drugs if he wanted to preserve his sight.

He did, and endured several terrifying trips to the emergency room when asthma attacks raged out of control and forced him to resume steroids temporarily to stay alive.

Nothing else he tried seemed to work. ?After having a really poor couple of years with significantly reduced quality of life and performance at work,? he told me, ?I was ready to give up my eyesight and go back on steroids just so I could breathe better.?

Treatment From the ?50s

Then, last spring, someone told him about the Buteyko method, a shallow-breathing technique developed in 1952 by a Russian doctor, Konstantin Buteyko. Mr. Wiebe watched a video demonstration on YouTube and mimicked the instructions shown.

?I could actually feel my airways relax and open,? he recalled. ?This was impressive. Two of the participants on the video were basically incapacitated by their asthma and on disability leave from their jobs. They each admitted that keeping up with the exercises was difficult but said they had been able to cut back on their medications by about 75 percent and their quality of life was gradually returning.?

A further search uncovered the Buteyko Center USA in his hometown, newly established as the official North American representative of the Buteyko Clinic in Moscow.

?When I came to the center, I was without hope,? Mr. Wiebe said. ?I was using my rescue inhaler 20 or more times in a 24-hour period. If I was exposed to any kind of irritant or allergen, I could easily get a reaction that jeopardized my existence and forced me to go back on steroids to save my life. I was a mess.?

But three months later, after a series of lessons and refresher sessions in shallow breathing, he said, ?I am using less than one puff of the inhaler each day ? no drugs, just breathing exercises.?

Mr. Wiebe doesn?t claim to be cured, though he believes this could eventually happen if he remains diligent about the exercises. But he said: ?My quality of life has improved beyond my expectations. It?s very exciting and amazing. More people should know about this.?

Ordinarily, during an asthma attack, people panic and breathe quickly and as deeply as they can, blowing off more and more carbon dioxide. Breathing rate is controlled not by the amount of oxygen in the blood but by the amount of carbon dioxide, the gas that regulates the acid-base level of the blood.

Dr. Buteyko concluded that hyperventilation ? breathing too fast and too deeply ? could be the underlying cause of asthma, making it worse by lowering the level of carbon dioxide in the blood so much that the airways constrict to conserve it.

This technique may seem counterintuitive: when short of breath or overly stressed, instead of taking a deep breath, the Buteyko method instructs people to breathe shallowly and slowly through the nose, breaking the vicious cycle of rapid, gasping breaths, airway constriction and increased wheezing.

The shallow breathing aspect intrigued me because I had discovered its benefits during my daily lap swims. I noticed that swimmers who had to stop to catch their breath after a few lengths of the pool were taking deep breaths every other stroke, whereas I take in small puffs of air after several strokes and can go indefinitely without becoming winded.

The Buteyko practitioners in Woodstock, Sasha and Thomas Yakovlev-Fredricksen, were trained in Moscow by Dr. Andrey Novozhilov, a Buteyko disciple. Their treatment involves two courses of five sessions each: one in breathing technique and the other in lifestyle management. The breathing exercises gradually enable clients to lengthen the time between breaths. Mr. Wiebe, for example, can now take a breath after more than 10 seconds instead of just 2 while at rest.

Responses May Vary

His board-certified pulmonologist, Dr. Marie C. Lingat, told me: ?Based on objective data, his breathing has improved since April even without steroids. The goal now is to make sure he maintains the improvement. The Buteyko method works for him, but that doesn?t mean everyone who has asthma would respond in the same way.?

In an interview, Mrs. Yakovlev-Fredricksen said: ?People don?t realize that too much air can be harmful to health. Almost every asthmatic breathes through his mouth and takes deep, forceful inhalations that trigger a bronchospasm,? the hallmark of asthma.

?We teach them to inhale through the nose, even when they speak and when they sleep, so they don?t lose too much carbon dioxide,? she added.

At the Woodstock center, clients are also taught how to deal with stress and how toexercise without hyperventilating and to avoid foods that in some people can provoke an asthma attack.

The practitioners emphasize that Buteyko clients are never told to stop their medications, though in controlled clinical trials in Australia and elsewhere, most have been able to reduce their dependence on drugs significantly. The various trials, including a British study of 384 patients, have found that, on average, those who are diligent about practicing Buteyko breathing can expect a 90 percent reduction in the use of rescue inhalers and a 50 percent reduction in the need for steroids within three to six months.

The British Thoracic Society has given the technique a ?B? rating, meaning that positive results of the trials are likely to have come from the Buteyko method and not some other factor. Now, perhaps, it is time for the pharmaceutically supported American medical community to explore this nondrug technique as well.

This is the first of two columns. Next week: The pros and cons 
of steroid treatments.


http://www.nytimes.com/2009/11/03/health/03brod.html?_r=1&em


New News on Vitamin D

http://www.fenceviewer.com/site/index.php?option=com_content&view=article&id=22952:New%20News%20on%20Vitamin%20D&catid=905:health&Itemid=90


Written by Jacqueline Weaver 
 
Tuesday, November 17, 2009 at 8:21 am

WINTER HARBOR ? Dr. Benjamin Newman, the ?Village Doc? in Winter Harbor, recently returned from a conference in Toronto that was part of ?Vitamin D Action,? an international public health project focused on addressing vitamin D deficiencies.

Newman said more and more scientists are recognizing the link between vitamin D deficiencies and a range of serious medical conditions.

For instance, the Mayo Clinic in Rochester, Minn., notes that vitamin D offers many benefits, especially for older adults, such as improved balance, reduction in the risk of bone fractures, and better thinking skills.

The Mayo Clinic goes on to state that low levels of vitamin D are associated with diabetes, cardiovascular disease, multiple sclerosis and other autoimmune disorders, and infections such as tuberculosis and periodontal disease. Low vitamin D levels also may affect certain cancers, including colon, breast and prostate cancers.

It is widely accepted that residents 42 degrees north latitude of Boston have the highest incidences of vitamin D deficiencies because of reduced sun exposure due to the angle of the sun.

The following are excerpts from an interview with Newman about the conference and vitamin D.

Q. When did you first get involved with vitamin D?

A. About 10 years ago. I started noticing associations between vitamin D deficiencies and medical problems in patients. I?m a clinician, not a researcher. It was purely observational. Double blind, randomized controlled trials mean more, but you can?t deny the observations of someone who has been in practice for a while.

Q. How long have you been checking vitamin D levels in patients?

A. I started 15 years ago in the Navy, where money wasn?t a problem.

Q. How were our vitamin D levels eons ago?

A. In the development of man when we lived near the equator and didn?t wear clothes we had on average 100 to 160 nanograms per milliliter. (A nanogram is one-billionth of a gram. A gram is about 1/30 of an ounce. A milliliter is equal to 1/1,000 liter. A liter is a little bigger than a quart).

Q. When you test patients, what are their vitamin D levels on average?

A. The average by laboratory test is 30-80 nanograms.

Q. How much should we have today?

A. I want my patients at 50-to-60 nanograms. That?s where we reap the most benefits.

Q. What is vitamin D?

A. Vitamin D is a hormone, not a vitamin, and it controls 2,000 genes. When you?re talking a compound that controls 2,000 genes you?re talking the atomic bomb. Every cell in the body makes vitamin D. You can get most nutrients one way or another from a good diet. Vitamin D is the exception.

Q. What does it do?

A. Take the flu virus, for example. The body stimulates cells to produce a chemical to destroy the germ. Vitamin D is a messenger to make or not make that chemical.

Q. Traditionally, what level of vitamin D have doctors found to be acceptable?

A. Thirty nanograms. That prevents rickets.

Q. What is the recommended daily dose of vitamin D?

A. The current daily recommended dose of vitamin D for adults 50 and older is 400 to 600 international units (IU). Eighty five years go you were told to take 400 units daily. Europe now recommends 800 units for children up to 5, and then 1,000 units a day after that. In Norway, where they have a high incidence of juvenile diabetes, all newborns are now put on vitamin D. The rate of juvenile diabetes in 16-year-olds has since decreased by 40 percent.

We haven?t increased the recommended dosages here. There is tremendous inertia in the medical profession.

Q. What do you mean by inertia?

A. Take Joseph Lister. In 1870, he noticed an association between washing hands and reducing death by infection. He was laughed out of town. Hand washing did not become the accepted practice in the United States until 1910. It wasn?t until the early 1960s that doctors in the operating room routinely put a mask over their noses.

Q. How much vitamin D should we be taking daily?

A. That needs to be determined by your doctor and the results of a lab test. It varies from patient to patient. There is no substitute for sitting down with a patient to determine, along with a blood test, what they need.

Q. At what levels can vitamin D be toxic?

A. It is extremely difficult to take toxic levels of vitamin D. We know if you take 30,000 units a day there will be no toxicity. To put that in perspective, there are 50,000 units in 1.25 milligrams. Baby aspirin is 81 milligrams.

Q. What diseases and illness can vitamin D cure and/or prevent?

A. Observationally, it appears that vitamin D is as good as a flu shot in preventing the flu. It helps prevent falls in old age, which is one of the leading cause of death in the elderly. Researchers have found there is a 67-70 percent reduction in the incidence of breast cancer, type 1 diabetes, multiple sclerosis and colon cancer.

Q. What is the best way to get vitamin D?

A. Sun is the best source of vitamin D, but only ultraviolet B (UVB) rays in the sun make vitamin D in the skin. And UVB rays are only one percent of the rays from the sun. As you get older and darker, your ability to convert the sun?s rays to vitamin D is significantly reduced. African-Americans, for instance, get little vitamin D from the sun.

Q. During what months are Mainers most likely to need a boost in vitamin D?

A. September through April, because of the angle of the sun 42 degrees latitude and north. If you live below 42 degrees latitude and you?re young and you?re walking around in a bathing suit, you can make 10,000 units of vitamin D in 10 minutes.

Q. What type of vitamin D supplement should people be taking?

A. Vitamin D3 is preferred. You can buy it over the counter, but you need to know what you?re taking. The problem is that over the counter supplements is an unregulated industry and there is no guarantee that what is in them is what you think is in them.

The best non-pharmacological way to get vitamin D is the sun. All you need is 20 minutes outside, three times a week, exposing your arms and face, or arms and legs. It?s still not enough, but the sun exposure won?t cause cancer or wrinkles at this level. Using sunblock or sunscreen will prevent the sun from producing vitamin D in the skin.

Q. How much does the blood test cost?

A. I can do it for $70.

Q. What would the average regimen of vitamin D cost for the year?

A. $35. Even if it doesn?t change anything, what have you lost?

For more health news, pick up a copy of The Ellsworth American.

 


The Acupuncture Bookshelf
          Please browse around our Acupuncture book shelf. Any books you purchase will help to support our non–commercial website.


Guidelines on Basic Training and Safety in Acupuncture
          World Health Organization;   1999;   35 pages (Adobe Acrobat)

          The increasing popularity in recent years of acupuncture as a form of therapy and the interest of some countries in introducing it into primary health care mean that national health authorities must ensure safety and competence in its use.


Acupuncture:
Review and Analysis of Reports on Controlled Clinical Trials

World Health Organization;   2003;   87 pages (Adobe Acrobat 2.18 MB)

In recognition of the increasing worldwide interest in acupuncture, the World Health Organization (WHO) conducted a symposium on acupuncture in June 1979 in Beijing, China. Physicians practising acupuncture in different countries were invited to identify the conditions that might benefit from this therapy. The participants drew up a list of 43 suitable diseases. However, this list of indications was not based on formal clinical trials conducted in a rigorous scientific manner, and its credibility has been questioned. The past two decades have seen extensive studies on acupuncture, and great efforts have been made to conduct controlled clinical trials that include the use of “sham” acupuncture or “placebo” acupuncture controls. Although still limited in number because of the difficulties of carrying out such trials, convincing reports, based on sound research methodology, have been published. In 1996, a draft report on the clinical practice of acupuncture was reviewed at the WHO Consultation on Acupuncture held in Cervia, Italy. The participants recommended that WHO should revise the report, focusing on data from controlled clinical trials. This publication is the outcome of that process.


Acupuncture Information and Resources
          This collection was developed by the National Center for Complementary and Alternative Medicine (NCCAM) @ the National Institutes of Health (NIH)


The Consensus Development Statement on the Use of Acupuncture
          Acupuncture is an effective treatment for nausea caused by cancer chemotherapy drugs, surgical anesthesia, and pregnancy; and for pain resulting from surgery and a variety of musculoskeletal conditions, an expert panel concluded. The panel of non–Federal, non–advocate experts was convened in November 1997 for the NIH Consensus Development Conference on Acupuncture, cosponsored by the OAM and the Office of Medical Applications of Research (OMAR). (NIH)


Position Statement on "Traditional Medicine"
          The World Health Organization (WHO) says: "Traditional medicine" refers to ways of protecting and restoring health that existed before the arrival of modern medicine. As the term implies, these approaches to health belong to the traditions of each country, and have been handed down from generation to generation. Traditional systems in general have had to meet the needs of the local communities for many centuries. China and India, for example, have developed very sophisticated systems such as acupuncture and ayurvedic medicine. In practice, the term "traditional medicine" refers to the following components: acupuncture, traditional birth attendants, mental healers and herbal medicine.


AMAC Position Paper on Laser Acupuncture
          Japan and several Scandinavian countries are at the forefront of clinical research work with laser. Low Level Laser Therapy (LLLT) is also used in Australia, Canada, France, Korea, People's Republic of China, U.K. and many other countries. A tissue repair research unit, examining the effects of laser, now exists at Guy's Hospital, London. Many centres of research are now developing around the world.


Current Bibliographies in Medicine:   Acupuncture
           National Library of Medicine
           This database contains 2302 citations from January 1970 through October 1997.


What is Electro Meridian Imaging (EMI)?
          The Traditional Chinese Medicine (TCM) analysis for the the meridian system is based on pulse diagnosis. This involves taking pulse readings, twice on each wrist; the first three lightly, and the next three deeply (for a total of 12 readings). All this changed in the early 1950s, with the development of Ryodoraku by Dr. Yoshio Nakatani of Japan. Nakatani developed his procedure of electronic evaluation by measuring skin conductance at the yuan (source) points of the wrist and ankle. He created one of the most significant acupuncture diagnostic methods yet created in either contemporary or traditional acupuncture.


Dr. Amaro's   "Dynamic Chiropractic"   Articles
          108 articles, organized by categories; This collection is of great value!
          Updated 2-27-2010.





http://www.acuxo.com/meridianPictures.asp?point=CV12&meridian=Conception%20Vessel
http://www.acuxo.com/meridianPictures.asp?point=CV12&meridian=Conception%20Vessel

http://vsearch.nlm.nih.gov/vivisimo/cgi-bin/query-meta?v%3Aproject=medlineplus&query=acupuncture&x=0&y=0

http://vsearch.nlm.nih.gov/vivisimo/cgi-bin/query-meta?v%3Aproject=medlineplus&query=acupuncture&x=0&y=0

http://www.yinyanghouse.com/acupuncturepoints/point_categories

http://www.yinyanghouse.com/acupuncturepoints/point_categories


http://www.chinesemedicinetimes.com/search?xSearch=acupuncture&submit=Search
http://www.chinesemedicinetimes.com/search?xSearch=acupuncture&submit=Search

http://www.itmonline.org/
http://www.itmonline.org/

 Acupuncture Charts

This section was compiled by Frank M. Painter, D.C.



Thanks to Dr. John Urbanski for donating these Charts. His web site is:  Acupuncture_Products.com
 
   
         This 39-page booklet describes the location of all acupuncture points, as well as using both the western and Chinese names for each point.


         This 14-page chart describes the location of all acupuncture points, as well as using both the western and Chinese names for each point.


         Koryo Hand Therapy is a scientific medical system that is quite simple to learn and easy to perform without any side effects or danger. If you have a problem or pain somewhere in your body, the reactions are reflected on the hands in the form of tender points. Pain commonly or frequently shown on the hands corresponds to the painful part of your body. Therefore, the stimulation of the tender points positively affects pain relief.


         Alarm points are located on the abdomen and chest, they are in close to their related Zang-Fu organ, and may be tender or sensitive if there is disharmony in the underlying organ. Visual examination, obtaining certain reactions when pressing the point or spontaneous sensation at the point are all significant diagnostic information.


         This updated chart defines alarm and associated Points and lists Spanish names for those points.


         This chart defines musculoskeletal and sensory treatment points and the Master Control Points. 


         The five element theory is the cornerstone of acupuncture and meridian therapy. This chart clearly shows the relationship of the five elements (Fire, Earth, Metal, Water and Wood).


         This chart contains 41 Cardinal points that are specific for conditions, functions and areas of the body. Each point is mapped out, listed by condition, point name is also listed by Chinese name with detailed description of point location.



 

Acupuncture Articles
 
   


  
The Neuroimmune Basis of Anti-inflammatory Acupuncture
           Integrative Cancer Therapies 2007 (Sep); 6 (3):   251–257 ~ FULL TEXT

           This review article presents the evidence that the antiinflammatory actions of acupuncture are mediated via the reflexive central inhibition of the innate immune system. Both laboratory and clinical evidence have recently shown the existence of a negative feedback loop between the autonomic nervous system and the innate immunity. There is also experimental evidence that the electrical stimulation of the vagus nerve inhibits macrophage activation and the production of TNF, IL-1beta , IL-6, IL-18, and other proinflammatory cytokines. It is therefore conceivable that along with hypnosis, meditation, prayer, guided imagery, biofeedback, and the placebo effect, the systemic anti-inflammatory actions of traditional and electro-acupuncture are directly or indirectly mediated by the efferent vagus nerve activation and inflammatory macrophage deactivation. The use of acupuncture as an adjunct therapy to conventional medical treatment for a number of chronic inflammatory and autoimmune diseases seems plausible and should be validated by confirming its cholinergicity.


  
Patients Seeking Care from Acupuncture Practitioners in the UK:
A National Survey

Complement Ther Med. 2006 (Mar);   14 (1):   20–30

Who seeks acupuncture treatment? According to this survey of 9408 acupuncture patients in the UK, 74% of patients were female. The most common main problem or symptom reported by patients was musculo-skeletal (38%), followed by psychological (11%), general (9%), neurological (8%) and gynaecological/obstetric (8%), while 3% of patients were seeking treatment for their general well-being.


  
Acupuncture for Upper-Extremity Rehabilitation in Chronic Stroke:A Randomized Sham-Controlled Study
Arch Phys Med Rehabil 2005 (Dec);   86 (12):   2248–2255

Based on ITT analyses, we conclude that acupuncture does not improve UE function or QOL in patients with chronic stroke symptoms. However, gains in UE function observed in protocol-compliant subjects suggest traditional Chinese acupuncture may help patients with chronic stroke symptoms. These results must be interpreted cautiously because of small sample sizes and multiple, unadjusted, post hoc comparisons. A larger, more definitive RCT using a similar design is feasible and warranted.


  
New Reporting Method for Acupuncture Services
to Begin in January 2005

Beginning Jan. 1, 2005, there will be a new reporting method for acupuncture services. Effective on that date, CPT codes 97780 (acupuncture, one or more needles; without electrical stimulation) and 97781 (acupuncture, one or more needles; with electrical stimulation) will be deleted. Four new codes have been developed for reporting acupuncture services.


  
Acupuncture of Chronic Headache Disorders in Primary Care: Randomised Controlled Trial and Economic Analysis
Health Technol Assess 2004 (Nov);   8 (48):   1–50

Patients in the acupuncture group experienced the equivalent of 22 fewer days of headache per year. SF-36 data favoured acupuncture, although differences reached significance only for physical role functioning, energy and change in health. Compared with controls, patients randomised to acupuncture used 13% less medication, made 23% fewer visits to GPs and took 13% fewer days off sick. The study suggests that acupuncture leads to persisting, clinically relevant benefits for primary care patients with chronic headache, particularly migraine.


  
Acupuncture Using Laser Needles Modulates Brain Function: First Evidence from Functional Transcranial Doppler Sonography and Functional Magnetic Resonance Imaging
Lasers Med Sci 2004 (Aug);   19 (1):   6–11

Acupuncture using laser needles is a new totally painless stimulation method which has been described for the first time. This paper presents an experimental double-blind study in acupuncture research in healthy volunteers using a new optical stimulation method. Significant changes ( p<0.05) of brain activity were demonstrated in the occipital and frontal gyrus by fMRI. Optical stimulation using properly adjusted laser needles has the advantage that the stimulation cannot be felt by the patient (painless and no tactile stimulation) and the operator may also be unaware of whether the stimulation system is active. Therefore true double-blind studies in acupuncture research can be performed.


  
Writing Case Reports – Author Guidelines for Acupuncture in Medicine
           Acupuncture in Medicine 2004 (Mar);   22 (2):   83–86 ~ FULL TEXT

           Case reports are particularly valuable in specialist clinical areas such as acupuncture to report new adverse events and to suggest possible new hypotheses. They can also be used to report events that have been reported previously but are rare or serious, in order to illustrate their frequency. They may illuminate the wider side of clinical practice by describing personal experiences of one practitioner. Constraints to writing case reports include finding time, working in isolation, and not having enough experience at the task. This article reproduces and develops a set of guidelines that were previously published, in an attempt to help authors to write thorough but succinct reports in a structured manner.


  
An Audit of the Effectiveness of Acupuncture on Musculoskeletal Pain in Primary Health Care
Acupuncture in Medicine 2002 (Mar);   20 (1):   22–25

We found an association between the general practitioner using fewer needles and patients experiencing greater pain relief. This could be a reflection of treating myofascial pain syndromes, which often appear to respond well to a single needle in the key trigger point. Overall, we found that sixty-nine percent of patients had a good or excellent response to acupuncture treatment.


  
Informed Consent for Acupuncture An Information Leaflet
Developed by Consensus

Acupuncture in Medicine 2001 (Dec);   19 (2):   123–130

Patients have the right to be fully informed about the likely benefits and risks of any proposed examination or treatment, and practitioners are obliged to obtain informed consent beforehand. Accurate information about the risks of acupuncture is available following publication of the results of two prospective surveys. An informed consent form is provided.


  
Standards for Reporting Interventions in Controlled Trials of Acupuncture: The STRICTA Recommendations
Acupuncture in Medicine 2002 (Mar);   20 (1):   22–25

Acupuncture treatment and control group interventions in parallel-group randomised trials of acupuncture are not always precisely reported. In an attempt to improve standards, an international group of experienced acupuncturists and researchers devised a set of recommendations, designating them STRICTA: STandards for Reporting Interventions in Controlled Trials of Acupuncture. FULL TEXT available


   Characteristics of Visits to Licensed Acupuncturists, Chiropractors, Massage Therapists, and Naturopathic Physicians
J Am Board Fam Pract 2002 (Nov-Dec);   15 (6):   463–480 ~ FULL TEXT

More than 80% of visits to CAM providers were by young and middle-aged adults, and roughly two thirds were by women. Children comprised 10% of visits to naturopathic physicians but only 1% to 4% of all visits to other CAM providers. At least two thirds of visits resulted from self-referrals, and only 4% to 12% of visits were from conventional physician referrals. Most visits to chiropractors and naturopathic physicians, but less than one third of visits to acupuncturists and massage therapists, were covered by insurance.


  
Relief of Chronic Neck and Shoulder Pain by Manual Acupuncture to Tender Points –– A Sham-controlled Randomized Trial
Complement Ther in Med 2002 (Sept);   10 (4):   217–222 ~ FULL TEXT

Acupuncture applied to tender points appears to have short-term effects on neck and shoulder pain and stiffness, but this study was unable to demonstrate any long-term superiority over sham acupuncture.


  
Acupuncture: Efficacy, Safety and Practice
         Up to five million people may have consulted a therapist specialising in complementary and alternative medicine (CAM) in the last year with an incalculable extra number consulting a doctor or other health professional practising CAM. A new report from the British Medical Association, published today (6–25–2000), looks at the usefulness, safety and availability of acupuncture – one of the most widely requested treatments.


  
Clinical Trials of Acupuncture: Consensus Recommendations for Optimal Treatment, Sham Controls and Blinding
Complement Ther in Medicine 2001 (Dec);   9 (4):   237–245 ~ FULL TEXT

Evidence of effectiveness is increasingly used to determine which health technologies are incorporated into public health provision. Acupuncture is a popular therapy that has been shown to be superior to placebo in the treatment of nausea and dental pain, and promising for migraine and osteoarthritis of the knee. For many other conditions, such as chronic pain, in which acupuncture is often used, the evidence is either insufficient or negative. Misleading results may occur for a number of reasons. False negative results may arise from inadequate treatment schedules and inappropriate control interventions. This consensus document considers these issues with the aim of improving the design of efficacy trials of acupuncture in order that they are more likely to be conclusive and more meaningfully interpreted. The FULL TEXT file is available


  
Acupuncture ~ A Complementary Treatment in General Practice
           Tidsskr Nor Laegeforen 2002;   122 (9) May 10:   921–923

           THIS REVIEW FOUND THAT: Acupuncture is the complementary treatment most commonly used by general (medical) practitioners. UNFORTUNATELY: "78% had acupuncture courses of less than four weeks' duration" AND THE MAJOR COMPLAINT WAS "Lack of time was regarded as the major limitation to the use of acupuncture." YEAH...ESPECIALLY THE TIME THEY INVESTED TO LEARN IT! UGH!


  
Carpal Tunnel Syndrome Pain Treated with Low-level Laser and Microamperes Transcutaneous Electric Nerve Stimulation: A Controlled Study
Arch Phys Med Rehabil 2002;   83 (7) Jul:   978–988

Significant decreases in MPQ score, median nerve sensory latency, and Phalen and Tinel signs after the real treatment series but not after the sham treatment series. Patients could perform their previous work (computer typist, handyman) and were stable for 1 to 3 years.


  
Acupuncture as Complementary Therapy for Back Pain
          Holist Nurs Pract 2001;   15 (3) Apr:   35–44

          Research has demonstrated that acupuncture may benefit those who suffer from back pain when they have failed to respond to previous treatment by drugs, bed rest, epidural injection, physiotherapy, osteopathy, chiropractics, and surgery. Acupuncture is a powerful and complementary therapy for back pain.


  
Acupuncture Treatment During Labour:
A Randomised Controlled Trial

BJOG 2002;   109 (6) Jun:   637–644

Acupuncture treatment during labour significantly reduced the need of epidural analgesia . Parturients who received acupuncture assessed a significantly better degree of relaxation compared with the control group. No negative effects of acupuncture given during labour were found in relation to delivery outcome.


   Texas Attorney General Restricts Acupuncturists from "Manipulation"
           For the past several years, the Texas Board of Chiropractic Examiners (TBCE) has received complaints, some quite serious, of patients injured by acupuncturists allegedly performing spinal manipulations. The TBCE forwarded the complaints to the appropriate regulatory body, the Texas State Board of Acupuncture Examiners (TSBAE), with the appeal for them to take action. Read the decision by the Texas Attorney General.


   Acupuncture Superior to Drug Therapy for Migraines
          In one of the largest studies of its kind to date, a team of investigators in Italy examined the effectiveness of acupuncture versus a variety of pharmacological therapies in treating migraines. Their results, published in a recent issue of the Journal of Traditional Chinese Medicine, revealed that patients given acupuncture experienced fewer migraine episodes, missed fewer days from work, and suffered no side effects compared to patients on conventional drug therapy. They also found acupuncture to be more cost–efficient, estimating a savings of hundreds of millions of dollars in private and social health expenditures if it were used to treat headaches alone instead of drugs.


  
Acupuncture and Stroke Recovery
          Johansson et al (1993) investigated the effectiveness of acupuncture as a supplement to physical therapy in recovery from stroke. Pang (1994) investigated two particular scalp acupuncture techniques in order to compare their effectiveness in treating apoplexy following stroke.


  
Acupuncture and Chronic Obstructive Pulmonary Disease (COPD)
           Two recent studies compare acupuncture with "sham" and demonstrate significant improvements in asthma symptons.


  
Acupuncture and Raynaud's Disease
          A recent study indicates that acupuncture surpasses drug treatment for Raynaud's disease, a vascular disorder that causes the small arteries of the hands and, less commonly, the feet to spasm during exposure to cold or stress. The appendages go white and sometimes hurt due to insufficient blood flow.


  
Acupuncture and Crack–Cocaine Addiction
          Lipton et al (1994) investigated ear acupuncture in treatment of cocaine dependency over a one–month period. 150 patients were randomly assigned to an experimental group and a placebo–control group. Konefal, Duncan and Clemence (1994) found a 57% reduction in the time it took to achieve a negative urine test with acupuncture.


   Acupuncture Wins British Medical Association Approval
          Acupuncture should become more widely available on the NHS and family doctors should be trained in some of its techniques, a BMA inquiry has concluded. The therapy has proved effective in treating back and dental pain, nausea and vomiting, and migraine, the BMA's Board of Science and Education has found after a two year study.


  
Beyond Endorphins in Acupuncture Analgesia:
The Science Behind the Art

In the last 20 years much has been written about acupuncture and its efficiency in relieving pain. The ancient Chinese clinicians practised acupuncture based on Traditional Chinese Medicine (TCM) principles using well established guidelines. Their reasoning were based on empirical responses rather than scientific principles. This discussion hopes to bring to highlight some recent research findings.


   Which Diseases Can Be Helped by Acupuncture?
          HealthWorld has excerpted sections from Lewith's "Acupuncture: It's Place in Western Medical Science"

 
   

Prime Sources for Acupuncture Information
 
   

The Acupuncture Bookshelf
          Please browse around our Acupuncture book shelf. Any books you purchase will help to support our non–commercial website.


Guidelines on Basic Training and Safety in Acupuncture
          World Health Organization;   1999;   35 pages (Adobe Acrobat)

          The increasing popularity in recent years of acupuncture as a form of therapy and the interest of some countries in introducing it into primary health care mean that national health authorities must ensure safety and competence in its use.


Acupuncture:
Review and Analysis of Reports on Controlled Clinical Trials

World Health Organization;   2003;   87 pages (Adobe Acrobat 2.18 MB)

In recognition of the increasing worldwide interest in acupuncture, the World Health Organization (WHO) conducted a symposium on acupuncture in June 1979 in Beijing, China. Physicians practising acupuncture in different countries were invited to identify the conditions that might benefit from this therapy. The participants drew up a list of 43 suitable diseases. However, this list of indications was not based on formal clinical trials conducted in a rigorous scientific manner, and its credibility has been questioned. The past two decades have seen extensive studies on acupuncture, and great efforts have been made to conduct controlled clinical trials that include the use of “sham” acupuncture or “placebo” acupuncture controls. Although still limited in number because of the difficulties of carrying out such trials, convincing reports, based on sound research methodology, have been published. In 1996, a draft report on the clinical practice of acupuncture was reviewed at the WHO Consultation on Acupuncture held in Cervia, Italy. The participants recommended that WHO should revise the report, focusing on data from controlled clinical trials. This publication is the outcome of that process.


Acupuncture Information and Resources
          This collection was developed by the National Center for Complementary and Alternative Medicine (NCCAM) @ the National Institutes of Health (NIH)


The Consensus Development Statement on the Use of Acupuncture
          Acupuncture is an effective treatment for nausea caused by cancer chemotherapy drugs, surgical anesthesia, and pregnancy; and for pain resulting from surgery and a variety of musculoskeletal conditions, an expert panel concluded. The panel of non–Federal, non–advocate experts was convened in November 1997 for the NIH Consensus Development Conference on Acupuncture, cosponsored by the OAM and the Office of Medical Applications of Research (OMAR). (NIH)


Position Statement on "Traditional Medicine"
          The World Health Organization (WHO) says: "Traditional medicine" refers to ways of protecting and restoring health that existed before the arrival of modern medicine. As the term implies, these approaches to health belong to the traditions of each country, and have been handed down from generation to generation. Traditional systems in general have had to meet the needs of the local communities for many centuries. China and India, for example, have developed very sophisticated systems such as acupuncture and ayurvedic medicine. In practice, the term "traditional medicine" refers to the following components: acupuncture, traditional birth attendants, mental healers and herbal medicine.


AMAC Position Paper on Laser Acupuncture
          Japan and several Scandinavian countries are at the forefront of clinical research work with laser. Low Level Laser Therapy (LLLT) is also used in Australia, Canada, France, Korea, People's Republic of China, U.K. and many other countries. A tissue repair research unit, examining the effects of laser, now exists at Guy's Hospital, London. Many centres of research are now developing around the world.


Current Bibliographies in Medicine:   Acupuncture
           National Library of Medicine
           This database contains 2302 citations from January 1970 through October 1997.


What is Electro Meridian Imaging (EMI)?
          The Traditional Chinese Medicine (TCM) analysis for the the meridian system is based on pulse diagnosis. This involves taking pulse readings, twice on each wrist; the first three lightly, and the next three deeply (for a total of 12 readings). All this changed in the early 1950s, with the development of Ryodoraku by Dr. Yoshio Nakatani of Japan. Nakatani developed his procedure of electronic evaluation by measuring skin conductance at the yuan (source) points of the wrist and ankle. He created one of the most significant acupuncture diagnostic methods yet created in either contemporary or traditional acupuncture.


Dr. Amaro's   "Dynamic Chiropractic"   Articles
          108 articles, organized by categories; This collection is of great value!
          Updated 2-27-2010.

 
   

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Acupuncture Charts     [Revolving New Icon]
          We are very grateful to Dr. John Urbanski for the use of these charts!   

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INTRODUCTION

Could we live happily ever after? Perhaps. One's interest in the genetically pre-programmed states of sublimity sketched in The Hedonistic Imperative is tempered by the knowledge that one is unlikely to be around to enjoy them. It's all very well being told our descendants will experience every moment of their lives as a magical epiphany. For emotional primitives and our loved ones at present, most of life's moments bring nothing of the sort. In centuries to come, our emotional well-being may indeed surpass anything that human legacy wetware can even contemplate. Right now, however, any future Post-Darwinian Era of paradise-engineering can seem an awfully long way off. Mainstream society today has a desperately underdeveloped conception of mental health.

        There's clearly a strong causal link between the raw biological capacity to experience happiness and the extent to which one's life is felt to be worthwhile. High-minded philosophy treatises should complicate but not confuse the primacy of the pleasure-pain axis. So one very practical method of life-enrichment consists in chemically engineering happier brains for all in the here-and-now. Yet how can this best be done?

         Any strategy which doesn't subvert our inbuilt hedonic treadmill of inhibitory feedback mechanisms in the CNS will fail. Political and socio-economic reforms offer at best a lame stopgap. To the scientific naturalist, all routes to happiness must ultimately be biological - "culture" and "talk-therapy" alike must be neurochemically encoded to exert any effect on the psyche. Some of these routes to happiness involve the traditional environmental detours. They are too technical, diverse and futile to tackle here. If the quality of our lives is to be significantly enhanced in the long term, then the genetically predisposed set-point of our emotional thermostats needs to be recalibrated. The malaise-ridden norm typically adaptive in humanity's ancestral environment must be scrapped. So while we wait until germ-line gene-therapy to promote mental super-health can become standard, it's worth considering instead how ordinary early 21st Century Homo sapiens can sustainably maximise emotional well-being with only present-day pharmacology to rely on. No less importantly, how is it possible to combine staying continuously "better than well" with retaining one's sense of social and ethical responsibility to other people and life-forms?

        Extracting reliable information on this topic is extraordinarily difficult for laity and professionals alike. The layman is more likely to be given heavily slanted propaganda. Unvarnished fact might confuse his supposedly uneducated and functionally diminutive brain. Career-scientists, on the other hand, are bedevilled by a different problem. Access to funds, laboratories, raw materials, journal publication, professional preferment, and licenses to conduct experimental trials is all dependent on researchers delivering results their paymasters want to hear. The disincentives to intellectual integrity could scarcely be greater; and they are cloaked in such reputable disguise.

        By way of illustration, it's worth contemplating one far-fetched scenario. How might an everlasting-happiness drug - a drug which (implausibly!) left someone who tried it once living happily-ever-after - find itself described in the literature?

"Substance x induces severe, irreversible structural damage to neurotransmitter subsystem y. Its sequelae include mood-congruent cognitive delusions, treatment-resistant euphoria, and toxic affective psychosis."

Eeek! Needless to say, no responsible adult would mess around with a potent neurotoxin under this description.

        Several excellent researchers play the game by the rules. They keep their heterodox opinions to themselves. Others find such cognitive dissonance too unpleasant. So they gradually internalise the puritanical role and tendency to warped scientific prose expected of them. [Whereas tortured non-human experimental animals, for instance, blandly get "used" and "sacrificed", certain socially taboo drugs always get "abused" by "drug-abusers"] On the other hand, some of the most original and productive minds in the field of psychopharmacology - pre-eminently Alexander Shulgin - have already been silenced. Many more careers have been intellectually strangled at birth or consigned to professional oblivion. The danger of poisoning the wells of information, for whatever motives, is straightforward. When young people discover they have been lied to or deceived, over cannabis for instance, they will pardonably assume that they have been lied to or deceived over the dangers of other illegals too. And this, to put it mildly, would be exceedingly rash.

        Most recently, the Internet daily delivers up an uncontrollable flood-tide of fresh ideas to counter official misinformation. Some of the online literature, for instance Erowid, is first-rate. At its best, Wikipedia puts print publications to shame. Unfortunately, a lot of web-published material isn't much more objective in content or style than the professional journals it complements. Medical ghostwriting, unacknowledged conflicts of interest and publication bias are endemic to "peer-reviewed" academic journals; but methodological rigour is scarce in the scientific counter-culture too. Devising one's own system of filtering and quality-control to drown out the noise is a challenging task for anybody.


SOME DEAD ENDS

One spectacularly incompetent route to a lifetime of happiness involves taking unsustainable psychostimulants such as cocaine or the amphetamines. In the short term, their activation of the sympathetic nervous system tends to elevate mood, motivation and energy. Users tend to talk a lot. Self-confidence is enhanced: these are "power drugs". Physical strength and mental acuity are variably increased. Whereas cocaine blocks the neuronal re-uptake of the catecholamine neurotransmitters noradrenaline and dopamine, amphetamine triggers to a much greater extent their synaptic release. Amphetamine feels coarser, lasts longer and costs less.

        In either case, libertarian indignation that the State presumes to subject its citizens to totalitarian-style mind-control should not obscure the fact that for most purposes these are not useful drugs. This is because the central nervous system supports a web of mutually inhibitory feedback-mechanisms. In response to a short-term increase of mood-mediating monoamines in the synapses, the genes and neuronal receptors re-regulate. So at best no real long-term benefit is derived from the use of such compounds. Neither cocaine nor amphetamine yield the sustained activation of intracellular signal-transduction cascades needed to cheat the hedonic treadmill and keep us truly happy.

        Some people continue to take psychostimulants casually for years without serious harm. Yet the potential risks of adverse physical, psychological and social ill-effects are high. Their use beyond narcolepsy and perhaps ADHD is best discouraged.

        The "depressant" opioids are somewhat more benign. They are effective painkillers. Opioids can also be extremely pleasurable. In classical antiquity, Aristotle - admittedly not always the soundest authority on medical matters - classified pain as an emotion. Opium was a traditional remedy for melancholic depression; its efficacy is arguably superior to Prozac, though comparative controlled clinical trials are lacking. In "animal models", opioids reverse the depressed behaviour, learned helplessness and neuroendocrine responses associated with clinical depression. By contrast, opioid antagonists such as naloxone exacerbate them. To confuse matters further, sufferers from depression typically share an increased sensitivity to pain; and modern "antidepressants" can themselves act as "physical" painkillers. Conversely, mu-opioid receptor agonists offer both unsurpassed pain-relief and extraordinary emotional well-being; and delta-opioid agonists and enkephalinase inhibitors can function as antidepressants. There is clearly an intimate link between "physical" and "emotional" pain. In defiance of dualist metaphysics, opioids tend to be good at banishing both.

        Contemporary medical orthodoxy classifies drug-induced bliss as an "adverse side-effect" of opioid analgesics - even in the terminally ill. Yet we could all do with having our native endorphin systems enriched. Later this century and beyond, the customised site-selective successors to today's opioid drugs may play a critical role in promoting emotional super-health. For example, one of the most exciting research breakthroughs in recent years has been the synthesis of JDTic. JDTic exerts a sustained anti-anxiety and mood-brightening effect: it is the first orally active selective kappa opioid antagonist. Kappa is the "ugly" opioid receptor whose endogenous ligand is dynorphin. The dynorphin/kappa-opioid receptor system is implicated in the unpleasant states of mind caused by chronic uncontrolled stress. Repeated use of cocaine, heroin, ethyl alcohol and other euphoriant drugs induces a compensatory up-regulation of the dynorphin/kappa-opioid receptor system too, causing anxiety, anhedonia and dysphoria. Whereas mu receptor agonist opioids induce euphoria by enhancing dopamine release in the nucleus accumbens, activation of kappa opioid receptors inhibits dopamine release from the mesolimbic terminals. This deficiency is subjectively unpleasant because the mesolimbic dopamine system regulates hedonic tone and the capacity to experience (and anticipate) happiness. Dopamine also modulates the threshold of pain perception. As of 2009, controlled clinical trials of JDTic or its analogues in humans have yet to begin. But results in non-human "animal models" are encouraging.

        Unfortunately, opioids in present-day human use are flawed. Taken at fixed dosage, they lose some of their euphoriant and analgesic effect as tolerance sets in; opioid drugs are physiologically addictive. Overdoses can cause respiratory depression; by contrast, physical pain is a potent respiratory stimulant. When taken recreationally, opioids inspire a dreamily contented disengagement from the problems of the world. Their use diminishes our drive to constructive activity as consumers in today's competitive global marketplace. More insidiously, excess consumption of narcotics inhibits the release of endogenous opioids normally induced by social interaction with friends and family. By diminishing the craving for human companionship, the addict substitutes one form of opioid addiction for another. Thus junkies are usually "selfish".

        The physical risks of opioid use shouldn't be exaggerated. Most of the problems that users suffer ultimately derive less from their choice of drug itself than from the illegal status of narcotics in prohibitionist society. Yet even if opioid drugs were legal and given away in cereal packets, such drugs wouldn't make a good choice of mood-booster - or at least not in their present, crudely non-specific guise. Kappa receptor agonists, for instance, impair dopamine function. They have dysphoric and psychotomimetic effects: one might as well drink ethyl alcohol spiced with meths. The paradise-engineers of posterity will surely weed out such adulterants from their elixirs altogether.

        By contrast to today's opioids, marijuana isn't usually addictive in the traditional sense of the term. It can still be habit-forming. Marijuana has euphoriant, psychedelic and sedative properties. Experiments with stoned rats suggest that cannabis use reduces the amount of corticotrophin-releasing factor (CRF) in the amygdala. Excess secretion of CRF is associated with abnormalities in the HPLA axis and depression. The rebound surge of CRF on ceasing cannabis-use correlates with increased vulnerability to stress and a withdrawal-reaction, arguably one good reason not to stop in the first instance. Stress-induced endocannabinoid deficit in the brain may induce melancholic depression in users and non-users alike. A dysfunctional response to stress, linked to a chronically overactive HPLA axis, causes anxiety disorders and depression; CRH-type 1 receptor antagonists like antalarmin are being investigated as potential anxiolytics and antidepressants. The deeper roots of our malaise lie buried in the evolutionary past.

        The primary psychoactive ingredient in marijuana is THC, tetrahydrocannabinol. Smoking or eating marijuana and its complex cocktail of compounds may rarely trigger episodes of depersonalisation, derealisation and psychosis. Sometimes it can induce paranoia, particularly in advocates of The War Against Drugs. More commonly, marijuana just leaves the user pleasantly and harmlessly stoned. It's fun. Sleepiness, pain-relief and euphoria are typical responses. Cannabinoid CB(1) receptor agonists are potential antidepressants. Indeed cannabinoids may be neuroprotective against the effects of stress. Conversely, cannabinoid CB(1) receptor antagonists/inverse agonists, like the new EC-licensed diet-drug rimonabant (Acomplia), may cause depression and anxiety. Indeed the first brain-derived substance found to bind to our cannabis receptors was christened "anandamide", a derivative of the Sanskrit word for internal contentment. Getting high may thus serve as an innocent recreational pastime in an uncaring world.

         Yet marijuana is not a wonderdrug. Cognitive function in the user is often impaired, albeit moderately and reversibly. Marijuana interferes with memory-formation by disrupting long-term potentiation in the hippocampus. One of the functions of endogenous cannabinoids in the brain is to promote selective short-term amnesia. Forgetting is not, as one might have supposed, a purely passive process. Either way, choosing deliberately to ingest an amnestic agent for long periods is scarcely an ideal life-strategy. It's especially flawed given the centrality of memory to human self-identity. Some artists and professional bohemians, it is true, apparently do find smoking grass an adjunct to creative thought. For persons of a more philistine temperament, on the other hand, it's hard to see such a drug as a major tool for life-affirmation or the development of the human species. This shortcoming does not, one ought scarcely need to add, suggest marijuana users should be persecuted and criminalised. Indeed the marijuana compound THC may actually be superior to commercially licensed products at blocking the formation of mind-rotting amyloid plaques of the memory-destroying Alzheimer's disease.

        The disparate drugs we label “psychedelics” - lysergamides like LSD-25, tryptamines like DMT and psilocybin, and phenethylamines such as mescaline - are sometimes exhilarating. At best, they are life-transforming and soul-enriching. They can certainly be mind-wrenching. Taking major psychedelics can generate experiences too outlandish for our normal conceptual framework to accommodate. We haven't even names for the strange new modes of perception, selfhood and introspection their biochemical pathways disclose.

        Unfortunately, one can’t look after the kids, fill in one’s tax forms or carry out one’s social responsibilities while tripping on LSD. Psychedelics are typically too bizarre, exotic and ineffable in their effects to integrate into the rest of one’s life. By trapping most of us in "ordinary" waking consciousness, selfish DNA stumbled on a cunning trick to help its vehicles leave more copies of itself. Worse, the psychedelics aren't primarily euphoriants. They don’t directly stimulate the pleasure-centres and guarantee the user a good trip. Both the serotonin- and catecholamine-like families trigger psychedelia mainly via their role as partial agonists of the 5-HT2A receptors in the central nervous system; 5-HT2 heteroreceptors exert a tonic inhibitory effect on the striatal dopaminergic neurons. Such agents aren’t a dependable choice of clinical or recreational mood-brightener, whether in the short- or long-term. Depressives, neurotics and other troubled souls in search of enlightenment are most likely to undergo nightmarish freak-outs. Psychotic derealisation isn't illuminating - or fun. The drug-naïve mind can’t make an informed prior choice of whether to explore radically altered states. For aspiring psychonauts can’t know, in advance, the true nature of what they may be choosing - or missing.

        Ultimately, when our well-being is genetically hardwired and invincible, psychedelia can be safely explored. The study of consciousness can become an experimental discipline. The synthesis of tomorrow’s designer-psychedelics may unleash an intellectual revolution without precedent. Until then, psychedelic drugs are too unpredictable - and our dark, Darwinian minds are too poisoned - responsibly to promote their use.

        Apparently by contrast, the empathogen "hug-drug" Ecstasy (methylenedioxymethamphetamine; MDMA) offers a wonderfully warm, sensuous, loving, and empathetic peak experience to the first-time user - "a brief fleeting moment of sanity" [Dr Claudio Naranjo]. MDMA enhances the release of serotonin and dopamine at the synaptic terminals; it also inhibits their reuptake. MDMA stimulates pro-social oxytocin release via activation of the serotonin 5-HT1A receptors. In consequence, distrust, suspicion and jealousy evaporate. They are replaced by a serene sense of universal love. The sensorium remains clear. Emotion is intensified. Much recreational drug-use tends to be self-centred. Drug use is often branded as selfish. Yet here is a "penicillin of the soul" which promises to subvert our DNA-driven tendency to self-aggrandisement.

        Disappointingly, whether due to enzyme-induction or other causes not fully understood, most users never fully recapture the magic of their first few trips. Moreover, Ecstasy is neurotoxic to serotonergic axons. It may even be harmful at sub-therapeutic doses. As the uncertain process of neural recovery sets in, heavy users in particular may experience the subtle long-drawn-out reversal of all the good effects they initially enjoyed from the drug. Taking a post-trip selective serotonin re-uptake inhibitor (SSRI) such as fluoxetine (Prozac) 2-6 hours afterward is prophylactic against the measurable post-E serotonin dip otherwise experienced some 48 hours later. Yet taking SSRIs on a regular basis largely nullifies the already attenuated benefits of prolonged Ecstasy use. In any case, the duration of the peak E experience is a mere 90 minutes. So taking Ecstasy scarcely amounts to a full-scale strategy for life either. Ecstasy does, on the other hand, deliver an exquisite foretaste of the beautiful forms of consciousness that ultimately await us.

        Another tantalising and deliciously sensuous hint of the sublime is offered - infrequently and unpredictably - by gamma-hydroxybutyrate (GHB). GHB usually takes the form of a clear, odourless, slightly salty-tasting liquid. In the brain, the GHB molecule is also an endogenous precursor and metabolite of the inhibitory neurotransmitter GABA. GHB is non-toxic; but it mustn't be mixed with alcohol or other depressants. It's metabolised quickly to carbon dioxide and water. GHB's steep dose-response curve means naïve users run the severe risk of falling asleep. When used lightly in recreational rather than stuporific or anaesthetic doses, GHB is a touchy-feely compound which typically induces deep muscular relaxation, a sense of serenity, and feelings of emotional warmth. Often it enhances emotional openness and the desire to socialise. Tactile sensitivity and the appreciation of music are enriched. Most remarkably, the moderate user may awake refreshed after a deep restful sleep: GHB appears temporarily to inhibit dopamine-release while increasing storage, leading to the brightened mood and sharpened mental focus of a subsequent "dopamine-rebound". GHB acts both as a disinhibitor and an aphrodisiac. Intensity of orgasm is heightened. Hence GHB is potentially useful in relieving the psychopathologies of prudery and sexual repression. Unfortunately, its therapeutic value has been eclipsed by its demonisation in the mass-media. Stories of chaste virgins turning into sex-crazed nymphomaniacs make great copy and poor scientific medicine. Moreover GHB is sometimes confused with the amnestic "date-rape" benzodiazepine, flunitrazepam - better-known as the potent and fast-acting sedative-hypnotic "forget pill", Rohypnol. Bought on the street, GHB may be confused with all sorts of other substances too.

        Yet even pure GHB is no magic elixir. Not everyone likes it. GHB's psychological effects are unpredictable and poorly understood. It has a relatively low therapeutic index. Nausea, dizziness, inco-ordination are common; reaction-time is slowed. GHB does not usually promote great depth of thought. Its very status as "an almost ideal sleep inducing-substance" makes it of limited use to those who aspire instead to be more intensely awake. The lack of any discernible body-count to fuel the periodic moral panics its use induces may allow a partial rehabilitation. Yet GHB evokes - at best - only a faint, fleeting parody of the life-long chemical nirvana on offer to our transhuman successors.

        Ethyl alcohol - the traditional date-rape drug of choice - and, most insidiously of all, cigarettes are the really sinister mass-killers. A report published in The Lancet in March 2007 ranked alcohol and tobacco as more hazardous to human health than LSD. Their cumulative human death-toll to date is around 100 million and climbing. A WHO report published in February 2008 projected that tobacco abuse may kill one billion people by the year 2100. With that poker-faced Alice-In-Wonderland logic popular amongst the world's sleazier governments, not merely do the authorities preserve the legal status of cigarette sales here in the UK on grounds of upholding personal liberty. The slickly expensive marketing and glamorisation of tobacco products to potential victims is sanctioned on similar grounds too. We ought to be as shocked at tobacco promotion as we'd certainly feel if instead the billboards urged kids to try heroin because it's cool. Yet familiarity breeds moral apathy. Youngsters are typically hooked before they are in any position to make an informed choice of their preferred poison - or even to abstain altogether. Meanwhile a state-supported export drive targets the poor in vulnerable Third World countries. With a cynicism that almost beggars belief, one celebrated British ex-Prime Minister accepted a million-dollar bribe from a leading member of the drug-cartels for her services. Her party's Home Secretary then delivered himself of blood-curdling calls for a crack-down on evil drug-pushers(!). He went on to increase the draconian penalties already available for personal users of cannabis.

        So long as our governments collude with the tobacco drug cartels to share out the billions of dollars of tax revenues mulcted from nicotine-addicts - thereby keeping direct taxes visibly down and themselves visibly in office - there seems little hope of a more intelligent approach to psychoactive drugs as a whole.


DIRTY MOOD BRIGHTENERS

The commonly recognised legal and illegal recreational drugs offer poor prospects for sustained biological mood-enhancement. So what about the heterogeneous group of compounds uninvitingly labelled as anxiolytics and antidepressants? Have they potentially anything significant to add to most people's quality of life? Official medical doctrine says no. Allegedly, only sufferers from clinically-sanctioned psychiatric disorders will benefit from such agents - though in recent years it has at last been formally recognised that depressive disorders are under-diagnosed and under-treated even by the early twenty-first century's abjectly poor standards of acceptable ill-being. Most of humankind, however, still doesn't fit any of the official diagnostic boxes. So can "diagnostic creep" triumph over therapeutic minimalism and enhance our quality of life? Yes. Must the goal of pharmacotherapy be as limited as Freud's aspiration for psychotherapy: "to transform hysterical misery into common unhappiness"? No.

        First, the boring but crucial preliminaries. Optimal nutrition and aerobic exercise will increase the efficacy of all the potential life-enhancers touted here. A rich supply of precursor chemicals (e.g. l-tryptophan, the rate-limiting step in the production of serotonin) can also reduce their effective drug dosages. By choosing to eat an idealised "stone-age" diet rich in organic nuts, seeds, fruit and vegetables, and drastically reducing one's consumption of saturated fat (red meat, fried foods), sugar (sweets etc) and hydrogenated oils (found in margarine and refined vegetable oils), then one's baseline of well-being - or at least relative ill-being - can be sustainably lifted. There is mounting evidence too that an omega-3 fatty acid-rich diet or supplementation is protective against depression and other psychiatric disorders. Folic acid augmentation is advisable as well. Visitors to HedWeb probably don't expect to be assailed by sermons on the benefits of exercise any more than food-faddism. Yet regular and moderately vigorous physical exertion releases endogenous opioids, enhances serotonin function, stimulates nerve growth factors, promotes cell proliferation in the hippocampus, and leads to a livelier, better-oxygenated brain.

        Alas, clean living and wholesome thoughts typically aren't enough. We need stronger medicine to flourish. At first glance, however, the standard, State-rationed chemicals aren't a brilliant bunch.

        The so-called minor tranquillisers, benzodiazepines such as diazepam (Valium), chlordiazepoxide (Librium), alprazolam (Xanax), lorazepam (Ativan), clonazepam (Klonopin) and the shorter-acting sedative-hypnotic temazepam (Restoril), are useful but still dreadfully crude anti-anxiety agents. Several benzodiazepines are of natural origin: diazepam, for instance, can be found in the potato. Benzodiazepines act primarily on the GABA (gamma aminobutyric acid) receptor complex. GABA functions as the main inhibitory neurotransmitter in the central nervous system. GABA is made from the main excitatory neurotransmitter, glutamate. The progress of molecular biology and neurogenetics in unravelling the fiendish complexity of GABA's receptor sub-types should eventually allow more targeted compounds to be developed. Ideally, these more selective and site-specific drugs will lack the sedative, amnestic and hypnotic properties of today's brands. Activation of GABA(A) receptors containing the alpha 1 subunit is responsible for benzodiazepine-induced sedation and memory deficits. It is hoped that newly-synthesised agonists selective for the alpha 2 GABA(A) receptor subtype may finally deliver a non-sedating antianxiety drug. Merck's investigational L838,417 is one such candidate. Human trials are eagerly awaited. The first non-benzodiazepine, non-sedating/amnesiac drug of its class to reach the market may prove to be DOV Pharmaceutical's ocinaplon. Ocinaplon is a GABA alpha-2 modulator. It exerts its anti-anxiety effect at doses (allegedly) substantially lower than doses that induce measurable sedation, amnesia, muscle relaxation and incoordination. Ocinaplon is in phase III clinical trials for anxiety (summer 2005; temporarily(?) suspended August 2005). In the meantime, currently licensed benzodiazepines tend to induce dependence, impair memory and psychomotor performance, dull consciousness and cloud the intellect. So there's not much chance of radical life-enrichment here, for now at least.

        Buspirone (Buspar) might seem more promising. It acts to desensitise the inhibitory autoreceptor 5-HT1A subtype of serotonin receptor, thereby modulating serotonin release and (sometimes) promoting a brightening of mood. Thus buspirone can be useful in anxious depressive states. Its active metabolite 1-PP is an anxiolytic 5-HT1A partial agonist too. Buspirone lacks the intellect-clouding effects of other clinical and alcoholic anti-anxiety agents. It's not a muscle relaxant. It's only mildly sedating. Yet buspirone's weak and equivocal effects on sub-types of dopamine function, while useful commercially for the purposes of touting its lack of "abuse-potential", mean buspirone isn't very exciting or popular. Crucially, unlike the benzodiazepines, it's not a fast-acting drug. Several weeks of use may pass before its dubious psychological benefits are felt. Researchers hope that newer 5-HT1A agonists in the pipeline will be more effective. Alas any therapeutic gain is likely to be modest. In June 2004, the FDA determined that Organon's gepirone (Ariza) was "not approvable". In February 2007, GlaxoSmithKline and Fabre-Kramer Pharmaceuticals announced an exclusive worldwide agreement for the development and commercialisation gepirone ER. A FDA review of its use for major depressive disorder is anticipated in 2009.

        Oxytocin is a natural anti-anxiety agent: the "cuddle hormone". Several drug companies, notably Wyeth, are investigating its patentable synthetic analogues. Enhanced oxytocin release contributes to the acute pro-social action of MDMA (Ecstasy). Oxytocin builds trust by reducing activity in the fear-processing circuitry of the amygdala. Taken off-label, oxytocin can be inhaled as an intranasal spray to combat social phobia. It reduces shyness and normal social anxiety. More controversially, oxytocin can be applied as an odourless body-spray to manipulate the responses of other people: "trust in a bottle". Nature's social peptide is also critical to pair-bonding. In future, mastery of the oxytocin system may allow us to control our degree of fidelity and attachment to each other far more effectively than marriage vows. The sociological implications of the widespread use and abuse of "social Viagra" would be far-reaching. It should be stressed that research into the safe and sustainable enrichment of human oxytocin function has barely begun.

         The ill-assorted drugs we today call antidepressants fall into several categories. Their delayed-onset mood-brightening effect is correlated with alterations in the concentration of catecholamines and/or serotonin in the central nervous system, long-term receptor re-regulation, activation of specific transcription factors regulating gene expression, and new nerve-cell growth in the hippocampus. In the first decade of the 21st century, older monoamine theories of depressive illness popular among researchers over the past 40 years have been eclipsed by the neurogenic hypothesis of depression and antidepressant action. The neurogenic model interprets depression, at least in its more severe forms, as a neurodegenerative disorder. Chronic uncontrolled stress causes oversecretion of gluocorticoid hormones, notably cortisol. Cortisol activates the glucocorticoid receptors that regulate metabolism, inflammation and immunity. An excess of glucocorticoid hormones reduces the rate of new brain cell-proliferation in the hippocampus. The hippocampus has the highest density of receptors for glucocorticoids in the brain. Stress-induced activation of the glucocorticoid receptors causes nerve cell death and dendritic atrophy in the hippocampus; by contrast, there is synaptic growth in the basolateral amygdala. The amygdala stores memories of emotional experiences - frequently fearful and unpleasant memories. Eventually, however, prolonged stress tends to atrophy the amygdala too. These long-term changes in brain morphology lower mood. They may result in anhedonia and depression in the genetically vulnerable. Antidepressants either diminish, prevent or (ideally) reverse stress-induced neural damage and impaired structural plasticity. How do they really work? Despite an explosive growth in neurobabble, no one knows.

        The tricyclics, prototypically imipramine (Tofranil), and their allies are relatives of the neuroleptic drug chlorpromazine. Chlorpromazine is also known as Largactil, the notorious "chemical cosh". Tricyclics block to varying degrees the reuptake of serotonin and noradrenaline into the nerve cell terminals from where they are released. The consequent changes in pre- and post-synaptic receptor sensitivity may lighten the spirits of 60-70% of the depressives who take them. Perhaps unsurprisingly given their parentage, the tricyclics are all dirty drugs, though some are dirtier than others. Their anti-cholinergic effects harm memory, concentration and intellectual performance. Their anti-histamine action induces drowsiness and sedation. Their adverse effect on cardiac function makes them dangerous in overdose. Most "euthymic" volunteers on whom they have been tested don't like their dulling effects of consciousness. Unlike chlorpromazine, the tricyclic antidepressants don't noticeably block the dopamine receptors. But with one notable exception, they do precious little to stimulate dopamine function either. Hence they're not much fun even for the severely depressed people who can benefit from taking them. For three decades they were the mainstay of the treatment of clinically-acknowledged depression. They contributed to the widely-held medical opinion that anything classed as an antidepressant won't help "normal" people; unless of course they were "really" depressed. Basically, tricyclics are cheap, nasty and usually best avoided.

        Better, but still deeply flawed, are the selective serotonin reuptake inhibitors [SSRIs]. Serotonin, "the civilising neurotransmitter", plays a vital role in mood, memory, appetite, sleep, pain perception and sexual desire.         Fluoxetine (Prozac), fluvoxamine (Luvox, Faverin), paroxetine (Paxil, Seroxat), sertraline (Zoloft, Lustral), and citalopram (Cipramil, Celexa) are currently licensed and marketed. More of their tweaked and enhanced relatives are on the way from pharmaceutical companies eager for a lucrative piece of the action. In a triumph of marketing hype and creative use of patent law if not clinical need, citalopram's S-enantiomer was FDA-licensed in 2002 as "Lexapro". The SSRIs all differ in their half-lives, chemical structure and precise specificities. Their functional effects are broadly similar, though Prozac is the most activating, longest-lasting, least selective and most likely to provoke dose-related akathisia; paroxetine has anticholinergic and sedating antihistaminergic effects; fluvoxamine most commonly induces nausea and has the shortest half-life; and citalopram is the most serotonin-selective. The mood-brightening, resilience-enhancing and anti-anxiety properties of the SSRIs really can make a (very) modest percentage of the population feel "better than well". Unpredictably, other users feel worse. As a class, SSRIs (mostly) don't have the physically unpleasant and cognitively debilitating anticholinergic effects of the tricyclics. SSRIs don't demand the dietary restrictions of the MAOIs. Their dependence potential and withdrawal reaction is usually milder than the opioids.

        The (sometimes) beneficent properties of the SSRIs are celebrated in Peter Kramer's contemporary classic Listening to Prozac. Kramer has written a remarkably honest book. It's a discursive memoir by a therapist who is forced to admit that many of his clients seemed rapidly to fare far better on a pill than on his industrial-strength regimen of caring talk-therapy. Kramer's discussion of "cosmetic psychopharmacology" and "designer personalities", however, enraged traditionalists. For chemical Calvinist orthodoxy finds the notion that people should have a right to choose pharmacologically who and what they want to be profoundly offensive. In Against Depression, published in May 2005, Kramer argues that depression should be eradicated altogether.

        Two common problems limit the usefulness of SSRIs, at least when taken on their own. The problems stem from the indirect inhibitory effect sometimes exerted by Prozac-style drugs on dopamine function, a consequence of deliberate selective targeting of the serotonin system.

  • First, SSRIs can compromise libido and sexual performance. This isn't always a disadvantage in over-excitable young males; indeed the currently unlicensed SSRI dapoxetine may shortly be marketed as an on-demand treatment for premature ejaculation. But SSRI-induced sexual dysfunction can still be a highly distressing phenomenon for older people too embarrassed to talk about it. Technical performance difficulties can sometimes be counteracted by taking the blood vessel dilators apomorphine or phentolamine; the alpha2-adrenergic antagonist yohimbine; a phosphodiesterase type-5 inhibitor like sildenafil (better known as the sexual rocket-fuel Viagra), long-acting tadalafil (Cialis) or newly licensed vardenafil (Levitra); or a dopamine agonist, licit or otherwise, before bedtime action. Investigational drugs that heighten female sexual arousal (e.g. flibansein, or melanocortin agonists like PT-141/bremelanotide) are another option. Indeed, unlicensed use of the world's first aphrodisiac and inhalable sex-drug may herald a cultural revolution without precedent. Yet polypharmacy is scarcely an ideal solution for existing SSRI users. One of the major signs of depression is loss of interest in sex and reduced libido. So it's questionable whether the FDA and the pharmaceutical industry should continue to promote serotonergic "antidepressants" that are anti-sexual; and collude to suppress antidepressants that are pro-sexual.

  • Second, though a few subjects may feel mildly euphoric, in other users the SSRIs serve more as mood-stabilisers and mood-flatteners in their lives. By increasing the user's emotional self-sufficiency, too, SSRIs may subtly change the "balance of power" in personal relationships - for good or ill. In some cases, SSRIs may even act as thymoanaesthetisers which diminish the intensity of felt emotion; by contrast, a mood-brightening serotonin reuptake-enhancer like tianeptine (Stablon) may intensify emotion instead. Affective flattening may be welcome to someone in the pit of unmitigated clinical depression. It is scarcely a life-enriching property for "normal" people who lack any convenient diagnostic category which acknowledges their malaise.

A backlash against SSRIs is now gathering pace. In February 2008, a Public Library of Science meta-analysis of four commonly prescribed "second generation" antidepressants - using both published and withheld drug-company data - reported that SSRIs were scarcely more effective as antidepressants than placebos. The illustrious UK psychopharmacologist Professor David Healy delivers an even more damning verdict on contemporary psychiatry: "there is probably no other branch of medicine where the outcomes for a core disease are steadily worsening." [p. 95; Shock Therapy by Edward Shorter and David Healy (2007)]

THE DOPAMINE CONNECTION

What's missing, crucially, is the therapeutic enrichment of hedonic tone via a combination of mu opioid pathway enhancement and prolonged stimulation of meso(cortico-)limbic dopamine function.

        This is really much more fun than it sounds. Yet the socially responsible use of reward pathway enhancements/remedial therapies is a technical, bioethical and medico-legal minefield. Complications aside, the currently available experimental evidence has persuaded many - but not all - investigators that the mesolimbic dopamine system serves as the final common pathway for pleasure in the brain. Enhanced responsiveness of post-synaptic dopamine D2/D3 receptors is vital to long-term emotional well-being. Insofar as they work, all "serotonergic" and "noradrenergic" mood-brighteners eventually act on the mesolimbic dopamine pathway, albeit in differing degrees and with varying delay. Even SSRIs depend on sensitization of the mesolimbic dopamine D2 receptors for their (modest) mood-lifting effect. New anti-Parkinsonian agents, notably the neuroprotective dopamine D3 receptor subtype selective pramipexole (Mirapex), ropinirole (Requip), and cabergoline (Dostinex) owe their potential role as fast-acting pro-sexual antidepressants to their dopaminergic action. Likewise, the possible mood-brightening effect of low doses of the dopamine receptor antagonist amisulpride (Solian), more commonly considered an antipsychotic agent, is explicable because amisulpride preferentially blocks the presynaptic dopamine D2/D3 autoreceptors; dopaminergic transmission is thereby enhanced.

        The full story is inevitably complex. Dopamine agonists and reuptake inhibitors are often inadequate long-term mood-brighteners by themselves. The mesolimbic dopamine system mediates reward-signalling, incentive salience and a sense of urgency and significance, not the essence of pure bliss. Dopamine isn't itself the magic pleasure-chemical, though its functional role in conjunction with glutamate and mu opioid agonists in regulating medium spiny neurons of the rostromedial shell of the nucleus accumbens is critical. Researchers into affective disorders can prematurely become over-attached to one particular neurotransmitter system, its receptor sub-types and their signal-transduction cascades. Traditionally, serotonin and noradrenaline have attracted the fiercest rival partisans in antidepressant research. "Dopaminergic" (and opioid) agents, by contrast, are suspect. They are politically incorrect since they are potentially "abusable". Moreover it can be argued that the research and development of safe and sustainable Ecstasy-like empathogens and sociabilisers is at least as morally urgent as the license of safe and sustainable euphoriants. At any rate, enhanced mesolimbic dopamine release, exclusively or otherwise, enriches the intensity of experience; increases pleasure and libido, and potentially boosts cognitive performance. Even better, whereas some dopaminergics are potentially toxic, some dopamine-enhancing agents may have neuroprotective properties as well.

        So what are the other contemporary options for chemical life-enhancement?

METHYLPHENIDATE (RITALIN); MINAPRINE (CANTOR); NOMIFENSINE (MERITAL)
        A SSRI can be combined ("augmented" sounds more soothing to the official medical ear) with a dopaminergic such as methylphenidate. As Ritalin, methylphenidate is prolifically dispensed to American schoolchildren for different purposes altogether. It is sometimes abused as an instrument of social control. In spite of its structural relationship to amphetamine, methylphenidate resembles in many ways a more benign version of cocaine, yet with a much longer half-life. Methylphenidate blocks the reuptake of, but doesn't significantly release, the catecholamines noradrenaline and dopamine. If it is taken in sustained-release form or combined with an SSRI, all of which have anti-obsessive-compulsive properties too, then the likelihood of dose-escalation is minimised. In Europe and North America, students sometimes take Ritalin to gain a competitive edge in exams. However, its long-term effect on the developing brain is poorly understood.

        Chewing coca leaves with a dash of powdered lime is a nutritious and energising way to sustain healthy mood. Unfortunately, it's illicit and not very good for one's teeth.

        A more cautious but still interesting option might be minaprine (Cantor). Minaprine blocks the reuptake of both dopamine and serotonin. It is also in some degree cholinomimetic. Thus it may exhibit both mood-brightening and nootropic properties. Much more research is needed. Unfortunately, minaprine is now obtainable only as a "research chemical".

        Merital (nomifensine) showed great promise as a pleasantly stimulating dopaminergic that also potently inhibits the reuptake of noradrenaline and - to a much lesser extent - serotonin. It was marketed by its manufacturers Hoechst with the slogan "vive la difference!" Merital was withdrawn from licensed use after the discovery of its rare side-effect of precipitating a serious blood-disorder. For retarded melancholics, however, it was typically a very effective and well-tolerated mood-brightener with minimal side-effects. The risk/reward ratio of its carefully-monitored use may have been misjudged. Nomifensine is now obtainable only as a research chemical too.

BUPROPION (WELLBUTRIN); AMINEPTINE (SURVECTOR); TIANEPTINE (STABLON)
Bupropion (Wellbutrin) is possibly less effective than nomifensine. Yet it's useful because it lacks the adverse effects on sexual function characteristic of the SSRIs. In some subjects - particularly women - libido, arousal, and the intensity and duration of orgasm may actually increase. Bupropion weakly blocks the reuptake, but diminishes the release, of dopamine. This may account for reports of its diminished propensity to induce mania in the genetically susceptible. Bupropion's active metabolites inhibit the reuptake of noradrenaline. Radafaxine, one of these metabolites, also blocks the dopamine transporters; radafaxine may in future be marketed as a slimming drug as well as an antidepressant. Bupropion itself, branded as Zyban, may help in giving up smoking. Scandalously, bupropion isn't licensed and marketed as an antidepressant in Europe - though doctors may prescribe Zyban to non-smoking depressives "off-label". Bupropion plus an SSRI is sometimes more effective than either agent alone. In June 2006, the FDA licensed bupropion/Wellbutrin XL as the first preventive pharmacological treatment of Seasonal Affective Disorder (SAD).

        Amineptine (Survector) is a cleanish, (relatively) selective dopamine reuptake blocker. Higher doses promote dopamine release too. Amineptine is pro-sexual and liable occasionally to cause spontaneous orgasms. It is a mild but pleasant psychostimulant and a fast-acting mood-brightener. Unlike most other tricyclics, it doesn't impair libido or cognitive function. Unlike typical stimulants and other activating agents, it may actually improve sleep architecture. Scandalously, amineptine isn't licensed and marketed in Britain and America. For it is feared it might have "abuse-potential". FDA pressure led to its withdrawal in Europe too. This drove amineptine onto the pharmaceutical grey market, discomfiting doctors and patients alike.

        Another "French" option is amineptine's cousin, tianeptine (Stablon). Tianeptine is a neuroprotective antidepressant that reverses the neuronal damage and lasting misery caused by uncontrolled stress. Chronic stress causes dysphoria by inducing corticotropin-releasing factor (CRF2) receptor stimulation of dynorphin release. The endogenous opioid peptide dynorphin activates the unpleasant kappa opioid receptors. Tianeptine acts both as a non-sedating anti-anxiety agent and a non-stimulating mood-brightener. Its use increases extracellular dopamine concentration in the nucleus accumbens and, at higher doses, in the frontal cortex. Uniquely in clinical medicine, tianeptine acts as a selective serotonin reuptake enhancer. Its puzzling efficacy as an antidepressant illustrates how little modern psychiatric medicine really understands about mind, mood and depression. Like other contemporary antidepressants, tianeptine's therapeutic action presumably depends on downstream adaptations both between and within neurons occurring over a period of several weeks. Chronic tianeptine use reverses stress-induced hippocampal dendritric atrophy and amgydaloid dendritic hypertrophy, which is just as nasty as it sounds. But the precise molecular mechanisms are obscure. Tianeptine/Stablon is not licensed in North America primarily because its patent has expired.

REBOXETINE (EDRONAX); ADRAFINIL (OLMIFON); MODAFINIL (PROVIGIL)
        Reboxetine (Edronax) is a relatively well-tolerated, relatively selective "noradrenergic" agent. Crudely, whereas serotonin plays a vital role in mood, noradrenaline is essential to maintaining drive, vigilance and the capacity for reward. There's a fair bit of evidence that chronically depressive people have dysfunctional and atypical noradrenergic systems - particularly their alpha2- and beta-adrenoceptors. Reboxetine itself typically doesn't have the disruptive effects on cognitive function or psychomotor performance common to older clinical mood-brighteners - though alas antimuscarinic effects are still not completely absent. Multiple interactions between the different monoamine systems make it hard to target one neurotransmitter system without triggering a cascade of effects on the others. But NorAdrenaline Reuptake Inhibitors (NARIs) - and dopaminergics like amineptine (Survector) - may be especially useful in drive-deficient "anergic" states where the capacity for sustained motivation is lacking; and for melancholic depressives with a poor ability to cope with stress. Reboxetine can be safely combined with an SSRI, though there is evidence that NARIs themselves indirectly enhance central serotonin function by a mechanism that doesn't depend on reuptake inhibition. More surprisingly perhaps, preliminary studies suggest reboxetine can actually reverse tranylcypromine-induced hypertensive crises. The "cheese effect" is triggered by ingesting tyramine-rich foods. Thus NARIs plus MAOIs may prove a potent form of combination-therapy if first options fail. EMSAM, the transdermal selegiline patch, is probably the safest choice of MAOI.

        Depressive hypersomniacs who fare poorly on SSRIs, or can't get hold of amineptine or EC-licensed reboxetine, might consider trying a so-called eugeroic ("good arousal") agent instead. Alpha1-adrenergic agonists like adrafinil (Olmifon) and modafinil (Provigil, Alertec) are centrally-acting psychostimulants that can brighten mood and sharpen mental focus. They stimulate the noradrenergic post-synaptic receptors, increase glutamatergic transmission, and activate the wakefulness-promoting orexinergic neurons, thereby boosting alertness, memory, mood, motivation and energy. At sensible dosages, they are remarkably free of side-effects. Modafinil was licensed by the FDA as Provigil for the treatment of narcolepsy in Dec 1998; and in September 2003, an advisory panel to the FDA endorsed its use for treating shift work sleep disorder and sleep apnea. However, the significance of these prescribing indications is rapidly being eroded. Modafinil and adrafinil are now mainly used off-label as so-called lifestyle drugs.

        Of course, many millions of insomniacs suffer from the opposite problem. They simply want regular sleep. Supracor's new sleep-aid eszopiclone (Lunesta) can be taken on a nightly basis indefinitely. It will be the first sleeping pill not to carry an FDA warning against long-term use.

MIRTAZAPINE (REMERON); NEFAZODONE (SERZONE); VENLAFAXINE (EFFEXOR) & DESVENLAFAXINE (PRISTIQ); DULOXETINE (CYMBALTA); ROLIPRAM; AGOMELATINE (VALDOXAN)
        NARIs are normally activating. Anxious and depressive insomniacs, on the other hand, may benefit more from "dual-action" mirtazapine; or from newly-licensed duloxetine.

        Mirtazapine (Remeron) is a structural analogue of the off-patent mianserin (Bolvidon). It is a comparatively new drug - a so-called NaSSA. By blocking the inhibitory presynaptic alpha2 adrenergic autoreceptors and stimulating only the 5-HT1A receptors, mirtazapine enhances noradrenaline and serotonin release while also blocking two specific (5-HT2 and 5-HT3) serotonin receptors implicated in dark moods and anxiety. By contrast, stimulation of the 5-HT2A receptors accounts for the initial anxiety, insomnia and sexual dysfunction sometimes reported with the SSRIs; stimulation of the 5-HT3 receptors causes nausea. Unfortunately, mirtazapine is a potent blocker of the histamine H1 receptors too. So it tends to have a somewhat sedative effect. This profile may be good for agitated depressives and insomniacs. Again, it is scarcely a recipe for life-affirmation.

        Nefazodone (Serzone) is another "dual action", mainly serotonergic agent. It inhibits the reuptake of serotonin while displaying post-synaptic 5-HT2A-receptor antagonism. This may be useful for anxious depressives; but again, it may cause feelings of weakness, drowsiness and lack of energy. Nefazodone is less likely to cause priapism than its older cousin trazodone (Desyrel). It is less likely to cause sexual dysfunction than the SSRIs. But nefazodone can also be toxic to the liver, albeit rarely. It may soon be withdrawn altogether by its manufacturer Bristol-Myers Squibb under threat of litigation.

         Venlafaxine (Effexor) is a phenethylamine. Thus it's a benign if distant chemical cousin of MDMA. Its manufacturers launched it as "Prozac with a punch". In February 2008, the FDA licensed its extended-release active metabolite desvenlafaxine as the antidepressant Pristiq after Weyth's venlafaxine patent expired. Venlafaxine inhibits the neuronal reuptake of serotonin, noradrenaline and dopamine in descending order of potency. If dopaminergically augmented, it offers another opening for creative psychopharmacology. Such augmentation-therapy remains (almost) clinically unexplored. Taken on its own at low dosage, venlafaxine acts primarily as a serotonin re-uptake inhibitor. At the high-level dosages most suitable for melancholic and hypersomnic temperaments, its noradrenergic (and weakly dopaminergic) action becomes more pronounced. Venlafaxine lacks anticholinergic activity; but some users are troubled by its antihistamine side-effects. Like the SSRIs, it is sometimes useful for a broad spectrum of disorders beyond clinical depression.

         It is possible that duloxetine (Cymbalta, Xeristar, Yentreve), licensed by the FDA in autumn 2004, and milnacipran (Ixel, Dalcipran, Toledomin), available in Europe, may be more effective than venlafaxine (Effexor) for a segment of the population that can benefit from dual serotonin-noradrenaline reuptake inhibition. Pain-ridden depressives in particular may respond well to this class of drug. Many depressed people suffer from poorly-defined aches and pains, persistent fatigue, and shoulder-, neck- and back-pain. Duloxetine relieves both the somatic and emotional symptoms of depression. Unlike venlafaxine, duloxetine exerts its more balanced serotonin and noradrenaline reuptake inhibition throughout the dosage range. Duloxetine also weakly inhibits the reuptake of dopamine, and shows minimal affinity for the histamine and cholinergic muscarinic receptors. Its side-effect profile appears to be relatively benign. Yet an authentic wonderdrug for mental health remains elusive. Early expectations that duloxetine would show superior efficacy in melancholic depressives have not yet been convincingly borne out in controlled clinical trials. Ill-served by mainstream medicine, victims of melancholic and retarded depression may actually do better on dual noradrenaline-dopamine reuptake inhibitors such as delicensed nomifensine (Merital) and/or mu opioid agonists/kappa opioid antagonists such as buprenorphine (Temgesic, Buprenex, Subutex). Duloxetine itself will probably prove a blockbuster product. It will most likely be marketed for everything from stress urinary incontinence, social phobia and generalised anxiety disorder, diabetic peripheral neuropathic pain and possibly irritable bowel syndrome. But alas it takes time to separate genuine therapeutic advance from drug company hype, typically not until the patents expire.

        Phosphodiesterase-inhibitors, both selective (e.g. the PDE type 4 inhibitor rolipram) and unselective, are another under-used option. The next few decades will take us much closer to the downstream intra-cellular action. For it is here that our minds will ultimately be healed, genetically or otherwise.

        Agomelatine (Valdoxan) is a novel antidepressant and anti-anxiety agent developed by Servier and licensed in the European Union in February 2009. A synthetic analogue of the natural hormone melatonin, agomelatine is a potent melatonin receptor agonist and a serotonin 5-HT2C receptor antagonist. Blockade of the neural 5-HT2C receptors enhances frontocortical adrenergic and dopaminergic transmission, potentially improving cognitive performance. In "animal models", agomelatine also reduces the adverse effects of stress on memory. By acting as a melatonin receptor agonist, agomelatine improves sleep quality. When taken once daily before bedtime, agomelatine doesn't cause daytime drowsiness and sedation like the old tricyclics; nor does its use kill libido like the SSRIs. Agomelatine is typically well tolerated and remarkably free from adverse side-effects at therapeutic dosages. Drug giant Novartis acquired the US rights to agomelatine from Servier in 2006. In July 2009, Novartis announced it was delaying submission for US regulatory approval another three years while it conducted additional Phase III trials. American consumers must now order agomelatine from Europe.

HYPERICUM
        Hypericum is important for a different reason altogether. Many constitutionally unhappy people refuse to have anything to do with orthodox Western medicine. They won't take "unnatural" pharmaceutical products at all. In consequence, they spend much of their lives trapped in a squalid psychochemical ghetto of low spirits. The only sort of remedy that they'll conceivably contemplate taking must carry a "natural" label and soothingly "herbal" description.

        Unfortunately, most folk remedies are only marginally effective. Our drug-metabolising enzymes are the product of an evolutionary arms race to counteract plant toxins. For plants tend to manufacture psychotropics because they poison or debilitate creatures tempted to eat them - not to heal our psychic woes. The Wisdom Of Nature is a quaint piece of make-believe. Perversely, several of the natural remedies that sometimes actually work - notably Cannabis sativa, Erythroxylon coca and Papaver somniferum - are now illegal to consume. Other "natural" interventions such as bright light therapy combined with good sleep discipline may be of limited use. But two options worth exploring are SAMe and St John's wort.

        Hypericum, the active ingredient in St John's wort, appears to be an effective mood-brightener and anxiolytic - by today's standards at least. Its side-effect profile and efficacy in mild-to-moderate depression compares favourably with its synthetic counterparts. Hypericum's blend of serotonin-reuptake inhibiting and (mild) MAO-inhibiting properties (not a combination otherwise to be explored with potent synthetics: the risk of the potentially fatal serotonin syndrome is too great) contributes to - without wholly explaining - its generally benign effects. Once again, much more research is needed, preferably not bankrolled by the makers of lucrative competing products. Thus a German trial published in the British Medical Journal in February 2005 reported that a proprietary standardised extract of hypericum/St John's wort was more effective and a better tolerated treatment of moderate to severe depression than the SSRI paroxetine (Paxil). This runs counter to the negative findings of the 2001 U.S. trial sponsored by the makers of the SSRI sertraline (Zoloft) - which concluded that for moderate to severe depression, St John's wort was no better than a placebo. Faith in the integrity of biological psychiatry would be greater if the single strongest predictive factor in the outcome of any published clinical trial wasn't the identity of the funding body. A Cochrane Review published in October 2008 found that hypericum extracts used to treat major depression had similar efficacy to standard antidepressants but fewer side-effects.

INOSITOL
        One further remedy, albeit at "unnatural" doses, is worth noting. Inositol levels tend to be low in depressives and high in euphoric people. Taking myo-inositol as a food supplement in doses of 12g and more per day represents perhaps the first successful use of the precursor strategy for a second messenger rather than a neurotransmitter in the search for long-term mood-brightening agents. Inositol and its derivatives serve as messenger molecules within the nervous system. The molecule itself is a naturally occurring isomer of glucose. It is a key intermediate of the phosphatidyl-inositol cycle. This is a second-messenger system used by several noradrenergic, serotonergic and cholinergic receptors. Adult westerners typically consume about one gram of inositol per day in their food. The richest dietary sources are fruits, nuts, beans and grains. The mood-darkening ("stabilising") effect of lithium in manically euphoric people may be explicable in terms of its inositol-depleting effect. Potentially, if taken in high doses, inositol seems to be a good way of lightening the spirits and diminishing anxiety in "euthymic" and depressed people alike. Dosages of even 50g and more reportedly produce no toxic side-effects. This regimen shouldn't be attempted unsupervised by people with a history of bipolar disorder. As usual, much more research is in order. One "problem" is that naturally-occurring compounds - such as inositol and SAMe - can't be patented. So the scope for high profit-margins is diminished. Progress is unlikely to be brisk.

THE MAO INHIBITORS

        A further option involves using both some of the oldest and the newest drugs on the block, the monoamine oxidase inhibitors (MAOIs). The older irreversible MAOIs certainly shouldn't be combined with SSRIs. It is inadvisable to combine them with stimulants or many other drugs. Yet both old and new, the MAOIs do have some very interesting properties. MAOIs may be particularly useful for rejection-sensitive, so-called atypical depressives who have "reversed vegetative symptoms" i.e. overeating and oversleeping.

        Monoamine oxidase has two main forms, type A and type B. They are coded by separate genes. MAO may be inhibited with agents that act reversibly or irreversibly; and selectively or unselectively; these categories are not absolute. For instance, the beta-carboline alkaloids found in the world's most popular drink, coffee, are competitive and reversible inhibitors of both MAO type A and type B. MAO type-A preferentially deaminates serotonin and noradrenaline, and also non-selectively dopamine; type B primarily metabolises dopamine, phenylethylamine (the "chocolate amphetamine") and various trace amines.

        The mood-elevating properties of the MAOIs were discovered quite by chance in a US veterans' hospital early in the 1950s. Many patients given the anti-tuberculotic drug iproniazid were not merely cured of their tuberculosis. They became exceptionally happy as well. The animated enthusiasm for life of a previously crotchety bunch of old soldiers disconcerted their doctors. For it transpired that their new-found euphoria wasn't just an understandable reaction to being cured of physical disease. MAOIs typically have mood-brightening properties as well. At the time, there was no accepted and clinically effective treatment for depression. Fortunately, via the usual circuitous routes, the appropriate lessons were eventually drawn. Many millions of people were successfully treated with MAOIs in consequence.

        Sadly, the role of MAO in deaminating tyramine (from the Greek word tyros, meaning cheese) wasn't at first understood. Certain MAOI-treated patients suffered hypertensive crises after eating varying amounts of tyramine-rich aged cheese; and several died. It is now recognised that the use of any MAOI which is both irreversible and unselective must be accompanied by dietary restrictions. But the adverse publicity of the initial inexplicable fatalities, combined with the introduction of a succession of dirty but sometimes tolerably effective tricyclic compounds, sent the use and reputation of MAOIs into a precipitous decline from which they still haven't fully recovered. The older non-selective and (more-or-less) irreversible inhibitors tranylcypromine (Parnate), phenelzine (Nardil) and isocarboxazid (Marplan) are nonetheless valuable antidepressants. Outside America, the the selective and reversible MAOI moclobemide. is used too. Of greater interest still are central-nervous-system-selective compounds, notably the neuroprotective antidepressant and anti-Alzheimer's drug TV3326 (ladostigil). MAOIs that lack the peripheral effects of currently explored drugs herald an exciting new window of therapeutic opportunity.

SELEGILINE (l-deprenyl, ELDEPRYL, EMSAM)
A recent New York study showed that smokers had on average 40% less of the enzyme, monoamine oxidase type-B, in their brains than non-smokers. Levels returned to normal on their giving up smoking. Not merely is the extra dopamine in the synapses rewarding. The level of MAO-b inhibition smokers enjoy apparently contributes to their reduced incidence of Parkinson's and Alzheimer's disease. Unfortunately they are liable to die horribly and prematurely of other diseases first.

        One option which the dopamine-craving nicotine addict might wish to explore is switching to the (relatively) selective MAO-b inhibitor selegiline, better known as l-deprenyl. Normally the brain's irreplaceable complement of 30-40 thousand odd dopaminergic cells tends to die off at around 13% per decade in adult life. Their death diminishes the quality and intensity of experience. It also saps what in more ontologically innocent times might have been called one's life-force. Eighty percent loss of dopamine neurons results in Parkinson's disease, often prefigured by depression. In future, the mood-enhancing transplantation of customized stem cells may restore a youthful zest for life in dopamine-depleted oldsters: such stem cell-derived monoaminergic grafts are currently on offer only to depressed rodents. Deprenyl has an anti-oxidant, immune-system-boosting and dopamine-cell-sparing effect. Its use boosts levels of tyrosine hydroxylase, growth hormone, superoxide dismutase and the production of key interleukins. Deprenyl offers protection against DNA damage and oxidative stress by hydroxyl and peroxyl radical trapping; and against excitotoxic damage from glutamate.

        Whatever the full explanation, deprenyl-driven MAOI-users, unlike cigarette smokers, are likely to be around to enjoy its distinctive benefits for a long time to come, possibly longer than their drug-naïve contemporaries. For in low doses, deprenyl enhances life-expectancy, of rats at least, by 20% and more. It enhances drive, libido and motivation; sharpens cognitive performance both subjectively and on a range of objective tests; serves as a useful adjunct in the palliative treatment of Alzheimer's and Parkinson's disease; and makes you feel good too. It is used successfully to treat canine cognitive dysfunction syndrome (CDS) in dogs. At dosages of around 10 mg or below daily, deprenyl retains its selectivity for the type-B MAO iso-enzyme. At MAO-B-selective dosages, deprenyl doesn't provoke the "cheese-effect"; tyramine is also broken down by MAO type-A. Deprenyl isn't addictive, which probably reflects its different delivery-mechanism and delayed reward compared to inhaled tobacco smoke. In November 2004, Yale University researchers launched a study of deprenyl for smokers who want to quit tobacco. Whether the Government would welcome the billions of pounds of lost revenue and a swollen population of energetic non-taxpayers that a switch in people's MAOI habits might entail is unclear.

        L-deprenyl/selegiline can now be delivered via a transdermal patch. In December 2004, pharmaceutical firms Bristol-Myers Squibb and Somerset Pharmaceuticals announced they had entered into an agreement to distribute and commercialize EMSAM, the first transdermal treatment for major depression. After various delays, in February 2006 the FDA granted EMSAM a product license for the treatment of major depressive disorder in adults. EMSAM's pharmacokinetic and pharmacodynamic properties promote the inhibition of MAO-A and MAO-B in the CNS while avoiding significant inhibition of intestinal and liver MAO-A enzyme. Three different strengths of EMSAM patch are currently marketed: 20mg/20cm2, 30mg/30cm2, and 40mg/40cm2, delivering daily doses averaging 6mg, 9mg and 12mg respectively. Use of the lowest dosage EMSAM 6 mg/24 hour patch calls for no dietary modification. At this dosage, MAO-A in the digestive tract is preserved at levels adequate to break down tyramine, while MAO in the brain is inhibited at levels adequate to induce an antidepressant effect. A restricted "MAOI diet" is prudently advised for the higher dosage EMSAM 9 mg/24 hr patch and the 12 mg/24 hr patch to avoid any risk of hypertensive crisis. But it's worth noting that (as of February 2010) no hypertensive crises following dietary indiscretions have been reported even in users of the high strength patches.

RASAGILINE (AZILECT)
Unlike deprenyl, the novel irreversible selective MAO-B-inhibitor rasagiline (Azilect) is not metabolized to methamphetamine or amphetamine. These trace amines are unlikely to contribute to deprenyl's neuroprotective action. Rasagiline gained an EC product license as Azilect in mid-2005 for the symptomatic treatment of Parkinson's disease. Azilect finally gained a US product license in May 2006. In August 2008, Teva announced promising results from a late-stage Phase III 18-month rasagiline trial. Parkinsonians who took a 1mg Azilect pill once a day from the start of the trial showed "significant improvement" over patients who started taking Azilect nine months later.

MOCLOBEMIDE (MANERIX, AURORIX)
Humans now have the capacity to choose their own individual level of activity or inhibition of the two primary monoamine oxidases. This does not quite enable the fine-tuning of personality variables with the functional equivalent of a graphic equaliser. It still represents a promising start. In MAO-inhibition, as in life, more is not always better. Excessive dosages of l-deprenyl, for instance, may actually shorten, not increase, life expectancy - at least in Parkinsonians if it's combined with l-dopa. And levels of above 80% inhibition of MAO-A may lead to a sharp and possibly unwanted fall in dopamine synthesis. Repairing Nature's niggardliness will be a priority for the decades ahead.

        Moclobemide (Manerix, Aurorix), the "gentle MAOI", is both a selective and reversible inhibitor of MAO-A. It marks the first RIMA to win clinical acceptance. Moclobemide lacks anti-cholinergic side-effects. It promotes the healthy growth of new neurons in the hippocampus. No dietary restrictions are needed. It is valuable as more than a mood-enhancer and resilience-booster. For moclobemide is often useful in overcoming social phobia, panic disorder, obsessive-compulsive symptoms, irritability and aggression owing to the way it enhances serotonin function. (The casual use of gobbledygook such as "enhanced x function" will rightly alert the reader that many complications are being skirted or omitted. Those hungry for the greater technical detail of a non-popular account can rest assured the literature will leave them feeling abundantly well-nourished).

TRANYLCYPROMINE (PARNATE)
Gentleness doesn't suit everyone. Moclobemide isn't much good at lifting deep melancholy. Tranylcypromine (Parnate), on the other hand, is one of the older and non-selective MAOIs - and is often none the worse for it. Structurally related to amphetamine, tranylcypromine is generally the most stimulating, dopaminergic and relatively fast-acting of the MAOIs. Some doctors are uncomfortable with its properties. This isn't just because of the dietary restrictions its use demands. In adequate doses, tranylcypromine tends to induce a mild euphoria even in "normal" subjects. Tranylcypromine use increases trace amines, modulates phospholipid metabolism and up-regulates GABA(B) receptors. In fact, its nicest effects, as for all of the compounds cited here, will vary in nature and extent from person to person. To some extent, optimal dosage and long-term drug-regimen of choice can be discovered only by (cautious) empirical self-investigation.

        Tranylcypromine is of course vastly preferable to the amphetamines and cocaine. Yet frequently and perversely, the more hazardous the drug, then the easier it is to get hold of in our society. The carcinogenic cocktail that carries off more people than all other toxins combined can be purchased quite legally and effortlessly at any tobacconist or newsagent. Obtaining the less lethal - but scarcely socially desirable - street opioids and psychostimulants requires a little more exertion. Yet they can still be readily purchased in pubs and clubs in all the big towns and cities. Many of the more beneficent drugs discussed here, on the other hand, are unlicensed, "investigational", or available on a prescription-only basis. They're not illegal to possess. But they are hard to obtain short of visiting countries where they're available over-the-counter or using online pharmacies of uncertain reputation.

        If the central principle at stake here were the preservation of a drug-free society, then some sort of totalitarian (or, more euphemistically, paternalistic) argument could be cobbled together for violating personal freedom so oppressively. Yet that's rarely the issue. For in most cases, the issue effectively amounts, not to drugs or no drugs, but to allowing people the choice to opt for better ones. Perhaps 80% of the population in Western countries currently drink ethyl alcohol or smoke cigarettes. Often they do both. Whether viewed in terms of mortality, morbidity or overall quality of life, we'd be better off if we switched to enhancing receptor sub-type selective dopaminergic, opioidergic, serotonergic and cholinergic function by the relatively safe, if crude, agents touched on here; and perhaps to the more exciting products under development. As a basic minimum, people shouldn't be legally robbed of the right to do so.

        This freedom of choice isn't conventional wisdom. It will be suggested that the level of medical expertise required to make informed choices exceeds that of the average layperson. A quasi-priestly medical caste wielding the power of the prescription-pad would doubtless wish to keep it that way. But the intrinsic difficulty and complexity of psychopharmacology or nutritional medicine, say, doesn't demand greater mental effort than, for instance, all those thousands of grimly unnatural hours spent by school students learning mathematics. Moreover it's far more interesting to study something palpably relevant to one's emotional well-being than something that demonstrably isn't. The notion of an education system geared to schooling people in, and for, happiness would nonetheless strike adherents of the reigning educational orthodoxy as abhorrent were it not so largely incomprehensible.


WORKING FOR A DRUG-FREE FUTURE

Suppose, for a moment, that the reproductive success of our DNA had been best served by coding for ecstatically happy vehicles rather than malaise-haunted emotional slum-dwellers. If this had been the case, then none of the pharmacological interventions discussed in The Good Drug Guide would be necessary. Life-long well-being would seem only "natural". We would all enjoy gloriously fulfilled lives. Each day would be animated by gradients of bliss. Unpleasant states of mind would be viewed as a tragic aberration. Bad thoughts and bad feelings could be diagnosed as a freakish but clinically treatable type of psychopathology.

         Of course, it didn't work out that way. Instead, the inclusive fitness of our genes has been served by the "natural" manufacture of some of the most vicious psychological adaptations imaginable. Sadness and anxiety are "normal". Discontent is "adaptive". Everyday emotional pain is part of "what makes us human".

        The rot goes deeper. Selfish DNA can count on innumerable dupes to act as its distal representatives even today as the biotech revolution unfolds. The need for "character-building" emotional pain gets justified with all manner of sophistries, both religious and profane. Suffering is good for you, one may be told. It's all part of life's rich tapestry.

         Actually, suffering exists only because it was good for our genes. Conditionally-activated negative emotions were fitness-enhancing in the ancestral environment. In the current era, apologists for mental pain are serving as the innocent mouthpieces of the nasty bits of code which spawned them. If pressed, primordial DNA's unwitting spokesmen would presumably disavow any such connection. Yet if one were purposely building an intelligent robotic survival-machine, then endowing it with the illusion of free-will would prove a highly fitness-enhancing adaptation. It's a trick which our genes stumbled upon; and then blindly exploited.

        Fortunately, over the next few centuries humanity will be able to outwit its ancient genetic masters. Our present status as throwaway genetic vehicles will finally be subverted. When gradients of heavenly well-being become the genetically predestined norm of mental health, then the very notion of tampering with our new-won "natural" condition and feeling "drugged" may come to seem immoral. It may also seem perverse. Why should anyone want to contaminate the divine ecstasy of their spirituo-biological soul-stuff with chemical pollutants? No thanks.

        Today's twisted victims of the primordial genetic code, on the other hand, view the notion of sullying their natural state of being through psychoactive drugs with a much more deep-seated ambivalence. They adopt it as a near-universal practice. Given the inadequacy of the third-rate pharmacological stopgaps on offer, and the lack of any serious drug-education, it's scarcely surprising we're so poor at using them. Thus concerned parents are surely right to worry about the trashy street drugs taken by their kids. Early in the 21st Century, "Just Say No" is frequently still a good rule-of-thumb. Yet with the right new genes and designer-drugs, there's no reason why mature Post-Darwinian life shouldn't just get better and better.

David Pearce
(last updated March 2009)


REFERENCES
and further reading

The Good Drug Guide
SEARCH
HedWeb
Future Opioids
BLTC Research
Superhappiness?
Utopian Surgery?
Just For Chemists
The Wired Society
Depression Central
Nutritional Psychiatry
The Abolitionist Project
Resources on Depression
The Hedonistic Imperative
The Reproductive Revolution
MDMA: Utopian Pharmacology
Critique of Huxley's Brave New World
Online International Pharmacies 2009

e-mail
info@bltc.com





Major Acupuncture Points Chart

  Jing Well Point Ying Spring Point Shu Stream Point Jing River Point He Sea Point Yuan Source Point Luo Connecting Point Xi Cleft Point Front Mu Point Back Shu Point Lower He Sea Point Mother Point Child Point Entry Point Exit Points
Lung 11 10 9 8 5 9 7 6 LU-01 BL-13 9 5 1 7
Large Intestine 1 2 3 5 11 4 6 7 ST-25 BL-25 ST-37 11 2 4 20
Stomach 45 44 43 41 36 42 40 34 REN-12 BL-21 ST-36 41 45 1 42
Spleen 1 2 3 5 9 3 4 8 LIV-13 BL-20 2 5 1 21
Heart 9 8 7 4 3 7 5 6 REN-14 BL-15 9 7 1 9
Small Intestine 1 2 3 5 8 4 7 6 REN-4 BL-27 ST-39 3 8 1 19
Bladder 67 66 65 60 40 64 58 63 REN-3 BL-28 BL-40 67 65 1 67
Kidney 1 2 3 7 10 3 4 5 GB-25 BL-23 7 1 1 22
Pericardium 9 8 7 5 3 7 6 4 REN-17 BL-14 9 7 1 8
San Jiao 1 2 3 6 10 4 5 7 REN-5 BL-22 BL-39 3 10 1 22
Gall Bladder 44 43 41 38 34 40 37 36 GB-24 BL-19 GB-34 43 38 1 41
Liver 1 2 3 4 8 3 5 6 LIV-14 BL-18 8 2 1 14
Ren (Conception) 15
Du (Governing) 1


Command Points
Stomach & Abdomen
Head & Back of Neck
Lower Back (Lumbar)
Face & Mouth

Heart & Chest
P-6
Fainting & Collapse
DU-26

 

 

Hui Meeting Points (Influential Points)
Zang (Yin) Organs
LIV-13
Fu (Yang) Organs
REN-12
Qi
REN-17
Blood
BL-17
Sinews
GB-34
Marrow
GB-39
Bones
BL-11
Vessels
LU-9
Four Seas Points
Sea of Qi
REN-17
Sea of Blood
BL-11, ST-37, ST-39
Sea of Water & Grain
ST-30,ST-36
Sea of Marrow
DU-16, DU-20

Jing Luo (Channels and Collaterals | Meridians and Sub-Meridians)

  • Jing Luo are the main channels of communication and energy distribution in the body.
  • Link interior Zang Fu organs with various tissues of superficial areas of the body. In this way they allow for internal adaptation to external change.
  • They connect different superficial areas of the body.
  • The Jing Luo are more external (and more Yang) than the Zang Fu Organs. When pathogens penetrate the body from the Exterior, they usually penetrate the superficial channels and then the main channels and finally the Zang Fu Organs.
  • Jing Luo cover the entire body.

Every part of the musculoskeletal system is related to a main meridian and its associated sub-meridians.

Via the main channel, every part of the body associated with a given internal Organ can be affected by imbalance in that Organ.

Example: The Bladder channel: connects the small toe, lateral aspect of foot and ankle, posterior aspect of leg, buttocks, sacroiliac and dorsal region, occiput, vertex, central frontal region and inner canthus of eye.

Knowing the pathway of the channels, we can make connections in symptoms as diverse as itchy eyes, occipital headaches, lumbar pain and spasms in the gastrocnemius. For example, the Heart channel begins in the axilla and ends on the small finger. It has long been noted in western biomedicine that in the case of myocardial infarction, the pain often travels along this channel. TCM provides a link between this external muscular pain and an imbalance in the associated internal Organ.


Distribution of the Jing Luo

Most superficial: Cutaneous Regions

Deeper Tendinomuscular Meridians in the musculature Province of Wei energy
1st line of defense and adaptation
Deeper Luo Meridians Associated with Main channels but are more superficial. Link Yin and Yang coupled pairs. Link Primary Meridians with surrounding tissues.
Deeper Divergent Meridians Reinforce the circulatory network of 12 Primary Meridians. Provide more functional contacts between Yin and Yang channels.
Deeper 12 Primary Meridians Connect with Zang Fu Organs. Carry mainly Ying (Nutritive Qi) and Blood.
  8 Extra Vessels CV GV and Chong Mai originate in Kidney Organ. The others connect with Principal channels.
   

Function: strengthen association between channels and control, store and regulate Qi and blood of channels (reservoirs). Carry mainly Yuan Qi.

The sub-meridian system (superficial channels) has the main functions of maintaining normal function providing for adaptation to changes in the external environment. This adaptation can often occur without the circulation of Qi in the main Meridians being too affected.

There is much disagreement regarding the pathways of the Luo and Tendinomuscular channels. In any case, these channels do not have their own points but share points of the Primary Meridians. The flow of Qi through these channels is affected by needling points on the Principal channels.

The Channels of Acupuncture

In Chinese acupuncture anatomy, the internal organs of the body are all interconnected with one another by pathways called meridians, which are located throughout the body. The concept of these pathways could be compared with Western ideas of the blood vessels and capillaries, or the nervous system with its centers and peripheral branches This system is not, however, the same as either of these other systems. The meridians, unlike the blood vessels, which can be seen with the naked eye, are not visible. As the blood vessels function as pathways for the blood, so the meridians are pathways in which energy is circulated throughout the body.

The meridians spread out through the entire body connecting all the tissues and organs of the body binding it together as an organic unit. They regulate normal functioning of the body, and diagnostically reflect pathology or illness. Meridians are also referred to as Vessels, Chings, or Channels.

In acupuncture we generally consider that there are 72 channels of therapeutic importance:

  • 12 Primary Meridians
  • 12 Tendinomuscular Meridians
  • 12 Transversal Lo Vessels
  • 12 Longitudinal Lo Vessels
  • 12 Distinct (Divergent) Meridians
  • 8 Extra (Ancestral) Vessels
  • 3 Extra Longitudinal Lo Vessels
  • 1 Huato Channel

The most important and essential ones for the circulation of Qi, and for most therapeutic applications are the twelve Primary Meridians and two of the Extra Vessels. The twelve Primary Meridians are also known as the twelve Chings.

The two extra Meridians are the Governing or Du Vessel (DU), and the Conception or Ren Vessel (REN). (The term Conception Vessel does not imply that this Vessel is exclusively concerned with the female, although it does have extensive connections with the female reproductive system, and is frequently used in the treatment of gynecological disturbances. It is, however, present in both male and female).

These two Extra Vessels are usually included in a listing of the twelve Meridians, because of their importance in the circulation of energy, and their value in many treatment formularies. They also have their own acupuncture points.

Some of the meridians of the body run in a more or less horizontal direction, while others run vertically. The twelve Primary Meridians are vertical channels.

The twelve Primary Meridians are also bilateral. This means they have symmetrical pathways on either side of the body in relation to the median (mid-line) of the body, just as we have a right and a left side. There is a Lung meridian on both the left side of the body and the right side of the body, and similarly with all of the other eleven Meridians. The acupuncture points for the various Meridians are in the same mirror image locations on either side of the body.

Summary

We have 12 bilateral Meridians. The two special vessels (the Conception Vessel and the Governor Vessel) are not bilateral. They are singular channels, which follow the midline of the body, one in front and one on the back. The following pages are diagrams of the locations of the meridians on the human body.

There are a number of ways in which the Primary Meridians can be classified. One method is to classify them into two groups, according to their polarity of Yin and Yang. The Chinese determined that some of the Meridians are predominantly of Yin energy, and some are predominantly of Yang energy.

Yin Channels (Organ) Yang Channels (Organ)


Lung (LU) Large Intestine (LI)
Spleen (SP) Stomach (ST)
Heart (HT) Small Intestine (SI)
Kidneys (KI) Bladder (BL)
Pericardium (PC) San Jiao (SJ)
Liver (LV) Gall Bladder (GB)

The Primary Meridians are also grouped together in coupled pairs, each Yin meridian being coupled to a specific Yang meridian. The pairs are coupled according to the table above, i.e., Lung with Large Intestine, Spleen with Stomach, Heart with Small Intestine, Kidneys with Bladder, Pericardium with San Jiao, and Liver with Gall Bladder.

Another way of classifying the Meridians is based on the main location of the Channel and its terminal point. Six Meridians are located on the upper portion of the body, and start or end on the fingers. The other six Meridians are located on the lower portion of the body and end or start at the toes. Which gives us the following relationships:

Hand Meridians Foot Meridians


Lung (LU) Stomach (ST)
Large Intestine (LI) Spleen (SP)
Heart (HT) Bladder (BL)
Small Intestine (SI) Kidneys (KI)
Pericardium (PC) Gall Bladder (GB)
San Jiao (SJ) Liver (LV)

By combining the Yin/Yang and Hand/Foot classifications or groupings, we get the following

  Abbreviations Pathway
 

3 Yin Meridians of the Hand (LU, HT, PC) Chest to Hand
3 Yang Meridians of the Hand (LI, Sl, SJ) Hand to Face
3 Yang Meridians of the Foot (ST, BL, GB) Face to Foot
3 Yin Meridians of the Foot (SP, KI, LV) Foot to Chest

As you can see, so far, the Meridians have been classified into a division of two groups according to Yin and Yang, hand and foot, and as coupled pairs. We are going to classify the Meridians according to the traditional Chinese idea of the cycle of Qi within the Meridians. The Chinese determined that the energy flows from one meridian to the next in a continuous and fixed order. It flows from meridian to meridian in a two-hour cycle, making the complete circuit once a day.

This cycle is known as the Horary cycle. As the Qi makes its way through the meridians, each meridian in turn, with its associated organ, has a two-hour period during which it is at maximum energy. The Horary Effect is recognizable by measurable increases of Qi within an organ system and meridian during its time of maximum energy. (Qi is, of course, present within every organ system all the time; its level simply fluctuates according to the Horary Cycle.)

If a person moves from one time zone to another, the resultant "jet lag" is a result of the biological Horary clock adjusting to the new time frame. Moving East or West causes this phenomena, but moving due North or South has no effect on the internal clock.

Just as each organ system has a waxing and waning two hour period of maximum energy on the Horary Cycle, there is also the minimum energy effect of the organ on the opposite, side of the cycle, 12 hours apart. An example of this is that while the Lungs have maximum energy from 3-5 AM, the Bladder on the opposite side of the table is at its minimum energy level, 3-5 PM. Qi begins entering the Lungs at 3 AM, and has reached its maximum concentration in the organ at 4 AM. By 5 AM it has done its tonification and repair work and is moving into the Large Intestine channel.

Knowledge of this cycle and its energetic effects is necessary for highly effective acupuncture treatments, as the various organs respond either very well or very little to acupuncture depending on their energetic state at the time of treatment. The Horary Cycle is an excellent diagnostic tool and will be dealt with on the diagnostic level later in this course work.

The flow of energy begins with the Meridian of the Lungs and completes its cycle with the Liver, to commence again at the Lungs, continuing the daily cycle throughout an individual's life span. The reason that the Chinese say that the flow begins with the Lungs, is that they consider the first independent function of a child at birth to be its first breath.

Circulation of Energy Through the Primary Meridians

The Classical Order of Meridians

Lungs 3 AM to 5 AM
Large Intestine 5 AM to 7 AM
Stomach 7 AM to 9 AM
Spleen 9 AM to 11 AM
Heart 11 AM to 1 PM
Small Intestine 1 PM to 3 PM
Bladder 3 PM to 5 PM
Kidney 5 PM to 7 PM
Pericardium 7 PM to 9 PM
San Jiao 9 PM to 11 PM
Gall Bladder 11 PM to 1 AM
Liver 1 AM to 3 AM

As you can see in the table of Classical Order of Meridians, the energy flows from one Channel to its coupled pair, and then on to the next coupled pair. The following is a diagram showing the order of energy circulation through the meridians.

The Twelve Meridians - In Classical Arrangement

  1. Hand Yin Lung Meridian (LU)
  2. Hand Yang Large Intestine Meridian (LI)
  3. Foot Yang Stomach Meridian (ST)
  4. Foot Yin Spleen Meridian (SP)
  5. Hand Yin Heart Meridian (HT)
  6. Hand Yang Small Intestine Meridian (SI)
  7. Foot Yang bladder Meridian (BL)
  8. Foot Yin Kidney Meridian (KI)
  9. Hand Yin Pericardium Meridian (PC)
  10. Hand Yang San Jiao Meridian (SJ)
  11. Foot Yang Gall Bladder Meridian (GB)
  12. Foot Yin Liver Meridian (LV)
  13. The Governing Vessel (DU), also called the Du Mai, or Du Channel
  14. The Conception Vessel (REN), also called the Ren Mai, or Ren Channel

A Yin meridian joins its Yang coupled meridian (and vice versa) in the extremities, either the fingers or the toes. Yin meridians of the Hand terminate in the fingers. Yang meridians of the Hand begin in the fingers. Yang meridians of the foot terminate in the toes. Yin meridians of the foot begin in the toes.

Note:

Although the Governing Vessel is of Yang nature and the Conception Vessel of Yin nature, these two are not, strictly speaking, a coupled pair in the same sense of the twelve Primary Meridians. The difference lies in the fact that the coupled pairs of P.M.s have specific channels of communication, which join them together. These are the Transversal Lo vessels. The Conception and Governor Vessels do not have Transversal Lo vessels, but rather connect all the Yin channels (Conception Vessel) or Yang Channels (Governor Vessel) respectively.

Each Principal Meridian has its own Transversal Lo vessel. These are actually crosswise connecting channels, known as anastomoses. Since each Principal Meridian has one Transversal Lo, each coupled pair of P.M.s is linked by two of these. (The one exception is the Heart channel, which is linked to the Small Intestine by only one Transversal Lo vessel. We could consider the Transversal Lo vessels as the horizontal or transversal pathways of the Meridians.

Understanding the energetic function of the Meridians is the Chinese equivalent of understanding the function of the organs in Western Medical thought. The meridians are connected with, and have their origin in, the internal organs: treating a meridian effects the organ to which it is connected. The acupuncturist manipulates the vital organs with needles utilizing the acupuncture points along the meridians to achieve the desired effect.

The practice of acupuncture rests upon the relationship that exists between a specific area on the surface of the skin and a particular organ or energetic function. The needles or stimulus acts directly on the meridian, which in turn affects the associated organ. The more appropriate the selection of the points on the meridian, the better the treatment results. Within the 12 Meridians and the two Extra Vessels lie the majority of acupuncture treatment technique.

The series of acupuncture points upon the skin, which constitute the outward line of the meridian, are primary evidence of the meridians existence although the meridians themselves are invisible. Acupuncture point locators indicate the difference in electrical resistance that exists around acupuncture points. The traditional methods of locating the points are by locating specific anatomical landmarks, using special methods of measurement which are valid for any human body, and by finger sensitivity. Finger sensitivity is necessary in many areas of acupuncture practice; locating the points, feeling the quality of the pulses, feeling the grip that Qi is exerting on an inserted needle, feeling (palpating) for sensitized areas of damage on the body.

The meridians provide communication lines between external body appendages and surfaces and the internal organs; upper and lower parts of the body; and provide for the circulation of energy. They govern the body's ability to function, carry Qi, and so contribute largely in the maintenance of health. This energy can be manipulated at stations along these communication lines, the acupuncture points along the meridians.

General Pathways of the Meridians

The circulating pathways of the twelve Meridians flow from the face to the feet, from the feet to the chest, from the chest into the hands, and from the hands back to the face. The Yang Meridians generally flow along the outward (lateral) side of the limbs and along the back of the body. The Yin Meridians pass along the inward (medial) side of the limbs and along the front of the body. It has already been mentioned that the pathways leading to or from the arms are called Hand Meridians, and those that descend to the legs or ascend from the legs are the Foot Meridians.

The three Yin hand meridians travel from chest to hand; the three Yang hand meridians, from hand to head (face). The three Yang foot meridians travel from head to foot; and the three Yin foot meridians travel from foot to chest. This describes the circulation of energy over the entire body and delineates the pathways in which Qi, or energy, flows.

With the arms raised over the head palms facing forward, the energy in the three Yin Hand Meridians (Lung, Heart, and Pericardium) will be flowing from the chest to the fingertips, upward along the forward portion of the arm. The energy in the three Yang Hand Meridians (Large Intestine, Small Intestine, and the San Jiao) will be flowing from the fingertips, downward on the back part of the arm, to end their flow in the face.

From the head, the energy of TWO of the three Meridians of the Foot (the Bladder and Gall Bladder, but not the Stomach) will be traveling down along the side or back of the body and outward side of the leg to end in the toes. To complete the cycle, the energy in the three Yin Meridians of the Foot (Spleen, Liver and Kidney) will be traveling up from the toes along the inward side of the leg, continuing along the front of the abdomen and ending in the chest, at which point the cycle begins again from the chest to the hand. There are exceptions to this, but the general pattern is accurate.

The Stomach Channel is one exception. Although it is a Yang Meridian, it runs on the front of the body with the Yin Meridians, instead of up the back like the rest of the Yang Meridians. The other exception is the Governor Vessel, which is a Yang Meridian in the center of the back, in which energy flows upward as opposed to the rest of the major Yang Meridians in which energy flows downward.

The Governor Vessel, or Du Mai (Du or GV), follows the spine upward on the back, travels over the head and ends on the inner surface of the upper lip. It has no direct connections to any internal organ. Its energy flow is Yang and ascends from the bottom of the pathway beginning near the anus. It connects with all the Yang Meridians of the body, and is important in many conditions requiring manipulation of the Yang energy of the body.

The Conception Vessel, or Ren Mai (CV or Ren) travels up the midline in front of the body. It runs from near the anus to the mouth, and its energy is Yin, ascending from the lower body to the upper, as does the Governing Vessel. In effect, these two meridians vertically encircle the body on its midline, front and back.

These two Vessels are not bilateral. They do not form a direct part of the organ meridian's energy circulation network, nor are they associated with any one organ. They belong to the eight Extra Vessels.

The energy traveling from the chest to the fingertip is predominantly Yin energy. Yet on its way back up the other side of the arm, it becomes Yang energy. The energy changes polarity, from Yin to Yang, or from Yang to Yin, the nearer it approaches the extremities of the limbs.

The energy traveling from the chest to the fingertip begins as predominantly Yin energy, but as the energy approaches the extremity the polarity begins to change, and by the time the tip of the finger is reached the Yin becomes progressively mixed with the Yang energy. Energy traveling from the fingertips to the face begins as mixed Yin/Yang, but by the time it arrives in the face it is predominantly Yang energy.

Energy traveling from the face to the toes begins as predominantly Yang energy. As this Yang energy approaches the lower extremities of the leg, the polarity begins to change again. By the time the toes are reached the Yang energy is mixed with the Yin energy in almost equal proportions. The return from the toes to the chest causes the transformation again. This Yin energy then flows back into the arm, to continue the cycle.

It can be seen, therefore, that as Qi circulates through the Primary Meridians, it alternates in coupled pairs of Yin and Yang Meridians, staying for two hours in the Yin and two hours in the Yang, in a smooth alternating rhythm.

In the central area of the head and chest, even though the energy passes from one Channel to another, there is no polarity change. The head is the area where one Yang meridian joins another Yang meridian, and the chest is where each Yin meridian joins another.

The polarity change is not a sudden thing, but occurs gradually, mostly between the elbow and the fingertips, and between the knee and the toes. Therapeutically, it is at points below the knee and below the elbow that energy polarity changes can be most easily accelerated or retarded. Within these limits, the most important control or energy manipulation acupuncture points are found.

On acupuncture charts, the meridians appear as thin surface lines connecting a series of dots that represent the acupuncture points. Actually, there is much more to each meridian than what is shown in the acupuncture charts and diagrams. Every Channel has an inner pathway and an outer pathway, and it is usually the outer pathway with its acupuncture points that is shown on most charts or drawings, and the inner pathways are not accessible to manipulation by needling.

The true extent of the Meridians cannot be shown by lines on a two-dimensional drawing. On a drawing the lines show us an imaginary line from point to point, which usually represents the approximate centerline of the sphere of influence of that Channel. According to the Chinese, each Channel is connected to all the tissues, organs and functions over which its acupuncture points have an influence or produce an effect, whether in the immediate area of the points or at a much distant area.

For example:
Examine the Heart Meridian with its nine acupuncture points running from the armpit down the inner surface of the arm to the tip of the little finger, very close to the surface. This much is shown on standard Meridian charts and most diagrams. However, the Heart Meridian naturally must be connected to the Heart, so it extends internally from the armpit point to the organ of the Heart itself. But, the Heart Meridian also has several other branches deep inside the body. One runs to the Small Intestine, and another branch connects to the head, specifically with the eye, tongue and brain. 

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Acupuncture Channels (Meridians)



  • Major Acupuncture Points Chart
    Yuan-Source, Luo-Connecting, Xi-Cleft, Five Shu Points, Front Mu, Back Shu, Mother, Child, Entry, Exit, Four Command Points, Hui Meeting Points, and Four Seas Points, all laid out in a matrix for easy reference.
  • The Eight Extraordinary Channels
    Ren Mai (Conception Vessel), Du Mai (Governing Vessel), Chong Mai (Thrusting Vessel), Yin Qiao (Yin), Yang Qiao (Yang), Yin Wei, Yang Wei, and the Dai Mai (Girdling, Belt Vessel)

General Acupuncture Information

Acupuncture Point Categories

  • Yuan (Source) Points
    Each of the 12 primary channels has a Yuan source point close to the wrists or the ankles where the source Qi is described as surfacing and lingering. In clinical practice, they are important in treating disharmony of the internal Zang-Fu organs, and are often combined with the Luo (Connecting) point of the interior-exterior related channel.
  • Luo (Connecting) Points
    Each of the 12 channels has a Luo point that links the interior-exterior related pairs of yin and yang channels in order. There are also three additional Luo points; one for the Ren Mai (Conception Vessel), one for the Du Mai (Governing Vessel), and the Great Luo Connecting point of the Spleen. The Luo points establish a system for qi and blood to be circulated throughout the entire body to nourish all tissues and the Zang-Fu organs.
  • Xi (Cleft) Points
    The Xi points are where the Qi and Blood which has flowed along the surface from the Jing Well points is described as plunging more deeply. Xi Cleft points are indicated generally for acute problems and pain, with the Xi Cleft points on the Yin channels having the added ability to treat blood disorders.
  • Hui (Meeting) Points
    The Hui points, also called the Eight Influential or Gathering Points are described as having a special effect on their related area; the vessels, blood, bones, Zang, Fu, marrow, sinews, and Qi.
  • Xi (Confluent) Points
    The Xi points of the eight extraordinary channels are used not only to treat disharmony in the specified extraordinary vessel but also their related primary channel.
  • Mu (Front) Points
    The Mu or gathering or collecting points are where the Qi of the respective Zang-Fu organs is infused. Located on the abdomen and chest, they are in close to their related Zang-Fu organ, and may tender or sensitive if there is disharmony in the underlying organ.
  • Shu (Back) Points
    There are 12 Back Shu points on the Bladder channel that correspond to each of the 12 Zang-Fu organs.
  • Window of Heaven
    Also called Window of the Sky points, these points can be used for rebellious qi and blood between the head and body, goiter and scrofula, emotional disorders, and sense organ disorders.
  • Sun Si-Miao Ghost Points
    Originally appearing in the Thousand Ducat Formulas by Sun Si-Miao, these points were indicated for mania and epilepsy.
  • Gao Wu Command
  • Ma Dan-yang Heavenly Star
  • The Meeting Points
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Richard Hammerschlag, Ph.D., Research Director at the Oregon College of Oriental Medicine; Adjunct Professor in the Department of Neurology Oregon Health and Science University

Richard Hammerschlag, Ph.D.


Acupuncture: An Evidence-Based Assessment

Course Title: Acupuncture: An Evidence-Based Assessment
Credits: 1 hour of CME; 1.2 nursing contact hours (CEU)
Cost: Free

Lecturer: Richard Hammerschlag, Ph.D., Dean of Research at the Oregon College of Oriental Medicine


Learning Objectives:

  • Discuss the history of acupuncture
  • Compare the differences between western medicine and Chinese medicine
  • Identify how acupuncture research is conducted
  • Describe research on the efficacy of acupuncture and the mechanisms underlying itsvarious uses

This lecture is part of the CAM Online Education Series. The series contains 10 chapters. Each lecture includes:

  • A video lecture by one author, including the transcript
  • A question and answer transcript
  • An optional online test
  • Additional resource links
  • A certificate of completion

Although developed for health care professionals to receive continuing education, members of the public are invited to view the series and learn more about various aspects of CAM and CAM research.

Take course

J

LBP, EAR AKU, CHAKRA ACU,


Thu, Mar 11, 2010 at 12:08 AM

The Ultimate Acupuncture Point Formula for Relieving Low Back Pain



By John Amaro, LAc, Dipl. Ac. (NCCAOM), FIAMA, DC

Low back (lumbar) pain has been reported to be one of the most common conditions for which sufferers worldwide seek medical attention. It has numerous causes and can never be lumped into one specific etiological category.

The same is true for treatment. There are numerous treatments available, of which chiropractic and acupuncture have repeatedly demonstrated their effectiveness in the majority of low back pain syndromes. The most important treatment goals are to achieve a successful level of pain reduction followed by correction and stabilization of the condition. Most low back pain suffers will wholeheartedly agree that pain relief is paramount, and as quickly as possible.

In my almost four decades of acupuncture and chiropractic practice, I have seen thousands of cases of low back pain that have been successfully treated. Only the very rare case has had to be referred for surgery. In the vast majority of cases, regardless of the specific cause, the patient has experienced significant pain relief in a very short period of time with the administration of a specialized acupuncture point formula. In many cases, pain relief was considerable before chiropractic and/or physiotherapy procedures were even implemented.

This formula is by no means a cure-all for every lumbar pain syndrome, but has proven the test of time in countless cases. It does not do what chiropractic can do regarding structure, nor does it do what physical therapy, soft-tissue treatment, physiotherapy, therapeutic massage and other non-invasive procedures can do to strengthen muscles, ligaments or tendons. Its primary application is for early pain relief.

As most practitioners of acupuncture are vitally aware, there are specific points on the body that are key to most low back conditions. The points, SI 3, BL 62, BL 40 (54) and "surround the dragon" are usual points of application. It stands to reason that there are many other points that may be selected for a variety of reasons and diagnosis, but as far as a general overall pain-relief application, the aforementioned acupuncture points are classic. It's important to note that any additional points that a practitioner has used successfully may be added to this basic formula without disrupting its effectiveness.

In my experience, approximately 90 percent of typical cases of low back pain can be predicted and expected to positively respond when one uses the three major "30" points along with the previous mentioned points. These three powerful points are known as GB 30, BL 30 and ST 30. GB 30 is directly over the sciatic nerve notch, a third of the way from the head of the femur on a line drawn from the tip of the coccyx. BL 30 is two-fingers breadth (1.5 tsun) from the midline (GV-DU MO), bilaterally level with the fourth sacral foramen. This is level with the top of the vertical buttock crease separating the right and left gluteal areas. ST 30 is precisely two tsun bilateral to CV (REN) 2, which is directly at the level of the symphysis pubes.

When one uses the additional points of CV 3, KI 12, CV 4 and KI 13, the clinical response can be potentially raised another percentage point or two. KI 12 is one-half tsun bilateral to CV 3, which is one tsun superior to CV 2. KI 13 is one-half tsun bilateral to CV 4, which is one tsun superior to CV 3. These four points, along with ST 30, are all points on the lower abdomen. Most practitioners and patients will find it unusual at first to use these points, since the pain is in the back. However, its polar opposite effects and the fact that the lower Kidney meridian is the direct opposite of the huo tuo jia ji points on the back make them some of the most powerful points for low back pain on the body.

So, in essence, the ultimate low back pain acupuncture formula for general pain relief, anti-inflammatory effects, increased blood flow and relaxed supporting muscles consists of the following points: SI 3, BL 62, BL 40 (54), GB 30, BL 30, ST 30, CV 3, KI 12, CV 4, and KI 13, in addition to the huo tuo jia ji points in the area of involvement and local GV points, with GV4 (ming men) being specific for lumbar pain. If you use this formula for low back pain as a substitute for, or in addition to, points which have shown success in your own practice, it is the very rare patient who will not see outstanding clinical pain relief in a very short time.

It is imperative that other procedures such as gua sha, direct low-level laser, cold therapy and heat therapy also be used. However, these acupuncture points can lead to successful symptom resolution without the use of ancillary treatment.

Even though I always recommend 12 treatments in cases of lumbar pain as a trial of therapy, I fully expect to discharge the patient from acute pain relief to stabilization care within the first four visits. Do not become discouraged if on some occasions it takes longer. However, the better you become with this procedure, the better your response will be.

These points are ideally treated with needles, but laser, electronic and percussive stimulation also may achieve favorable response. Needle retention should be no longer than 10 minutes with either electrical or manual stimulation.

All the best for your success using this formula. Drop me a note and share some of what I expect will be dramatic and successful responses. I would love to share your experiences in a future article. You can also contact me and request a graphic of these points should you wish to see them on a human form for easy application. Simply send your request for the Ultimate Low Back Acupuncture Formula directly to my e-mail address. All the best in 2010, the Year of the Tiger.


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Spinal Hua Tuo Therapy

By John Amaro, LAc, Dipl. Ac. (NCCAOM), FIAMA, DC

Without question, some of the most dynamic acupuncture points on the human body are known as the Hua Tuo jiaji points. These points are extremely easy to locate and use. They respond not only to the acupuncture needle, but also to any type of percussion such as a neurological reflex hammer, Wartenberg pinwheel, tuning fork, green and red laser, percussive instrument, gua sha, teishein (non-invasive needle) or firm digital pressure.

Any form of stimulation works absolute wonders in clinical practice when it comes to the Hua Tuo jiaji points.

The points were discovered by the legendary physician Hua Tuo, who was born in 110 A.D. and lived to the unprecedented age (at that time) of 97. He was reputedly murdered by the ruler of the Wei Dynasty after the ruler suspected an assassination attempt when Hua Tuo suggested brain surgery for his severe headaches. Hua Tuo was considered immortal, as he appeared to be in the prime of life even while approaching 100 years old. He was rumored to have found the secrets of exceptional health and longevity. He was known to stimulate his discovered points routinely, which may explain his unnatural longevity and health.

Spinal points actually extend both upward through the cervical spine and downward across the sacrum. However,only the 17 bilateral points attributed to Hua Tuo carry his name as Hua Tuo jiaji. The points in the cervical spine and sacrum are correctly and simply known as jia (lining) ji (spine).The Hua Tuo jiaji points are located just 1/2 human inch (a human inch is the distance across the widest part of the patient's thumb) bilateral to the Du Mai (GV) midline over the vertebral spinous process, bilateral from T1 through L5. The shu (associated points) of the 12 primary meridians, beginning at T3, are located 1.5 tsun from the Du Mo midline. These points work in startlingly similar fashion to the meric (mere = zone) system of chiropractic.

In traditional chiropractic circles, exceptional clinical response in most health conditions is thought to be obtained by treating an insulted nerve at the level of the intervertebral foramina due to displacement of the vertebrae; in modern times, explained as a vertebral fixation. These spinal fixations will cause both hypertonicity and hypotonicity of the paravertebral musculature, resulting in a neurothlipsis or so-called "pinched nerve." The nerve involved will affect the organ and tissue at the level of the involvement. Thus, the third thoracic vertebrae has a direct response to anything in the level of the lung including the bronchi, pleura, chest, breast, etc. This same explanation extends up and down the spine with respect to all organs, muscles, bone and structures of the body.

Hua Tuo developed a system of healing that appears to be remarkably similar to this approach; however, he did it 2,000 years prior to the discovery of both osteopathy and chiropractic. By the stimulation of these specific points at the precise vertebral level, virtually any condition known to man can be positively affected. That does not mean to say these points will cure everything; however, in my experience, the success rate in using these points at the precise locations is nothing short of miraculous.

The key is to understand the exact level of the vertebra in relation to the organ and tissue it controls. For example, Thoracic 6 is specific to the stomach, whereas Thoracic 7 and 8 are specific to the spleen/pancreas. The jiaji points of C7 are specific to the thyroid, as well as the shoulders and elbows. The classic acupuncture point known as BL 10 is 1.3 tsun bilateral to DU 15, which is just below the pseudo spinous of the first cervical vertebrae. However, the jiaji point, located 0.5 tsun lateral to DU 15, will affect the pituitary gland, scalp, brain, inner and middle ear, and sympathetic nervous system. An "energetic subluxation" at this point will manifest itself in neurasthenia, insomnia, hypertension, migraine, chronic tiredness, vertigo, headaches and susceptibility to colds.

These reflexes are very specific and have been a vital part of certain specialty practices of chiropractic for well over a century. The stimulation of the Hua Tuo jiaji points is not a routine or well-known procedure in the chiropractic profession. However, the reflex levels are classic and extremely well-established. I always advise practitioners to stimulate not only the Hua Tuo jiaji points, but also the GV itself and if appropriate, the shu point during treatment. Gua sha is an exceptional way to stimulate these points, as it is quick, easy and effective.

In as much as the specific reflex areas of the spine are not exclusive to, but generally only used by specialty practices, it is assumed that most chiropractic and acupuncture practitioners are unaware of the exact location of these points. Contact me directly at dramaro@iama.edu dramaro -at- iama.edu if you have questions and I will be glad to help.

_______________________________________________________________________

Battlefield Acupuncture for the Clinical Practitioner

By John Amaro, LAc, Dipl. Ac. (NCCAOM), FIAMA, DC

Recently, I have received several requests for information on battlefield acupuncture, a term first used in 2001 by my friend and colleague Col. Richard Niemtzow, MD, PhD, who serves as a consultant for complementary and alternative medicine to the Surgeon General of the Air Force. I have served with him on the board of Directors of the Auriculotherapy Certification Institute.

It was recently announced that the U.S. Air Force will begin training physicians being deployed to Iraq and Afghanistan in a specific type of treatment. The treatment uses small needles in the skin of the ear to block pain in as few as five minutes and can last for several days or longer. The procedure was initially introduced in 2008 at Landstuhl Regional Medical Center (LRMC), where it was applied to wounded service members and local patients for pain relief, with significant results. The hospital, located near Ramstein Air Base in Germany, is the largest and most modern U.S. military medical facility outside the United States.

One of the pain specialists at LRMC personally experienced a 25 percent increased range of motion and a 50 percent reduction in pain for chronic shoulder and upper back pain he had endured for several years. As a result of his outstanding success, this pain specialist recruited his most challenging patients, for whom traditional pain treatment had offered limited relief. Within minutes of the needles being inserted, many said their pain was reduced by up to 75 percent. A 25 percent reduction would be considered a success with traditional pain medications.

Despite its name, battlefield acupuncture is not purposely designed to replace standard medical care for war-related injuries, but rather to assist in pain relief and in many cases eliminate the need for pain medication for acute and chronic pain. This procedure is extremely easy to learn and may be taught to anyone in an extremely short time. It allows a provider to confidently complete a treatment and expect a good result within minutes. There are virtually no complications and patients are subjected to little or no discomfort.

It has been reported that only approximately 15 percent of patients do not respond to this acupuncture procedure, but of those who do, their pain reduction often averages about 75 percent. The frequency of application and the duration of relief vary with each patient, but treatment can progress from about two times a week to as little as once a month or longer. In some cases, further acupuncture treatment may not be required.

There are five specific ear points that are classically used; however, many practitioners only use two. The five points are: Wonderful Point (also known as Point Zero), Shen Men, Omega 2, Thalamus and the Cingulate Gyrus. The Cingulate Gyrus point and the Thalamus are the two points all practitioners use.

Acupuncture Points As in so many acupuncture procedures, practitioners may place the points in different locations. The Cingulate Gyrus has also been called the Subcortex by Terry Oleson, PhD (international authority on auriculotherapy). Beate Strittmatter, MD, a German authority, places it slightly differently (see Illustration). Personally, I use both locations just to make sure I cover all of my bases.

The Omega 2 point is on the internal of the helix. Due to the thinness of the auricle at this point, any stimulation from the exterior will contact the Omega 2 point. Some may wish to approach this point from the interior, but I personally go from the exterior.

The Thalamus point is directly opposite on the internal side of the exterior points known as the Temple or Sun. Most battlefield acupuncture practitioners approach the Thalamus from the internal position. However, I have always felt this point could be accessed just as easily by stimulation of the Temple (Sun) points from the exterior, and have used it that way for years.

The official procedure uses gold semi-permanent needles, which are placed directly into the point and left to fall out on their own in a day or two. I have seen marvelous results with low-level laser directly to the points, as well as electronic stimulation. Conventional acupuncture needles may be stimulated for 10 minutes. Then use an acu-patch, which is a small stimulation sphere attached by flesh-colored adhesive. This can be left in place for several days or longer.

This procedure is too valuable to overlook in your general practice. It is easy, quick and effective. Do not limit yourself to just acute or chronic pain with this combination of points. It is also extremely effective in anxiety, neurosis, neurasthenia and any psychological or stress-related issues.




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Ear Acupuncture: "Which Ear Do I Treat?"

By John Amaro, LAc, Dipl. Ac. (NCCAOM), FIAMA, DC

Perhaps one of the most perplexing clinical questions concerning ear acupuncture is which ear to treat for maximum effectiveness. As most practitioners are aware, some "authorities" have advised that if "the patient is a woman," treat the left ear.

On the other hand, other "authorities" say to treat the right ear based on yin/yang principles. The same is true for male patients. Some authorities say if the problem is truly on the left side of the body, treat the opposite side; other authorities advise to treat the same side as the affliction. If the problem is an internal disorder, some say to treat both ears; however, an equal number recommend treating one ear or the other, based on a multitude of principles which have been shown to be highly questionable.

I personally knew of a quite elderly MD in the early 1970s who returned to practice with his MD son after being in retirement for more than 15 years. The senior doctor was so taken by the ease, effectiveness and excitement of "auriculotherapy" that he joined his son's internal medicine practice, attending to patients three days a week, seeing between 35 and 50 patients a day.

The junior doctor had purchased a used dental chair for his enthusiastic father, and the senior doctor (bear in mind, he was in his upper 80s) had his charts on the wall in front of him and a stool which was perched on the patients' right side. He treated every patient's right ear because that was where his stool was located. Based upon his stellar clinical response, which was probably more due to his infectious enthusiasm and expectation than his skills, one would think you should always treat the right ear. It certainly seemed to work for him. However, when I studied in extreme Northwest China in 1980 and in Tibet in 1985, I learned of what I believe to be one of the most significant applications of which side of the body to treat. I have personally used this procedure for well over 25 years and can speak of its value.

In 2003, I wrote a two part series titled, "The Caduceus, Chakras, Acupuncture and Healing."* I highly recommend you read these two articles for a general background, as space limitations do not allow me to explain the entire procedure in explicit detail. Be sure to read the part concerning the nations that have contributed to acupuncture education. This is imperative.

In those two articles, among a variety of educational thoughts, the general concept of the "ida," "pingala" and "sushumna" was discussed. This provides the basic framework for the procedure to be discussed here. Ida is the feminine (yin) or right side, which is activated through the breath through the left nostril, whereas the pingala is the masculine (yang), which is activated through breath in the right nostril. The sushumna constitutes the spinal tracts and cord (GV and CV). The three of these make up what we know as the intertwining snake comprising the chakras, the energetic basis for the meridians and what has become to be known as the medical caduceus. Please bear in mind, the concepts of the ida (feminine, right, yin), pingala (masculine, left, yang) and sushumna (Ren and Du) are mind numbing as to detail and only a fraction of the explanations are discussed here.

Quite simply, if you were to apply pressure to the outside of the right nostril, blocking it completely, and breathe deeply through the left nostril, and then repeat the procedure by applying pressure to the outside of the left nostril (blocking it completely) and breathing deeply through the right nostril, you would discover that you have a definite nostril which is more open than the other. In the acupuncture programs I teach, we demonstrate this to the surprise of the entire class. A class of 50 or more will demonstrate the above-described procedure, and fully 48% of the participants will clearly show a right nostril open, whereas another 48% will show the left nostril open completely. The remaining 2% will report both nostrils are equally open.

This is extremely significant; if the "right" nostril (pingala) is more open, this means the left brain (masculine, analytical) is in full activation, whereas if the "left" nostril (ida) is more open, the right brain (feminine, creative) is fully engaged. From an ear acupuncture approach, and many applications of body acupuncture to include cerebral acupuncture, this means if the right nostril is open, the left ear is more receptive to treatment; if the left nostril is open, treat the right ear. If both nostrils are open, treat bilaterally.

The most stunning part of this concept is that the person of usual health will naturally shift back and forth between the left and right nostril being open in relation to the harmonics and flow of the horary cycle as it goes through the four-hour element cycle of each of the 12 meridians in a 24-hour day. As a general rule, the average person will shift from left to right and back again every three to four hours, as each of the specific elements has a four-hour maximum flow before moving to the next dominate element.

Lung and Large Intestine (Metal) are from 3 a.m. to 7 a.m., followed by Stomach and Spleen (Earth) from 7 a.m. to 11 a.m. If a practitioner checked a patient and found both nostrils equally open, this would mean the patient is in a state of transgression between left and right, suffering from a malady that does not permit the shift from left to right. This is critically important. Of equal importance is a person who, because of chronic sinusitis, a deviated nasal septum or other cause, is not allowed to shift the openness of the nostril throughout the day.

In essence, the bottom line is that before initiating either ear acupuncture or cerebral acupuncture, always have the patient completely block each nostril in turn by pressing firmly with the finger on the nasal ala and breathing deeply through the unimpeded nostril. The nostril that is open indicates treating the opposite side (ear or cerebral). If the nostrils are determined to be open equally, it is imperative to treat bilaterally.

Initiating this concept into your clinical practice will reap incredible clinical responses possibly not seen in previous applications. Remember: Even if you do not do this procedure routinely, you are still going to have a 50-percent chance of choosing the right ear. Try it and let me hear of your victories. It is truly spectacular.

*Editor's note: Dr. Amaro's two-part series on "The Caduceus, Chakras, Acupuncture and Healing" appeared in the April 21 and June 2, 2003 issues of Dynamic Chiropractic, respectively: www.chiroweb.com/archives/21/09/01.html and www.chiroweb.com/archives/21/12/01.html.


The Caduceus, Chakras, Acupuncture and Healing, Part II

By John Amaro, LAc, Dipl. Ac. (NCCAOM), FIAMA, DC

Part I of this article (DC, April 21) explored the historical perspectives and healing corollaries of the medical caduceus, represented by the double-coiled serpent, as it relates to the chakras and acupuncture.
As I was preparing that article, I found it difficult to encapsulate the information into a format consistent with this column space. The topic of the caduceus and chakras, as it relates to acupuncture and healing, may well be one of the most challenging I have endeavored to describe. This is only because of the vast amount of information this topic encompasses, including the philosophies of dozens of nations, both ancient and contemporary. I soon realized that what I have learned over the years and practice clinically on this topic could easily fill a book.

As a student of the Asian healing arts for over three decades, I have observed firsthand healing principles in nine separate Asian nations. However, my studies have taken me to a variety of nations and historical times I have not personally observed, yet still formed my education. This was most recently brought to mind with the world focused in 2003 on the Middle East, specifically Iraq; Syria; Turkey; Iran; Afghanistan; Pakistan; and India.

Most practitioners of acupuncture and Asian medicine in the Americas, Australia and Europe tend to think of China as the place of origin of this style of healing. However, when one explores the numerous healing disciplines, from scores of nations, that have contributed to the development of traditional Chinese medicine (TCM) over the centuries, the amount of knowledge is humbling, to say the least. These contributions have occurred from all of the mentioned Middle Eastern nations, ancient Greece and Rome. The healing philosophies of Persia and India have had an extremely strong influence in developing the philosophical concepts that created the healing principles of Tibet and Nepal.

The primary nationality comprising China's westernmost regions has a strong medical tradition that combines Islamic (Unani) medicine with ayurvedic medicine of India, along with TCM. The Hui, or Muslim Chinese, are most heavily concentrated in Northern and Western China. Much of their medicine has, at its root, a strong Arabic influence, introduced when the Arabs came into Western China in the ninth century. As the Arabs conquered the Mediterranean, what they gathered from the Greeks in regard to medicine became a vital part of the medicine and philosophies of the entire Middle East.

image

 

Part I of this article drew a strong corollary between the double-coiled snakes around a single shaft and its relationship to what was referred to in the spinal tracts of Indian medicine as the "ida," "pingala" and "sushumna" that comprise the kundalini, or the power centers of the body. (Refer to part I for illustrations.) Every time the ida and pingala, represented by the snakes in the caduceus, cross one another, the crossing forms what is referred to as a "chakra" when applied to the body.

Historically, these chakras are represented on the front of the body, and correlate with what we know in acupuncture as vital acupoints.

The study of the chakras is a topic that goes well beyond the space limitations of this column. I urge the reader to visit his or her local book dealer for a variety of literature devoted to the significance of the chakras. You may contact me at the e-mail address at the end of this article for specific sources. It is imperative, however, that those involved in Asian medicine explore the importance of the chakras in its creation and distribution of the energetic field of the body.

Anyone who has ever studied Asian medicine is familiar with the ancient concepts of the "five elements," as it forms one of the most practical, clinical and historical foundations of acupuncture. The relationships between the elements, the meridians they represent, and general factors affecting the body, are time-honored. There is a strong relationship between the chakras and the five elements in Western, Tibetan, Nepalese, and even Southern Chinese acupuncture.

Examine Figure 1 and Figure 2. Please note that the chakras on the anterior body indicated by the crossing of the two tracts have a specific relationship to a specific acupuncture point and vibratory color, namely:

Note that each chakra has a particular relationship to a yin and yang coupled set of meridians (e.g., 5th chakra-Ren 22-Bl/KI). Also note each chakra is associated with a particular color, consistent with the colors associated with the elements in five-element acupuncture. The meridian correlation to a chakra is based on the color associated with the five elements. For example, green is associated with the wood element, which, in turn, is associated with the LIV/GB meridian.

Chakra
Acupoint
Color
7th
DU 20
violet/white
6th
YinTang
indigo
5th
Ren 22
blue
4th
Ren 17
green
3rd
Ren 12
yellow
2nd
Ren 3-8
orange
1st
Ren 1
red

  

In Figure 2, on the posterior of the body, please note that each chakra has a specific relationship to a particular vertebral level. For example, the 5th chakra is connected with DU 14, between C7/T1. The meridian and color relationship, as in the anterior body, are the same for the posterior body.

To utilize one of the most powerful healing affects in ancient Western Chinese, Persian and Indian acupuncture, make a correlation between the involved meridian and the associated chakra, and utilize acupoint locations on the anterior (yin) and posterior (yang) side of the body related to the involved chakra.

One of my favorite clinical stories that illustrates this concept relates to a gentleman whose son-in-law lives in Paris. The son-in-law suffered from extreme low-back pain with radiating sciatica, which was excruciating. After exhausting all forms of "alternative" medicine, including acupuncture and chiropractic, the patient was scheduled for a decompression laminectomy. Prior to going into the hospital for surgery, the patient was advised of a "healer" who practiced on the third floor of a building in Paris, not far from the patient's home. He was convinced he should at least give it one more chance. On arriving at the building, he was met with three flights of stairs, which he navigated slowly and painfully. After explaining the history of the problem, the practitioner simply placed his two overlapped fingers directly on the top of the patient's sternum at the manubrium. After holding this spot for approximately two minutes, the healer leaned away from the patient and asked how he felt. The patient, being a busy, no-nonsense businessman, was mortified this was all the practitioner had in mind to do. Disgusted with the fact he had just climbed three flights of stairs with considerable pain, he turned, and in a huff, started down the stairs. When he reached the first landing, he suddenly turned and went back up to the practitioner, demanding to know what he had done to him. The pain that had been so excruciating had suddenly lifted to a tolerable ache. The patient returned the following day for a follow-up treatment that completely resolved his condition, at least with regard to pain. His surgery was cancelled. Two full years have passed with no return of the symptoms.

This is an ideal example of the abovementioned principle in action. Due to the patient's spinal condition, it was ascertained through acupuncture principles that he had involvement of the bladder and kidney meridians. Each is associated with the water element, which is associated with the color blue. The 5th chakra is likewise associated with the vibratory energy of "blue." Therefore, in five element/chakra balancing, this action will be taken directly at Ren 22, which is the 5th chakra.

Since many of the conditions we see clinically are of the musculoskeletal variety, it behooves us to recognize that muscles, tendons and ligaments are under the influence of the wood element, associated with the meridians of the gallbladder and liver. These two meridians have their related chakra at CV (Ren) 17. One of the most startling clinical responses you can expect results from stimulation of CV 17 in any musculoskeletal-ligamentous condition. Likewise, it is imperative one take action on both the yin and the yang chakra, by stimulating DU 11 between T5/6.

The same is true for the 3rd chakra, as it connects with the stomach meridian and the earth element. Its posterior chakra is specifically at the double-point of DU7 and DU6, between T10/11 and T11/12. It is imperative to realize that the earth element is divided: The 2nd chakra is likewise associated with the earth element; however, it is related specifically to the spleen meridian and associated with the color orange. This entire area from the navel to the pubic symphysis constitutes what is known as the "tan tien" or center of energy. The spleen meridian in TCM is responsible for the creation of chi through nourishment.

Those with metal-element situations affecting LU/LI will receive significant results by stimulation of the 7th chakra relating to DU 20 and specific vertebral stimulation at DU16 at the atlanto/occipital area. Keep in mind: The color associated with the 7th chakra is violet; however, white is likewise associated here, as it is the culmination of all the colors. White is reflective of the metal element. DU 20 has a powerful effect on any condition affecting the lung or large intestine meridian. Academically, it is not a classic point for these meridians, but it is extremely important in the "chakra" style of acupuncture. Symptoms associated with the fire element have shown stunning success by utilizing Ren 1 in the perineum. It can also be reached through the posterior at DU3 between L4/5. As opposed to stimulating Ren 1 in its delicate location, utilizing the Korean hand point (at the base of the hand, just distal of the wrist on the palmar surface) has yielded stellar effects.

The one chakra that does not have a specific color associated with the five elements is the 6th chakra: indigo. This becomes a combination of the blue of the 5th chakra and the violet of the 7th chakra. In clinical applications, it has a very strong influence with the kidney meridian. Just as the 2nd and 3rd chakras are divided into the color of orange (which does not exist on the five elements) for the 2nd chakra and yellow of the 3rd chakra, the same thing occurs at the 5th, 6th and 7th chakras. Consider the bladder meridian associated with the 5th chakra, and the kidney with the 6th.

Note how the ida and pingala cross at DU 26; however, no mention of a chakra is located here. This is perhaps one of the most powerful points on the body for a variety of conditions, which is often overlooked in acupuncture. Most practitioners know this point to be effective in reviving a fainted patient; however, it is extremely powerful for pain and anxiety. It meets all of the criteria of a chakra in that it is at the junction of the crossing ida and pingala; however, it is usually not associated with a chakra location. DU 26, in my opinion, is a landmark acupuncture point. Begin to use it for any pain condition. This point is so powerful, I will have to reserve further comment for an entire article devoted specifically to its application.

Any practitioner who is academically knowledgeable of the five elements can utilize some creative imagination and successfully treat hundreds of conditions specifically through the chakras. Assume a patient visits your clinic with the complaint of macular degeneration. Besides the typical medical approach to this condition, the practitioner will draw a corollary between the eyes and the liver meridian. This, of course, would be associated with the green, which is the 4th chakra, with its key point on the yin side at CV (Ren) 17 and yang side at DU11 T5/6.

Electromeridian imaging (EMI) has shown incredible promise in contemporary acupuncture with regard to this application. On electronic examination, any time a paired meridian, such as BL/KI or LU/LI, is involved by being elevated, depressed or split, direct action to the chakra has shown quicker stabilization of the meridians. This same concept can be applied to auriculotherapy (ear acupuncture). This is accomplished by discovering the involved paired or single meridian electronically, then locating the corresponding ear point. The effect is extremely noteworthy.

When one begins to correlate the various factors attributed to the five elements, such as environmental; emotional; body parts; senses; and tastes, and begins treating both the yin and yang chakra related to specific conditions, it opens up a dimension in acupuncture that is one of the easiest and most effective to utilize in your practice.

Be sure to read my previous articles on EMI [www.chiroweb.com/archives/20/20/01.html and www.chiroweb.com/archives/20/26/01.html]. This contemporary method of diagnosis, combined with the ancient principles of acupoint chakra balancing, will create a new environment in your office that will be rewarded by increased referrals, financial benefits, and most importantly, patient satisfaction.

John Amaro, DC, FIAMA, Dipl. Ac, LAc
Carefree, Arizona

dramaro@iama.edu dramaro -at- iama.edu

_____________________________

The Power of Innate Acupuncture Point Selection

By John Amaro, LAc, Dipl. Ac. (NCCAOM), FIAMA, DC

In the early days of my career, I treated a young lady who had suffered extensive neurologic injuries to her face after slipping while cleaning the side of the bathtub. She'd experienced agonizing nose and facial pain, 24 hours a day, seven days a week, for over four years.
She complained of multiple paraesthesias, and that her teeth felt like "mush" against her tongue. Virtually every medical doctor in every specialty she consulted ultimately suggested psychiatric care, simply out of total frustration in their failure to eliminate (or even reduce) her horrific pain.

The DCs my patient saw were some of the best, including technique experts in cerebral manipulation; endonasal technique; kinesiology; and various adjustive procedures from the atlas to the coccyx. She consulted me for the possibility of acupuncture, even though it was quite new in the U.S. in 1973. In those early days of acupuncture, only the most desperate patients sought it.

Although I was young in my practice, I possessed incredible confidence, albeit backed by minimal clinical experience. After numerous acupuncture treatments; chiropractic adjustments to the spine; manipulation of the hard and soft palates; and "pulling" her uvula, I came to the hard realization that I, too, had failed her. I suggested she see a psychiatrist. Why, when a patient fails to respond, are we so eager to put the blame on the patient's mentality?

One evening, I felt a sudden urge to find a newspaper article I had saved in a large box in the back of my closet. After dragging out the box and extracting papers, photos, etc., I found a small steno notebook. I threw it over my shoulder to join the rest of the heap, but instead, it struck me right between the eyes, scratching my forehead with the sharp edge of the projecting spiral binding.

The notebook landed in my lap, with a page staring up at me that said, "For nasal pain - point #17." There was also a small, barely legible sketch I had drawn of a hand with the acupoint illustrated. This was the notebook I used on my first visit to China in 1973, when I visited the Tai Chung Medical School in Taipei. It was at the school that I was first presented with the concept of Chinese hand acupuncture.

Talk about something hitting you right between the eyes! I immediately thought of my patient, and wondered if this point could do something for her. Up to that point, I had used every method I knew, and had accepted that I was going to have to relieve her from care.

On her next visit, I stimulated the point I had discovered, quite by accident, the night before. She was irritated with me, because the only procedure I performed during that visit was to tap with a noninvasive needle (teishein) on a point on her wrist. She felt the simplicity of this treatment was inadequate to help her raging pain, and wanted me to do more. Frankly, at that point, there was nothing else I knew to do.

As she walked through the reception room on her way to the door following her treatment, the patient slumped into a dead faint in the middle of the floor. Upon reviving, she explained that she had been overwhelmed because, as she moved across the room, her pain and paraesthesia, which had been of the highest magnitude, were suddenly and instantly relieved.

I can't explain it, and it makes no sense to my physiologic (or just plain logical) mind, but it happened. I shall never forget that acupuncture point, located two fingerbreadths distal to the dorsal wrist crease, in line with an imaginary line drawn down the middle of the index finger.

The patient was released from over four years of devastating, unexplained pain and paraesthesia in a matter of seconds - an incredible testimony to acupuncture. However, it is imperative to understand the whole message, not just the specific point used. The real message is to always act upon those glimmers of innate intuitive insight, and to truly listen to that small voice whispering in your ear throughout the day. Anyone who has been in the health care field long enough to be called a "veteran" knows exactly what I am talking about. Sometimes, the answer to a troubling case may come to you in the most unusual way. Always be receptive to innate, intuitive thoughts regarding patient care.

Years ago, I attended what may have been one of the first graduate school programs in acupuncture in the United States. The principle speaker, from Kowloon, China, stated, "When you don't know what to do any more with a patient, or didn't know what to do in the first place - always consider tsing (jing-well) points, because they're magic. "My initial thought was that this was an extremely exaggerated, simplistic statement, barely worthy of note. However, I scribbled the thought down, which as we know, unfortunately often ends up buried in a myriad of words and paper, never to be seen again.

Months passed, and my practice became increasingly filled with fewer and fewer open appointments. Acupuncture was at a fever pitch, as the general public was inundated with positive reports of its effectiveness from the media.

As I was closing the office one evening in late spring, the front door opened. Standing before me were a mother and father carrying their daughter, who was in obvious severe neurologic insult. Gazing upon this twisted child, I wondered how, because of her advanced condition, the parents could care for her. I then noticed the hospital band on her wrist. The parents explained to me that they were in the process of returning the child to ChildrenÕs Mercy Hospital, as they had been out on a rare day pass. Apparently, it was the child's seventh birthday, and she had been taken home to celebrate with friends and family. This was to be her last birthday. The prognosis was grave.

The diagnosis from the Mayo Clinic was Òidiopathic neurogenic syndrome. Since she suffered from an unusual, unexplained neurologic condition, there was treatment to save her life, only to prolong it Ð and that was failing. She presented rigid neurologic opisthotonis; death imminent.

On the way back to the hospital following the party, which was literally a living funeral, family and friends gathered to be with the child one last time. The child's parents passed my office and decided to stop. Having heard of the benefits of acupuncture, they wondered if perhaps it could help.

As the parents explained the gravity of the situation, including the diagnosis and prognosis, I was frankly overwhelmed. With tears streaming down their faces, they asked if I could treat their baby. Looking at this pitifully rigid child and the parents, I reluctantly told them, "I'm sorry, this is really out of my league, I wouldn't even know where to begin." When they asked if I would just try, as they had literally nowhere else to go, or even if I would work on her as a research project, I again responded with apologies and sorrow that I wouldn't even know where to begin.

At that point, it became as if someone was sitting on my shoulder, whispering, "When you don't know what to do anymore, or didn't know what to do in the first place, always use the tsing points, because they're magic." Was it a thought in my head, or were these words being whispered to me? In any event, the feeling was too strong to ignore. I took a nonpenetrating teishein (one of the original nine acupuncture needles first described) and stimulated each and every one of the 12 meridian tsing points next to the nail bed, for approximately 15 to 20 strokes apiece. I then took a green marking pen and marked each point I had just stimulated, instructing the parents to repeat this procedure every day in the morning and evening, using a ballpoint pen.

Even though they realized they were now on the way back to the hospital to watch their daughter's eventual demise, the parents left the office with a glimmer of hope and the words of a master. (I am embarrassed to say I never even got his name.)

That event happened on a spring evening. One morning that fall, this child began school with her regular class. I only officially saw her once; however, the parents stimulated the tsing points of that child with love, compassion and expectation twice a day. I was invited to her eighth birthday party! To this day, I still use a green felt-tip pen to mark points for follow-up stimulation.

From where did this point selection arise? It had absolutely nothing to do with my academic excellence or highly evolved intellect; it came directly from innate intuition, and listening to what was being said. How many times do we hear, but not listen? Sometimes, we are afraid to act, because the thought may be contrary to what we felt was proper academia. Be alert and aware of the many clues and fleeting thoughts received throughout the day. Acting on some of these innate intuitions can be extremely rewarding.

My last celebrated case of innate intuition bordered on the eerie. I recently saw a middle-aged woman complaining of multiple visceral symptomatologies. It appeared as though every system of her body was pathologically involved, from respiration to the cardiovascular, digestion, musculoskeletal, lymphatic and endocrine systems. She had seen a variety of specialists and was taking 14 different medications. She presented an extremely complicated case history that, when the primary doctors she was seeing came in, needed to be filed in two folders because of the sheer mass of the paperwork.

I began treatment on her using the "electro-meridian imaging" (EMI) method of diagnosis; it showed extreme involvement of 10 of her 12 meridians. She had been to a TCM practitioner I know has a stellar reputation, but even with his years of practice, he could not commit to a TCM diagnosis. To say this was a complicated case would be an understatement.

One afternoon, while driving my car, I was stopped in traffic and found myself wandering mentally. I thought of this patient, what her underlying problem might be, and what I could do for her. As I sat gazing out the passenger window, another vehicle pulled up beside me and rolled just past my window as its rear bumper came into my direct view. I couldn't help but notice its license number: LU6-TW4.

I tried my best to talk myself out of using these two acupuncture points on this patient; however, having been in similar situations before, I had no choice. Following the first treatment, the patient's condition worsened, which I did not think was possible. However, by the next morning, she reported feeling considerably improved. I treated her two times a week for four weeks, at which time she stated she felt like an entirely new person. I also balanced her meridians using EMI.

A recent examination by her primary medical physician revealed major improvements in her blood chemistry. Her symptoms are a fraction of what she previously experienced. Her EMI exam is close to being balanced. She is energetic, sleeps all night and has regained her appetite. She came into the office recently stating she had just signed up for a yoga class. She is excited about the future, as her extreme depression is now just a memory. She has received a total of 12 treatments.

LU6 is the hsi point and TW4 is the yuan point. They have to have a rational explanation. However, how they worked together in this case is a mystery to me. I guess the biggest mystery is, whose car was that?

Of course, this is just a freaky coincidence... or a script from a "Twilight Zone" episode... or a total fabrication - a dream after too many Shitake mushrooms. Our rational mind will not allow for any other explanation. However, these events are around us daily. Take advantage of them.

We are often presented with the answer to our patients' problems (or our own) in unusual ways. We may see a sentence in a book or a billboard that triggers a thought, hear a statement on TV. Act upon it. Don't be afraid to let intuition enter your thoughts. These thoughts, coupled with sound academic principles, are extremely powerful. Keep yourself mentally attuned by constant reading and study, but also allow the sixth sense to become a part of your being.

One of the most significant masters I have had the good fortune to study with said it best: "When the student is ready, the teacher shall appear."

Best wishes for a healthy, happy, productive 2003.

John Amaro, DC, FIAMA, Dipl. Ac, LAc
Carefree, Arizona


Spectacular Acupuncture Points in Diffuse Musculoskeletal Pain -- with or without Needles!

By John Amaro, LAc, Dipl. Ac. (NCCAOM), FIAMA, DC

The treatment of musculoskeletal conditions by acupuncture is legendary. There are perhaps no modalities in the healing arts which are as effective for specific area pain relief. As a general rule, acupuncture is most easily applied to a particular joint or area of musculoskeletal complaint with the use of acupuncture point stimulation at the area of complaint.
This procedure known as "surround the dragon" is one of the most classic of acupuncture techniques. It is used throughout the acupuncture world and has been for centuries. But what happens when the pain is extreme and diffuse throughout the body? How do we treat and where is our focus?

In "surround the dragon" for localized problem areas, acupuncturists palpate tender (ah shi) points in and around the area of complaint and stimulate them. Even though needle stimulation is most often thought of as acupuncture, it must be remembered, "Acupuncture is a principle, not a technique." Therefore, many forms of stimulation are as effective as needles: simple electronic stimulation; noninvasive pressure stimulation through a "teishein"; red light laser stimulation; heat; cold; pressure; and ultrasound. In addition to "surround the dragon," traditional Chinese medicine (TCM) recognizes three patterns of disease which are most often connected with diffuse systemic pain and are extremely important to treat. They are "dampness," "blood vacuity (deficiency)" and "exterior wind."

Dampness

Dampness is primarily associated with loose stool; fatigue; nausea; general heaviness in the body; multiple painful sites; and joint stiffness, with difficulty in locating an exact point of pain. The tongue is greasy and the pulse is slippery and boggy. According to TCM, the way to treat this situation is to remove dampness by supplementing the spleen. When musculoskeletal conditions arise as a result of dampness, it responds remarkably well to the liberal use of moxa, which can be used through the use of a moxa stick held close to specific points, or by attaching moxa to the end of the needle and allowing it to burn. A practical approach is to have the practitioner mark the points for the patient and have the patient apply warming moxa to the specific points at home through the use of a moxa stick held close to the point. There are a number of specific acupuncture points which have a remarkable effect on conditions brought on by dampness. They include:

  • GB 34 (outside of knee), the most important of all the musculoskeletal points of multiple site pain origins;

     

  • ST40, classically used to disperse phlegm;
  • SP 9 (inside of knee), removes dampness;

     

  • JEN MO 9 (CV 9) removes dampness;

     

  • SP 3, SP 6 supplements spleen qi;

     

  • BL 20 (associated point for the spleen);

     

  • LIV 13 (alarm point for the spleen tip of the 11th rib), the major meeting points of the viscera;

     

  • JEN MO 12 (CV 12) with CX(P) 6, extremely effective in conditions of nausea and constriction of the chest as a result of dampness;

     

  • ST 36 supplements spleen qi;

     

  • SP 21, great luo point, deals with any systemic pain due to dampness.

Exterior Wind

Exterior wind is a common occurrence which is responsible for multiple musculoskeletal pain sites. Even though exterior wind can produce multiple pain sites, it is most often associated with the neck, upper back and shoulders. Wind generally is much more of an acute pain than that of dampness, coming on very quickly even in the otherwise healthy individual. These conditions usually occur when the patient has been in direct wind situations, such as having a fan or air conditioning duct blowing on them. It may even occur when a patient is protected from the wind but wind is exhibiting itself in the environment such as a very windy day. It is the energy of wind in the environment which is the culprit. In these situations the extraordinary meridians become taxed, which generally produces the pain. In TCM, the tongue has a thin white coat and the pulse is considered floating. In needle therapy, it is suggested to use a superficial stimulation. In situations where cold is combined with wind, moxa to the points are very effective. The points of significance in wind conditions are:

  • GB 34, specific meeting point for all the sinews;

     

  • GB 31 disperses wind from the lower half of the body;

     

  • LI 4 disperses wind from the upper half of the body;

     

  • BL 12, point where perverse wind energy enters the body, disperses wind;

     

  • BL 10, GB 20 are points just below the occiput that disperse wind and also are points where wind enters the body;

     

  • BL 11, point of significance for any bone problem;

     

  • TH 5 and GB 41, master points for the balancing of the yang wei mo and du mai; significant in any multiple joint or musculoskeletal pain, especially as connected with arthritis;
  • SI 3 and BL 62, master points for multiple pain, especially of the back; deals with the governing vessel and yang qiao mai.

     

  • GV 14 and LI 11, used in fever.

Blood Vacuity (Deficiency)

This pattern creates diffuse relatively mild pain which and produces discomfort on palpation throughout the body. The pain is most often described as being in the flesh, as opposed to the joints or muscles. The patient generally presents appearing sick with symptoms of pale dry skin; brittleness of the nails; fatigue; insomnia; nervousness; vertigo; and general emaciation. In TCM diagnosis, the pulse is thready and the tongue is pale. Treatment is focused on supplementing qi and blood and supporting the spleen. It is advised to use few needles and to avoid strong stimulation. Moxa is also effective when used with a moxa stick applied to the point. Points of significance are:

  • ST 37, ST 39, used for vague general pain with lowered energy ("Sea of Blood" points);

     

  • SP 4, master point for supplementing blood and affecting the spleen meridian;

     

  • SI 6, powerful point for general pain in the elderly or very weak;

     

  • BL 11, great bone point but also a point associated with Sea of Blood;

     

  • BL 20, associated point for the spleen;

     

  • BL 17, diaphragm point but also meeting point of blood;

     

  • GB 34, master point for the sinews;

     

  • SP 10, powerful point to increase blood;

     

  • ST 36, SP 6, supplements spleen and affects blood.
The points you have been presented with here are some of the most classic points historically used by "masters" in the field of acupuncture. They are simple to use, especially with noninvasive procedures, and produce spectacular results. Should you use needles, do not leave the needles indwelling more than 20 minutes at a maximum. If you have the patient use a moxa roll on the points themselves at home, remind them to just warm the point as opposed to overheating it.

I have written this article for those who are familiar with the location of the aforementioned acupuncture points. If you are a neophyte or confused as to the location of these points, be sure to include acupuncture postgraduate education in your schedule this year. You absolutely cannot afford not to. You've been given the keys. Now go out and open the doors to allow the pain to leave. Let me know of your stellar cases.


Use Some of the Most Powerful Acupuncture Points as an Adjunct to Your Practice!

By John Amaro, LAc, Dipl. Ac. (NCCAOM), FIAMA, DC

In the practice of acupuncture, there is no question that some of the most powerful points on the body are the "MU" points, otherwise known as "alarm" points. These points are diagnostic, therapeutic, and have stood for centuries as first-choice points by countless masters in the treatment of a multitude of health conditions.

Each of the specific acupuncture meridians has an alarm point on the anterior side of the body which is located over the organ for which it is named, i.e., the lung meridian is over the lung, the gallbladder meridian alarm point is over the gallbladder, etc. All but two of the alarm points are on the chest and abdomen. Those two points are found at the tip of the eleventh and twelfth rib and correspond to the spleen and kidney meridians, respectively.
Master Asian acupuncturists use these points extensively, but the typical contemporary practitioner has a tendency to disregard these points in favor of others. In my opinion, to ignore these points is perhaps one of the worst mistakes a practitioner can make.

I like to refer to the alarm points as being the circuit box of the body. If a health condition exists and a meridian is involved, it will "trip a circuit breaker." If the lung meridian is involved in a case of bronchitis, the lung alarm point is the localized therapy for those skilled in muscle testing (applied kinesiology) but will also be acutely tender to palpation.

There are a number of factors concerning acupuncture which are extremely significant in the diagnosis and treatment of meridians. For example, the functions of the skin are controlled by the lung meridian; muscle and ligaments are controlled by the liver meridian; and hearing is controlled by the kidney meridian. Emotions such as grief, sorrow, worry, fear and anger are associated with individual meridians, as are environmental factors, which may trigger disease processes.

One of the primary treatments involving the principle of acupuncture, which virtually any practitioner may employ, is to simply palpate and treat the tender alarm points. Since each alarm point is directly associated with a specific meridian, a general treatment approach affecting all of the alarm points would not be out of order. Treatment may consist of something as easy as firm, direct digital stimulation for 12-20 seconds per point, or simple electronic stimulation via one of the inexpensive but powerful electronic devices available today. Acupuncture is a principle not a technique. There are a number of acceptable ways (without needles) to treat an acupuncture point, although proper needle procedures to these points create dramatic effects.

One of the easiest methods, and one in which your patient may participate, is to utilize the Koryo Sooji Chim or Korean hand system to generally stimulate one or all of the meridian alarm points. In 1971, a complete system of acupuncture was discovered which today has over 20,000 practitioners internationally. These practitioners practice a system of acupuncture that employs nothing more than the use of specific points on the hands. Each meridian point on the body has a corresponding point on the hand.

Examine the charts of both the body alarm points and the Korean hand system. General stimulation of these points will provide dramatic response. Even if you are a neophyte in acupuncture, using the points shown here is easy, effective and available. I strongly urge you to use these points.

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Here is my wish to you for a wonderful holiday season and the best in 2000, "The Year of the Dragon"!
















The "Forbidden Points" of Acupuncture!

By John Amaro, LAc, Dipl. Ac. (NCCAOM), FIAMA, DC

Of the approximately 1,000 acupuncture points on the body, only a few have been shown through historical and clinical experience to be contraindicated for certain types of stimulation.
Throughout history, the two primary methods of acupoint stimulation have been moxibustion, the burning of the herb artemesia vulgaris at the acupoint, or the insertion of acupuncture needles.
Today, with the advent of electronic forms of stimulation and laser beams, the acupuncture points which are forbidden to both acupuncture or moxa can be safely and effectively treated.

One of the most memorable experiences in my acupuncture career involves a class I was teaching some years ago. Commenting on the birthrate in Mao Tse Tung's People's Republic of China, I noted that in the mid-1960s, Chairman Mao issued an edict proclaiming no married couple could have more than one child. This was an attempt to keep the population of China at one billion or less by the year 2000. The latest estimates I have seen of China's population is 1.4 billion. Even though it was a noble attempt, it didn't quite work. However, it is hard to imagine what the population would have been had this edict not been put forth.

If a woman in China is pregnant with a second child, or in numerous cases, if the couple knows the first pregnancy is a girl, the couple will go to the medical clinic for an abortion. One common method of abortion is simply to use strong acupuncture point stimulation of San Yin Chiao (SP6) in conjunction with He Gu (LI4). The abortion is generally realized within 24 hours.

After relating this information to the class, a doctor in the class suddenly became pasty white and began to experience dry heaves. He ran outside, and through the closed doors, I could hear him become violently ill. During the class break, I found the doctor in the hall with his head in his hands sobbing uncontrollably. The doctor stated that he and his wife had been married for 12 years, and with both he and his wife having come from large families, they were excited about having their own. They both wanted a houseful of kids.

As the doctor continued, he told me his wife had been pregnant seven different times over their 12-year marriage. Each time she became pregnant, shortly into the pregnancy, she would miscarry. She had sought the help of numerous specialists to no avail. She had no problem in becoming pregnant, but could never take the fetus to term.

The doctor was distraught about the "abortion" points. To boost her immune system and provide the best possible health for his wife's pregnancies, he had stimulated SP6 and LI4 each time she was carrying. He was sick to think he may have inadvertently caused the abortion of the fetuses.

The story ends on a happy note. At last report, the couple have three children. They named the first child, a girl, Johnna (after me)!

Take appropriate caution concerning the following list of forbidden acupoints. Disobeying the rules can be quite costly.

Point --Stimulation Point --Stimulation
LU 11 Moxa
LU 10 Moxa
LI 4 Needle during pregnancy
LI 15 Moxa
LI 19 Moxa
LI 20 Moxa
ST1 Needle
ST 2 Needle
ST 7 Moxa
ST 8 Moxa
ST 9 Needle (deep)
ST 17 Needle, moxa
ST 25 Needle during pregnancy
ST 32 Moxa
SP 2 Moxa during and shortly after pregnancy
SP 6
Pregnancy
SP 7
Moxa
HT 1
Needle
HT 2
Needle
SI 10
Moxa
SI 11
Needle
SI 18
Moxa
BL 1
Moxa
BL 2
Moxa
BL 6
Needle
BL 49
Needle
BL 51
Moxa
BL 54
Moxa
BL 56
Needle
BL 60
Needle during pregnancy
BL 62
Moxa
BL 67
Needle during pregnancy
KI 11
Needle
P(CX)8 Needle two times in same treatment or with nasal polyps
TH 7 Needle
TH 8
Needle
TH 16
Needle
TH 19
Bleeding
TH 23
Moxa
GB 1
Moxa
GB 3
Needle (deep)
GB 4
Needle (deep)
GB 5
Needle (deep)
GB 15
Moxa (potential blindness)
GB 18
Needle
GB 21
Needle heart problems or in pregnancy
GB 22
Moxa
GB 33
Moxa
GB 42
Moxa
LIV 12
Needle
CV 4
Needle or moxa during pregnancy
CV 5
Needle or moxa in female patient
CV 8
Needle
CV 11
Moxa during pregnancy
CV 14
Needle (deep)
CV 15 Needle
CV 17
Needle
GV 4
Moxa in young males
GV 6
Moxa
GV 11
Needle
GV 15
Needle (deep)
GV 16
Moxa
GV 17
Needle or moxa
GV 23
Moxa
GV 24
Needle
GV 26
Moxa (extreme warning)
GV 28
Moxa

Most acupuncture authorities will agree with this list. It is imperative that acupuncturists know and understand the potential risks if these points are stimulated with needle or moxa. Laser and electronic stimulation have been shown to be acceptable substitutes in virtually all cases.

The Pulse Points from the Second Century A.D.


by John Amaro,DC,FIAMA,Dipl.Ac.(NCCAOM)

The Han Dynasty, which flourished from 206 B.C. to 220 A.D., gave us one of the most revered books on acupuncture ever written, namely the Nan Jing, otherwise known as the "Classic of Difficulties." It was written following the first book on medical conditions, the famous Nei Jin.

The Nan Jing discussed a number of topics, including the "eight extraordinary meridians," the theory of the mother/son rule regarding tonification and sedation, the Luo points, and the meridians and points. However, the Nan Jing is best known for introducing pulse diagnosis to the wrist.

Previously, acupuncture pulse diagnosis was used at a variety of points, with most meridians having multiple pulse locations. A very little-known technique used in acupuncture, which developed within the first 400 years of the first millennium, was the stimulation of the related pulse points to affect the associated meridian.

Practitioners of acupuncture from the far Western provinces of China use this technique to generally affect the meridian channels. The points shown here are of historical significance, because it was at these points that acupuncture pulse diagnosis was originally used.

Should you have a difficult case in which you have properly ascertained which meridian is involved, use the points listed here, and you may find remarkable clinical response. Even though there is very little further information on this ancient system of healing, it definitely bears our attention.

Lung LU9 - LU5 - LU4, LU3 - LU2 - LU1

Large intestine LI4 - LI5 - ST4

Stomach ST5 - ST9 - ST30 - ST42

Spleen SP11 - SP12

Heart HT1 - HT3 - HT4

Small intestine SI16 - GB1

Bladder BL54

Kidney KI3 - KI9 - KI10

Pericardium P8

Triple heater GB2 - GB3

Gallbladder ST7 - GB2 - GB39

Liver ST9 - CV2 - LIV3 - LIV10 - LIV11

For those who are well versed at "therapy localization" a la AK, these points are very reactive for meridian examination. I am told by one of the masters I studied with in Western China, that some masters were known to dowse these points with a small piece of gold, malachite or jade attached to a leather string.

As you can see by the list of points, they are all, with the exception of a few, quite powerful. Try them on your next difficult case. You have nothing to lose and everything to gain.

John Amaro DC, FIAMA,Dipl.Ac(IAMA),Diplo.Ac.(NCCAOM)
Carefree, Arizona

Dr.Amaro@IAMA.edu

Cerebral Acupuncture (for Neurological Syndromes)

By John Amaro, LAc, Dipl. Ac. (NCCAOM), FIAMA, DC

It would be highly unlikely to find an adult today who has never heard of acupuncture, or who could not come up with some kind of definition of acupuncture. Most people would tell you that acupuncture is an therapy which is thousands of years old.
Even though this is true, there are a number of procedures which fall under the heading of acupuncture which in fact are not ancient: perhaps the most notable is cerebral acupuncture.

Cerebral acupuncture, otherwise known as scalp or skull acupuncture, is a system which does not utilize acupoints, but specific zones on the head which have very specific indications.

Generally credited to an unnamed "barefoot" doctor in central China, history is now telling us that cerebral acupuncture was first theorized and applied by Dr. Huang Xue-Long in 1934. Cerebral acupuncture was resurrected in the early 1970s, coincidentally corresponding with North America's interest in acupuncture.

A visitor to any hospital, clinic, institute or research center in China will see numerous patients receiving this relatively new procedure. It is the number one treatment for any neurological syndrome. It is extremely easy to apply and the clinical results border on the miraculous in many cases.

It is common to see, especially in the communal clinics of remote China, the patient male or female, having their head shaved and longer than usual slender needles being threaded just under the skin of the scalp to stimulate a particular zone or zones. It has been my observation that the head is not often shaved for this procedure in the clinics of the larger cities.

I could write columns every month for the next year to simply relate some of the incredible case histories I personally have encountered with cerebral acupuncture, but it's probably best for you to create your own success stories as opposed to reading about mine.

On returning from my first trip to China in 1973, where I first witnessed cerebral acupuncture, I began to experiment with a variety of different types of stimulations, as the state I was practicing in did not allow for puncturing of the skin by DCs. I experimented with everything from the "teishein" (mechanical stimulation) through electronic stimulation, and finally to laser. I have concluded that virtually everything works!

The best part of cerebral acupuncture is that it's a "this for that" system, meaning "this" zone is specific for "that" problem, and "that " zone is great for "this" situation. In other words, what you see is what you get. The equilibrium zone is specific for equilibrium, whereas the leg and foot zone does just that.

  1. Vasovagal
  2. Chorea
  3. Motor
  4. Sensory
  5. Functional
  6. Vertigo/Hearing
  7. Speech
  8. Thorax
  9. Abdomen
  10. Reproductive
  11. Leg & Foot
  12. Speech
  13. Visual
  14. Equilibrium

The primary landmark to determine locations is the acupuncture point known as GV 20 at the extreme top center of the head. Draw an imaginary line from the very extreme top of the ear to the center of the skull, this is GV 20. The chorea zone begins less than a human inch anterior to GV 20, whereas the motor zone begins less than a human inch posterior to this point.

With noninvasive procedures, one does not have to be specific as we would with a needle. Therefore the patient or patient's family can be advised to stimulate these points themselves with a comb, brush or similar modality.

Perhaps the most notable and certainly most utilized zones for a clinical practitioner would be the sensory and motor zone. Both of these zones are divided into an upper 1/5, a middle 2/5, and a lower 2/5. The sensory zone upper 1/5 is specific for leg, back, neck and occiput pain, numbness or paraesthesia. The middle 2/5 is for upper limb involvement; the lower 2/5 is for facial paralysis and paraesthesia, migraine and TMJ dysfunction. The motor zone upper 1/5 is for the lower extremity; the middle 2/5 is for the upper extremity, and the lower 2/5 is for paralysis, loss of and slurring of speech with drooling.

The motor and sensory can be used for virtually any condition whereby motor and or sensory symptomatology occurs. The other well used zone is the chorea zone, which deals with any choreic movement such as tremors, Parkinson's, Huntington's chorea and similar neurological dysfunctions. The vertigo and hearing zone is specific for Meniere's syndrome; the functional zone is specific for the function of the limbs. Visual is not for nearsightedness, but for neurologically induced visual disturbance. The same is true of speech (neurologically induced, such as CVA).

The leg and foot zone is tremendous for sciatica, femoral nerve involvement, or any syndrome which affects the leg and or foot, especially when combined with the motor or sensory zone.

The rule is to stimulate the opposite side of the involvement, however most practitioners in China stimulate bilateral. If you are using stimulation such as a quartz peizo stimulator, I suggest general stimulation back and forth over the entire zone for approximately 20-30 seconds with a multitude of stimulations. The same is generally true for electronic stimulation of either micro or macro current. If you are using teishein, the same general rule applies and with laser, stroking the light source over the entire zone for about 20 seconds per inch is a standard rule of treatment.

This chart should be available in each treatment room of your office for quick and easy reference. Feel free to photo copy the accompanying chart or a full color chart is available through the International Academy of Clinical Acupuncture.

Cerebral acupuncture is incredibly effective, quick in its application, does not require invasive procedure, nor requires a background or knowledge of acupuncture. Therefore I can see no reason whatsoever why the reader of this article wouldn't add this important work to your arsenal of procedures immediately. It is truly a significant addition to healing.

________________

"The Most Important Notes of Acupuncture"

Part I-A

By John Amaro, LAc, Dipl. Ac. (NCCAOM), FIAMA, DC

Yes, I was really serious about clipping Part I of this column and saving it for future reference. To make my point perfectly clear, we are repeating the graphics of the first four meridians, namely LU, LI, ST, and SP.

For those of you in North America, you have seen these graphics in the September 12, 1990 issue of Dynamic Chiropractic. For those in the rest of the world, this is your first opportunity. Please heed my advice -- clip and save this column. Don't miss an issue of Dynamic Chiropractic. The information presented in this column alone will undoubtedly, positively alter the course of thousands of your patients' lives.

What we are presenting here and throughout this series is the classic "meridian" pathway as described by the ancients, 5,000 or more years ago. The graphics presented here are unique in that they also show the "internal" meridian pathway illustrated by a broken line as well as the classic pathway shown by a solid line.

Perhaps one of the most significant rules of acupuncture is: A Meridian Affects What It Is Named After Or Where It Courses To (or through). It is imperative you take a few minutes, analyze that last statement, and become more than familiar with each of the pathways discussed.

To affect a meridian, one may simply stimulate (non-invasive is fine), the source point on the meridian which you will find shown in the descriptions. For example, it is possible to affect an eye condition by stimulating the source point of the stomach (ST42) as the meridian flows just under the eye. An inner knee problem could be possibly treated by SP3, as well as surround the dragon (points on and around the knee).

Sounds too easy? Sorry! Obviously there are more rules to learn, however, these will get you started with a significant number of successes.

Do these "meridians" physically exist? I seriously doubt it. Researchers have been unsuccessful to physically display the "meridians," however, they likewise have been unsuccessful in physically producing beta, gamma, radio, as well as other "waves" known to exist. I personally feel the mechanism of acupuncture/meridian therapy affects the electromagnetic flow of the body through the "meridian waves" of the body. I do not stand alone regarding that thought even though I just now coined the word "meridian wave." I kind of like it!

Figure 1

Figure 2

Figure 3

________________________

The Most Important Notes of Acupuncture -- Part III

By John Amaro, LAc, Dipl. Ac. (NCCAOM), FIAMA, DC

In retrospect, we have been presented with eight meridians in Part I and II of this series and are now ready for four more. If you took my advice in Part II, you are very familiar with the meridians presented and in all liklihood have a few success cases under your belt.

If you are typical, there are also a few people you didn't help at all. You probably thought you were the only one. Once we finish this series of articles we will expound on how to minimize your failure cases, but first things first.

Another cardinal rule of acupuncture is "Always stimulate scar tissue wherever you find it." Even if the scar was produced in the sterile environment of a hospital surgical arena, the meridian flow of magnetic energy may be disrupted as a radio broadcast signal would be if a large building or mountain were in the path of the beam. Often times, serious conditions are the result of simple appearing scars which adversely affect the meridian flow. I prefer the teishein (non-invasive) pressure device or he ne laser to stimulate the scar; however, any form will work.

Also remember, the chiropractic adjustment is of paramount importance and is fully utilizing the principles of acupuncture. It makes no difference if the adjustment is given prior to acupoint stimulation or after, as long as it is accomplished.

Study the next four meridians offered here, digest them completely, and begin using them if you have not done so. Remember, "A farmer never plowed a field by turning it over in his mind."

Figure 1

Figure 2

Figure 4
__________________________________________________________________________________________________

The Most Important Notes of Acupuncture -- Part IV

By John Amaro, LAc, Dipl. Ac. (NCCAOM), FIAMA, DC

In this final installment of "The Most Important Notes of Acupuncture," take particular note of the two meridians illustrated here, namely the "conception" and "governing vessel."

These two meridians have an extremely important significance to acupuncture and are generally classified as "extra" meridians, even though they comprise the totality of the meridian system.

Energy enters the body, according to ancient philosophy, at the CV8 point (Shrine of God), and leaves the body at death through the same point. It is of extreme importance especially in any neurologic disorder, primarily of children, and is considered forbidden to the needle. The classics of acupuncture suggest filling the navel with salt, covering the salt with a thin slice of ginger, and burning a moxa cone (concentrated herbs) over the point. In my experience I find laser light to have an extremely significant benefit.

In an earlier article in Dynamic Chiropractic, Feb. 1, 1989, titled "Did D.D. Palmer Understand Acupuncture?" I discussed the "Mei Hua" system of acupuncture in which the governing vessel (number seven point located between T10-11) and a secondary point (between T11-12) are always used prior to general stimulation of the spinous and transverse processes of the vertebral level of the involvement in any condition. This system is generally only used by "masters" and carries with it an extremely high success rate.

Please study the notes shared with you concerning these two most important meridians and generally review all of the meridians on a weekly basis. We are now ready to begin 1991 with an academic approach to acupuncture, which will affect your practice in a positive manner regarding results, patient referrals, and accelerated healing.

May I wish you a healthy and joyful 1991. 

Vessel of Conception
 

CV 1 Midway between the anus and the scrotum or posterior commissure of the vulva. Emergency drowning point after CPR has failed, mental or spiritual problems.

CV 3 Four human inches below the umbilicus. Bladder alarm point, muscle and joint problems, also check ST 3, GB 13, and GB 22.

Palace of the Child: Three human inches bilateral to CV 3. Treat with "Sperm Palace" for infertility.

CV 4 Three human inches below the umbilicus. Small intestine alarm point.

CV 5 Two human inches below the umbilicus. Tripple heater alarm point, lower burner.

CV 8 The center of the umbilicus. "Shrine of God," powerful point for children's disorders.

CV 12 Four human inches above the umbilicus, or between the umbilicus and the costophrenic angle. Stomach alarm point, middle burner, check every visit, stimulate if sore.

CV 14 One human inch below the xiphoid process and six human inches above the umbilicus. Heart alarm point, heart disease, hiatal hernia.

CV 15 Along the median line, below the xiphoid process.

CV 17 Level with the 4th intercostal space and midway between the nipples, two human inches above the xiphoid process. Pericardium alarm point, anti-smoking point, respiratory problems, upper burner.

CV 22 Middle of the depression above the suprasternal notch. Main thyroid point.

CV 24 Middle of the mentolabial sulcus. "Water Ditch," drooling, facial involvement.

GV 1 Between the tip of the coccyx and the anus.

GV 2 In the middle of the sacral hiatus. Polarity point.

GV 4 Below the spinous process of the 2nd lumbar vertebra. Adrenal command point, multiple sclerosis, low back pain.

Sperm Palace: Three finger breadths bilateral to GV 4. Most effective point for male or female infertility, treat with "Palace of the Child."

GV 7 Below the spinous process of the 10th thoracic vertebra. MEI HUA, famous acupuncturist who treated GV 7, then spine at level of involvement.

GV 14 Between the spinous process of the 7th cervical vertebra and that of the 1st thoracic vertebra. "Big Bump," Five Star Point, connects with many meridians, treat every visit with ST 12.

GV 16 One human inch above the middle of the natural line of the hair at the back of the head, in the depression below the occipital protuberance. Occipital cephalalgia, memory problems, use with GB 20 for neck pain and occipital headache, relaxes the body in general, said to enhance psychic awareness.

GV 20 Five human inches from the middle of the natural line of the hair at the top of the head, in line with the ears. BEI HUA "One Hundred Meeting Places" or "Cure of 100 Diseases," point for hemorrhoids, use caution with teishin, may cause blackout.

GV 23 One human inch above the middle of the natural line of the hair on the forehead. Opens closed sinuses immediately.

Yintang "Seal Palace": Directly in the middle of the forehead, between the eyebrows. Frontal headache, "Third eye" in psychic awareness.

GV 25 The tip of the nose. Increase lung vital capacity, sober a drunk (may cause nausea).

GV 26 The tip of the philtrum. Emergency point for fainting or shock, Chinese use for high fever. 

John A. Amaro, D.C., F.I.A.C.A., DIPL. AC
Carefree, Arizona


_________________________

Edema and Swelling -- What Can Be Done?

By John Amaro, LAc, Dipl. Ac. (NCCAOM), FIAMA, DC

Besides pain and fatigue, I think the condition I see most often, which is generally not looked upon as a condition but as a symptom of a much larger medical entity, is probably edema.

Edema in and of itself can sometimes be more of a problem for a patient than the condition which has created it.

Even though most edema is generally seen in the lower extremities, it also affects every area of the body.

Prescription diuretics are effective, as are Vitamin C and several other natural occurring substances, but personally I find nothing quite as effective as acupuncture in the vast majority of these cases.

Obviously, there are going to be cases where more heroic measures need to be taken, but in the lion's share of the cases that we see in a typical chiropractic setting, the follow points are perhaps one of the most memorable formulas for this common problem.

KI 16 ... .05 inch bilateral to navel (CV 8)
KI 27 ... in small depression just below lower border of clavicle 2 inches bilateral to CV
KI 2 ... (see diagram)
KI 3 ... midway between the medial malleolus and the tendocalcaneus
KI 6 ... one thumb-width below the medical malleolus
*CV 9 ... one thumb-width above the navel (CV 9) *this point is very important
SP 9 ... in the depression of the lower border of the medical condyle of the tibia
SP 6 ... four fingers breadth above the medial malleolus on the midline
GB 25 ... tip of the 12th rib
BL 23 ... 1.5 inch lateral to the lower border of spinous of second lumbar vertebra

 

Full Body Diagram

Side View of Legs

Rear View of Whole Body

Diagram of Foot

 

Try stimulating these points with a quartz-piezo stimulator or HeNe laser for greatest effect. Acupressure does not even receive honorable mention.

Incidentally, I saw a patient lose 18 lbs. of water weight in seven days with this formula. Let me know of your successes.

John A. Amaro, DC, FIACA, Dipl.Ac.
Carefree, Arizona


Inflammation and Acupuncture

By John Amaro, LAc, Dipl. Ac. (NCCAOM), FIAMA, DC

Perhaps one of the most common conditions which patients bring to our doorsteps, is pain associated with an inflammatory process. Even though inflammation can be virtually anywhere, we as chiropractic practitioners often see it in the musculoskeletal realm.

Throughout the course of history, people have known the benefits of a variety of plants to relieve pain and suffering which upon investigation, have shown to be anti-inflammatory in nature. One of the most infamous herbs for pain and inflammation, which plays a major role in one of history's highlight moments, is known to the Chinese as mo yao, or known to us as myrrh. I believe you probably know the rest of the story.

Acupuncture, and I use that word as a philosophy, not as a technique, has also been used for centuries to control inflammation with startling response. One of my favorite case histories concerns itself with an elderly lady who sought care in my office after dealing with a disabling sciatic condition for months. She had exhausted the usual and customary medical treatment, which had failed, and now sought alternative treatment. She had already been under the care of a better than average DC, who she said aggravated the situation. She now wants to try acupuncture.

During the examination, she made the comment, "My leg is on fire, if I could just throw a bucket of water on it, it would be better." This emotional response was often repeated throughout each treatment which she received from me. This particular patient received approximately 18 treatments consisting of low force chiropractic and acupuncture, however her response to treatment was virtually none. Finally, I understood what she had been saying. It was as if there before me stood an angel disguised as a patient who was there to teach me a lesson in life.

In acupuncture, there are a number of different points which have very specific characteristics, one may tonify while the other sedates. There are points of fire, earth, metal, wood, and water. In what is referred to as the law of five elements, water extinguishes fire, or as she said: "Doctor, my leg is on fire, if you could just throw a bucket of water on it I know it will be okay."

The patient's pain was a combination of sciatic and femoral neuralgia according the location which was distinctly down the back of the leg and radiating into the side of the leg. Realizing the gallbladder and bladder meridian corresponded exactly where the pain and paraesthesia was located, I selected the water point of each of these two meridians. Electronically stimulating GB43 and BL66 bilaterally as an adjunct to her treatment, I was shocked when she exclaimed to the entire office that her pain had vanished. If this makes no sense to you, then welcome to the world of acupuncture.

I personally had given her close to 20 treatments, not counting the four or five orthopedic, neurologist and chiropractors she had seen previously. Now in one instant, her pain was not just diminished, but gone. She followed up on my advice with several more treatments, however, she really didn't need anything as far as the pain was concerned. She now comes in once a year for a routine treatment, and refers scores of patients. I am convinced she was really an "angel," as I relate this case history to the entire chiropractic profession worldwide.

Learning from this experience, we should be aware of the water points of each of the meridians. If you do not have a background in clinical acupuncture, than get one. If it's been forever that you glanced through your notes, refamiliarize yourself with the meridian pathways. Understand that a meridian affects what it is named after or where it courses through.

Really confused about how to use these? Suffice it to say that anytime anyone has any inflammatory condition in the body, these points are paramount. If you see a patient with inflammation (fire) in the shoulder use the water points of the upper extremity. The same logic would be true of the lower extremity. The best part is, if you really don't know which point to use, use a combination of all of the water points as a general treatment. This should only be used however with electrical stimulation and not with a needle. Why? If you really don't know what point to use, you have no business using a needle!! Electrical stimulation will not cause extreme disruption to occur by driving perverse energies deeper in the body.

In essence, the water points are dynamic, powerful points to relieve inflammation anywhere in the body. They are perhaps best used with simple electronic stimulation, rather than needles by the nonexpert. The water points are quick, easy, and incredibly effective. They are all located at the elbow, inside of the knee or the point right next to the tsing point (fingertip). Disregard the he-sea points on this graphic. We will discuss them at another time. In the meantime, begin using the water points often throughout your practice day, they are truly dynamic.


The Treatment of Chronic Pain

By John Amaro, LAc, Dipl. Ac. (NCCAOM), FIAMA, DC

The American public has been emotionally and physically traumatized due to announcements by the FDA concerning the devastating health effects discovered in a number of prescription pain medications, including of the COX-2 inhibitors - some of the most popular pain drugs on the market.

With Vioxx, Bextra, Celebrex, Aleve and Naprosyn being named in specific consumer health advisories, and warnings to medical physicians to "stop prescribing," millions of Americans who have relied heavily on these drugs to ease their pain and positively impact their lifestyle are now wondering what their future holds, where they can go, and what they can do to ease their chronic pain.

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Acupuncture is without question one of the most powerful pain-altering modalities in the world. Its reputation for pain relief is known and respected internationally. It may be practiced successfully with a variety of procedures other than needles, including lasers, electronic and noninvasive stimulation devices for those who are needle-phobic and would not consider acupuncture otherwise.

Literally millions of Americans suffering chronic pain are beginning to seek the care of those knowledgeable in the academics and techniques of acupuncture, to help ease their pain and lessen their dependency on dangerous and cautioned prescription drugs.

There are a variety of techniques, procedures, acupoints and philosophies surrounding acupuncture and pain relief worldwide. As a practitioner whose clinic has seen in excess of 100 patients a day, five days a week, I have had the opportunity to attend to a number of patients suffering from a host of maladies. Chronic pain, however, may be the most common occurrence seen in a practitioner's office. Historically, our clinic has averaged a 94 percent success rate of "cure" to "major clinical response" with chronic pain, based on the patient's response index. Only 3 percent of all pain patients have reported less than satisfactory response in 34 years of practice. It is obvious that the acupoints for pain are extremely effective.

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The acupoints illustrated throughout this article are without question some of my favorite for the successful treatment of chronic pain. This list does not constitute the totality of effective points available to us as practitioners. There are many more effective points not listed here; however, the illustrations are my personal favorite points that have elicited incredible clinical success in chronic pain. Many points illustrated in this paper will be instantly recognized, while others will make little sense. Regardless, please use them, even though space does not allow for a detailed explanation of each point.

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Most of these points have been taught to me by some of the great masters of acupuncture in a variety of Asian nations. To say that combination of acupoints is effective for chronic pain would be an understatement. All illustrated points do not need to be stimulated on the same day if only needles are used. Utilizing a combination of both laser/electronic stimulation and needle on the points is also extremely effective. Otherwise, all points may be stimulated for 12-15 seconds with either a green 535nm, 5mw laser or a red 635nm, 5mw laser. Microcurrent electronic stimulation is also quite effective as a stand-alone treatment.

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Best wishes for your successful treatment of severe and unrelenting pain syndromes. I would also like to hear of your successes.

John Amaro, DC, FIAMA, Dipl. Ac, LAc
Carefree, Arizona

dramaro@iama.edu dramaro -at- iama.edu


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The Eight (Hui) Influential Points

By John Amaro, LAc, Dipl. Ac. (NCCAOM), FIAMA, DC

Some of the most "influential points" on the body are named accordingly. These particular acupuncture points exert a profound effect on the functioning of the body. Each of them has a specific systemic effect on a particular tissue, body area or organ system.

Because illness may generally assert an effect on multiple sites in the body, the influential points have a practical effect by eliminating superfluous needle stimulation and focusing the treatment on as few points as possible. A classic example would be the influential point GB 34 (just in front of the tibial tuberosity). This point is the classic point for any symptomatology affecting the "sinews." The stimulation of GB 34 has a positive effect on any symptoms dealing with muscles, ligaments or tendons.

Regardless of the location of the musculoskeletal condition, GB 34 will have a positive effect. Whether a person is suffering with rotator cuff syndrome or epicondylitis, the influential point for the "sinews" will have a particular effect, even though it is far removed from the site of discomfort. However, most practitioners will, in addition to GB 34, stimulate local points in the area of pain.

GB 39 is the "influential point of marrow" and is located just above the external malleolus. Marrow is generally referred to as assisting brain function or bone marrow itself. In traditional Chinese medicine (TCM) bone marrow does not have a relationship to blood formation as it does in Western physiology. The point is not typically used for blood disorders as one might think.

GB 39 has a particular effect on both sciatic neuritis and cervicalgia, as it is a specific point linking the yang meridians of the lower extremity, namely the gallbladder, stomach and bladder. Remember, a meridian affects what it is named after and where it courses. This point has also been used for vertigo and brain dysfunction.

LU 9 is the "influential point of the vessels," a point often used to help make the pulse more prominent in those with fine and weak pulses. This point is used in when using pulse diagnosis and has been used in cardiovascular disease. Its ancient claim to fame is for conditions affecting the pulse.

BL 11 is known as the "influential point of bone." This point is two fingers breadth bilateral to C7-T1. It is probably one of the most controversial points on the body: in part because of its effect on bone, but primarily due to its effect with pathogenic wind. When a patient complains of bone symptomatology due to an attack of pathogenic wind, as in "bi-patterns," this point has a particularly high effect rate. Additional points (BL 12, GB 21, TH 15) have very similar effects.

BL 17 is known as the "influential point of blood." The point is two fingers breadth bilateral to T5-6. This is one of the classic points and deals with blood stasis. In classical osteopathy, this acupoint deals with any condition involving blood. "The rule of the artery is supreme," said Andrew Taylor Still. Anytime pain is a factor, blood will be involved. Think of this point as one of the most important points on the body.

CV 17 (ren mai) is known as the "influential point of chi." Known as the mu/alarm point for the pericardium/circulation/sex meridian, it is particularly related to the lungs. Located two inches above the xiphoid process, it is often used for conditions affecting the lungs and heart. This point has numerous applications, as it is also the fourth chakra; it also has hormonal effects, due to its relationship to the pericardium meridian.

CV 12 (ren mai) is known as the "influential point of the bowels." Located halfway between the umbilicus and the xiphoid process, this point is the alarm point for the stomach. It is perhaps one of the most significant points on the body for any stomach or bowel symptomatology. It has an effect on the spleen meridian.

Liv 13 is the "influential point of the viscera," located at the tip of the 11th rib. This point is known as the alarm point of the spleen. It is one of the premier points on the body, affecting visceral symptomatolgy. This point, when used with BL 38 (on the vertebral border of the scapula halfway between the top and bottom), is legendary for patients with visceral complaints, regardless of its origin. The relationship of the spleen meridians to the extraordinary meridians is one of the most important relationships in the body. This point is critical.

GB 34 is the "influential point of the sinews," located just in front of the tibial tuberosity. This is one of the classic points on the body for any condition affecting muscles, ligaments and tendons. It has been used for thousands of years in every Asian nation.

The eight points presented here are extremely powerful. You will find these points an incredible addition to a clinical practice. Strong caution is urged when using needle stimulation, as some of these points are in sensitive and potentially dangerous areas. Remember: Acupuncture is a principle, not a technique. Therefore, many techniques can be safely used, including laser and electronic stimulation.

Best wishes for your successful use of the principles of acupuncture in the "Year of the Dragon."

"What Points Do You Use For ________?"

By John Amaro, LAc, Dipl. Ac. (NCCAOM), FIAMA, DC

Without hesitation, the number-one question posed to me by doctors interested in the application of acupuncture is simply, "What points do you use for ________?"

This simplified approach to what many practitioners feel is the practice of acupuncture is in reality a far cry from proper applications that deal with a host of theoretical and procedural processes both ancient and modern.

Even though this article will be read by doctors around the world, I speak especially to my American brethren who, having been born Americans, feel we have the birthright to change ancient acupuncture traditions. It appears this is quickly becoming a global trend. Some seek to make acupuncture easier and less complicated, sometimes disregarding the hows, whys and historical significance of acupuncture.

Many health care practitioners who "dabble" with acupuncture through simple stimulation of patterns of acupuncture points often find themselves frustrated when they achieve outstanding results on some patients, but no response on others. This is usually attributed to the fact that many practitioners commonly use cookbook approaches. Even though they are acceptable, they are not specific for the individual patient.

The practitioner must understand the reasoning behind the specific points on the meridian system and how and why they are used in a clinical practice, as opposed to the simple, "What points do you use for ________?" To practice proper acupuncture, the medical/chiropractic professional needs an understanding of the principles of acupuncture, along with scientific correspondences and knowledge of special reflex areas that are essential to its successful practice.

Acupuncture does not have to involve the myriad of myth, shamanism and folklore that abounds in many of the ancient principles of traditional Chinese medicine (TCM). TCM is just one method of a large multinational system which includes Japan, Korea, Taiwan, southeast Asia and Malaysia, not to mention every country in Europe which has used acupuncture extensively for centuries. European applications have demystified many of acupuncture's explanations that are more compatible with Western scientific thought.

Still, practitioners will continue to ask, "What points are good for ________?" In The Science of Acupuncture Therapy, Richard Cheng,MD,PhD, discusses many of these orthopedic/neurologic basic points and formulas. These points have been found to be effective in the majority of cases based on neurologic explanations, rather than the TCM explanations.

Dr. Cheng, a personal friend of mine and faculty member of the International Academy of Medical Acupuncture, is a neurophysiologist who is internationally recognized researcher. He was one of the principal researchers in the discovery of endorphins and enkephalins at the University of Toronto. His work has been published in numerous prestigious scientific journals that earned him the first PhD in acupuncture research in North America. Following are specific points Dr. Cheng's neurologic research has shown to be extremely effective in pain control.

The points will only be listed by number. (Dr. Cheng's book is illustrated). Should you not know the location of these powerful points, bring out your acupuncture chart or mannequin and begin your review. I have personally used these important points for years. The following represent just a few from the book.

Neuralgic Headaches

GV 15; TW 17; ST 4; GB 1; GB 14; ST 7; LI 20; BL 2; BL 9

Acupuncture Points for Neck Pain

GV 16; GV 15; GV 14; BL 10; BL 11; GB 20; GB 21; SI 15; SI 17; ST 9

Sciatica

GB 30; BL 54 (UB 40)

Elbow Pain

LI 11; LI 10; P 3; SI 8

Wrist Pain

TH 4; LI 5

Hip Pain

SP 12; BL 49; BL 48; GB 31; LIV 11

Knee Disorders

SP 9; SP 10; GB 34; LIV 7; GB 33; ST 35; knee eye; ST 32; BL 53; KI 10

Ankle Pain

KE 3; BL 60; ST 41

Dr. Cheng lists the following as the 11 master/major points that should be learned in detail:

LI 4; HT 7; LI 11; GB 20; P 6; TW 5; GV 26; ST 36; SP 6; SP 10; Shen Men (ear)

As the practice of acupuncture has now become firmly established in North America, it is important that the chiropractic physician becomes more acutely aware of the nature of acupuncture and not rely on simple formulae. Even though many formulae and powerful points remain an important part of even traditional acupuncture, being able to devise a treatment approach based on the individual patient is what will set you apart from the mediocre practitioner.

Learn acupuncture well! - ok DOC.

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Dr. Vaman JN

PhD MSAR MAHMA PGA HARVARD                
+91 44 6527 1655 / 4355 9905
+91 98412 67434 drvaman@medaku.com            www.medaku.com

" Let noble thoughts come to us from all sides " , RIGVEDA 1-89
( AA NO BHADRA KRITVO YANTU VISHWATAH )