The Mechanism of Acupuncture – Beyond Neurohumoral Theory

By Charles Shang, MD HARVARD

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:

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

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.

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

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

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.

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

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.

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.

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.

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.

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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MECHANISM OF ACUPUNCTURE EFFECT

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].

Micro-Acupuncture Systems As Fractals Of The Human Body

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

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

OMA – Ortho-Molecular Acupuncture

OMA – Ortho-Molecular Acupuncture. Sounds complex – it means Using Right Molecules/ Nutrition along with Acupuncture.

Orthomolecular medicine, as conceptualized by double-Nobel laureate Linus Pauling, aims to restore the optimum environment of the body by correcting imbalances or deficiencies based on individual biochemistry, using substances natural to the body such as vitamins, minerals, amino acids, trace elements and fatty acids.

The term "orthomolecular" was first used by Linus Pauling in a paper he wrote in the journal Science in 1968. The key idea in orthomolecular medicine is that genetic factors affect not only the physical characteristics of individuals, but also to their biochemical milieu. Biochemical pathways of the body have significant genetic variability and diseases such as atherosclerosis, cancer, schizophrenia or depression are associated with specific biochemical abnormalities which are causal or contributing factors of the illness.

It is rare to find cancer, arthritis, or other degenerative diseases in cultures considered "primitive" by Western civilization. Is it because of diet? In the 50s you had 8-10 psychiatric diseases but now there are hundreds! Is this a clever invention of drug companies? The fact that degenerative diseases appear in these cultures only when modern packaged foods and additives are introduced would certainly support that idea. Max Gerson said "Stay close to nature and its eternal laws will protect you." He considered that degenerative diseases were brought on by toxic, degraded food, water and air.

The OMA Therapy seeks to regenerate the body to health, supporting each important metabolic requirement by flooding the body with nutrients from organically grown fruits and vegetables daily with weekly Acupuncture treatments. Raw and cooked solid foods are generously consumed. Oxygenation is usually more than doubled, as oxygen deficiency in the blood contributes to many degenerative diseases. The metabolism is also stimulated through the addition of thyroid, potassium and other supplements, and by avoiding heavy animal fats, excess protein, sodium and other toxins.

Degenerative diseases render the body increasingly unable to excrete waste materials adequately, commonly resulting in liver and kidney failure. To prevent this, the OMA Therapy uses intensive detoxification to eliminate wastes, regenerate the liver, reactivate the immune system and restore the body’s essential defenses – enzyme, mineral and hormone systems. With generous, high-quality nutrition, increased oxygen availability, Acupuncture detoxification, and improved metabolism, the cells – and the body – can regenerate, become healthy and prevent future illness.

No treatment works for everyone, every time. Anyone who tells you otherwise is not giving you the facts. We know that when you have been diagnosed with a life-threatening ailment, choosing the best strategy for fighting your illness can be a bewildering task. Everyone claims to have either "the best treatment", "the fastest cure", or "the only therapy that works." In most cases your trusted family physician only has knowledge of conventional treatments, and is either unaware of, or even hostile toward alternative options. No matter how many opinions you receive on how to treat your disease, you are going to make the final decision on what to do, and you must be comfortable with your decision. Choose a treatment that makes the most sense to you.

Most therapies, conventional or alternative treat only the individual symptoms while ignoring what is ultimately causing the disease. The reason the OMA Therapy is effective with so many different ailments is because it restores the body’s incredible ability to heal itself. Rather than treating only the symptoms of a particular disease, the OMA Therapy treats the cause of the disease itself. Although we feel the OMA Therapy is the most comprehensive treatment for disease, we don’t claim it will cure everything or everyone.

If interested to learn more please visit www.medaku.com

Meridians & Diagnosis in Acupuncture

The three yin meridians of the hand start in the chest and run to the end of Fingers where they meet the three yang meridians of the hand. The three yang meridians of the hand start from the end of the fingers and ascend to the head where they meet the three yang meridians of the foot. The three yang meridians of the foot start from the head and run down to the toes where they meet the three yin meridians of the foot. The three yin meridians of the foot start from the toes and ascend to the abdomen and chest where they meet the three yin meridians of the hand. Thus, a closed yin and yang circuit is formed. The three yang meridians of the hand terminate at the head where the three yang meridians of the foot start. This reflects the ancient saying that "the head is the juncture of all the yang meridians". a) The meridian starts from the middle jiao (energizer), the portion between the diaphragm and the umbilicus of the body, and runs downward to connect with the large intestine. Then it ascends along the upper orifice of the stomach and crosses the diaphragm before pertaining to the Lung. b) It exits the Lung system (point Zhongfu, LU I) and runs down along the medial Side of the upper arm and in front of the Heart Meridian of Hand-Shaoyin and the Pericardium Meridian of Hand-Jueyin. Then it goes through the cubital fossa and enters cunkou (on the wrist over the radial artery where pulse is felt) along the anterior border of medial side of the forearm. It continues to run along the thenar eminence and the thenar border and arrives at the medial Side of the thumb tip (point Shaoshang, LU 11). c) A branch starts from Lieque (LU 7) and runs along the radial side to the tip of the index finger, where it links with the Large Intestine Meridian of Hand-Yangming. Course B > Ch 1 > Inspection Observation of the tongue, also known as tongue diagnosis, is an important procedure in diagnosis by inspection in TCM. It provides primary information for the Chinese physicians to make diagnosis. Why is it said that the observation of the tongue can determine the pathological change of the internal organs? The theory of TCM believes that the tongue directly or indirectly connects with many zang-fu organs through the meridians and collaterals. The deep branch of Heart Meridian of Hand-Shaoyin goes to the root of the tongue, the Spleen Meridian of Foot-Taiyin traverses the root of the tongue and spreads over its lower surface, the Kidney Meridian of Foot-Shaoyin terminates at the root of the tongue. Therefore, the essential qi of the zang-fu organs can go upward to nourish the tongue, and pathological changes of the zang-fu organs can be reflected by changes in tongue conditions Therefore, the observation of the tongue can determine the pathological changes of the internal organs. How to observe the tongue? Observation of the tongue includes the tongue proper and its coating. The tongue proper refers to the muscular tissue of the tongue, which is also known as the tongue body. The tongue coating refers to a layer of "moss" over the tongue surface, which is produced by the stomach qi. A normal tongue is of proper size, soft in quality, free in motion, slightly red in color and with a thin layer of white coating which is neither dry nor over moist. The tongue is divided into four areas, namely, tip, central part, root and border. The tip of the tongue often reveals the pathological changes of the heart and lung, its border reveals those of the liver and gallbladder, its central part reveals those of the spleen and stomach, and its root reveals those of the kidney. This method of diagnosing the pathological changes of the zang-fu organs by dividing the tongue into corresponding areas is clinically significant. Tongue diagnosis 1. Tongue proper This is to observe the color and form of the tongue proper. a) Color of the tongue proper A pale tongue is less red than a normal tongue, and indicates syndromes of deficiency type and cold syndromes caused by deficiency of yang qi or insufficiency of qi and blood. A red tongue is bright red and redder than a normal tongue. It indicates various heat syndromes including interior heat syndromes of excess type and interior heat syndromes of deficiency type. A deep red tongue indicates an extreme heat condition. In exogenous febrile diseases, it indicates invasion of pathogenic heat. In endogenous diseases, it indicates yin deficiency leading to hyperactivity of fire. A blue purple tongue indicates stagnation of blood, which is related to either cold or heat. A deep blue purplish tongue, dry and lusterless, is related to heat, whilst a pale purplish and moist tongue is related to cold. The presence of purplish spots on the tongue surface also indicates stagnation of blood. b) Form of the tongue proper A swollen tongue is larger than normal. If a swollen tongue is delicate in quality and pale in color, and with tooth prints on the border, it indicates yang deficiency of the spleen and kidney. The condition is due to impaired circulation of body fluid producing harmful water, retained fluid, phlegm and damp. If a swollen tongue is deep red in color occupying the entire space of the mouth, it indicates excessive heat in the heart and spleen. If a swollen tongue is blue purplish and dark, it indicates toxicosis. A thin tongue is smaller and thinner than normal. A thin and pale tongue indicates deficiency of qi and blood. A thin, dry and deep red tongue indicates hyperactivity of fire due to deficiency of yin in which body fluid is consumed. A cracked tongue indicates excessive heat consuming body fluid if the tongue is deep red in color, and indicates deficiency of blood if the tongue is pale. A cracked tongue may be present in a normal person. If so, the cracks are not deep, and remain there all the time unchanged. This is considered normal. A thorny and red tongue (the papillary buds over the surface of the tongue swell up like thorns) indicates accumulation of pathogenic heat in the interior. The more the pathogenic heat is, the more enlarged and profuse the thorns will be. A deviated tongue indicates wind-stroke or early threatening signs of wind-stroke. A rigid tongue lacks flexibility and is difficult to protrude, retract or roll. A rigid tongue seen in exogenous febrile diseases often indicates invasion of the pericardium by heat, retention of turbid phlegm in the interior, or excessive pathogenic heat consuming body fluid. A rigid tongue present in endogenous diseases indicates wind stroke or early threatening signs of wind-stroke. A flaccid tongue is weak in motion and often indicates extreme deficiency of qi and blood or consumption of yin fluid depriving the tongue of the nourishment. If a flaccid tongue is pale, it indicates deficiency of qi and blood. If it is deep red, it indicates collapse of yin. Tongue coating a) Quality of the tongue coating i) Thick coating and thin coating: The tongue coating is considered thin when the tongue proper can indistinctly be seen through it, and considered thick when the tongue proper cannot be seen through it. One can understand the severity of the pathogenic factors and progression of the pathological conditions by distinguishing the thickness and thinness of the tongue coating. Generally speaking, a thin tongue coating is present when the superficial portion of the body is affected in a disease, or when the disease is due to deficiency of the anti-pathogenic qi. Retention of damp and phlegm or food in the interior of the body, or inward transmission of the pathogenic factor from the exterior may produce a thick tongue coating. Thickening of coating indicates inward transmission of the pathogenic factor from the exterior, and is a sign of aggravation of the disease. Thinning of coating points to gradual elimination of the pathogenic factor, and is a sign of alleviation of the pathological conditions. ii) Moist coating and dry coating: One can understand the condition of the body fluid by distinguishing the moisture and dryness of the tongue coating A normal tongue coating is moist and lustrous, which is the manifestation of normal dissemination of the body fluid. A dry tongue coating, which looks coarse and feels lacking moisture indicates consumption of body fluid due to excessive heat or consumption of yin fluid not allowing it to nourish upwards. If there is excessive moisture over the tongue surface, and the saliva dribbles when the tongue is stuck out in a severe case, it is a slippery tongue coating. The condition is due to upward flooding of harmful water and damp. iii) Sticky coating and granular coating Both sticky and granular tongue coating help deduce the turbid damp in the intestines and stomach. It is a sticky coating when the tongue is covered by a turbid layer of fine greasy substance, which is hard to be scrubbed. A sticky tongue coating is often seen in syndromes resulting from retention of turbid damp and phlegm or retention of food. It will be a granular coating if the granules on the tongue surface are coarse, loose and thick like residue of making curd, and easily scrubbed. iv) A pasty tongue coating often results from excessive yang heat bringing the turbid qi in the stomach upwards. It is also seen in syndromes caused by retention of turbid phlegm or retention of food. v) Peeled Coating: The tongue with a part of its coating peeling off is known as "geographical tongue". It is a sign of consumption of qi and yin of the stomach. If the entire coating peels off leaving the surface mirror smooth, the condition is known as "glossy tongue". It is a sign of exhaustion of the stomach yin and severe damage of the stomach qi. b) Color of the tongue coating i) White Coating A thin and white coating is normal. Yet a white coating may appear in an illness. If so, it indicates exterior syndromes and cold syndromes. A thin and white coating is present in exterior cold syndromes, whilst a thick and white coating is seen in interior cold syndromes. ii) Yellow coating A yellow coating indicates interior syndromes and heat syndromes. The deeper yellow the coating refers to the more severe pathogenic heat it indicates. A light yellow coating points to mild heat, a deep yellow coating to severe heat, a burnt yellow coating to accumulation of heat. iii) Grey coating: Gray coating indicates interior syndromes, and may be seen in interior heat syndromes or syndromes resulting from cold and damp. If a grey coating is yellowish and dry, it signifies consumption of body fluid due to excessive heat. If a grey coating is whitish and moist, it implies retention of cold damp in the interior or retention of phlegm and fluid. As a grey coating often develops into a black coating, a greyish black coating is seen iv) Black coating: A black coating indicates interior syndromes due to extreme heat or excessive cold. A black coating is often the outcome of the further development of a yellow coating or a grey coating, It is present at the severe stage of an illness. If a black coating is yellowish and dry, possibly with thorns, it signifies consumption of body fluid due to extreme heat. A pale black and slippery coating implies excessive cold due to yang deficiency. 4. Precautions in tongue diagnosis As each disease undergoes a complicated process, the conditions of the tongue proper and its coating are the manifestations of interior complicated pathological changes. The conditions of the tongue proper mainly reflect deficiency or excess of the zang-fu organs and relative strength of the essential qi. The condition of the tongue coating reflects the depth and nature of the invading pathogenic factors. A comprehensive analysis of the conditions of both the tongue proper and its coating is required on the basis of their respective indications. The condition of the tongue proper and that of its coating are generally conformable; the disease to be indicated is often the outcome of combining the two. For instance, retention of heat of excess type in the interior produces a red tongue with a dry and yellow coating; a pale tongue with a moist and white coating is often present in cold syndromes of deficiency type. But situations, in which the condition of the tongue proper does not agree with the condition of its coating, may occur. Only by a comprehensive analysis can reliable information be provided for further differentiation of syndromes. It is desirable to observe the tongue in direct natural light. The patient is required to protrude the tongue naturally. Some food and drugs may color the tongue coating, and the thickness and moisture of the tongue coating may change after eating or scraping the tongue. Attention should be paid to the exclusion of false phenomena induced by such factors in the clinical situation.

Auricular points

Auricular points are specific points on the auricle to which stimuli are given for treatment of disease.

When disorders occur in the internal organs or other parts of the body, various reactions may appear at the corresponding parts of the auricle, such as tenderness, decreased resistance to electric current, morphological changes and discoloration.

The following is a table showing the location of commonly used auricular points and their indications:

Area Auricular	Name of Point		Location	Indications
Helix crus	Diaphragm		On the helix crus	Hiccup, jaundice
Helix	Lower Portion of Rectum		On end of helix, near supratragic notch	Constipation, diarrhea
	Urethra		On helix, at level of lower border of inferior antihelix crus	Frequency and urgency of micturition, retention of urine
	External Genitalia		On helix, at level of upper border of inferior antihelix crus	Impotence, eczema of the perineum
	Ear Apex		At tip of auricle when folded towards tragus	Acute conjunctivitis, hypertension
	Helix 1-6		Region from lower border of auricular tubercle (Helix 1) to midpoint of lower border of lo- bule (Helix 6) is divided into five equal parts. The points marking the divisions are respectively Helix 2, 3, 4 and 5.	Acute tonsillitis
Scapha	Finger		In scapha, superior to auricular tubercle	Pain at corresponding part of body
	Wrist		In scapha, level with auricular tubercle
	Elbow		Between Pt. Wrist and Pt. Shoulder
	Shoulder		In scapha, level with supratragic notch
	Clavicle		In scapha, level with notch between antitragus and antihelix, slightly lateral to helix cauda
	Shoulder Joint		Between Pt. Shoulder and Pt. Clavicle
Superior antihelix crus	Toe		At posterior upper corner of superior antihelix crus
	Ankle		At anterior upper corner of superior antihelix crus
	Knee		At origin of superior antihelix crus, Jevel with upper border of inferior antihelix crus
Inferior antihelix crus	Buttocks		Posterior half of upper border of inferior antihelix crus	Pain at corresponding part of body
	Sciatic Nerve		Anterior half of upper border of inferior antihelix crus	Sciatica
	Sympathetic Nerve		At junction of inferior antihelix crus and medial border of helix	Diseases of digestive and circulatory systems
Antihelix	Abdomen		On antihelix, level with lower border of inferior antihelix crus	Adbominal pain, dysmenorrhea
	Chest		On antihelix, level with supratragic notch	Chest pain, intercostal neuralgia
	Neck		At junction of antihelix and antitragus, near scapha	Strained neck
		Lumbosacral Vertebrae	Curved line of medial border of antihelix corresponds to vertebral column. The line is divided into 3 parts by drawing two horizontal lines respectively from Pt. Lower Portion of Rectum and Pt. Shoulder Joint. The upper, middle and lower parts are respectively locations of Lumbosacral, Thoracic and Cervical Vertebrae.	Pain at corresponding part of body
		Thoracic Vertebrae
		Cervical Vertebrae
Triangular fossa	Ear-Shenmen		At bifurcating point of superior antihelix crus and inferior an- tihelix crus	Insomnia, dream-disturbed sleep, inflammation, pain
	Uterus (Seminal Vesicle)		In triangular fossa, at midpoint inferior to border of helix	Irregular menstruation, leu- korrhea, dysmenorrhea, im- potence, nocturnal emission
Tragus	External Nose		In centre of lateral aspect of tragus	Rhinitis
	Pharynx & Larynx		Upper half of medial aspect of tragus	Pharyngitis, laryngitis, tonsillitis
	Internal Nose		In medial and inferior aspect of tragus	Rhinitis, maxillary sinusitis
	Tragic Apex		At upper tubercle on border of tragus	Toothache
	Adrenal		At lower tubercle on border of tragus	Hypotension, pulselessness, shock, asthma, inflammation
Notch between anti-tragus & antihelix	Brain Stem		At junction of antitragus and antihelix	Headache, vertigo
Antitragus	Ear-Asthma		At apex of antitragus	Asthma, bronchitis, mumps
	Brain Point		At midpoint of line connecting Pt. Ear-Asthma and Pt. Brain Stem	Enuresis
	Subcortex		On interior wall of antitragus	Insomnia, dream-disturbed sleep, inflammation, pain
	Testis (Ovary)		A part of Pt. Subcortex, at lower part of interior wall of antitragus	Epididymitis, irregular menstruation
	Forehead		At anterior inferior comer of lateral aspect of antitragus	Headache, dizziness, insomnia
	Occiput		At posterior superior corner of lateral aspect of antitragus	Headache, neurasthenia
	Taiyang		At midpoint of line connecting Pt. Forehead and Pt. Occiput	Unilateral headache
Periphery of helix crus	Esophagus		At anterior two-thirds of inferior aspect of helix crus	Dysphagia
	Cardiac Orifice		At posterior third of inferior aspect of helix crus	Nausea, vomiting
	Stomach		At area where helix crus terminates	Gastralgia, vomiting, dyspepsia
	Duodenum		At posterior third of superior aspect of helix crus	Duodenal ulcer, pylorospasm
	Small Intestine		At middle third of superior aspect of helix crus	Dyspepsia, palpitation
	Large Intestine		At anterior third of superior aspect of helix crus	Diarrhea, constipation
	Appendix		Between Pt. Large Intestine and Pt. Small Intestine	Acute simple appendicitis
Cymba conchae	Urinary Bladder		On lower border of inferior an- tihelix crus, directly above Pt. Large Intestine	Enuresis, retention of urine
	Kidney		On lower border of inferior an- tihelix crus, directly above Pt. Small Intestine	Lumbago, tinnitus, impaired hearing
	Liver		Posterior to Pt. Stomach. and Pt. Duodenum	Hepatitis, hypochondriac pain, eye diseases
	Spleen		Inferior to Pt. Liver, close to border of antihelix	Abdominal distension, dyspepsia
	Pancreas & Gallbladder		Between Pt. Liver and Pt. Kidney	Pancreatitis, dyspepsia, diseases of bile duct
Cavum conchae	Mouth		Close to posterior wall of orifice of external auditory meatus	Facial paralysis, ulceration of the mouth
	Heart		In centre of cavum conchae	Hysteria, palpitation, arrhythmia
	Lung		A U-shaped area superior, inferior and posterior to Pt. Heart	Cough, asthma, urticaria
	Trachea		Between Pt. Mouth and Pt. Heart	Cough
	Endocrine		In cavum conchae, near intertragic notch	Dysmenorrhea, irregular menstruation
	Sanjiao		In middle of four points of Mouth, Endocrine, Subcortex and Lung	Constipation, edema
Intertragic notch	Eye 1 Eye 2		On both sides of intertragic notch, the anterior being Eye 1 and the posterior Eye 2	Glaucoma, myopia, hordeolum
Lobule	Toothache 1		At postero-inferior corner of 1st section of lobule	Toothache, anaesthetic point for tooth extraction
	Toothache 2		In centre of 4th section of lobule	–
	Eye		In centre of 5th section of lobule	Eye diseases
Back of auricle	Internal Ear		In centre of 6th section of lobule	Tinnitus, impaired hearing
	Tonsil		In centre of 8th section of lobule	Tonsillitis
	Groove for Lowering Blood Pressure		At back of ear, in groove between lateral border of protuberance of cartilage and helix	Hypertension
	Upper Portion of Back of Auricle		On protuberance of cartilage at upper portion of back of auricle	Back and low back pain, skin diseases
	Middle Portion of Back of Auricle		At midpoint of line connecting the two points of upper and lower portion of back of auricle	–
	Lower Portion of Back of Auricle		On protuberance of cartilage at lower portion of back of auricle	–
	Root of Auricular Vagus Nerve		At junction of back of auricle and mastoid, level with helix crus	Gastralgia, headache, asthma, biliary ascariasis

* In order to facilitate location, the lobule is divided into 9 sections. First, draw a horizontal line at the cartilage border of the intertragic notch. Draw two parallel lines below it to divide the lobule into three equal parts transversely. Then divide the second parallel line into three equal parts with points and draw two vertical lines from the points crossing the three horizontal lines to divide the lobule into nine sections.

15 stimulation areas in scalp acupuncture

There are 15 stimulation areas in scalp acupuncture.

Although they are called "areas", they are in fact extremely narrow bands of varying length, and it is along these lines that the needles are inserted.

To perform scalp acupuncture ( head needle therapy) effectively, the acupuncturist should locate the treatment areas with a great deal of accuracy.

For this purpose there are four important lines of reference which must first be outlined on the surface of the scalp. These are:-

1) The Antero-Posterior Midline which is a line drawn in the sagittal plane, from the nasion ( midpoint between the two eyebrows) to the lower edge of the external occipital protuberance.

2) The Supercilio-Occipital Line ( Eyebrow-Occiput Line) which is a line drawn obliquely downwards from the upper border of the midpoint of the eyebrow to the tip of the external occipital protuberance, on the lateral side of the head. There are therefore two of these lines, one on each side of the head.

3) The Horizontal line on the back of the head at the level of the external occipital protuberance.

4) The Anterior Hair Line which is 3 cm above the eyebrows.

The location of the 15 stimulation areas of scalp acupuncture and their therapeutic indications are as follows:-

Area	Location	Indication
Motor Area	A line connecting 2 points called the upper and lower points of the Motor Area. The upper point is situated on the antero-posterior midline, 0.5 cm behind its midpoint. The lower point of the Motor Area is the point in the temporal region where the supercilio-occipital line intersects the anterior hairline.	Motor paralysis of the contralateral side
(a) Lower limb and trunk area	Upper fifth of Motor Area	Paralysis of contralateral lower limb
(b) Upper limb area	Second and third fifths of Motor Area	Paralysis of contralateral upper limb
(c) Facial area (also called 1st Speech Area)	Lower two fifths of Motor area	Paralysis of face (opposite side), motor aphasia, dribbling saliva, impaired speech
Sensory Area	A line parallel to and 1.5 cm posterior to the Motor area	Sensory disorders of the contralateral side
(a) Lower limb, head and trunk area	Upper fifth of Sensory Area	Low back pain (opposite side), numbness or paraesthesia in that area, occipital headache, stiff neck, vertigo
(b) Upper limb area	Second and third fifths of sensory area.	Pain, numbers or other paraesthesia of contralateral upper limb.
(c) Facial area	Lower two fifths of Sensory Area	Migraine headache, trigeminal neuralgia, toothache (opposite side), arthritis of the temperomandibular joint
Choreo-Tremor Control Area	Parallel to and 1.5 cm anterior to Motor Area	Syndenham’s chorea, parkinsonism, athetosis, tremors, palsy and related syndromes
Vasomotor Area ( also called Vasoconstriction and Vasodilatation Area)	Parallel to and 1.5 cm anterior to Choreo-Tremor Control Area	Superficial oedema, hypertension
Foot-Motor Sensory Area	A line 3 cm long and parallel to the antero-posterior midline, its midpoint 1 cm away from midpoint of antero-posterior midline	Paralysis, pain or numbness of contralateral lower limb, acute lower back sprain, nocturnal enuresis, prolapsed uterus
Auditory Area (also called Vertigo-Auditory Area)	A horizontal line 4 cm long, its midpoint 1.5 cm above the apex of the ear	Deafness, tinnitus, vertigo, meniere’s syndrome
2nd Speech Area	A vertical line 3 cm long, parallel to the anterior-posterior midline, its upper end 2 cm postero-inferior to the parietal tubercle	Nominal aphasia
3rd Speech area	A horizontal line 4 cm long drawn posteriorly from the midpoint of the Auditory Area	Sensory (receptive) aphasia
Area of Application (Usage Area)	At the parietal tubercle three needles are inserted inferiorly, anteriorly and posteriorly to a length of 3 cm with 40 degree angles between them	Apraxia
Visual Area	A line 4 cm long drawn upwards and parallel to the antero-posterior midline from a point 1 cm lateral to the external occipital protuberance	Cortical (central) Blindness
Balance Area (Equilibrium Area)	A line 4 cm long drawn downwards and parallel to the antero-posterior midline from a point at the level of the external occipital protuberance 3.5 cm lateral to the midline	Loss of balance due to cerebellar disorders
Stomach Area (Gastric Area)	A line 2 cm long drawn directly backwards and parallel to the antero-posterior midline from a point on the anterior hairline vertically above the pupil of the eye	Disorders of the upper abdomen and general malaise
Thoracic Cavity Area	A line 4 cm long, parallel to the antero-posterior midline, with its midpoint at the anterior hairline, midway between the stomach area and the midline	Chest pain, palpitation, shortness of breath, bronchial asthma
Reproduction Area (Genital Area)	A line 4 cm long, parallel to the antero-posterior midline, drawn directly backwards from the anterior extremity of the Stomach Area at the same distance which separates the Stomach area from the Thoracic Cavity Area	Impotence, ejaculation praecox, functional uterine haemorrhage also used for surgery for prolapsed uterus combined with Foot-Motor Sensory Area
Hepatocystic Area (Liver and Gall Bladder Area)	A line 2 cm long extending anteriorly from the Stomach area	Pain or discomfort in the epigastrium and right hypochondrium, diseases of the liver and biliary system

The Ultimate Acupuncture Point Formula for Relieving Low Back Pain

Pain, Other Ills

Acupuncture has long baffled medical experts and no wonder: It holds that an invisible life force called qi (pronounced chee) travels up and down the body in 14 meridians. Illness and pain are due to blockages and imbalances in qi. Inserting thin needles into the body at precise points can unblock the meridians, practitioners believe, and treat everything from arthritis and asthma to anxiety, acne and infertility.

WSJ’s health columnist Melinda Beck tests out acupuncture as an alternative means to reduce her neck and back pain.

Does It Work?

While scientists say further research is essential, some studies have provided evidence of acupuncture’s effects.

• Arthritis of the Knee: Acupuncture significantly reduced pain and restored function, according to a 2004 government study.
• Headaches: Two 2009 reviews found that acupuncture cut both tension and migraine headaches.
• Lower Back Pain: Acupuncture eased it in a big study last year, but so did a sham treatment where needles didn’t penetrate the skin.
• Cancer: Has proven effective in reducing nausea and fatigue caused by chemotherapy.
• Infertility: Improves the odds of pregnancy for women undergoing in-vitro fertilization, according to a 2008 review of seven clinical trials.
• Addiction: Often used to help quit smoking, drinking, drug use and overeating, but there is no conclusive evidence that it works.

After decades of cynicism, Western medical experts are using high-tech tools to unravel the ancient mysteries of how acupuncture works. WSJ’s Health columnist Melinda Beck joins Simon Constable on the News Hub to discuss.

As fanciful as that seems, acupuncture does have real effects on the human body, which scientists are documenting using high-tech tools. Neuroimaging studies show that it seems to calm areas of the brain that register pain and activate those involved in rest and recuperation. Doppler ultrasound shows that acupuncture increases blood flow in treated areas. Thermal imaging shows that it can make inflammation subside.

Scientists are also finding parallels between the ancient concepts and modern anatomy. Many of the 365 acupuncture points correspond to nerve bundles or muscle trigger points. Several meridians track major arteries and nerves. "If people have a heart attack, the pain will radiate up across the chest and down the left arm. That’s where the heart meridian goes," says Peter Dorsher, a specialist in pain management and rehabilitation at the Mayo Clinic in Jacksonville, Fla. "Gallbladder pain will radiate to the right upper shoulder, just where the gallbladder meridian goes."

Many medical experts remain deeply skeptical about acupuncture, of course, and studies of its effectiveness have been mixed. "Something measurable is happening when you stick a needle into a patient—that doesn’t impress me at all," says Edzard Ernst, a professor of complementary medicine at the University of Exeter in England and co-author of the book, "Trick or Treatment." Acupuncture "clearly has a very strong placebo effect. Whether it does anything else, the jury is still out."

Even so, the use of acupuncture continues to spread—often alongside conventional medicine. U.S. Navy, Air Force and Army doctors are using acupuncture to treat musculoskeletal problems, pain and stress in stateside hospitals and combat zones in Iraq and Afghanistan. Delegations from Acupuncturists Without Borders are holding communal ear-needling sessions to reduce stress among earthquake victims in Haiti. Major medical centers—from M.D. Anderson in Houston to Memorial Sloan-Kettering in New York—use acupuncture to counteract the side effects of chemotherapy.

In a 2007 survey, 3.2 million Americans had undergone acupuncture in the past year—up from 2.1 million in 2001, according to the government’s National Center for Complementary and Alternative Medicine.

The most common uses are for chronic pain conditions like arthritis, lower back pain and headaches, as well as fatigue, anxiety and digestive problems, often when conventional medicine fails. At about $50 per session, it’s relatively inexpensive and covered by some insurers.

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It is also generally safe. About 10% of patients experience some bleeding at the needle sites, although in very rare cases, fatalities have occurred due to infections or injury to vital organs, mostly due to inexperienced practitioners.

Most states require that acupuncturists be licensed, and the Food and Drug Administration requires that needles be new and sterile.

Diagnoses are complicated. An acupuncturist will examine a patient’s tongue and take three different pulses on each wrist, as well as asking questions about digestion, sleep and other habits, before determining which meridians may be blocked and where to place the needles. The 14 meridians are thought to be based on the rivers of China, and the 365 points may represent the days of the year. "Invaders" such as wind, cold, heat, dampness, dryness factor into illness, so can five phases known as fire, earth, metal, water and wood.

Using Acupuncture to Treat Stress

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"It’s not like there’s a Merck Manual for acupuncture," says Joseph M. Helms, who has trained some 4,000 physicians in acupuncture at his institute in Berkeley, Calif. "Every case is evaluated on an individual basis, based on the presentation of the patient and the knowledge of the acupuncturist."

Dr. Helms notes that Western doctors also examine a patient’s tongue for signs of illness. As for qi, he says, while the word doesn’t exist in Western medicine, there are similar concepts. "We’ll say, ‘A 27-year-old female appears moribund; she doesn’t respond to stimuli. Or an 85-year old woman is exhibiting a vacant stare.’ We’re talking about the same energy and vitality, we’re just not making it a unique category that we quantify."

Studies in the early 1980s found that acupuncture works in part by stimulating the release of endorphins, the body’s natural feel-good chemicals, much like vigorous exercise does. Now, a growing body of research suggests that it may have several mechanisms of action. Those include stimulating blood flow and tissue repair at the needle sites and sending nerve signals to the brain that regulate the perception of pain and reboot the autonomic nervous system, which governs unconscious functions such as heart beat, respiration and digestion, according to Alejandro Elorriaga, director of the medical acupuncture program at McMaster University in Ontario, which teaches a contemporary version to physicians.

Vitaly Napadow

A specialized MRI scan shows the effects of acupuncture. The top two images show the brain of a healthy subject. In the middle two images, a patient with carpal tunnel syndrome registers pain (indicated by red and yellow). The bottom images show the calming effect (indicated by blue) in the brain after acupuncture.

"You can think Western, you can think Eastern. As long as your needle goes to the nerve, you will get some effect," Dr. Elorriaga says.

What’s more, an odd phenomenon occurs when acupuncture needles are inserted into the body and rotated: Connective tissue wraps around them like spaghetti around a fork, according to ultrasound studies at the University of Vermont. Helene Langevin, research associate professor of neurology, says this action stretches cells in the connective tissue much like massage and yoga do, and may act like acupuncture meridians to send signals throughout the body. "That’s what we’re hoping to study next," she says.

Related

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• Aches & Claims: Using Acupuncture to Ease Chronic Pain

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• discuss

“ My former spouse had shingles. Doctors told her that the terrible pain would probably last 2 or 3 years. She got acupuncture treatments, plus some Chinese herbs, and the pain was totally gone with 6 weeks. ”

—Alan Agardi

Meanwhile, neuroimaging studies at the Martinos Center for Biomedical Imaging at Massachusetts General Hospital in Boston have shown that acupuncture affects a network of systems in the brain, including decreasing activity in the limbic system, the emotional part of the brain, and activating it in the parts of the brain that typically light up when the brain is at rest.

Other studies at the Martinos Center have shown that patients with carpal tunnel syndrome, a painful compression of nerves in the wrist, have heightened activity in parts of the brain that regulate sensation and fear, but after acupuncture, their brain patterns more closely resemble those of healthy subjects. Brain scans of patients with fibromyalgia show that both acupuncture and sham acupuncture (using real needles on random points in the body) cause the release of endorphins. But real acupuncture also increased the number of receptors for pain-reducing neurotransmitters, bringing patients even more relief.

The fact that many patients get some relief and register some brain changes from fake acupuncture has caused controversy in designing clinical trials. Some critics say that proves that what patients think of as benefit from acupuncture is mainly the placebo effect. Acupuncture proponents counter that placebos that too closely mimic the treatment experience may have a real benefit.

"I don’t see any disconnect between how acupuncture works and how a placebo works," says radiologist Vitaly Napadow at the Martinos center. "The body knows how to heal itself. That’s what a placebo does, too."

Write to Melinda Beck at HealthJournal

Acupuncture for Chronic Pain Relief

What is Acupuncture?

Long practiced in traditional Chinese medicine, acupuncture is an alternative therapy that involves using needles to stimulate specific points on the body. These points are said to connect with certain pathways (or “meridians”) that carry vital energy (or “chi“) throughout the body.

According to the theory of acupuncture, blockages in the flow of chi disrupt well-being and lead to illness. By stimulating acupuncture points, practitioners aim to clear up blockages and restore the client’s health and vitality.

Learn more about acupuncture, including what to expect from an acupuncture session.

Acupuncture for Pain

Pain or musculoskeletal complaints account for seven of the top ten conditions for which individuals use acupuncture, according to the 2007 National Health Interview Survey. The National Center for Complementary and Alternative Medicine states that acupuncture appears to be a promising alternative for some pain conditions, but cautions that further research is needed before conclusions about acupuncture’s effectiveness can be drawn.

Here’s a look at pain conditions that have been shown to improve with the use of acupuncture:

1) Acupuncture for Migraines and Headaches

A research review published in 2009 suggests that acupuncture is at least as effective as, or possibly more effective than, medication in protecting against migraines, while another review from the same year shows that acupuncture may be beneficial for people with frequent episodic or chronic tension headaches.

Learn more about using acupuncture to treat migraines and headaches.

2) Acupuncture for Arthritis

Research indicates that acupuncture may be useful for people with osteoarthritis (especially osteoarthritis of the knee). In a 2007 review and meta-analysis, for instance, researchers concluded that acupuncture administered in an intensive two- to four-week treatment regimen may offer significant short-term relief of osteoarthritis-related knee pain.

Learn more about using acupuncture to relieve arthritis pain.

3) Acupuncture for Low Back Pain

In a 2009 study of 638 adults with chronic low back pain, participants undergoing 10 acupuncture sessions (administered over the course of seven weeks) had greater improvement in symptoms than those who received standard care. One year after treatment, study members in the acupuncture group were also more likely to show significant improvements in dysfunction.

A meta-analysis of 33 clinical trials, published in 2005, concluded that acupuncture effectively relieves chronic low back pain. However, the review’s authors note that “no evidence suggests that acupuncture is more effective than other active therapies.”

More On Acupuncture for Pain Relief

Emerging evidence suggests that people with the following conditions may also benefit from the use of acupuncture:

• carpal tunnel syndrome
• menstrual cramps
• temporomandibular joint dysfunction (also known as “TMJ”)
• tennis elbow

Is Acupuncture Safe?

Acupuncture is generally considered safe, and adverse events are rare. Additionally, the National Center for Complementary and Alternative Medicine notes that “there are fewer adverse effects associated with acupuncture than with many standard drug treatments (such as anti-inflammatory medication and steroid injections) used to manage painful musculoskeletal conditions.”

The Ultimate Acupuncture Point Formula for Relieving Low Back Pain

Acupuncture Charts and Tables

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
Atlas of Acupuncture Points This 39-page booklet describes the location of all acupuncture points, as well as using both the western and Chinese names for each point. Point Location Chart This 14-page chart describes the location of all acupuncture points, as well as using both the western and Chinese names for each point. Korean (Koryo) Hand Acupuncture Chart 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 Chart 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. Chinese Auriculotherapy Chart This updated chart defines alarm and associated Points and lists Spanish names for those points. Chinese Auriculotherapy Chart This chart defines musculoskeletal and sensory treatment points and the Master Control Points. Five Elements Chart 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). Cardinal Points of Acupuncture Chart 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.
Charts and Tables
Acupuncture Charts We are very grateful to Dr. John Urbanski for the use of these charts!

The Acupuncture Bookshelf

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.