In this article we will discuss the traditional Chinese medicine and western acupuncture in detail with and also about the safety and uses of acupuncture needles


 Acupuncture is an intervention involving the insertion and manipulation of fine needles into the body to achieve a therapeutic effect. From a traditional Chinese medicine perspective the anatomical sites at which these needles are inserted are specified and these points are located along channels (mai in Chinese) that have come to be known as meridians in the West (in part owing to their similarity to geographical meridian lines. There are 12 principle meridians with both superficial and deep representations, and a number of so-called extraordinary meridians. Again, from a traditional Chinese medicine perspective, these meridians are believed to have specific effects on the physiology of body organ systems and are named accordingly, for example Lung (LU), Heart (HT), Pericardium (PC), Stomach (ST), Large Intestine (LI), Small Intestine (SI) and Bladder (BL) meridians. The insertion of acupuncture needles and their stimulation either manually or via electrical stimulation is believed to effect the flow of qi, pronounced ‘chi’, and commonly translated as vital energy, life force or spirit, while a literal translation of the Chinese character for qi is ‘vapors rising from food’ (Basser 1999). It is believed in traditional Chinese medicine that by effecting qi flow along the meridians a person’s overall health and well-being can be beneficially influenced. . In order to effectively produce this therapeutic effect it is commonly believed that needling stimulation is required to produce a specific sensation know in Chinese as de qi and described as a deep heavy aching sensation which may propagate along the needled meridian.



Diagnosis in traditional Chinese medicine conceptually views the health status of an individual as a microcosm of nature and thus could be viewed as a human meteorological report (Kaptchuk 2002). Linked to this are the concepts of five fundamental universal elements and that of balancing a person’s yin and yang with those of nature, terms originally denoting the shaded and sunny aspect of a hill respectively. These terms of yin and yang are also used to classify acupuncture meridians, the former being on the inner aspect of a limb and the latter on the outer aspect.



In traditional Chinese medicine, the body is viewed as being comprised of functional systems or zang-fu in Chinese. Though not directly associated, each system is named according to an organ. The zang systems are linked with the solid, yin organs, for instance the kidneys, while the fu systems are linked with the hollow yang organs, for instance the stomach. The individual acupuncture points are named and numbered according to the meridian along which they are located, for example LI4, ST36. Points are located on an individual’s body in relation to tendons, muscles and bony points, and a system of proportional measurements using the ‘cun’ as its base measurement which is the width of that individual’s interphalangeal joint of the thumb (Cheng 1987). Palpation is also viewed as being of great importance in locating points to needle. Historically, and in keeping with the traditional Chinese medicine view of health being related to a numerical and holistic paradigm, 365 points were described to reflect the days of the year without any further objective basis (Lun 1975) In addition to these classical meridian points, needle insertion can be directed locally to the symptomatic area or into points of maximal tenderness referred to as ah-shi (translated as ‘oh yes’/‘that’s it’) points. Interestingly, the Chinese character used to denote an acupuncture point can also mean ‘hole’ suggesting that acupuncture points may be viewed as points of access to structures deeper in the body (Langevin and Yandow 2002).



Western medical acupuncture may appear very similar to traditional Chinese medicine acupuncture. Needles are inserted often both local to the symptomatic region of the body and more distally along the arm or leg, often with points in the hand or foot. Once the needles are in place they are typically manipulated by hand or by electrical stimulation over the course of a treatment lasting anywhere from 5–30 minutes. The points are typically named using traditional Chinese medicine terminology and often empirical points are added to the points used.




The key differences between Western and traditional Chinese medicine acupuncture

 is in the patient assessment, expectation and in the

 intention behind the treatment itself. While a traditional Chinese medicine approach would typically assess a patient’s ‘qi balance and flow’ by taking a history and using observation of the tongue, eyes and specific palpation of the pulse, a Western approach would seek to make a clinical diagnosis based on pathology using history and clinical assessment findings. In terms of the treatment itself, a traditional Chinese medicine practitioner would seek to alter qi movement and flow by needling, whereas a Western practitioner would attempt to stimulate specific neurochemical and both connective and contractile tissue responses by needling. In addition, a traditional Chinese medicine practitioner would chose points according to meridians with a consideration of the effects this may have on organ system physiology. Although Western acupuncture may still use classic traditional Chinese medicine nomenclature to specify the points used often no consideration is given to the potential effects on organ systems, for instance in the case of using points along

 the bladder meridian to treat lower back pain. Instead, the local, segmental, extra-segmental and central neurological effects are what concern a Western acupuncture practitioner.



 Acupuncture use by general practitioners (GPs) in the UK is increasing and it is now likely to be the most prevalent of all complementary therapies. Thomas et al. (2001) reported that in 1998 approximately 7% of English

 adults had received acupuncture treatment at some point. Within National Health Service (NHS) chronic pain clinics, acupuncture is estimated to be offered in 84%

 of cases (Woollam and Jackson 1998). According to the Acupuncture Association of Chartered Physiotherapists (AACP) there are approximately 5000 AACP-registered physiotherapists now working in the NHS and in private practice in the UK.




As with any physiologically active and invasive therapeutic intervention, considerations of not only the effectiveness but also of the safety of acupuncture are necessary.

 The mere fact that acupuncture has been practised for centuries does not provide sufficient evidence of its safety. Historically, autoclave procedures were employed for sterilising needles and it was not until reports of acupuncture-related cross infection, such as hepatitis B (Kent et al. 1988) coupled in no small way with the outbreak of AIDS in the 1980s, that single-use needles were advocated. It is clear that reports of adverse events and more serious complications attributed to acupuncture during the 1970s and 1980s highlight the improvements in acupuncture safety that have been made in the past three decades. Further reports of acupuncture-associated hepatitis B transmission were, however, reported in the 1990s (Rosted 1997; White 1999). The latter of these reports not only recommended the use of single-use, disposable needles, but also the vaccination of all acupuncture practitioners against hepatitis B. During the 1990s it was proposed that a theoretical risk of transmitting variant Creutzfeldt-Jacob Disease existed even with autoclaved needles, further supporting the use of sterile single-use needles.

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