Using Acupuncture
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Objectives
1. To review the concept of clinical strategies in
acupuncture, a step-by-step approach to
development of a treatment plan.
2. To review the schools of acupuncture in the
United States, their advantages and
disadvantages.
3. To incorporate different forms of acupuncture in
your treatment plans.
Table of Contents
I. Introduction
II. Symptomatic treatments
A.
B.
C.
D.
Energetic cycles
Inverse-contrary law
Curious/Extraordinary meridians
TCM Pattern Treatment
Pain
An unpleasant sensory and
emotional experience associated
with actual or potential tissue
damage, or described in terms of
such damage.
by the International Association
of the Study of Pain
Western Medicine
Perception
Modulation
Transmission
Transduction
Transduction
At the origin of pain
Treatments
1. Remove the source
2. Treat the injury/disease
* antibiotics
* anti-inflammatories
* surgical wound care
Transmission
Conveying pain signals through the nervous system
Treatments
1. Nerve/Epidural Blocks
2. Anticonvulsants
Gabapentin (Neurontin)
Pregabalin (Lyrica)
Carbamazepin (Tegretol)
Phenytoin (Dilantin)
Milnacipran (Savella)
Modulation
Neural activity may be altered along the pain pathway
Treatments
TENS
1. TENS
2. Biofeedback
3. Endogenous Opioid System
Perception
Subjective sensation of pain
Treatments
1. Analgesics/Narcotics
* Morphine
*Hydrocodone (Vicodan)
* Oxycodone (Oxycontin
2. Anti-depressants
*Amitriptyline (Elavil)
*Fluxetine (Prozac)
*Sertraline(Zoloft)
*Doxepin(Sinequan)
3. Biofeedback, hypnosis
(psychological intervention)
Anatomical
(Surgery)
Chemical
(Medicine)
Energetic
Acupuncture
KHT
Etc.
I. Introduction:
Qi (Chi)
Bi-digital o-ring test
(Kinesiology)
Pulse Diagnosis
A. Traditional Pulses
B. New TCM pulses
C. Curious meridian pulses
D. Yin-yang pulses
E. Seven-Star pulses
Pulse Diagnosis
A. Traditional Pulses (Five Element Pulses)
Right
Left
Cun
Guan
Chi
Superficial
LI
ST
TH
Deep
LU
SP
PC
Superficial
SI
GB
BL
Deep
HT
LR
KI
Pulse Diagnosis
28 pulse types occur in combinations
Tight
Slippery
Full
Big
Wiry
Choppy
Empty
Thin
Knotted
Floating
Hollow
Rapid
Intermittent
Sinking
Flooding
Slow
Frail
Hidden
Leather
Long
Scattered
Soggy
Moderate
Short
Confined
Hurried
Spinning beam
Intermittent
Pulse Diagnosis
Normal Moderate, Slippery
Excess Full, Long, Flooding
Deficient
Pulse Diagnosis
B. New TCM Pulses
Focuses on overall quality and
types of pulses
Pulse Diagnosis
C. Curious Meridian Pulses
1.
-Cun
-Guan
-Chi
b. Yin Wei
-Cun
-Guan
-Chi
c. Du Mo
(superficial)
-Cun
-Guan
-Chi
d. Dai Mo
(superficial)
-Guan
-
Pulse Diagnosis
e. Chong Mo
(Deep)
-Guan
-
f. Yang Qiao
(Superficial)
-Chi
g. Ren Mo
(Deep)
-Cun
-Guan
-Chi
h. Yin Qiao
(Deep)
-Chi
Pulse Diagnosis
D. Yin-yang Pulse (Constitutional Balance),
comparing arterial pulses diameter
at both sides LU9 and ST9
ST9 pulse diameter larger: yang-type pulse
LU9 pulse diameter larger: yin-type pulse
(See Chapter IV)
Pulse Diagnosis
E. Seven Star Pulses
Head/neck
Cun upper heater
Diaphragm
Guan middle heater
Sacroiliac
Chi lower heater
Legs
Hara/abdominal Diagnosis
10
Tongue Diagnosis
Heat yellow coating
Cold white coating
Pale blood deficiency
Purplish blood stasis
Scalloping margin Qi stagnation
Cracks Yin deficiency
Acupuncture
Symptomatic Treatment
Meridian Therapy
Constitutional Treatment
Battle Field
Special Force/Tactical
Army/Strategic
International Policy
11
F.
Auricular Acupuncture
- Chinese
- French
B.
French Energetics
G.
C.
Scalp Acupuncture
- Chinese
- YNSA
D.
H.
E.
Hand Acupuncture
- Korean (KHT)
- Sujok
- Chinese
Others
- Ryodorakn
- MARIA
Acupuncture
Schools
Symptomatic
Treatment
Meridian
Therapy
Constitutional
Treatment
French Energetics
+++
++
TCM Classical
++
+++
+++
TCM New
++
++
++
Five Element
++
+++
Japanese
++
+++
++
Auricular
+++
-/+
Hand Acupuncture
+++
+++
+++
Scalp Acupuncture
+++
-/+
-/+
Others
12
Circadian Clock
With
Entry and Exit Points on the Main Meridians
Triple Heater 22
Exit
Pericardium 1 Entry
Kidney 22 Exit
Gallbladder 1
Entry
Exit
Triple
Heater
(San Jiao)
9 11 pm
Gallbladder
11 pm 1 am
Gallbladder 41
Entry Liver 1
Liver
1 3 am
Pericardium
7 9 pm
Kidney
5 7 pm
Exit
Liver 41
Entry
Lung
3 5 am
Kidney 1 Entry
Urinary Bladder 67 Exit
Urinary Bladder
3 5 pm
Exit
Lung 1
Large Intestine
5 7 am
Small Intestine
1 3 pm
Stomach
7 9 am
Heart
11 am 1 pm
Entry
Entry
Lung 7
Large Intestine 1
Large Intestine 20
Stomach 1
Spleen
9 11 am
Exit
Entry
Exit
Entry
Exit Stomach 42
Spleen 1
Exit
Spleen 21
13
14
15
16
B. Auricular Acupuncture
- French
(Auricular therapy and Auricular Medicine)
- Chinese
C. Hand Acupuncture
17
Figure 3.0:
Relationship of the
right and left sides
of the palms and
the front of the
body
Figure 3.1:
Relationship of the right
and left sides of the
back and hands
18
19
D. Scalp Acupuncture
- Chinese
- Yamamoto New Scalp Acupuncture
20
YNSA
21
YNSA
S. Sciatic
K. Knee
1. Lateral
2. Medial
3. ?
22
Tai Yang
Jue Yin
SI, BL
PC, LR
Yang Ming
Shao Yin
LI, ST
HT, KI
Shao Yang
Tai Yin
TH, GB
LU, SP
[Inverse]
23
Version I
Problem
Inverse
&
Contrary
Same cycle
point
Ipsilateral
Contralateral
Problems
Extremity
Inverse
Contrary
Tai Yang
SI
BL
Upper
Lower
LR
PC
SP
LU
Shao Yang
TH
GB
Upper
Lower
SP
LU
LR
PC
Yang Ming
LI
ST
Upper
Lower
ST
LI
KI
HT
Tai Yin
LU
SP
Upper
Lower
GB
TH
BL
SI
Shao Yin
HT
KI
Upper
Lower
KI
HT
ST
LI
Jue Yin
PC
LR
Upper
Lower
BL
SI
GB
TH
24
Version II
Problem
Inverse
Inverse
Contrary
25
Channel
Derivation
Chong Mo
KI
Yin Wei
Mo
Du Mo
SP; KI; LR
None
Master Coupled
Point
Point
SP-4
PC-6
F-4
K-9
PC-6
SP-4
(GV-9)*
K-9
F-4
SI-3
BL-62
H-2
I-38
Classic
Name
Classic
Function
Western Medicine
Integration
Assault
Vessel;
Mother of
the 12
Meridians;
Sea of
Blood
Organizes the 5
organs and six
energies by
receiving,
organizing and
propelling
Ancestral energy
through the
curious and
principle
meridians
Chain
(linking,
binding) of
Yin
Equilibrates
energy on the Yin
(interior); controls
and protects
movement in the
3 Yins of the foot
Governing
Vessel;
Sea of the
Yang
Meridians
Receives and
controls all of the
Yang channels
and concentrates
them
Channel
Derivation
Yang Qiao
Mo
BL
Dai Mo
Yang Wei
Mo
None
GB
Master Coupled
Point
Point
BL-62
SI-3
I-38
H-2
GB-41
TE-5
M-31
L-4
TE-5
GB-41
L-4
M-31
Classic
Name
Classic
Function
Western Medicine
Integration
Motility
(heel,
rising-up)
of Yang
Assures
movement of
energy on Yang
surfaces; exit
point of deep
disturbances
Belt
Meridian
Regulation
between bottom
and top; holds
everything
together;
connects inside
and outside;
connects Yin and
Yang; disorders
predominantly
affect females;
principle effect on
meridians below
the waist
Chain
(linking,
binding) of
Yang
Equilibrates
energy on the
Yang surface of
the body;
controls and
protects
movement of the
three Yangs of
the foot
26
Channel
Derivation
Jenn Mo
Ren
None
Yin Qiao
Mo
KI; BL
Master Coupled
Point
Point
LU-7
KI-6
C-8
J-2
KI-6
LU-7
J-2
C-8
Classic
Name
Classic
Function
Western Medicine
Integration
Conceptio
n Vessel;
the
Tchong
Mo of
women
Receives all of
the Yin channels
and sends them
out again;
principally
feminine
symptomatology
Symptoms similar to
Tchong Mo, but more
diffuse autonomic
dysfunction; problems of
sexuality menses,
fibroids, digestion, lungs
and bronchi
Motility
(heel,
rising-up)
of Yin
Assures the
movement of
Energy on the Yin
surface (interior);
puts Yin into
movement;
regulates Yin and
Yang meridians
on medial and
lateral surfaces,
especially in the
legs
27
Smooth
Rough
3x or more
ST or SP
LI or LU
2x
BL or K
SI or HT
1x
GB or LR
TH or PC
28
Smooth
Rough
3x or more
SP or ST
LU or LI
2x
K or BL
HT or SI
1x
LR or GB
PC or TH
SilverGold
GoldSilver
or (-) (+)
or (+) (-)
29
Three Constitutions
CONSTITUTION
SYNDROME
PULSE
Type
EXCESS
LI
ST
UB
Lg. Intestine
Sedation
DEFICIENCY
SI
SJ
GB
Gall Bladder
Tonification
EXCESS
LV
PC
Heart
Sedation
DEFICIENCY
SP
LU
KD
Lung
Tonification
EXCESS
SJ
SI
ST
Sm.
Intestine
Sedation
DEFICIENCY
LI
UB
GB
Lg. Intestine
Tonification
EXCESS
LV
KD
LU
Kidney
Sedation
DEFICIENCY
PC
SP
Heart
Tonification
YANG
YANG EXCESS
SYNDROME
YIN
YANG
KIDNEY EXCESS
SYNDROME
POSSIBLE
PRESCRIPTIONS
YIN
Three Constitutions
CONSTITUTION
SYNDROME
PULSE
Type
EXCESS
GB
Bladder
Sedation
UB
YANG
YIN EXCESS
SYNDROME
POSSIBLE
PRESCRIPTIONS
DEFICIENCY
SI
SJ
LI
ST
Stomach
Tonification
EXCESS
SP
LU
PC
Spleen
Sedation
YIN
DEFICIENCY
ED
LV
Kidney
Tonification
30
31
Summary
I.
II.
III.
Symptomatic Treatments
A. Hand KHT, Sujok, Chinese
B. Ear Auricular/French, Chinese
C. Scalp YNSA, Chinese
Meridian Balance/Treatment
A. Energetic Cycles (Systemic/Symmetrical Problems)
B. Inverse Contrary Law (Asymmetrical Problems)
C. TCM Patterns and Special Effect Points.
Constitutional Balance
A. KHT
B. Others
By no means that this is the only way to treat a patient with acupuncture. There are
different interpretations and uses of these terms and methods that I have put together. I
find that this is the most cost-effective and time-effective combination with
comprehensive consideration to the patients energetic system.
Pharmacodynamics vs. Acu-dynamics
Pharmacokinetics vs. Acu-kinetics
32
Pharmacodynamics:
What is the drug doing to our body?
Effects on target site
Effects on other organs
Toxicity, etc.
Acu-dynamics:
What would happen if I stimulate this acupuncture point this way at this time?
Pharmokinetics:
What is the body going to the drug?
Means of delivery
Absorption
Blood/target concentration
Volume of distribution
Half-life
Biotransformation and elimination, etc.
Acu-kinetics:
How is the body perceiving this point(s)
Stimulation and use for our benefit, to pursue and main your best personal state, and to
reject the undesirable effects.
Perioperative Acupuncture
Y. P. Mok, M.D.
2014 ASA
33
Learning Objectives
To examine the philosophy and
indications of applying acupuncture in
the perioperative setting
To describe the application of
acupuncture in the levels of
perioperative stages
To discuss the concept of reversal of
acupuncture treatment
Disclosure
Dr. Y.P. Mok has no financial interest in
any of the subjects in this presentation
34
Structural
Anatomical
(Surgery)
Chemical
(Medicine)
Energetic
Acupunctur
e Physical
Medicine
Acupuncture Schools in US
1.
2.
French Energetics
TCM
1.
2.
3.
4.
5.
Five Element
Japanese Meridian Therapy
Auricular Therapy/Medicine
1.
2.
6.
KHT
SUJOK
Scalp Acupuncture
1.
2.
8.
French
Chinese
7.
New Style
Ancient/Classical
YN SA
Chinese
Others
35
Acupuncture Strategy
I.
Symptomatic Treatment
II.
Meridian Therapy/Balance
Acupuncture
Symptomatic Treatment
Meridian Therapy
Constitutional
Treatment
Battle Field
Special Forces/Tactical
Army/Strategic
International Policy
36
Acupuncture
Schools
Symptomatic
Treatment
Meridian
Therapy
Constitutional
Treatment
+++
++
TCM Classical
++
+++
+++
TCM New
++
++
++
++
+++
Japanese
++
+++
++
Auricular
+++
-/+
Hand
Acupuncture
+++
+++
+++
Scalp
Acupuncture
+++
-/+
-/+
French
Energetics
Five Element
Others
37
38
Pre-Operative Acupuncture
Indications & Applications
I.
39
LUNG
HEART
LUNG
40
Pre-Operative Acupuncture
Indications & Applications
II.
41
LUNG
HEART
LUNG
42
Pre-Operative Acupuncture
Indications & Application
III. Extraordinary (curious) Meridian
(in KHT)
Intra Operative
Acupuncture effects were proven,
limitations were defined.
Interpretations of effects are subjective,
unreliable, and variable.
43
44
Fourth:
Allow rapid/early emergence
Preemptive analgesia
45
Occasional Uses
1. Correspondence point treatments to
reduce pain of injections (local
anesthetics injection, regional anesthesia,
vascular access, bone marrow biopsy,
etc.)
2. Pre-Op sedation for patients who cannot
tolerate or refuse pre-medications.
46
47
Summary
Principles of Perioperative Acupuncture
1. Simple Minimal Time Consumption.
2. Safe Avoid Complications before and
during surgery.
3. Politically Correct
Patient (and family) selection.
Surgeon factors.
Red tapes (Institutional, Regional, State, etc.)
48
Summary
Goals
Types of Acupuncture
Available
Pre-Op
Intra-Op
Post-Op
49
50
51