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ACUPUNCTURE

Definition
Acupuncture literally means to puncture with a
needle
Acupuncture is a form of ancient Chinese
medicine in which fine needles are inserted into
the skin at certain points on the body.
It is a complementary or alternative medicine
(CAM). This means that acupuncture is different
in important ways from treatments that are part
of conventional western medicine. Unlike
conventional treatments, the use of acupuncture
is not always based on scientific evidence.

Traditional Chinese medicine is based on a number of


philosophical concepts, one of which postulates that
any manifestation of disease is considered a sign of
imbalance between the yin and yang forces in the body
In traditional Chinese medicine, disease is seen as a
sign of imbalance between two complementary
polarities (yin and yang). Needling the appropriate
position of the 361 traditional acupuncture points
(World Health Organisation, 1993) is proposed to
rebalance the functioning by contacting the vital
energy Qi.

In classical acupuncture theory, it is believed that all disorders are


reflected at specific points either on the skin surface or just
beneath it. Vital energy circulates throughout the body along the
so-called meridians, which have either yin or yang char- acteristics.
A correct choice for needling among the 361 classical acupuncture
points located on these meridians is believed to restore the balance
in the body When the needles have been placed successfully, the
patient is supposed to experience a sensation known as teh chi,
defined as a subjective feeling of fullness, numb- ness, tingling, and
warmth with some local soreness and a feeling of distension around
the acupuncture point. There is no consensus among
acupuncturists about the necessity of reaching teh chi for
acupuncture to be effec- tive

Safety
Unlike many drugs, it is non-toxic, and adverse reactions are minimal
Even if the effect of acupuncture therapy is less potent than that of
conventional treatments, acupuncture may still be worth considering
because of the toxicity or adverse effects of conventional treatments.
Acupuncture is one of the safest medical treatments, both conventional
and complementary, on offer in the UK.

Two surveys conducted independently of each other and published in the


British Medical Journal in 2001 concluded that the risk of a serious
adverse reaction to acupuncture is less than 1 in 10,000. This is far less
than many orthodox medical treatments.
One survey was of traditional acupuncturists and the other of doctors who
practise acupuncture. A total of 66,000 treatments were
reviewed altogether, with only a handful of minor and transient side
effects recorded.

Absolute Contraindication

Broken, inflamed or infected skin.


Allergy to metal (unless not allergic to the needles being used)
Needle phobia, un co-operative/confused patients
Uncontrolled movements (e.g uncontrolled epileptics; severe athetoids)
Unstable diabetes
Unstable epilepsy
Unstable haemorrhagic stroke
Unstable acute cardiac arrhythmias or cardiac failure (blood pressure can
be further reduced and interfere with cardiac medication)
Heart valve disease
Lymphoedema or limbs which are prone to lymphoedema (on affected
limb)
Axillary lymph node surgery (affected limb)
Immuno-suppression ,e.g splenectomy patients; radiotherapy under 8
weeks
Non-consent

Precaution

Poor circulation or damaged skin


Anticoagulants. Treat if International Normalised Ratio (INR) stable. Needling near
or into joint spaces increases risk of haemarthrosis.
Haemophilia and other Clotting Disorders
Fatigued patients
Hungry patients
Impaired sensation
Low blood pressure
Stable diabetes
Controlled epilepsy
Immuno-deficiency e.g HIV
Steroids (poor skin healing)
Pregnancy (avoid strong DeQi)
Children (under 16 yrs)
Heart condition do not treat upper quadrant with EA Heart /Pericardium
Meridians
Avoid lumps, moles and cancerous growths
Those with a fear of needles.

Forbidden Points

Potentially Hazardous Acupoints

Near to Femoral artery


Near to eye
Overlies Gallbladder
Close to dangerous structures in the neck
Chest (Risk of Pneumothorax)
Radial artery

Particular care should be taken in needling points in


proximity to vulnerable structures. Points on the chest,
back or abdomen should preferably be needled obliquely
or horizontally to avoid injury to vital organs.

Risks and Side-Effects


Mild, short-lasting side effects occur in around 7-11% of
patients. These include:
Pain where the needles puncture the skin
Bleeding or bruising where the needles puncture the
skin
Drowsiness
Worsening of pre-existing symptoms
Serious complications from treatment, such as
infections or damage to tissue, are extremely rare.
They usually occur only as a result of bad practice,
carried out by an acupuncturist who has not been
properly trained.

1. Lewith GT et al. On the evaluation of the clinical effect of acupuncture. Pain, 1983,
16:111127.
2. Pomeranz B. Acupuncture analgesia for chronic pain: brief survey of clinical trials.
In: Pomeranz B, Stux G, eds. Scientific bases of acupuncture. Berlin/Heidelberg,
Springer-Verlag, 1989: 197199.
3. Richardson PH et al. Acupuncture for the treatment of paina review of
evaluation research. Pain, 1986, 24:1540

, the
proportion of chronic pain relieved by acupuncture is generally in the range 55
85%, which compares favourably with that of potent drugs (morphine helps in
70% of cases) and far outweighs the placebo effect (3035%) (13)
As mentioned
previously, acupuncture is comparable with morphine preparations in its
effectiveness against chronic pain, but without the adverse effects of morphine,
such as dependency.

there are reports of


controlled clinical trials showing that acupuncture is effective in the treatment of
rheumatoid arthritis (46), although not as potent as corticosteroids. Because,
unlike corticosteroids, acupuncture treatment, does not cause serious side-effects,
it seems reasonable to use acupuncture for treating this condition, despite the
difference in effectiveness.

Man SC et al. Preliminary clinical study of acupuncture in rheumatoid arthritis.


Journal of Rheumatology, 1974, 1:126129.
[Observation of the effect of acupuncture and moxibustion on
rheumatoid arthritis in 434 cases.] Chinese Acupuncture and Moxibustion, 1992,
12(1):911 [in Chinese

Does it work?
Currently, the National Institute for Health and
Clinical Excellence (NICE) recommends
acupuncture as a treatment option only for
lower back pain. NICE makes this
recommendation on the basis of scientific
evidence.

There is no scientific evidence for the


existence of Qi or meridians. More research is
needed before acupunctures method of
action is fully understood.

Clinical Guidelines for the use of


Acupuncture
within the Physiotherapy Service