Acupuncture (4) -clinical practice
Clinical practice
In a modern acupuncture session, an initial consultation is followed by taking the pulse on both arms, and an inspection of the tongue. Classically, in clinical practice, acupuncture is highly individualized and based on philosophy and intuition, and not on controlled scientific research. In the United States, acupuncture typically lasts from 10 to 60 minutes, with diagnosis and treatment for a single session ranging from $25 to $80 in 2011. Sometimes needles are left in the ear for up to 3 days.
Clinical practice varies depending on the country. A comparison of the average number of patients treated per hour found significant differences between China (10) and the United States (1.2). Acupuncture is used to treat various type of pain, neurological problems and stroke rehabilitation. Studies conducted in China and Brazil found that the majority of patients were female, though in one study the majority of Chinese patients using acupuncture for stroke rehabilitation were male.
Needles
Acupuncture needles are typically made of stainless steel wire. They are usually disposable, but reusable needles are sometimes used as well, though they must be sterilized between uses. Needles vary in length between 13 to 130 millimetres (0.51 to 5.1 in), with shorter needles used near the face and eyes, and longer needles in more fleshy areas; needle diameters vary from 0.16聽mm (0.006聽in) to 0.46聽mm (0.018聽in), with thicker needles used on more robust patients. Thinner needles may be flexible and require tubes for insertion. The tip of the needle should not be made too sharp to prevent breakage, although blunt needles cause more pain.
Apart from the usual filiform needle, there are also other needle types which can be utilized, such as three-edged needles and the Nine Ancient Needles. Japanese acupuncturists use extremely thin needles that are used superficially, sometimes without penetrating the skin, and surrounded by a guide tube (a technique adopted in China and the West). Korean acupuncture uses copper needles and has a greater focus on the hand.
Needling technique
Insertion
Since most pain is felt in the superficial layers of the skin, a quick insertion of the needle is recommended. If skilled enough, a practitioner purportedly can insert the needles without causing any pain.
Both peer-reviewed medical journals, and acupuncture journals reviewed by acupuncturists, have published on the painfulness of acupuncture treatments, in some cases within the context of reporting studies testing acupuncture’s effectiveness. A peer-reviewed medical journal on pain published an article stating that "acupuncture is a painful and unpleasant treatment". There are other cases in which patients have found the insertion of needles in acupuncture too painful to endure. An acupuncture journal, peer-reviewed by acupuncturists, published an article describing insertion of needles in TCM acupuncture and random needling acupuncture as "painful stimulation". In a peer-reviewed medical journal, one medical scientist published that Japanese acupuncture is "far less painful" than Chinese acupuncture, and that Japanese acupuncture needles are smaller than Chinese acupuncture needles.
De-qi sensation
De-qi (Chinese: 寰楁皵) refers to a sensation of numbness, distension, or electrical tingling at the needling site which might radiate along the corresponding meridian. If de-qi can not be generated, inaccurate location of the acupoint, improper depth of needle insertion, inadequate manual manipulation, or a very weak constitution of the patient have to be considered, all of which are thought to decrease the likelihood of successful treatment. If the de-qi sensation doesn't immediately occur upon needle insertion, various manual manipulation techniques can be applied to promote it (such as "plucking", "shaking" or "trembling").
Once de-qi is achieved, further techniques might be utilized which aim to "influence" the de-qi; for example, by certain manipulation the de-qi sensation allegedly can be conducted from the needling site towards more distant sites of the body. Other techniques aim at "tonifying" (Chinese: 琛?/span>) or "sedating" qi. The former techniques are used in deficiency patterns, the latter in excess patterns.
De qi is more important in Chinese acupuncture, while Western and Japanese patients may not consider it a necessary part of the treatment.
Related practices
- Acupressure (a blend of "acupuncture" and "pressure") uses physical pressure applied to acupuncture points by the hand, elbow, or with various devices.
- Moxibustion 鈥?Acupuncture is often accompanied by moxibustion, the burning of cone-shaped preparations of mugwort on or near the skin, often but not always near or on an acupuncture point. Traditionally acupuncture was used to treat acute conditions while moxibustion was used for chronic diseases. Moxibustion could be direct (the cone was placed directly on the skin and allowed to burn the skin producing a blister and eventually a scar), or indirect (either a cone of mugwort was placed on a slice of garlic, ginger or other vegetable, or a cylinder of mugwort was held above the skin, close enough to either warm or burn it).
- Fire cupping
- Tuina is a TCM method of attempting to stimulate the flow of qi by various bare handed techniques that do not involve needles.
- Electroacupuncture is a form of acupuncture in which acupuncture needles are attached to a device that generates continuous electric pulses. Another term is percutaneous electrical nerve stimulation.
- Sonopuncture or acutonics is a stimulation of the body similar to acupuncture, but using sound instead of needles. This may be done using purpose-built transducers to direct a narrow ultrasound beam to a depth of 6鈥? centimetres at acupuncture meridian points on the body. Alternatively, tuning forks or other sound emitting devices are used.
- Acupuncture point injection is the injection of various substances (such as drugs, vitamins or herbal extracts) into acupuncture point.
- Ear acupuncture is a form of acupuncture developed in France which is based on the assumption of reflexological representation of the entire body in the outer ear.
- Scalp acupuncture is likewise based on reflexological considerations regarding the scalp area; it has been developed in Japan.
- Hand acupuncture similarly centers around assumed reflex zones of the hand; it has been developed in Korea.
- Medical acupuncture tries to integrate reflexological concepts, the trigger point model, and anatomical insights (such as dermatome distribution) into acupuncture practice, and emphasizes a more formulaic approach to acupuncture point location.
- Cosmetic acupuncture is the use of acupuncture in an attempt to reduce wrinkles on the face.
