Acu 4 - May 12

Introduction to Treatment Modalities

Acupuncture and moxibustion officially transition into the "Technique Part" of the course, focusing on treatment tools.
Treatment Categories: * Internal Treatment: Refers to the intake of herbs that go inside the body. * External Treatment: Includes acupuncture, moxibustion, cupping, and gua sha. While external, these techniques treat internal issues, pain, and conditions not caused by physical injury, as pain can originate from internal organs.

History and Tools of Acupuncture

Antiquity: Acupuncture is considered the earliest modality, with records dating back approximately $100,000 \text{ years ago}$ .
Ancient Tools: The earliest needles were needle-shaped stones. These were made from a dark-colored stone called "Huaxha" stone. Many modern gua sha tools are still marketed as being made from this stone.
Acupuncture Definition: Stimulating specific points using apparatuses or instruments inserted into the skin.
Needle Types: * Various sizes and types of needles exist. * Long Blossom Needle/Seven-Star Needle: Used to tap or insert into the skin but are typically not retained for long periods; the application is very temporary.

Moxibustion: Material and Applications

Moxibustion (Ai Yi): Involves fumigating points with ignited moxa leaves or sticks.
Material: Made from the leaf of the mugwort plant. * Harvesting: The plant matures in May; it is picked, dried, and ground into a floss. * Nature: It is pure Yang and hot in nature.
Clinical Applications: * Internal/External Herb: Used for female issues like dysmenorrhea (painful periods) caused by coldness in the uterus. * Foot Soaks: Dried leaves can be boiled to create a decoction. Soaking feet in this liquid is effective for patients with chronically cold feet.
Forms of Moxa: * Moxa Sticks: Common sticks used for regional heating. * Loose Moxa Floss: Formed into cones for direct or indirect application. * Smokeless Moxa: Modern charcoal-like sticks. They are useful in certain situations but are generally considered less effective than the traditional smoky variety.

Cupping and Modern Techniques

Cupping: Involves sucking or plucking a point or site of complaint using specially made containers.
Materials: Historically pottery, bamboo, or metal; modern cups are typically glass, plastic, or silicone. * Glass Cups: Popular because they allow visibility of the skin, are reasonably priced, and easy to use, though they break easily if dropped. * Electrical Power Cups: Connected to machines; they are safer (no fire) and provide more powerful suction than manual suction guns.
Other Modern Modalities: * Electrical Acupuncture: Very popular; utilizes small and large electrical devices connected to needles. * Acupoint Injection: Common in China; involves injecting herbal decoctions or medicine, though not authorized for use in Canada. * Pricking Therapy: Uses a three-edged needle or lancet for bloodletting; authorized for use in Canada. * Cutting Therapy: Uses a sword-like needle/tiny knife; largely not allowed or utilized in Canada. * Intradermal Needle Embedding: Allowed in Canada; used for longer treatment durations. * Catgut Embedding: A thread (absorbable surgical thread) is inserted via an injection needle into the fat layer. Popular in China for weight loss as it is said to break fat growth. However, it can cause issues for those with scar-tissue constitutions. Status: Not allowed for use in Canada.

Physical Device Therapies and Non-Invasive Methods

Acupoint Therapy Devices: Utilize electricity, light, magnets, heat, or chemokines to regulate the organism. Examples include: * Physiotherapy Devices: Use vibration, heat, or electricity. * Electrical Stimulators: Devices that touch the point without a needle, delivering a mild shock sensation without heat. * TDP Lamp: Uses infrared radiation to assist treatment.
Specialized Irradiations: * Laser Irradiation: A high-end machine (can cost up to $\$50,000$ ) that uses a small red laser spot on the skin. It has no sensation; while some consider it a placebo, it is used for patients with needle phobias. * Other Non-invasive types: Iontophoresis, electrosurgery, and magnetotherapy.

Minute Needling and Hologram Theory

Concept: Treating the whole body through a hologram represented in a small, relatively isolated area.
Applications: * Scalp Acupuncture: Specific areas on the scalp corresponding to organs or tissues. * Auricular (Ear) Acupuncture: The ear represents the whole body. * Face Acupuncture: Different from the theory of the $14 \text{ meridians}$ . Points are determined by facial location (e.g., center for heart, nose tip for spleen, sides for stomach). * Other Holograms: Eye, nose, hand, foot (reflexology), and wrist-ankle acupuncture.

Foundational Functions and Principles of Treatment

Primary Functions: To regulate Qi and Blood and to balance Yin and Yang.
The Street Metaphor: Channels are like streets in a city. If there are no streets, buildings (organs) cannot communicate or transport goods. To "become rich" (be healthy), one must build and maintain the streets.
The River Metaphor: * Channels are like rivers where Qi and Blood flow smoothly. * Acupuncture points are like decks along the riverbank. * Selecting the correct point (deck) ensures you reach the correct destination (organ/function). * Incorrect selection leads to different results or side effects.
De Qi (The Needling Sensation): Points are like sleeping stations. Inserting a needle "awakens" the point and gives it commands/orders. Without obtaining the De Qi sensation, the point remains "asleep" and the treatment is ineffective.

Clinical Anatomy and Specific Point Categories

Five Shu Points (Anatomical Logic): The depth and function of points change as they move from descriptors of water (Well, Spring, Stream, River, Sea) to locations closer to the torso. * Jing-well Points: Located at fingertips. The muscle/tissue is very shallow here with bone underneath, so there isn't much blood. Used for resuscitating consciousness because they are where Yin and Yang channels connect and can remove stagnations completely (like cleaning dust from a room corner).
Xi-Cleft Points (Metaphor and Function): * Definition: "Xi" means a very tiny space. * River Analogy: These points are the narrowest locations in the channel "river." * Three Common Functions: Treating pain (due to obstruction in the narrow passage), acute conditions (due to imbalance/stagnation), and bleeding (like water splashing aggressively out of a narrow channel). * Examples: * Lung 6 (Kongzui): Used for nosebleeds because the lung dislikes dryness. * Spleen 8 (Diji): Specifically used for dysmenorrhea (painful periods).

Circadian Rhythms and Organ Time (The Chinese Body Clock)

Organ Activity Windows: * $3:00-5:00 \text{ AM}$ : Lung Channel (Time for deep breathing). * $5:00-7:00 \text{ AM}$ : Large Intestine (Time to wake up and clear the bowels). * $7:00-9:00 \text{ AM}$ : Stomach Channel (Optimal time for breakfast). * $11:00 \text{ AM} - 1:00 \text{ PM}$ : Heart Channel (Good for a short nap, roughly $\text{30 minutes}$ ; oversleeping consumes Qi). * $11:00 \text{ PM} - 1:00 \text{ AM}$ : Gallbladder Channel. * $1:00-3:00 \text{ AM}$ : Liver Channel (Liver stores blood and detoxifies).
Sleep Health: At night, Yang Qi must go inside to rest. If one stays up late, Yang Qi remains active and consumes Yin and Blood. This is why chronically working night shifts raises the risk of Yin deficiency. Diagnosis can be aided by asking when a patient wakes up (e.g., waking at $3:00 \text{ AM}$ suggests a Lung issue).

Filiform Needle Specifications and practice

Structure: Consists of the handle, root, shaft (body), and tip.
Lengths (Metric vs. Tsun): * $0.5 \text{ tsun}$ = $13-15 \text{ mm}$ * $1 \text{ tsun}$ = $25 \text{ mm}$ * $1.5 \text{ tsun}$ = $40 \text{ mm}$ * $2 \text{ tsun}$ = $50 \text{ mm}$ * $3 \text{ tsun}$ = $75 \text{ mm}$ * At least $\frac{1}{4}$ of the needle shaft must remain above the skin to prevent the risk of a broken needle.
Diameters (Gauge): * Gauge 30: $0.30 \text{ mm}$ * Gauge 32: $0.25 \text{ mm}$ * Face/Cosmetic needles: Range from $0.10 \text{ mm}$ to $0.20 \text{ mm}$ .
Practice Methods: * Paper Packet: Use a toilet paper packet squeezed flat and wrapped with string. Practice thrusting and the tube method. * Cotton Cushion: Wrap cotton with gauze to feel the difference in resistance compared to paper or flesh.

Clinical Preparation and Positioning

Sterilization: Hands must be washed, and the site sterilized with $70\% - 75\%$ isopropyl alcohol. Quality brands for needles include EACUE and Sakura.
Patient Posture: Proper posture prevents "stuck," bent, or broken needles. * Supine: Lie on back; best for first-time patients and limb points. * Prone: Lie on stomach; used for back, neck, or back-shu points. * Side Lying: Used for unilateral issues (e.g., ear or GB channel). * Sitting: Used for short retention or head/shoulder points.

Needling Techniques and Manipulations

Insertion Methods: * Finger Pressure: Using the thumbnail of the pressing hand to guide the needle. * Stretching Skin: Used where skin is loose (e.g., the abdomen). * Pinching Skin: Used where skin is thin (e.g., Lung 7 or head). * Tube Method: Using a guide tube for easier insertion.
Angles: * Perpendicular: $\text{90 degrees}$ . * Oblique: $\text{30 to 60 degrees}$ (used in the torso to avoid organs). * Transverse/Subcutaneous: $\text{15 to 25 degrees}$ (used for thin skin or fascia).
Fundamental Manipulations: * Lifting/Thrusting: Changing depth; frequency is about $\text{60 sets per minute}$ . * Rotation: Moving the thumb and index finger back and forth between $\text{180 and 360 degrees}$ .
Auxiliary Manipulations: * Tracing: Massaging along the channel to guide Qi. * Flicking: Tapping the needle tail to induce sensation. * Scraping: Using the fingernail on the needle tail wire. * Shaking, Twisting, Flying, and Trembling.

De Qi: The Arrival and Induction of Qi

The Fish Metaphor: Obtaining De Qi feels like a "fish biting a fishing line," creating a pulling sensation for the practitioner.
Patient Sensations: Soreness, numbness, distension, heaviness. Cold or heat sensations are also possible.
Clinical Outcome: The faster Qi arrives, the better the prognosis. If Qi does not arrive, use induction techniques: * Four Gates: Combined with Ren 6 (male) or Ren 4 (female) to strengthen Qi. * Tracing/Massaging: Along the course of the channel.

Questions & Discussion

Question on Face Acupuncture: A student asked if face acupuncture uses the same theory as the $14 \text{ meridians}$ . * Response: No, as a hologram, it is different theory. While not strictly required for exams at the college, it is available in workshops.
Question on Pulse Sensitivity: A student asked why the speaker uses only the left hand to feel the pulse. * Response: The speaker's left-hand fingers are naturally more sensitive. The left side pulse represents Yin and Blood (Heart, Liver, Kidney Yin), while the right side represents Yang and Qi.
Question on Night Shifts: A student asked about the health of police and medical workers on night shifts. * Response: They sacrifice for society, but some constitutions handle it better than others. One patient worked nights for $15 \text{ years}$ and remained healthy, but for most, it consumes Yin over time.
Question on Twisting Manipulation: A student asked about clockwise vs. counter-clockwise rotation. * Response: Clockwise is generally reinforcing; counter-clockwise is reducing. However, the fundamental rotation should be back and forth to avoid tangling muscle fibers or creating a stuck needle.
Question on GB 21: A student asked about needling Gallbladder 21. * Response: Use a transverse/superficial insertion to avoid puncturing the lung. This "loosen the muscle" technique is effective for tight trapezius muscles. Combining this with the He-sea point (GB 34) helps regulate the channel Qi.