Introduction

Acupuncture has a long history with the earliest extant text – the Yellow Emperor’s Internal Cannon (黄帝内经 Huángdì nèijīng) – being compiled in around 300 BCE. Much of this text has been developed over the centuries and still has relevance in the practice of acupuncture today.

Many lineages and traditions have come and gone: those that are clinically relevant and effective endure, those that are not, do not and are discarded. This ‘what works persists’ notion has guided the development of Chinese medical theory and practice over centuries and continues in the current era.

Modern Traditional Chinese Medicine (TCM) is the proper name of the primary style of acupuncture and Chinese medicine practiced in China and around the world today. TCM was developed as a medical system after the Communists under Mao came to power in the middle of last century, and was intended to codify the huge variety of styles and lineages present at the time, into a cohesive system.

The medicine was also exported to other countries, with Korea and Japan particularly developing domestic approaches. Acupuncture reached the West (Europe and then North America) in the 1970’s and today is practiced widely in those parts of the world, along with South America, Australia and South Africa.

An additional and perhaps surprising aspect of the pollination of the West by East Asian medicine, is the re-pollination, back into the China and East Asia, of East Asian medicine from the West.

Acupuncture

The standard description of acupuncture often states that it involves ‘the insertion of thin needles into the skin at specific locations in order to balance the energy of the body’. This is not incorrect, but there is obviously more to it than that.

The needles used are indeed thin – the needles I use are either 0.20 or 0.25mm in diameter and either 15 or 25mm long. They are inserted into the skin in specific locations known as acupuncture points (or acupoints), of which there are around 400 commonly listed in standard acupoint books. While these 400 points are found everywhere on the body – the head, face, neck, back, chest, abdomen and limbs – the points I most commonly use in clinic are found on the lower arms & hands, and the lower legs & feet.

It is one of the not-so-obvious aspects of acupuncture treatment that the greatest effect is often obtained by concentrating the treatment as far away from the issue as possible. An common example would be in the treatment of headaches which are commonly treated by using points on the lower legs and feet.

Another possibility, especially in the case of musculoskeletal conditions is to choose to treat a particular joint issue with another joint entirely. For example, the patient experiences right knee pain: needling the right knee itself may exacerbate the situation, so the left elbow is chosen to effect change on the right knee. This may sound like magical thinking, but when the intricacies of Chinese medical channel theory are understood and used in the right context, it is entirely possible to help that right knee.

Moxibustion

This treatment method is not as well-known as the use of acupuncture needles. It involves the use of the dried, sifted leaves of the Chinese mugwort plant (Artemisia argyi Folium – 艾叶 ài yè) to apply therapeutic heat to the body. This happens in two ways: indirectly, where a moxa stick is used to warm a large area of the body (for example, an entire shoulder joint), and directly, where the moxa is rolled into a cones and placed on the skin at a specific acupoints.

In spite of it not being well-known, moxibustion is an integral part of acupuncture treatment – the Chinese term for acupuncture generally includes both needle and moxibustion – 针灸 zhēnjiǔ – where 针 zhēn means needle and 灸 jiǔ means moxibustion. The bottom half of the character for moxibustion contains the character for fire (火 huǒ), alluding to the fact that its therapeutic effect is due to the effect of heat when the moxa is lit and applied to the skin.

Direct moxa - small moxa cone being burnt on acupoint ST-26 wai ling 外陵

Cupping

This treatment method involves the use of suction cups on the larger muscles of the body, particularly on the back. The suction action is almost like a reverse massage which pulls up stiff and knotted muscles, rather than pushing them down. The effect of cupping is often at the deeper muscle level and it is often described by patients as a really deep deep tissue massage. The Chinese term is 拔罐法 báguànfǎʼ, the literal translation of which is ‘to pull up or draw out by suction method’. Admittedly, a longer term than cupping, but much more descriptive…

Modern cups are made out of glass instead of the more traditional bamboo or animal horn, which enables them to be cleaned and sterilised very easily. Two methods are currently popular: the first is a more traditional approach which I use in practice, whereby a vacuum is formed in the cup by using a lighted cotton wool ball to extract the oxygen from the cup, which is then placed quickly on the skin. The second method is to place the cup on the skin and then pump the air out of the cup causing a suction. Either way the skin and possibly some superficial muscle is drawn up into the cup.

Cupping causes blood to be drawn to the surface of the skin which results in very visible circular ‘bruises’ to form. They are an indication of the process having worked rather than something going wrong, and will disappear in two to three weeks.