ACUPUNCTURE AND RELATED TREATMENT MODALITIES Part I: Theoretical Background

Margaret VI. Beal,

CNM.

MSN

Many Americans first heard of acupuc~!c;e when the New York 7imes corremondent James Reston was treated tith tt in 1971. Reston had been t~~~elins

regkmd ~dalist

in Betttns

when

anesthesia at the rinti-lmHospital. On his second

c~.~fully with accupuncture and moxibustion. or the burning of herbs, over valious locations on his body. The pain rexlIved and did not return. Reston wrote about his personal experiences as well as o&rvations of surgenes conducted under acupuncture anesthesiain two articles that appearedin the New York Times (1,2j that w_~T. At that time ths idea that acupuncturecould be thempatic was astonishing to so many readem that skeptics accused Reston of slagmy the event, an accusationhe respondedto by saying it “greatly ov-

err&s my imagtnation, courage and self-sxriftce” (21. Twenty years later, although it is not as acceptedhere as it is in Asia and Europe, xupunctire is available as an alternative health treatment in many commw!tles In the United States. Professionally oriented and popular pressi. have pobltshed artcles and bwb on the use of acupuncture Icx drug withdrawal symptoms W, anesthesia and analgesia, and cardiovascular and neumlogtc disorders (3, 4). Acupuncture is regulated in many states in the Llnlted States (4) and is slowly making inroads into the system of publtc payment for health services 16). The use of acupuncture in drug withdrawal treatment and anesrbesia are relatively new developments in a long hbtw of a medicalwtem based on i phil&phy of health very different from our OWL Although arceptancehas grown for the idea that ac”punch~recan be beneficial. most Amedcan health pmfessionals have little understandingof the conceptual framework undedying the treatment or of the related modalities such as

rcwibwtion, acupresmre,and skku. lhe ~wpose of this arUcleIs to inform the nurse-ml&fey rcmm”nlty of the theoretIcal frameworks used by pmctttioners of these modalities, and their range of applications In health care. Research on applications of these modalities to care during pregnancy and birth will be presented in a further article.

HISTORICAL BACKGROUND Chinese acupuncture is part of tm dittonal Chinese medicine ITCMj. a medicine that includes both a;“puncture and herbology as major components of therapy. Other as p&s cf therapy include exercise and nutrition. Traditional Chinw medtcineis over 2,oW years old (6). and its oldest major text d&es from about 300 BC (7). This text, the Huangdi Nei Ching Su Wen (Nei Cbingj or The Yellow Emperor’s Clrruic of lntemal Medicine, comes b us via a complex history of revision and commentay by a lipcageof scholars. Although the text is

Journal of Nurse-Mtdwtfery .

Vol. 37. No. 4. .lulylAug,sa ,953

atmbuted to Huangdt, one of the earliest and perhaps legendary emperors d China, linguistir and historical research has led to the conclusion that theNeiChing wascompiledcirca 300 BC. Tbe science of Chinese medicine developed more elaborately over the next millennium and went inio a decline behxeen the 15th and 19th centuries AD Although western medicine was firsttntioduced into China during the 17th.century tmw!s of the Jesuits, it begen to make real inroads into acceptance during the 19th century. when CMsttan mtssionaly boards reattzed that medicine could be of aid to their work Thus western medicine began to have an impact on China at a time when its own tradition was in e schoktiy decline. The ideas of pubk health. western-style hospitals,and medical schoolswere introduced into China in the late 19ih and early 20th centuries. and although most people did not have accessto western stvle health care, the value of it was “p“rectated. In 1912, with the found;nq bf the Republic,Dr. Sun YatSen came into power. He was a medical doctor, educated in western schools.and “nder his leadership the government began a policy o? fostering w&em medicine. Efforts to terminate the pm&e of Chtt medtdne were not successful,however, because of the fact that Chinese medktne was trusted by the population and, as a matter of pmcttcallty,western medicine was sdll not available to most people. Mao Tse-Tong had commented on

b,,mal d Nurse.hUdwi,pnl .

the problems of inadequate numbers that of doctorsduring the Long March and the umr age&tthe ocruv;‘“3 1,~. nese. After the revolution of 1949, the Chinese government worked to we at the dehnitions and foster cooperation between westem concepts undertying the theory of and traditional Chinew doctors. and acupuncture and related treatment to establish e system of now-famous modalit& “barefoot doctors” baiaincdin first aid and preventive care. In an ofterDEFlNlTlONS quoted statementMao said, “Chinese medicine end phsnnacolcqy are a The Erqbh word for ac”purxture was great treasure-house. :“a efforts wined from the Latin “acus,” o: should be made to explore them and needle, by early Eurowan observers raise them to a high& level” (8). In of the p&&Joseph Needham. an the 1950% colleges of TCM were authority on the history of Chinese founded in many Chinese cities. A science,.has deftned acupuncture as major project was begun in 1954 to “the implentation of thin needles to publish a new, stand&Jtted edition different depths at a great vartety of of the texts of TCM. Since that time. points on the surface of the human the government has had a policy of b&---points gathered in connected working :or collaboration between anap according to a highly systematized pawem with a complex and sopmctittonersand researchersin westem medklne and TCM. According to phisttated. if medieval, physk%gkal themy behind it” (9). In its original sane scholars,the standardizationof tredtttonal texts and codification of foml, ecupunctore was part of an extemd tbm that also included treditional practices into a more offmoxtbustton, or the burning of a cial TCM has greatly oversimplifted -ration of the herb Attemtsta uulthe practice. The cottabwation begetis. The moxtbution can be eftween western medkine and TCM has fected e&her by leaveson the at times obscured hue meanings, betop of an acupuncture needle. so that cause the two disciplines lacked a the heat is conducted to the body by common language to speak to each thewed!+z,byho!d%goibumingstkk and compromise ha; seemed of herbal preparation wer the bodv wetghtedtowardwestem medicine(7). close to a ,i,t or points. or by pknAddittonally. the field has been altngapavderedformofthehabeither tered by effow of researchershained dhectiy or indtrectty leg, on top of an in the w&em scientificmodel to find intermedian, object, such as a slice of the biochemical mediates of acuon ihe skin. puncture treatment Much of the researchcarded out h the United States Acuprasure is a geneml form for timulation of poink by means of in recent years has focused on ident3fytngthe mechankms of action for pressure, wtng the thumbs. fingers. w hands. Acupws.we can be done acupunchwe anesthesia (4). Acuto another person. eg. by a prac% punctore anesthesia,which had been tioner or a htend. and can also be developed by the Chinese doling the pafamedononself.Stsaf~ 19SOs,lends i&If particularly well to of bodwrk that ori@na!ed in Japan this type of researchapproach. Work early the centuy (10). It has routs in by Pomemnz end many others has both Chinese and Japanese ecuied to the diivey that some of the pu”cture. as we!l as in Chines and pain-relieving effects of acupunctixe Japanese t,ar,ttio,~d massage. T;id are due to activation of rndoqenws shiatsu practitioner’s repertott inopiates (41. dudes pcint stimulation and a vade$ At this time pmationers are entaof other technique3 that involve ing the field with a vadety of skill lev-

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stretching and rotation of body parts, and use of the thumbs. hands. elbows, and knees of the practitioner on the client’s body. Shiatsu and acupressureare taught In situations that vary from a self-help and comfort-inducingtechniqueto be used between friends to a professional level of training. Some praciSown of shiabu and acupressure Indude therayy with mntibustion whereas others do not. UNDERLYING CONCEPTS

the other. In the disdpllnes of the mati. arts the student is taught to focus on and move from the center of ch’l In the body, and to respond to the opponent’s ch’i-directedforce by deflectingit or using tt againsthim, rather than receiving the blow. The feats performed by martial arts practitioners are notatibuted,ust to hard v.wk and dIl&nce In buildingskength f?eveloplngthe awareness of ch’l energy and the ability to work with it are just as essential. The traditional oriental health practitioner learns to feel this enemu within herself and the client, and learns to affect the flow of ch’i within the client so as to assist in the maintenance or restoration of health. The concept of flow in ch’i is inMnslcally tied to movement and dir&ion. Cfii is seen as flowing through our bodies in resell-described channels or pathways, called meridians. The meridians together form a kind of net of interconnected pathways. mentioned before, h&h is seen as a state of balance,and stxdRcaPy balancein flow of ch’i in the medd-ians and r&red internal organs. Energy may be bound up or overabundant in one or more meridians, perhaps in specific points on the meridians. Energy may also becomeundenuoolied or deficient in others. Imb&an% in the flow of ch’i is a major factor in an individual’s health stahts or loss of health. Additionelly, meddian imba!ancesmay be seen as a cxuse of symptoms or syndromes that may not be identlfted and txeatable according to western medical taxonomits. but which may be recognized in traditional oriental ones. Thus, a practitioner of acup”“*re or ecupressure might be able to relieve a condition not yet sufficiently patho. lo& as to be recognizedin a western diagnostic frame&k. Traditional Chinese culture dates man in relation to heaven andoarth, and the meridians are seen as organized into pairs of opposites, ytn and yang. The yin/yang model is one duality, and in the case of the meddI,

Tm&mnal Chinese medicinegrew cut of ancient Chinese culhxe, the culture that produced the philosophy of Taoism. Accordingto this view, mankind is placedin relation to the heavens abvveand the earth below. Health is described as a state of balanceor harmony wdhin an individual and behveen the individual and nature. CH;i The human is seen as empowered by a life energy or basic life force. This life energy, caUedch’i in Chinese and ki in Jatxmese. is the srne force that is expr&ed in the growth of plants and the cyclecf the seasons. “When Ch’i is flowing aI of life’s processes are in operation in a rhythmic and harmonious way. This Life Force IS a cohesionof our body/mind/spirit,and the ~“tegration of tie myriad aspects ofeach individual human being. Ch’i is spoken of with reverence because it is the basis of life, and because, if it goa awry. i: becomes the basis of dIse.ase”Ill). Because this energy seems invisible to us, how can the practitioner think of working with it toi Uwrapeu. tic purposes? Even if we have not pmctird them ourselves, most of us have been at least superiicial~yexposed to the martial arts Martial arts practice is an example of another mode of working with &‘I. Indeed. the marnal art.5and the hwJ!i”ing a* are related pm&es in that many pmctilioners of one also participatein

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Acupuncture and related treatment modalities. Part I: Theoretical background.

An introduction to the therapeutic applications, history, and theory of acupuncture and several related treatment modalities is presented. The practic...
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