Acupuncture is one of the treatment modalities of comprehensive traditional Chinese medicine. The word acupuncture is derived from the Latin words acus, “needle,” and punctura, “a pricking.” The original Chinese term for acupuncture is Jin Jiao, which describes the practice of “acupuncture and moxibustion.” Moxibustion, which is the burning of moxa (Artemisia vulgaris) over the acupuncture points, can also be used.

The history of traditional Chinese medicine can be traced back 3,000 years. The Yellow Emperor’s Classic of Internal Medicine from the fourth century BC described the practice of
puncturing the body for pain relief. Traditional Chinese medicine is a system of thoughts and practices that are based on the investigations of nature, causes, and effects. It takes the principles of realism and ethics and employs them for the prevention and healing of illnesses.

The yin and yang concept underlies the theoretical framework of acupuncture. Yin and yang are two opposite dynamics that cannot exist in isolation. Rather, they are in a constant state of dynamic balance. If yin and yang are not balanced, illnesses may occur in the body.

The human body is controlled by a vital force called Qi (pronunciation “chee”). Qi circulates throughout the body and defends its various parts. There are 365 identified acupuncture points in the body, which fall along 12 principal and eight extrameridian systems. Qi is postulated to flow through these meridians in the body.

Acupuncture utilizes a technique of inserting very fine thread-thin needles into strategic points in the body called acupuncture points. Acupuncture needles vary from 0.5 to 5 in. in length and from 36 to 42 gauge. There are a wide variety of needles currently available. In Huang Di Nei Jin (The Yellow Emperor’s Internal Classic), Ling Shu described nine shapes of acupuncture needles. Sterile, disposable stainless steel acupuncture needles are the current standard for acupuncture treatment.

After sterilizing the site of the needle entrance on the skin, the acupuncture needle is inserted few millimeters into the epidermis. Following placement of the acupuncture needle, stimulation of the acupuncture point may be achieved manually or by the application of lowvoltage electrodes onto the needle in a method called electroacupuncture.

Each acupuncture point has a prescribed depth of insertion. Manual techniques may involve the lifting and thrusting of the needle or twisting and twirling. De-Qi is a typical sensation that is associated with proper acupuncture needle position. Patients describe the sensation as a feeling of soreness, numbness, warmth, heaviness, or pressure around the area where the needle is inserted. The De-Qi sensation is mediated through nonmyelinated C fibers. Many practitioners consider this sensation to be crucial in achieving the effects of acupuncture. Electroacupuncture achieves a similar effect through the use of high- or lowfrequency electricity.

Very little pain is associated with acupuncture. For various conditions, multiple acupuncture treatment sessions over an extended period may be required to achieve its greatest effectiveness.

Auricular, hand, and scalp acupuncture can be used as microsystems of acupuncture. For example, for the auricular acupuncture (Fig. 52.1), the upper region of the external ear is manipulated to alleviate conditions in the leg and feet. The middle region of the external ear represents chest and back pain. The lower regions are used to relieve headache and neurologic conditions. Auricular acupuncture can also be used for preoperative anxiety control.

The frequency, as well as the number of acupuncture treatments, varies among acupuncture providers. Most practitioners would agree that more than one treatment is necessary to experience the full effect of acupuncture.

Acupuncture inhibits the transmission of pain according to the gate control theory. It may act by stimulating sensory A-β fibers, thereby directly inhibiting the spinal transmission of pain by a smaller A-δ and C fibers.

Acupuncture stimulates the production of endogenous opioid peptides, such as endorphins and enkephalins, and stimulates the endogenous descending inhibitory pathways. In human studies, analysis of cerebrospinal fluid showed elevated levels of serotonin, endorphins, and enkephalins following acupuncture treatments. Acupuncture analgesia is mainly achieved by the activation of the endogenous anti-nociceptive system to modulate pain transmission and pain response. Low-frequency (2 Hz) and high-frequency (100 Hz) electrical acupuncture
selectively induces the release of enkephalins and dynorphins in both experimental animals and humans. Acupuncture analgesia may be reversed by naloxone.

Functional magnetic resonance imaging has been used to investigate the effect of acupuncture in normal volunteers. With functional magnetic resonance imaging, acupuncture needle manipulation on the LI 4 (Hegu) point (Fig. 52.2) is seen to modulate the activity of the limbic system and subcortical structure. Individual variation occurs in the cortical activation patterns elicited by electrical acupuncture stimulation. Real acupuncture elicited significantly higher activation than sham acupuncture over the hypothalamus and primary
somatosensorimotor cortex and deactivation over the rostral segment of anterior cingulated cortex.