The abundance in the literature of recent years of publications on acupuncture allows you to get by with only a brief preamble. As for history, it is enough to point out that acupuncture is based on thousands of years of empirical experience, attracting more and more attention from Western medicine and the desire to combine empiricism and science. This slowly advancing integration would undoubtedly be faster if the vast majority of Western work on acupuncture was not so dependent on ancient Eastern notions and mystical terminology. Only recently can it be considered the beginning of the demystification of the method and attempts to use neurophysiological mechanisms to explain the effects of acupuncture.
The Chinese themselves have always been excellent observers and explained their observations in their inherent form of thinking and perception. For our own understanding, it is necessary to clarify all aspects that are alien to the ideas of European medicine, and interpret them based on observations of the course of the disease and the effects of acupuncture from the standpoint of scientific medicine. In this case, it is advisable not to immediately narrow the scope of the study to the limits of any individual mechanisms, but to think about the system as a whole. Only in this way is it possible to bring under the rules many obscure points associated with the action of acupuncture.
Not everything is clear to us until now, however, in general, the remaining dark zone begins to brighten. In this regard, the key point is the fact that until recently, too little attention was paid to the role of the muscular system and its reactivity in acupuncture. As the first argument in favor of this role, it can be pointed out that the course of almost all meridians coincides with the known functions of the muscle chains (Bergsmann), and that the so-called partner meridians, such as the meridians of the lungs, colon, liver, and gall bladder, correspond to the directions actions of antagonistic muscle groups.
The observed and demonstrated opposite of these partner meridians corresponds by analogy to the Sherrington reciprocal innervation law, according to which the state of muscle tone or its regulation is carried out through the gamma system and its close connections with the autonomic system as an essential mechanism of associated reflex processes. In accordance with the indicated law of reciprocal innervation, muscle groups-antagonists, relaxing, facilitate and make the function of agonists more economical, that is, they behave just like the partner meridians during acupuncture; the fact is known that the so-called toning can be achieved only through a decrease in tone, i.e. sedation, of the partner meridians. The activity of muscle chains allows us to understand the still fundamental rule of acupuncture, which at first seemed unclear, namely, why it is introduced in areas located contralaterally diagonally to the affected area. Here it is worth recalling the passive and active motor exercises known to physiotherapists according to the methodology of Bobath and Kabat, i.e., the methods of proprioceptive muscle relief (PMO), which also use the diagonal movement from top to bottom of the contralateral segments.
Another argument in favor of the leading role of the system that regulates muscle tone in the mechanism of action of acupuncture is originated in China, and then widely supplemented and modernized with corrective or therapeutic exercise. The exercises used for these purposes are aimed at improving health and, after the entire program is completed, provide the perfect balance of the entire muscular system and vascular network with the appearance of a sensation of pleasant relaxation similar to the state after successful acupuncture. In addition to these subjective sensations, comparative palpation along the meridians shows a corresponding decrease in tone and allows you to choose the right points.
Meridians and muscle chains
As a last argument, one more random observation (Macdonald) should be given that when direct rays of light hit a wet body, you can see that typical meridians coincide with muscle contours. Confirmation and reproduction of this phenomenon turned out to be possible when photographing with a flash of bodies greased with vegetable oil, while the light flares on the protruding muscle contours corresponded to the course of the meridians.
Observations and discussions about the role of muscles in acupuncture are based on Chinese original literature, and it should be pointed out that in addition to the well-known 12 pairs of main meridians and the front and back meridians of the midline, Chinese literature also speaks of 12 muscle-tendon vessels. These 12 muscle meridians should have basically the same direction as the main meridians, but in Chinese drawings they have no connection with the internal organs.
With acupuncture, we are not only talking about some kind of treatment that affects the skin reflector. By choosing the point, direction and depth of the needle, it is possible to purposefully act on various tissue layers of the musculoskeletal system, thus fulfilling the requirements of structure-dependent therapy. In addition, acupuncture allows you to take into account the severity of existing disorders and the expected response of the patient to acupuncture. By choosing the right point, it is possible to achieve a varying degree of intensity of the therapeutic effect from mild superficial reactions to the direct suppression of the lesion. In this case, the effect can be enhanced by the duration of the needle at the injection point or by stirring it.
At the end of the theoretical discussions about the action of acupuncture for the sake of clarity, it should be concluded that everything here is presented in a simplified form and only to the extent that is directly related to the reflex therapy of lesions of the musculoskeletal system.
General directions of treatment
The choice of needles and the technique of their introduction.
For acupuncture, stainless steel needles of various lengths are mainly used. The use of needles of gold and silver was indicated, but no advantages were found. Thin and flexible stainless steel needles are inserted more easily and painlessly. The most commonly used are the so-called hair needles – these are round, thin and elastic steel needles with a length of 1 to 20 cm. The technique of their introduction with proper training is not a problem. When introducing very long and flexible needles, it may be advisable to use guides that
allow the needles to be inserted into the skin by lightly tapping them on their heads. Having removed the tubular guide, it is easy to introduce the needle further to the required depth. The correct position of the needle in most cases, as already mentioned, is signaled by the appearance of a sensation of heat, heaviness, and itching. You should always strive for the appearance of such a reaction, which can be enhanced by light rotation or vibration. It is necessary to ensure that this reaction is within the boundaries of painlessness.
The number of needles and the length of the needles in the tissues
Again and again, questions arise as to how many needles need to be inserted in one acupuncture session, and how long they should remain in place. The answer to these questions sends us to the criteria for the selection and application of reflexology techniques. Here, the constitutional features of the patient and the true conditions of regulation (normoergy, hyperergy, hypoergy) are crucial for planning therapy. All this to a large extent applies to acupuncture, and in this regard, it is necessary to give a compliment to the Chinese for the fact that they already took this into account, and to a much greater extent; than western medicine. Additionally, the influence of external factors such as heat, cold, humidity, draft and the development of the disease is taken into account. These components are correlated with the constitutional characteristics of the individual, and thus the patient’s reaction to the planned therapy is predicted and its dosage is established. Returning to the questions posed, it should be said that the injection site, the number of needles, the need for additional stimulation, and the duration of stimulation are determined individually. In general, it can be noted that it is almost never necessary to inject more than 10 needles, and often fewer of them are enough, and the duration of exposure is on average 10 minutes. The frequency of sessions, of course, depends on the situation, in acute syndromes you can conduct sessions daily or even several times a day, and in chronic course – with interruptions up to a week.
Point selection criteria
When choosing points in each individual case, one should proceed from the following principle: those points that lie on the meridians and coincide with the localization of the lesion are selected. This includes those local points that are directly related to the pain zone, as well as distant points. The latter lie, as their name already shows, far from the pathological site, not on the directly interested meridian, but on the second part of the pair of meridians (cranio-caudal rule) and on the friendly partner meridian. Certain points are selected specifically for acute acute pain syndrome, in this case it becomes possible to increase the therapeutic effect and its intensity through the contralateral and diagonal points (the rule of contralateral and diagonal distant points). Through primary acupuncture at distant points, using active or passive movements (within painless limits), one can prepare for acupuncture at local points.
With equally strong central and distal pains, first of all, a short-term effect is performed at points close to the spine, and then at distal points.
If during treatment the pain in the main pain areas subsides, then stimulation of other points is not required, because in this case, deterioration may occur.
As for acupuncture directly in the pain area,
it should be noted that the most effective is the deep introduction of the needle through the bulk of the muscle, and this will be advisable only if the starting point (trigger) is in this area.
These criteria should be considered as a prerequisite that the stimulation of the selected combination of points for this syndrome will have the desired effect. In order to facilitate the integration of acupuncture into the complex of reflexology, special numbered programs dependent on body segments have been developed. This material contains only program numbers as an indication of the selected points.
Recommended Treatment Programs
Suggestions for the treatment of the most common pain zones.
The proposed programs should not be construed as rigid schemes. Depending on the situation, variations are possible with the rejection of some points or with a combination of programs. In principle, it should be recalled that in hyperergic, overly responsive patients, treatment should be carried out gently and, as a rule, with a smaller number of needles, and that in acute situations, acupuncture should first begin with distant points (respectively, cranio-caudal, contralateral and diagonal rules), and that palpation of the pain area gives an indication of the choice of additional points to be stimulated.