Traditional Acupuncture and TCM
When someone hears the term acupuncture the image of needles being placed all over the body in the interest of health is what typically comes to mind. This is an accurate depiction of what acupuncture involves. The part of this picture that cannot be appreciated is the philosophy that governs the application of this technique. Traditionally, acupuncture is applied as part of an Eastern Medicine approach to illness, known as (TCM) Traditional Chinese Medicine. This approach has an amazing history dating back thousands of years in China. The Eastern medical approach is vastly different than the Western Medical Approach we use here in the USA. This is not to imply superiority of one approach to the other, but rather to emphasize two treatment paradigms that do not mix. At its core, the TCM approach is based on the balance of a vital energy force believed to flow throughout the body in channels called meridians. This energy force is know as Qi (pronounced chi). There are numerous meridians, most of which are named after organs of the body. Interestingly, the acupuncture points and the meridians on which they lie are not based on anatomic structures. The actual points on the body where the needles are placed is based primarily on tradition not the specific structures in which the needles are inserted. Further, it is important to realize that acupuncture makes up only a portion of the total TCM approach.
In Western medicine we have no equivalence to Qi or meridians. We have found however, that the use of acupuncture needling is a very powerful and useful tool. The naming of the Western use of acupuncture is vast and unfamiliar to most consumers. Terms such as medical acupuncture, dry needling, intramuscular manual therapy and acutherapy all denote the use of acupuncture needles in differing models, some of which involve the use of some TCM principles. Clinicians using these techniques include physicians, physical therapists, chiropractors and even some dentists. Individuals using TCM exclusively have completed specialty training in TCM only and need not be licensed medical professionals in any Western Medical approach. This is important information for patients to understand if they choose to receive acupuncture from any provider.
In my practice I use the terms acuptherapy or dry needling to describe our acupuncture technique and philosophy. This philosophy is grounded in a Western Medical approach, and I make it a point to educate my patients on what and why we may choose to use acupuncture as part of a treatment plan for musculoskeletal dysfunction and pain. The use of acupuncture in this model is grounded in the body’s physiologic responses to the needles. This response involves the nervous, immune, and musculoskeletal systems. Many of the muscular points and the radiating pain they produced was document in the myofascial pain syndromes documented by Janet Travell some 50 years ago. As such, this is an anatomic approach, meaning needles are applied specifically based on anatomic structures in contrast to the meridian system of TCM.
How and Why Does This System Work??
This is a great question, and I encourage all patients to ask it of their acupuncture provider. I like to begin answering the question by asking another question. That question is, do you think the tissues of your body know the difference between a sterile acupuncture needle or a sliver? The answer is no!, and there is lies the rationale for the western approach. Let me explain. If you develop low back pain and your motion is limited or painful in certain directions or positions, your body will unconsciously compensate to keep you out of pain and complete your daily activities. The tissues (muscle, bone, tendon, nerve…) that are the source of the pain or that compensate for it are strained and often inflamed. In fact, if this situation persists these tissues may even cause pain to radiate to other regions of the body. With an understanding of the anatomy and biomechanics we can target these tissues and use acupuncture needling in these areas.
There is nothing magic about the needles themselves, but when they are inserted they cause the body to react physiologically in the same manner they would if you got a sliver. The needle represents a microtrauma to the tissues it is inserted in. So the body says, “Hey whats going on here, there is something in the muscle that is not supposed to be there”, and it mounts a response. This response occurs on several levels. First the body will start an immune response because again it doesn’t know if it needs to be ready to fight an infection from this foreign object. It will also launch a neuromuscular response causing muscle in the area of the trauma to relax as well as causing the release of pain relieving chemicals (opoids). These physiologic responses to trauma are very complex and involve interactions of several body systems, which is beyond the scope of this article. Thankfully, we don’t have to understand all of chemical reactions that make it possible to receive the benefit of treatment. The take home point is that these responses are well documented in Western Medical literature.
Treatment should be minimally painless to pain free, and patients typically experience a significant improvement in symptoms if not immediately within 24 hours. I have found that depending on the chronicity of the problems most patients receive 3-8 treatments total over a period of several weeks. Patients should ask their clinician to explain their philosophy in needling, and understand all components of their treatment plan before commencing with treatment.