Dear Dr King
It's my first time to post in this forum. After studying this informative course I have some question to ask you.
According to the course materials, some acupoints are located near key arteries such as Jing-riverqu LU 8 and Taiyuan LU 9. How dangerous it is if TCM students fail to insert the needle on precise points but to arteries or nerves?
Have you ever experienced such mistake of students and how to prevent the mistake?
I wonder if massage on the acupoints can effectively replace needle insertion in treatment.
Thank you
_________________
I love TCM
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Posted: Mon Jun 26, 2006 2:00 am
Sorry for my poor Enlish. My subject is ''Does it safe for acupuncture?''
_________________
I love TCM
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Posted: Mon Jun 26, 2006 2:06 am
Hi, Sonus,
Nice to have you here in the forum!
Sure it's not good to insert the needle into the key arteries!
So, TCM students need the clinical practice.
Nobody should do acupuncture without the guidance by the experienced acupuncture physicians.
That's also why acupuncture is taken as medicine in China, it's not magic, neither is so simple to perform it.
To prevent any harm or damage by acupuncture requires the good clinical practice.
Medboo training center never recommends or advocates anybody who's got no medical knowledge to practice acupuncture without good instruction or learning in clinic.
Because of the good training in China, I never experienced any mistake myself, neither encounter any students who've made such mistake.
Both traditional Chinese therapeutic massage and acupuncture are taken as specialties of medicine in China and they are more or less related, but they are different. Nobody should or could replace one with another.
I, personally, state that acupuncture does need a good training before practice.
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Posted: Tue Jun 27, 2006 6:17 am
Hi, Sonus,
Nice to have you here in the forum!
Sure it's not good to insert the needle into the key arteries!
So, TCM students need the clinical practice.
Nobody should do acupuncture without the guidance by the experienced acupuncture physicians.
That's also why acupuncture is taken as medicine in China, it's not magic, neither is so simple to perform it.
To prevent any harm or damage by acupuncture requires the good clinical practice.
Medboo training center never recommends or advocates anybody who's got no medical knowledge to practice acupuncture without good instruction or learning in clinic.
Because of the good training in China, I never experienced any mistake myself, neither encounter any students who've made such mistake.
Both traditional Chinese therapeutic massage and acupuncture are taken as specialties of medicine in China and they are more or less related, but they are different. Nobody should or could replace one with another.
I, personally, state that acupuncture does need a good training before practice.
--------------------------------
Posted: Tue Jun 27, 2006 6:19 am
Thank you for your clear response.
_________________
I love TCM
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Posted: Tue Jun 27, 2006 9:29 pm
[quote:2a72d8ba1c="sonus"]
According to the course materials, some acupoints are located near key arteries such as Jing-riverqu LU 8 and Taiyuan LU 9. How dangerous it is if TCM students fail to insert the needle on precise points but to arteries or nerves? Have you ever experienced such mistake of students and how to prevent the mistake?[/quote:2a72d8ba1c]
[b:2a72d8ba1c]PRECAUTIONS TO BE TAKEN[/b:2a72d8ba1c]
(according to the [b:2a72d8ba1c][i:2a72d8ba1c]Guidelines on Basic Training and Safety in Acupuncture[/i:2a72d8ba1c][/b:2a72d8ba1c] by the World Health Organization)
Special care should be taken in needling points in proximity to vital organs or sensitive areas. Because of the characteristics of the needles used, the particular sites for needling, the depth of needle insertion, the manipulation techniques used, and the stimulation given, accidents may occur during treatment. In most instances they can be avoided if adequate precautions are taken. If they do occur, the acupuncturist should know how to manage them effectively and avoid any additional harm. Accidental injury to an important organ requires urgent medical or surgical help.
[b:2a72d8ba1c]Chest, back and abdomen[/b:2a72d8ba1c]
Points on the chest, back and abdomen should be needled cautiously, preferably obliquely or horizontally, so as to avoid injury to vital organs. Attention should be paid to the direction and depth of insertion of needles.
[b:2a72d8ba1c]Lung and pleura[/b:2a72d8ba1c]
Injury to the lung and pleura caused by too deep insertion of a needle into points on the chest, back or supraclavicular fossa may cause traumatic pneumothorax. Cough, chest pain and dyspnoea are the usual symptoms and occur abruptly during the manipulation, especially if there is severe laceration of the lung by the needle. Alternatively, symptoms may develop gradually over several hours after the acupuncture treatment.
[b:2a72d8ba1c]Liver, spleen and kidney[/b:2a72d8ba1c]
Puncture of the liver or spleen may cause a tear with bleeding, local pain and tenderness, and rigidity of the abdominal muscles. Puncturing the kidney may cause pain in the lumbar region and haematuria. If the damage is minor the bleeding will stop spontaneously but, if the bleeding is serious, shock may follow
with a drop of blood pressure.
[b:2a72d8ba1c]Central nervous system[/b:2a72d8ba1c]
Inappropriate manipulation at points between or beside the upper cervical vertebrae, such as GV 15 yamen and GV 16 fengfu may puncture the medulla oblongata, causing headache, nausea, vomiting, sudden slowing of respiration and disorientation, followed by convulsions, paralysis or coma. Between other vertebrae above the first lumbar, too deep needling may puncture the spinal
cord, causing lightning pain felt in the extremities or on the trunk below the level of puncture.
[b:2a72d8ba1c]Other points[/b:2a72d8ba1c]
Other points which are potentially dangerous and which therefore require special skill and experience in their use include:
- BL 1 jingming and ST 1 chengqi, located close to the eyeball;
- CV 22 tiantu, in front of the trachea;
- ST 9 renying, near the carotid artery;
- SP 11 jimen and SP 12 chongmen, near the femoral artery; and
- LU 9 taiyuan on the radial artery.
[b:2a72d8ba1c]Circulatory system[/b:2a72d8ba1c]
Care should be taken in needling areas of poor circulation (e.g. varicose veins) where there is a risk of infection, and to avoid accidental puncture of arteries (sometimes aberrant) which may cause bleeding, haematoma, arterial spasm or more serious complications when pathological change is present (e.g. aneurysm, atherosclerosis). Generally, bleeding due to puncture of a superficial blood vessel may be stopped by direct pressure.
Last edited by Sergiy on Sun Jul 09, 2006 12:47 pm; edited 1 time in total
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Posted: Sun Jul 09, 2006 11:44 am
[quote:72790ed964="sonus"]I wonder if massage on the acupoints can effectively replace needle insertion in treatment.[/quote:72790ed964]
[quote:72790ed964="David King"]Both traditional Chinese therapeutic massage and acupuncture are taken as specialties of medicine in China and they are more or less related, but they are different. Nobody should or could replace one with another. I, personally, state that acupuncture does need a good training before practice.[/quote:72790ed964]
Of course, acupuncture and Chinese therapeutic massage ([i:72790ed964]tuina[/i:72790ed964]) are different. However, WHO in their [i:72790ed964]Guidelines on Basic Training and Safety in Acupuncture[/i:72790ed964] recommend teaching [b:72790ed964][i:72790ed964]acupressure[/i:72790ed964][/b:72790ed964] ([i:72790ed964]zhi-ya[/i:72790ed964]) to [i:72790ed964]primary health care personnel[/i:72790ed964] rather than acupuncture, as the former is much safer with little trainig. Below is the excerpt from the [i:72790ed964]Guidelines[/i:72790ed964]:
[size=11:72790ed964]"It would seem wiser, in such cases, to [i:72790ed964]train such personnel in acupressure[/i:72790ed964] ([i:72790ed964]zhi-ya[/i:72790ed964]) rather than in acupuncture itself. Training in acupressure would make no great demands, could be incorporated into the general training of primary health care personnel, and [i:72790ed964]would carry no risk to the patient[/i:72790ed964]. The use of acupressure in primary health care would have to be evaluated after a suitable trial period. Some personnel who show particular aptitude might be chosen for basic training in acupuncture, a training programme being arranged according to the applications envisaged".[/size:72790ed964]
NOTE: The WHO [i:72790ed964]Guidelines on Basic Training and Safety in Acupuncture[/i:72790ed964] were drafted by Professor [i:72790ed964]Zhu-Fan Xie[/i:72790ed964], Honorary Director of the Institute of Integrated Medicine, First Hospital of Beijing Medical University, China, based on the WHO Consultation on Acupuncture in 1996 in Cervia, Italy and the comments submited through the WHO Regional Offices and the World Federation of Acupuncture and Moxibustion Societies (WFAS).
Acupressure could be practiced by different allied health practitioners (nurses, physiotherapists, etc.) even when the contry/state law do not allow them to perform invasive treatments requiring penetration of the skin.
A simple blunt [i:72790ed964]non-penetrating[/i:72790ed964] tapping needle (Chinese [i:72790ed964]shi zhen[/i:72790ed964], Japanese [i:72790ed964]teishin[/i:72790ed964]) could be used to safely perform [i:72790ed964]acupresure[/i:72790ed964]. By the way, as far as i know, it was one of the original nine acupuncture needles, first described in the [i:72790ed964]Huang Di Nei Jing[/i:72790ed964] as having a round and blunt tip, “like a grain of millet” (see #3 on the picture below from [i:72790ed964]Dr. Zhu Lian[/i:72790ed964]'s book [i:72790ed964]New Acupuncture[/i:72790ed964]).
[img:72790ed964]http://eastbook.by.ru/chju-lyan/g8d1_02.gif[/img:72790ed964]
A [i:72790ed964]shi zhen[/i:72790ed964] needle could be ordered online, among others, from the Acu-International Supplies, Inc. (see https://www.acuinternational.com/ASPCart/prodetails.asp?prodid=715&start=1 ) or the Golden Spirit (see http://www.goldenspirit.com/JapaneseMeridiantherapy/Meridiantherapytools.htm ).
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Posted: Sun Jul 09, 2006 12:46 pm
[quote:44afb0e20c]NOTE: The WHO Guidelines on Basic Training and Safety in Acupuncture were drafted by Professor Zhu-Fan Xie, Honorary Director of the Institute of Integrated Medicine, First Hospital of Beijing Medical University, China, based on the WHO Consultation on Acupuncture in 1996 in Cervia, Italy and the comments submited through the WHO Regional Offices and the World Federation of Acupuncture and Moxibustion Societies [/quote:44afb0e20c]
When we need a meal but we have only salads, so we may take salad as a meal, but is salad a real meal? Could we take salads everyday as meal?
By the way, Prof. Xie Zhufan, with good background of western medicine, used to be an specialist of renology. However, it is hardly to call Prof. Xie an expert of acupuncture, especially the acupressure.
Acupressure used to be a small part of the traditional Chinese therapeutic massage, but it's even more difficult to do it well than do acupuncture. The reason I compare it with salad is because majority of acupressure practitioners nowadays have not grasped the real essence of it. So, it's not a good meal, it's only a salad for most cases.
A acupoint could be thrusted with a acupuncture needle as long as 160mm, how deep one's finger force could reach? Acupuncture needles could be retained in the body for days, how long one's fingers could exert the pressure on the acupoints?
To be supreme in acupressure, one must undergo a very hard training, the physical training and the energy Qi cultivation.
So, one has very strong fingers, which might penetrate bricks and one would also have very good energy, the Qi. For sure that's also very useful in martial arts' purpose.
In any textbooks of acupuncture in the schools of traditional Chinese medicine and acupuncture in China, acupressure is not mentioned much, even nothing.
Personally I think Dr. Zhu, Lian's a good person, maybe also a good acupuncturist, but at the moment just very few people in the acupuncture circle in China know her name.
The blunt needle was indeed recorded in "Huangdi Nei Jing", but it's not really in use in China. It is also indeed used for acupressure, but one must have good energy or good Qi, so you may know if the Qi is opened or the Qi arrives to the target point.
I'm trying to make something clear.
[/quote]
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Posted: Mon Jul 10, 2006 9:38 pm
[quote:6193c7f0af="David King"]When we need a meal but we have only salads, so we may take salad as a meal, but is salad a real meal? Could we take salads everyday as meal? [/quote:6193c7f0af]
Actually, I was not trying to say that acupressure is as effective as acupuncture. I think, the main point of the WHO guidlines in this respect was that acupressure [i:6193c7f0af]would carry much less, if any, risk to the patient[/i:6193c7f0af] when performed by practitioners with little training. Indeed, you would not be likely to perforate the abdominal cavity, trachea, or pleura with your fingers (unless you can really [i:6193c7f0af]penetrate bricks[/i:6193c7f0af] with them ).
[quote:6193c7f0af="David King"]The blunt needle was indeed recorded in "Huangdi Nei Jing", but it's not really in use in China.[/quote:6193c7f0af]
It seems that it is much more in use in Japan, so the Japanese took it from you . [size=11:6193c7f0af] http://www.paradigm-pubs.com/assets/pdf/japac4.pdf [/size:6193c7f0af]
[quote:6193c7f0af="David King"]Personally I think Dr. Zhu, Lian's a good person, maybe also a good acupuncturist,...[/quote:6193c7f0af]
I have no reasons to be particularly fond of Dr. Zhu Lian, besides that hers was the first acupuncture book I read many years ago and that the book is available online, so it is easy to make references to the pictures from it in this forum. Also, as far as I know, it was the first Chinese acupuncture book published in Russia.
[quote:6193c7f0af="David King"]...but at the moment just very few people in the acupuncture circle in China know her name.[/quote:6193c7f0af]
That is a pity. After all, she was the first director of the Institute of Acupuncture and Moxibustion, wasn't she?
[quote:6193c7f0af="David King"]I'm trying to make something clear.
[/quote:6193c7f0af]
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Posted: Tue Jul 11, 2006 10:20 pm
Just some more thoughts about the safe use of acupuncture. They seem quite practical to me.
[b:c63f6bacd0]Safety can be guaranteed[/b:c63f6bacd0]
From the article [i:c63f6bacd0]THE SAFE USE OF DIFFICULT & DANGEROUS ACUPUNCTURE POINTS[/i:c63f6bacd0] by Alicia Grant & Prof. Bo-Ying Ma ([i:c63f6bacd0]Journal of Chinese Medicine[/i:c63f6bacd0] 2003, No. 72, P.11-15)
"[i:c63f6bacd0][b:c63f6bacd0]The principle is to understand and remember why a point can be dangerous; every risk can be avoided if due care is taken[/b:c63f6bacd0][/i:c63f6bacd0]".
Regarding needling technique, the article suggests the following:
• Check that the needles are not in close proximity to organs or arteries.
• Consider the patient’s build with regard to depth of needling. It is noted in the Huang Di Nei Jing (Yellow Emeror’s Classic of Internal Medicine) that the recommended depth of insertion is for a patient of average build. All cun measurements refer of course to the patient’s cun, not the acupuncturist’s, who should check their hands against the patient’s.
• If it is possible for the needle to touch a bone at a special point, e.g. Shanzhong REN-17 but it has not done so at the normal recommended anatomical depth, do not insert deeper: this is how the cardiac tamponade accident occurred in Norway. This also applies to Tianzong SI-11 as the scapula can also have a foramen.
• If the skin is lifted on insertion of the needle, penetration of the organ can be avoided.
• On the chest and back over the lung the angle of insertion is oblique or horizontal. The tip of the needle is usually directed obliquely towards the midline on the urinary bladder channel and obliquely and laterally on all other channel points passing over the trunk.
• When needling points around the eye, the patient is asked to look in the opposite direction to the point being needled and the practitioner gently holds the eyeball in that position while carefully inserting the needle. The needle is not retained for very long.
• Points near arteries should be palpated to ascertain the exact position of the artery and one finger should press against the artery while the other hand inserts the needle.
"[i:c63f6bacd0]Following the above techniques will ensure that your practice will be safe and effective[/i:c63f6bacd0]" (Alicia Grant & Prof. Bo-Ying Ma).
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Posted: Mon Jul 17, 2006 6:23 pm
Thank you Dr King and Sergiy
Your duscussion is really worthy of practicing acupuncture.
_________________
I love TCM
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Posted: Tue Jul 18, 2006 3:39 am
"Holding a needle can be compared as holding a tiger" is a saying in acupuncture circle in China.
It means carefulness and attention are required during acupuncture practice. For sure experience could reduce greatly the riskyness or dangerousness of doing acupuncture.
In general, practice of acupuncture is quite safe. The untoward effect or accidents caused by acupuncture are much less than those of medication, even Chinese herbal medication, so it's of its own advantage.
To take herbs, you must know very well the condition of the patient, making an accurate differential diagnosis of syndromes, otherwise, you may really aggravate the disease.
While to do acupuncture, you don't have to worry about it, you may not really help with your practice, but you can rarely harm the patient with your practice.
For quite sure, one must undergo a good training before the acupuncture practice!!!
As it is stated in one post in the forum that one Medical Doctor (of course western medicine) in Europe did over 50 needles in one foot of a patient, so that foot got paralyzed.
To do anything, there would be more or less risk, but if we know how to do it, we could avoid the risk or to minimize the chance of getting to the risk. Everybody knows it is risky to drive, but still so many would drive despite the riskiness. To do acupuncture, the riskiness is much less than driving.
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David King
Posted: Tue Jul 18, 2006 6:11 pm
[quote:dd093f0b0c="David King"]Acupressure used to be a small part of the traditional Chinese therapeutic massage, but it's even more difficult to do it well than do acupuncture. The reason I compare it with salad is because majority of acupressure practitioners nowadays have not grasped the real essence of it. So, it's not a good meal, it's only a salad for most cases.[/quote:dd093f0b0c]
[i:dd093f0b0c]A new randomised controlled clinical trial on the effectiveness of acupressure[/i:dd093f0b0c].
[size=16:dd093f0b0c][b:dd093f0b0c]Treatment of low back pain by [u:dd093f0b0c]acupressure[/u:dd093f0b0c] and physical therapy: [u:dd093f0b0c]randomised controlled trial[/u:dd093f0b0c][/b:dd093f0b0c][/size:dd093f0b0c]
Lisa Li-Chen Hsieh, Chung-Hung Kuo, Liang Huei Lee, Amy Ming-Fang Yen, Kuo-Liong Chien and Tony Hsiu-Hsi Chen
[i:dd093f0b0c]British Medical Journal[/i:dd093f0b0c] 2006; 332; 696-700
FULL TEXT: http://bmj.com/cgi/content/full/332/7543/696
[size=14:dd093f0b0c][b:dd093f0b0c]Abstract[/b:dd093f0b0c][/size:dd093f0b0c]
[b:dd093f0b0c]Objective[/b:dd093f0b0c] To evaluate the effectiveness of [u:dd093f0b0c]acupressure[/u:dd093f0b0c] in terms of disability, pain scores, and functional status.
[b:dd093f0b0c]Design[/b:dd093f0b0c] Randomised controlled trial.
[b:dd093f0b0c]Setting[/b:dd093f0b0c] Orthopaedic clinic in Kaohsiung, Taiwan.
[b:dd093f0b0c]Participants[/b:dd093f0b0c] 129 patients with chronic low back pain.
[b:dd093f0b0c]Intervention[/b:dd093f0b0c] Acupressure or physical therapy for one month.
[b:dd093f0b0c]Main outcome measures[/b:dd093f0b0c] Self administered Chinese versions of standard outcome measures for low back pain (primary outcome: Roland and Morris disability questionnaire) at baseline, after treatment, and at six month follow-up.
[b:dd093f0b0c]Results[/b:dd093f0b0c] The mean total Roland and Morris disability questionnaire score after treatment was significantly lower in the acupressure group than in the physical therapy group regardless of the difference in absolute score ( - 3.8, 95% confidence interval - 5.7 to - 1.9) or mean change from the baseline ( - 4.64, - 6.39 to - 2.89). Acupressure conferred an 89% (95% confidence interval 61% to 97%) reduction in significant disability compared with physical therapy. The improvement in disability score in the acupressure group compared with the physical group remained at six month follow-up. Statistically significant differences also occurred between the two groups for all six domains of the core outcome, pain visual scale, and modified Oswestry disability questionnaire after treatment and at six month follow-up.
[b:dd093f0b0c]Discussion[/b:dd093f0b0c] This study shows that [u:dd093f0b0c]acupressure is more efficacious in alleviating low back pain than is physical therapy[/u:dd093f0b0c], as measured by pain visual analogue scale, core outcome measures, Roland and Morris disability questionnaire, and Oswestry disability questionnaire. The results support the conclusion of the previous randomised controlled clinical trial on low back pain treated by acupressure. [u:dd093f0b0c]Acupressure may thus be useful for reducing pain and improving body function and level of disability in low back pain[/u:dd093f0b0c].
[b:dd093f0b0c]Conclusions[/b:dd093f0b0c] [u:dd093f0b0c]Acupressure was effective in reducing low back pain in terms of disability, pain scores, and functional status[/u:dd093f0b0c]. The benefit was sustained for six months.
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Posted: Sun Jul 30, 2006 12:44 pm
Yes, traditional Chinese therapeutic massage is often used alone to treat low back pain and satisfactory effect is often obtained.
So, if the acupressure is good enough, for this problem it should be well effective.
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Posted: Sun Jul 30, 2006 11:38 pm
ABOUT ACUPRESSURE IN PAEDIATRICS
"It is often asked whether one can massage the points instead of doing acupuncture, and the answer is certainly [i:23e3148ca2]yes[/i:23e3148ca2]. For mild conditions, massage of the points is extremely effective. [i:23e3148ca2]For most of the conditions described in this book, however, massage is actually more painful than acupuncture[/i:23e3148ca2] . Frequently, the points are spontaneously tender, and for massage to be effective, at least two minutes should be spent on each point, for a total of ten to fifteen minutes per treatment. [i:23e3148ca2]For many Western children, holding still for this length of time is more of a penance than an acupuncture treatment[/i:23e3148ca2]".
[u:23e3148ca2]FROM[/u:23e3148ca2]: Lucy Lee, Ph.D. [i:23e3148ca2]Applying Traditional Chinese Medicine For Pediatrics - Advanced Study Course[/i:23e3148ca2] (a homestudy correspondence course approved by the California Acupuncture Board for 15 CE hours), [i:23e3148ca2]Dynasty School[/i:23e3148ca2] (CA).
The course is available for downloading free of charge from http://www.dynastyschool.com/pediatrics.pdf , but the exam is $149 ([i:23e3148ca2]for U.S. licensed practitioners only[/i:23e3148ca2]).
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Posted: Mon Jul 31, 2006 8:27 pm
It's no strange sometimes massage is more painful than acupuncture!
[quote:f45eb37794][b:f45eb37794]Conclusions[/b:f45eb37794] Acupressure was effective in reducing low back pain in terms of disability, pain scores, and functional status. The benefit was sustained for six months.[/quote:f45eb37794]
This sounds too absolute!
Whether the benefit could be sustained for six months is quite dependent on the patients' condition and the therapeutists' manipulation!
Clinically, for some cases, the benefit could be even less than 6 days, or maybe less than two days!!!
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David King
Posted: Fri Aug 04, 2006 12:51 pm
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