Is it save for acupuncture?

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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sonus

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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sonus

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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David King

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.

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David King

Posted: Tue Jun 27, 2006 6:19 am    

Thank you for your clear response.
_________________
I love TCM

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sonus

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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Sergiy

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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Sergiy

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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David King

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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Sergiy

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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Sergiy

Posted: Mon Jul 17, 2006 6:23 pm