Acupuncture Therapy Dr. Sinan Butrus F.I.C.M.S Kurdistan Board for Medical Specialties

1. Acupuncture Therapy Dr. Sinan Butrus F.I.C.M.S Kurdistan Board for Medical Specialties Clinical Standards & Guidelines

2. What is Acupuncture? • Acus meaning needle • Pungare meaing to pierce • Moxabustion (jiu) Applied heated element

3. Acupuncture is the insertion of needles in specific points on the body • First needles were made from Stone

4. The Needles Fire needles Bleeding needles 10 cm Fine bleeding needle Standard needles Snader, 1994

5. History of Acupuncture • Practiced in China for over 4,000 years • Used in western countries from around 1950’s • 1958;the first case of acupuncture anesthesia in Shanghai. • 2002; a Taipei medical center used acupuncture as anesthesia to transplant liver.

6. Acupuncture and Chinese Traditional Medicine CTM are the fastest growing movement in healthcare today at a rate of 230% per year. • Approximately 4,000 physicians in the United States have received training in acupuncture therapy • 10-15 million Americans spend ~$500 million per year on acupuncture • 1 in 10 Americans have tried acupuncture

7. Dr. Freddie Fu’s experience with acupuncture • Dr. Freddie Fu, chairman of the orthopedic surgery department and head of sports medicine at University of Pittsburgh Medical Center. • Fu said acupuncture helped improve the range of motion in his left leg, which was broken when a motorist hit him on his bicycle. • “We see tons of patients for therapy and non-operative things that Western techniques may not be able to treat," said Fu. “ I think definitely there's a place for acupuncture. Surgery is not for everyone and a lot of people don't like taking pills for pain or allergies. With acupuncture, patients induce their bodies' systems and defenses to heal themselves." (Source: Pittsburgh Post Gazette— Oct. 14, 2003)

8. Empirical Observations over Thousands of Years Scientific Methods Case-Based Medicine Comparison of East & West East. Ancient West. Modern • Art of Medicine • Technology of Medicine • Holistic View • Molecular and Organ View • Circular Logic • Linear Logic • Energetic • Mechanistic

9. Scientific Evidence ?

10. Acupuncture Theory (1) • Qi the vital energy originates from the major organs, and flows along the continuously circulatory channels called meridian. 2. Meridianchannel from the surface of the body to the very deep of the body. 3. Acupuncture pointsthose where the energy flow can be stimulated and the function of related organs can be regulate.

11. Acupuncture Theory (2) • Ying & yangthe two forces opposite to each other. Yin is the negative power while yang is the positive. According to Zhou-yi, everything contains both of them. 5. The five elementsMetal Wood Water Fire Earth These five natural forces can add power to one of the others ,and at the same time, reduce the power of another element.

12. What is Acupuncture? Acupuncture works on energy in the body known as Qi (pronounced chi) Manipulating body balance through regulating flow of Qi Energy Flows through the 14 meridians in the body, these meridians connect to each organ in the body

13. What exactly is Chi? • Chi is an energy that, according to ancient Chinese beliefs, permeates all things • Qi is body’s energy, vitality or “life force” it’s what gives an organism an “aliveness.” • Chi must be able to flow freely throughout the body in order for a person to maintain overall health • Chi flows along the meridians of the body

14. Vapor Qi Rice • Qi(Character with vapor rising above cooking rice) • “Life Force” made up of air and food transformed by body into blood and body fluids

15. Meridians • Meridians have decreased electrical resistance relative to surrounding skin • Qi flows as micro-electrical current • Flows in a circuit • Toes to fingers to head to toes • Up on anterior surface of the body • Down on posterior surface of the body

16. Lung Meridian: LU Heart Meridian: HT Pericardium M.: PC Spleen Meridian: SP Liver Meridian: LIV Kidney Meridian: KID Conception Vessels: CV Large Intestines M.: LI Small Intestines M.: SI Triple Heater M.: TH Stomach Meridian: ST Gallbladder M.: GB Bladder Meridian: BL Governing Vessels M.: GV 14 Major Meridians

17. Meridians

18. The acupuncture points are located where the Meridians surface at the skin and are easily accessible by needling. The points located at neurovascular bundles where nerves penetrate the body fascia and bifurcate Blood vessel walls (veins) appear to have AP points directly on or in them .

19. Originally there were 365 acupuncture points, but through the years this number has increased to over 2,000 Each point is believed to correspond with a particular illness or injury

20. YIN YANG

21. Yin and Yang are always opposites of each other. If they are not balanced then there will be illness. Injury or illness cause yin and yang to become distressed and unbalanced .

22. Five ElementsMetal Wood Water Fire Earth • Chronic overwork/abuse/disease leads to deficiency of Water (fatigue, chronic UTI/stones/incontinence, joint pains, low back pain, fear, low self-esteem) Water controls Fire (Water Def – Fire Excess) Excess Fire symptoms result (anxiety, hot flashes, palpitations, insomnia, inflammation) Acupuncture works by trying to balance the body Treat by “Tonifying” deficiencies and “Dispersing” excesses • Release excess Fire • Tonify deficient Water

24. Is there a medical basis to acupuncture? • Acupuncture is not based on modern medical science • There is no obvious correlation between the 14 identified meridians and the actual location of organs and nerves within the body

27. How Does Acupuncture Work? • The physiologic effects of acupuncture therapy cannot be explained by a single mechanism, but rather a series of interactions among the Nervous, Endocrine & Immune System • Simple in concept, complex in action • Starts from Local Effects • Expands to involve the entire Neural Axis

28. Traditional Chinese Medicine TCM Physiology • Stomach separates pure from impure Qi of food • Impure to Small Intestine (process repeats again) • Pure Qi to Spleen • Spleen sends Food Qi to Lung Lung combines it with pure Qi extracted from air Food/Air Qi “heated” by Qi provided by Kidney to make “Nutritive Qi” The Life Force In Heart to blood & tissue fluid to make Health

29. Acupuncture involves the insertion of thin needles.

30. Safety • The FDA approved acupuncture needles for use in 1996. • The FDA requires that sterile, non-toxic needles be used and disposed of after use.

31. Diagnosis • Questioning includes: sleep quality, mood, dietary preferences, functioning of senses, digestion and elimination, urination, condition of skin and hair, energy level, exercise and work habits, menstrual cycle and childbearing history for women • Visual examination of complexion, emotional affect, body language; reveals state of Qi in the body

32. Palpation: variations in temp, hardness or softness of tissues, dryness, dampness, discoloration, lumps and bumps, sensations of tenderness or pain • Radial pulse reveals amount, strength, smoothness indicate flow of Qi and blood in various parts of the body • Tongue looking at shape, coat, color Initially a course is recommended • 6 sessions, every week once a week • Top up sessions as and when required

33. Tongue Diagnosis shape, color, size, coating, positioning,movement and sublingual veins

34. (KI) Yang deficiency Swollen, pale, scalloped, thin clear coat Kidney Yin Deficiency Excess Heat in Heart Long, thin, dry, red body with lateral deviation Dry yellow coat Heart Yin and Blood Deficiency Tongue body pale and tip red and pointed No coat Severe Yin Deficiency Long-standing heat or fire (LR or ST) Red tongue body with black, dry central coat

37. Allergic rhinitis & sinusitis Dysentery, acute bacillary Facial pain Hypotension, primary Hypertension, essential Leukopenia Morning sickness Pain in dentistry Renal colic Adverse rxns to radiation and chemotherapy Biliary colic Dysmenorrhea, Malposition of the fetus Headache Low back pain Nausea and vomitting Periarthritis of shoulder Rheumatoid arthritis Stroke Depression Epigastralgia Knee pain Sprain Neck pain Postoperative pain Sciatica Tennis elbow World Health Organization Endorses Acupuncture ( http://www.who.int/medicines/library/trm/acupuncture/acupuncture_trials.pdf)

38. Ten Reasons to Try Acupuncture 1. It works 2. Western doctors recommend it 3.It treats the root cause of your medical problem 4. An ounce of prevention is worth a pound of cure 5. It relieves your stress while helping your medical problems 6. It boosts your immune system 7. It has a very low risk of side effects 8. You want to avoid surgery 9. Nothing else has helped your medical problems 10. It is one of the oldest continually practiced forms of medicine in the world

39. Conditions acupuncture is NOT recommended • Difficulty breathing, shortness of breath • Dizziness • Acute chest/upper abdomen pain or pressure • Sudden weakness or severe pain • Sudden bleeding • Falls • Suicide attempts • Severe infection • Heart failure

40. Risks 1 Absolute Phobia of needles! Pacemaker Anticoagulation Pregnancy Not a contraindication. Theoretical concern of causing contractions • Allergic reaction to needles • Infection from unsterilized needles • Retained Needle • Putting off treatments that are known to be effective

41. Risks 2 • Fainting • Convulsions • Nerve Damage • Temporary (24hr) clinical worsening • Organ puncture (Bladder or lung puncture)

42. Thank You