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Principles and Practice Contemporary Acupuncture Sung Liao, Mathew H. M. Lee, Lorenz K. of Congress Cataloging-in-Publication Data Lee, WB The publisher offers discounts on this book when ordered in bulk quantities. For more information, write to Special Sales/Professional Marketing at the address below. This book is printed on acid-free paper. Copyright 1994 by Marcel Dekker, Inc. All Rights Reserved. Neither this book nor any part may be reproduced transmitted in any form by any means, electronic mechanical, includingphotocopying, microfilming, and recording, by any information storage and retrieval system, without permission in writing from the publisher. Marcel Dekker, Inc. Madison Avenue, New York, New York Current printing digit): PRINTED IN THE UNITED STATES OF AMERICA Acupuncture has been practiced for centuries on an essentially pragmatic basis. Its practitioners make no claim to understand why it is effective and to what extent it is Even though great efforts have been made since ancient times to explain it, acupuncture has remained basically at the medieval level. the Western-trained mind, this is an intolerable predicament. The authors of this book, basically clinicians in the field of chronic pain abatement and rehabilitation, have had extensive experience in basic and clinical research academically, and have also been practicing acupuncture since Collectively, we have treated tens of thousands of patients and have learned enormously from caring for them. This experience has convinced that acupuncture does have an important place in the clinical management of chronic pain and other disease conditions, complementary and supplemental to mainstream Western medicine. Our interest in utilizing acupuncture as a therapeutic modality combined with our desire to advance its scientific foundation compels to share our experiences and our ideas in this book, however personal and anecdotal, with physicians, dentists, other health-care professionals, and all others who wish to gain some insight into this fascinating healing art. efforts, if they appear controversial, must by no means be misconstrued as derogatory. Our hope is to upgrade this ancient healing art to complement mainstream modern medicine in order to, the Chinese say, ferry all the sufferers drowning in the bitter sea across to the shores of happiness. Hence, humanity will be better served. We trust our readers will concur with us. This book was originally started in the early by one of The real impetus to write this current book collectively started when first and then LKYN determined that there IV was a great need for an up-to-date book about acupuncture. Since we started the practice of acupuncture in we have witnessed the tremendous of scientific research in this area. In turn, this research has advanced the understanding of chronic pain. What is more important, it has culminated in the establishment of the Office of Alternative Medicine at the National Institutes of Health in Joseph Jacobs, M.D., Honorary Fellow of American College of Acupuncture, is its Director. Our desire to share our personal experience with our friends and colleagues has further spurred on. We comment on this in Chapter The opinions and comments expressed in this book are entirely ours and do not represent any of the institutions or organizations which we may have been associated with at one time or another. We have attempted our best to keep the materials as accurate and up-to-date as possible. Our readers must exercise their own judgment in the use of our suggested acupoints and other materials in this book. In the Chinese tradition of reverence to the elderly, we align the sequence of the authors according to their ages. Sung J. Liao, M.D.,M.P.H., D.P.H., Dip. Bact., F.A.C.P. Mathew H. M. Lee, M.D., M.P.H., F.A.C.P. Lorenz K. Y. Ng, M.D., F.A.C.P.M. We are indebted to Dr. Felix Mann. If he had not dramatically alleviated the frozen shoulder of one of us (SE) with acupuncture in December we would never have believed in such possible effects of this healing and started to learn it from him. Dr. Nguyen Van Nghi most graciously and patiently taught us not only in this country but also in his clinic in Marseilles. The interest the late Howard A. Rusk, M.D. (Honorary Fellow of American Academy of Acupuncture) in acupuncture and traditional Chinese medicine was a great inspiration to us. The late Mrs. Katharine Lilly Conroy's and the late Alice Tully's interest in acupuncture a rehabilitation modality gave us great encouragement. Mr. and Mrs. Fortune Pope, Mr. William Mazer, and the late Mrs. Helen Mazer, have given steadfast support to our acupuncture and chronic pain research for the past two decades. Kenneth Riland, D.O., Honorary Fellow of American Academy of Acupuncture, and physician to the late Governor Nelson Rockefeller, assisted in the establishment of the New York State Commission on Acupuncture in One of us had the privilege to serve on it. The encouragement of Arthur B. Martin, Esq. and Mr. Roy A. Dorsey of Atlanta, Georgia has helped to broaden our knowledge of this healing Of our many friends in the Chinese Ministry of Public Health, we are much indebted to Dr. Chen Zhongwu, former Director of the Bureau of Medical Administration and now Honorary President of the Chinese Rehabilitation Medicine Association, and Dr. Zhao Tongbin, Vice Director of the International Center for Medical and Health Exchange, who made possible our many study tours of acupuncture in China since It is impossible to mention the many friends at various institutions of traditional Chinese medicine V Yl that we visited, but we would especially like to thank Professors Ji Zhongpu, Wang Xuetai, and Chen Xinlong at the Beijing Academy of Traditional Chinese Medicine and Institute of Acupuncture, and Professor Cao Xiaoding, Director of the State Laboratory of Medical Neurobiology, Shanghai Medical University. Without Mr. Thomas A. Liao's indefatigable support in computer programming and preparation of almost all of the photographs, this book could not have been fruitfully composed. The assistance by Elizabeth K. Rosenblatt, Ed.M. and Margaret L. Thompson, M.D., MS. in preparing and reviewing the manuscript was invaluable. We are very thankful to Joan Ruszkowski (Director), and her staff of the Waterbury Hospital Health Library, Waterbury, Connecticut, for their tremendous help in the literature search and many related tasks. Mr. John F. Smith, photographer, Waterbury and Morris, Connecticut, assisted very skillfully in preparing many of the photographs. Messrs. Leo T. McGovern and Kevin T. McGovern of Cine'-Med, Woodbury, Connecticut graciously provided graphics support. Messrs. Thomas Honocks (Director) and Jack Eckert of the Library for Historical Services, The College of Physicians of Philadelphia, kindly provided with a copy of Franklin Bache's book on acupuncture. We thank the publisher, Marcel Dekker, Inc., for accepting this book for publication, and particularly Ms. Tammerly Booth, Ms. Kerry Doyle, Ms. Melissa Gelertner, Messrs. Joseph Stubenrauch and John McGarrell, and their associates for their invaluable assistance. We would also like to recognize Marcel Dekker, Inc.'s farsightedness in publishing the Acupuncrum Mmud by late colleague Luke W. Chu, M.D. and his associates in 1979. We would be remiss if we did not acknowledge how grateful we are to our wives, Karin M. Liao, Mary Lou Lee, and Roberta M. Ng. Only with their patience, tolerance, and indulgence was the completion of this book possible, PREFACE 111 ACKNOWLEDGMENTS V CHAPTER Introduction CHAPTER The Historic Background A. Evolution Acupuncture [E Bim or Stone Puncture (Puncturing), Zhen (Needling), and Acupuncture B. Medicine and Divination C. Acupuncture Literature D. The Teaching of Acupuncture E. Acupuncture in Asia F. Acupuncture in Europe G. Acupuncture in the United States CHAPTER The Traditional (Philosophico-Alchemic) Bases Acupuncture [m A. and Homeostasis Man Microcosm Yin and Ymg [TfiE] B. Five (or Five Elements) C. and Circulation D. The Jing-Luo System (i. e., the Meridians) vi i Foot Tai Yang Jing Foot Shao Yang Jing Foot Yung Ming Jing Foot Tai Yin Jing 5. Foot Shao Yin Jing Foot Yin Jing Hand Jing Tai Yang Hand Shao rang Jing San or Hand Yung Ming Jing 10. Hand Tai Yin Jing 11. Hand Xin Zhu Jing Hand Shao Yin Jing E. or F. 1. B. IX C. Neuropharmacologic Mechanisms D. Afferent Stimulation: Peripheral Activating Mechanisms E. Stimulus Parameters and Possible Neural Specificity F. The Autonomic Nervous System G. The Biophysical Phenomena The Electrophysical Properties of the Acupuncture Needle The Electrophysiologic Properties of Acupoints and Meridians Nordenstrom's Electrophysiologic View of Acupuncture H. Possible Clinical Applications CHAPTER 5. Acupuncture and Hypnosis CHAPTER Chronic Pain a Disease A. Pain in Traditional Chinese Medicine B. Modem Definition of Pain C. Chronic Pain as a Medical Entity D. Theories to Explain the Mechanisms Pain The Specificity Theory The Reverberation (or Central Summation) Theory The Pattern Theory The Gate Control Theory 5. The Neurohumoral Theory E. Pain and Sensory Dermatome Sherrington's Remaining Sensibility