Acupuncture
Dr. Lin Wai-ling,
Professional Consultant of the Hong Kong Institute of Integrative Medicine,
Registered Chinese Medicine Practitioner
Host: Ms Janet Wong
Information Compilation: Ms Kitty Au Yeung
Introduction: Acupuncture has a long history in traditional Chinese medicine. In recent years, authoritative Western medical institutions have also accepted the use of acupuncture to alleviate symptoms for patients. Some cancer patients want to try acupuncture to alleviate the side effects of treatment, but they don't quite understand the principles. In this interview, Dr. Lin Wai-ling will explain the definition, basic principles, implementation process of acupuncture, and how it can help cancer patients.
Part One - Definition and Basic Principles of Acupuncture
Part Two - The Process of Performing Acupuncture
Part Three - Acupuncture Techniques
Part Four - Moxibustion
Part Five - Other Related Methods
Part Six - How Acupuncture Can Help Cancer Patients
Part One - Definition and Basic Principles of Acupuncture
Wong: Acupuncture has a long history in traditional Chinese medicine, and in recent years, authoritative Western medical schools have also begun to accept the use of acupuncture to alleviate symptoms for patients.
Today I am very pleased to invite Dr. Lin Wai-ling from the Hong Kong Institute of Integrative Medicine to talk with us.
Dr. Lin, thank you for accepting my interview.
Lin: You're welcome.
Definition
Wong: What is the definition of acupuncture ?
Lin: Acupuncture （針灸）is a combination of "acupuncture"（針法） and "moxibustion"（灸法）, that is, stimulating meridians with needles; and warming acupoints with mugwort or other Chinese medicines.
Acupuncture is an important part of traditional Chinese medicine treatment.
Basic Principles
Wong: What are the basic principles?
Lin: Simply put, we can understand it this way:
1. Yin-Yang Balance（陰陽調和、平衡狀態）
Chinese medicine places great emphasis on the theory of Yin and Yang, believing that when the Yin and Yang of the human body are in harmony and reach a state of balance, it can maintain a healthy physiological state. However, various internal and external factors can disrupt this balance, leading to pathological changes in the body.
2. Meridians（經絡）
The theory of meridians in traditional Chinese medicine believes that meridians connect and link all the organs and tissues in the human body, including viscera, skin, muscles, bones, etc., making them closely linked as a whole. The meridian system is also responsible for transporting the body's qi, blood, and body fluids, maintaining balance and stability among all tissues and organs in the body.
When the meridians are blocked, the circulation of qi and blood in the human body will also be obstructed, giving the pathogenic qi an opportunity to take advantage, and the human body will begin to show pathological changes.
3. How Acupuncture Reverses Pathological Changes（針灸如何逆轉病變）
Acupuncture treatment can adjust the circulation of qi and blood in the human body, harmonize the organs, dredge the meridians, and restore the meridian system to normal, so as to balance yin and yang, support the righteous and expel the evil, and the disease can be cured.
Wong: Has acupuncture been increasingly accepted in the field of Western medicine in recent years?
Lin: Yes. According to the first edition of the "World Health Acupuncture Special Issue" by the World Health Organization (WHO) in 1980, it proposed and recommended 43 diseases for the promotion and application of acupuncture treatment worldwide. In November 1996, the World Health Organization (WHO) approved 64 indications for acupuncture at a meeting in Milan, Italy, including diseases of the digestive system, endocrine metabolic diseases, gynecological diseases, neuropsychiatric diseases, and musculoskeletal diseases.
Part Two - The Process of Performing Acupuncture
Wong: So how does traditional Chinese medicine perform acupuncture?
Lin: The traditional Chinese medicine doctor makes a differential diagnosis of the patient, finds the corresponding acupoints with the disease, and stimulates the acupoints with specially made metal needles or burning moxa, etc., to harmonize the qi and blood and dredge the meridians.
Through treatment, the body can return to the balance of yin and yang, and the body can return to the "yin is flat and yang is secret"（陰平陽秘） (referring to the dynamic balance of yin and yang——-the flat and secret in "yin is flat and yang is secret" are the same meaning, balance. "Yin is flat" means that the yin qi is smooth, and "yang is secret" means that the yang qi is guarded, which is the relative balance maintained by the mutual regulation of yin and yang.), thus restoring its normal physiological functions, thereby achieving the purpose of curing diseases.
Wong: From the perspective of modern medicine, how can this principle be explained?
Lin: From the perspective of modern medicine and physiology, after acupuncture stimulates the local body, it will cause a series of responses in the autonomic nervous system, including:
-Speed up blood circulation;
-Promote the secretion of the immune system; and
-Increase various substances that help the body fight disease and relieve pain, such as endorphins/anti dopamine (Endorphin), adenosine (Adenosine), etc.;
In this way, the effect of curing diseases and strengthening health can be achieved.
Wong: Are there any studies suggesting that the effect of acupuncture may be related to the interstitium?
Lin: Yes, recent studies have proposed new perspectives, suggesting that the key to acupuncture may lie in the interstitium (間質） under the human skin and around the main tissues and organs.
For a long time, scientists have not found any anatomical evidence for acupuncture, and there are no arteries, veins, or nervous systems that correspond to meridians. This makes it difficult for scholars studying acupuncture therapy to explain why inserting a needle at one acupoint can affect parts outside the needle insertion, achieving a wider therapeutic effect.
In 2018, a research team at the Mount Sinai Beth Israel Medical Research Center in the United States proposed a possible relationship between acupuncture and the interstitium, because the part of the human skin layer where the needle is inserted is the interstitium. If acupuncture can affect the flow of fluid in the interstitium, it may further help explain the treatment of acupuncture.
Part Three - Acupuncture Techniques（針法）
Classification
Wong: Perhaps we should systematically discuss "acupuncture techniques" first, and then talk about "moxibustion".
What different categories are there for "acupuncture techniques"?
Lin: It can be divided into "manual needle manipulation"（手法運針） and "electroacupuncture"（電針）.
Manual Needle Manipulation(手法）
This refers to the doctor of traditional Chinese medicine first inserting the needle at the selected acupoint, and then using manual techniques to make it "get qi"（得氣）, that is, the acupuncture part has a "sour"（酸）、"numb"（麻）, "swelling"（脹）, "heavy（重）" feeling.
Basically, manual needle manipulation is applicable to all diseases, including: head, face, body pain, internal diseases, gynecological diseases, skin and surgical diseases, otorhinolaryngology diseases, emergencies, etc.
Electroacupuncture
Wong: What about electroacupuncture?
Lin: Electroacupuncture is another acupuncture stimulation method promoted by modern technology, which uses the electrical pulses emitted by the electroacupuncture machine to enhance the stimulation of related meridians.
After the doctor of traditional Chinese medicine selects the acupoints, the two poles of the electroacupuncture machine are connected to the handle of the needle inserted into the acupoints, and then the required waveform and frequency are selected to continue to stimulate the acupoints with current.
Common indications for electroacupuncture:
-Diseases with paralysis as the main symptom, such as: hemiplegia, facial paralysis, sequelae of encephalitis and other nerve paralysis, etc.;
-Pain diseases, such as migraines, neck and shoulder pain, back pain, joint pain, toothache, etc.; and
-Those with dull needle sensation.
Electroacupuncture can also maintain a longer acupuncture stimulation effect.
Wong: When do you use "manual needle manipulation" and when do you use "electroacupuncture"?
Lin: Manual needle manipulation and electroacupuncture are two different types of stimulation:
-Manual needle manipulation is achieved by stimulating acupoints through mechanical principles such as "lifting, inserting, twisting"（提插捻轉）, mainly with a sense of sourness and swelling, mainly transmitted to the central nervous system through mainly type III fine fibers; while electric acupuncture mainly relies on the action of electric current to excite acupoint tissues, mainly with numbness, mainly transmitted to the central nervous system through mainly type II tissue fibers;
-The acupuncture effects of manual needle manipulation and electric acupuncture are also different. Experimental studies have pointed out that manual needle manipulation is better than electric acupuncture in improving skin temperature, analgesic anesthesia, adjusting gastric electrical activity, promoting lymphocyte transformation, and inhibiting epileptic discharge. Electric acupuncture is better than manual needle manipulation in promoting the phagocytic function of the reticuloendothelial system and the effect on peptides related to pre-melanin.
Therefore, manual needle manipulation and electric acupuncture have their own strengths. Even simple needle retention has a certain effect. It is not that one method is definitely better than the other. Traditional Chinese medicine will choose the appropriate treatment method for patients according to the specific clinical situation.
Classification of nerve fibers:
1. Classification based on electrophysiological characteristics is mainly based on conduction speed (the time of appearance of each peak in the compound action potential) and the difference in post-potential, and the fibers of peripheral nerves of mammals are divided into A, B, and C. Class A: includes myelinated somatic afferent and efferent fibers, which are further divided into α, β, γ, δ according to their average conduction speed. Class B: myelinated pre-fiber of the autonomic nervous system. Class C: includes unmyelinated somatic afferent fibers (drC) and autonomic postganglionic fibers (sC). Class D fibers have a diameter of <3μm and a conduction speed of <15m/s, which is very similar to Aδ fibers, but the peak potential and post-potential of the two are very different. The peak potential of Aδ fibers is longer, and the post-negative post-potential has a large positive post-potential.
2. According to the size of the fiber diameter and the source, the afferent fibers are divided into I, II, III, N four types (see attached table), and type I fibers include two types, Ia and Ib.
| Fiber category | Source | Diameter (μm) | Conduction speed (m/s) | Classification in electrophysiology |
| I | Afferent fibers of muscle spindles and tendon organs | 12-22 | 70-120 | Aα |
| II | Afferent fibers of skin mechanoreceptors (touch, pressure, vibration receptor afferent fibers) | 5-12 | 25-70 | Aβ |
| III | Afferent fibers of skin pain and temperature sensation, afferent fibers of deep pressure sensation of muscles | 2-5 | 10-25 | Aδ |
| N | Unmyelinated pain fibers, temperature, mechanical receptor input fibers | 0.1-1.3 | 1 | C |
Part Four - Moxibustion
Wong: So how about moxibustion?
Definition
Lin: Moxibustion（炙） - mostly refers to the method of treating diseases by fumigating or burning acupoints or local skin of the body with fire.
Moxibustion usually uses mugwort, applying gentle heat to the body surface, achieving the function of warming and unblocking the meridians.
Implementation process
Wong: How about the implementation process?
Lin: Just like when a traditional Chinese medicine doctor uses medicine clinically, he will first use the four diagnoses (looking, smelling, asking, palpitation)（望、聞、問、切）, understand the patient's medical history, symptoms and physical signs, through comprehensive analysis, clarify the cause, nature, and location of the disease; then according to the results of the diagnosis, apply the corresponding treatment method, that is, the unique "syndrome differentiation and treatment" （辨證論治）of traditional Chinese medicine.
Moxibustion treatment also needs syndrome differentiation and treatment:
-The TCM doctor judges the nature of the disease (whether it belongs to yang or yin, cold or heat, deficiency or reality) through the relevant information obtained from the four diagnoses; identifies the location of the disease (on the surface or inside), in the viscera or in the organs, in which meridian positions, etc;
-Based on the results, formulate corresponding treatment methods, including
- Theory;
- Method;
- Prescription;
- Acupoint; and
- Technique
Five aspects, in order to dredge the meridians, adjust the qi and blood, thereby balance yin and yang, harmonize the viscera, and fill the qi and blood.
However, one point to add is that the TCM doctor needs to choose the most suitable treatment for him according to the patient's physique or the disease he suffers from. For example, if the patient's physique is "hot"（偏熱） or is already feverish, it is not suitable to use "moxibustion treatment"; on the contrary, if the patient suffers from "cold evil"（寒邪） and the physique is also suitable, then "moxibustion treatment" can be used. An example is if the stomach is "cold", then applying moxibustion to the relevant acupoints can warm the stomach and relieve discomfort.
Classification
Wong: What are the classifications of moxibustion?
Lin: Moxibustion is mainly divided into two categories - moxibustion（艾灸） and non-moxibustion（非艾灸）:
Moxibustion（艾灸） - mainly uses moxa wool or moxa sticks.
It's worth mentioning that in traditional moxibustion, there is a method called "direct moxibustion"（直接灸）, which involves burning moxa wool directly on the skin, which can cause slight burning discomfort to the patient and may cause small blisters on the local skin. However, as long as appropriate care is taken, the skin will heal naturally and there will be no major problems. Of course, the practitioner should clearly explain to the patient before moxibustion the possible side effects of "direct moxibustion" and how to deal with them; and
Non-moxibustion（非艾灸） - including lamp moxibustion（燈火灸）, electric moxibustion（電熱灸）, medicinal patches （藥物敷貼）(such as sky moxibustion（如天灸）), etc.
Lamp moxibustion is one of the moxibustion methods. It refers to the moxibustion method of directly burning the acupoints with a lamp wick dipped in vegetable oil. Also known as lamp wick moxibustion, lamp lighting, and scorching method. When operating, you should dip an appropriate amount of oil and move quickly to prevent burns caused by dripping burning oil. When the lamp fire burns the skin of the acupoint, you can hear a slight "pop" sound, and the lamp fire is extinguished, which is called a burn. Each acupoint is generally only moxibustion once. After moxibustion, the local area is slightly red, and cleanliness should be paid attention to avoid infection. "Compendium of Materia Medica" Volume 6（《本草綱目》卷六): "Lamp fire, mainly treats children's wind shock, coma, convulsions, all diseases of vision, and also treats headaches and swelling pain."（燈火，主治小兒驚風、昏迷、搐搦，竄視諸病，又治頭風脹痛。） It is also used in clinical practice for mumps, hiccups, vomiting, abdominal pain in the genitals, poor digestion in children, functional uterine bleeding, cold hands and feet, etc. This method is suitable for the treatment of various diseases, such as headache, stomach pain, chest pain, back pain, arthralgia, hernia, exogenous, nosebleed, scrofula, tumor, eczema, menstrual disorders, leucorrhea, dysmenorrhea, breast disease, etc. It is more commonly used for epidemic mumps, poor digestion in children, convulsions, hiccups, abdominal pain, functional uterine bleeding, tennis elbow, etc. Note: There are often small burns in the moxibustion area of this method, which should be kept clean to prevent infection, and should not be exposed to raw water within 3 days after moxibustion.
Electric moxibustion is a type of moxibustion that uses electricity as a heat source. The electric moxibustion device is a non-moxa heat source moxibustion device that was developed earlier by modern acupuncture workers and other discipline workers, and it has been continuously improved and perfected, so there are more types of this kind of moxibustion device. Among them, the imitation moxibustion therapy device is more commonly used. The so-called imitation moxibustion device is based on the spectrum radiated by the traditional moxibustion burning, using simulation technology to simulate, fully exerting the traditional moxibustion function of warming the meridians and dispelling cold, dredging the meridians, activating blood and removing stasis, and anti-inflammatory and analgesic, and it is pollution-free and non-damaging, and easy to operate.
Acupoint application therapy（穴位敷貼療法） is a method of grinding medicine into fine powder, mixing it with various different liquids to make a paste, and applying it to certain acupoints or affected areas to treat diseases. This is an application by ancient doctors who combined the special functions of external application of medicine and meridian acupoints, greatly improving clinical efficacy.
Heavenly moxibustion（天炙） is a combination of acupoint application therapy and traditional Chinese medicine which is time based. It is a method of applying warm and hot Chinese medicine to acupoints on specific days. The medicine stimulates local acupoints through the skin, thereby achieving the effects of warming yang and benefiting qi, strengthening the spleen and kidney, benefiting the lungs, dispelling wind and cold, strengthening the organs, and relieving pain. The "Huangdi Neijing" （《黃帝內經》）states "nourish yang in spring and summer, nourish yin in autumn and winter"（春夏養陽，秋冬養陰）, and "treat summer diseases in winter, and winter diseases in summer"（夏病冬治，冬病夏治）. The three-volt moxibustion（三伏灸） in summer and the three-nine moxibustion（三九灸） in winter are based on this principle for treatment and health care. It is a kind of therapy that "prevents before illness, prevents changes after illness"（未病先防、既病防變）, and is mainly used in clinical treatment of deficiency-cold diseases, with a wide range of indications. It includes:
- respiratory diseases, such as: allergic rhinitis, asthma, chronic cough, physical weakness and recurrent colds, etc.;
- digestive system diseases, such as: chronic stomach pain/abdominal pain, recurrent diarrhea/constipation, children's anorexia, etc.;
-gynecological diseases, such as: menstrual disorders, dysmenorrhea, postpartum pain, etc.; and
-limbs joint pain, neck and shoulder pain, back pain, etc. that belong to the category of cold paralysis in traditional Chinese medicine.
When used clinically, it must comply with the syndrome differentiation and treatment of traditional Chinese medicine, and use Chinese medicine prepared in a specific ratio, combined with accurate acupoints for application, to achieve the best therapeutic effect.
Wong: When doing moxibustion, you need to burn moxa. Will the substances produced during the burning process harm the patient's lungs?
Lin: It is undeniable that long-term inhalation of moxibustion smoke is harmful to people. The dust and other toxic substances in it may harm the human lungs, especially patients with asthma. If the symptoms do not improve after moxibustion, it is best to stop moxibustion.
There are indeed cases of moxa smoke allergy in the population. The symptoms caused by moxa smoke are similar to those of hay fever, including enlarged tonsils, throat itching, eye pain, eustachian tube itching, and obvious drowsiness. Some people gradually become very sensitive to smoking, so much so that they can hardly tolerate a room with smoke. Sometimes there are feelings of heat or irritability in the chest, suggesting that moxa smoke has a certain impact on human health.
However, if the quality of the selected moxa stick is good, inhaling a small amount of moxa smoke is harmless to the human body. Moreover, moxa smoke has some health benefits for the human body.
As the saying goes, "All drugs are poisons" （是藥三分毒）no drug is absolutely safe, but we cannot give up using it because of a small amount of toxic substances. Therefore, how to find an appropriate balance between the efficacy and safety of moxa smoke is something we need to consider.
Part Five - Other Related Methods
Wong: In addition to acupuncture, I understand that traditional Chinese medicine also includes massage, hot compresses, and fumigation. Could you please explain?
Massage（推拿按摩）
Lin: Massage and acupressure are also common treatments in traditional Chinese medicine clinics. They have a wide range of applications and can harmonize qi and blood, unblock meridians, balance yin and yang in the body, and achieve the effect of strengthening the body and eliminating evil.
Generally speaking, the stimulation of massage and acupressure is gentle, with fewer side effects, and is more suitable for people who are afraid of acupuncture. In addition, some massage and acupressure techniques are simple and very safe, so they can be used as a self-care or caregiver-operated treatment method.
Hot Compress with Chinese Medicine（中藥熱敷）
On the other hand, hot compresses and fumigation（中藥熱敷） with Chinese medicine are one of the characteristic treatments of external Chinese medicine. They use heated Chinese medicine or medicinal liquid to apply heat and fumigate the affected area, promoting local and systemic circulation of qi and blood, thereby achieving the effects of unblocking meridians, lubricating joints, dispelling wind and dampness, and activating blood to relieve pain（疏通經絡、滑利關節、祛風除濕、活血止痛等作用）.
Hot compresses and fumigation with Chinese medicine have significant effects, few side effects, and a wide range of applications. In clinical practice, they are often used for limb injuries with stasis and accumulation, limb pain or soreness, numbness, joint stiffness and spasm caused by wind, cold, and dampness. For cancer patients, using hot compresses or fumigation with Chinese medicine on the limbs before and during chemotherapy can effectively alleviate local pain, numbness, and other discomforts.
Wong: Is it true that in traditional Chinese medicine, "if it flows, it doesn't hurt"?
Lin: Yes, that's correct. The occurrence of pain is due to the poor circulation of qi and blood in the meridians. The heat from hot compresses and moxibustion can promote the circulation of blood and qi, thereby achieving the effect of smooth circulation of blood and qi, warming and unblocking the meridians, and "if it flows, it doesn't hurt"（通則不疼）.
Part Six - How Acupuncture Can Help Cancer Patients
Wong: Now let's move on to the part we are most concerned about, which is how acupuncture can help cancer patients?
Lin: As early as 1997, the National Institutes of Health (NIH) in the United States pointed out that acupuncture can alleviate nausea, vomiting, pain and other side effects of cancer radiation therapy and chemotherapy, and it is quite safe and should be included in regular medical treatments. To date, many of the cancer centers in the United States have set up complementary therapy centers and provide acupuncture services.
Wong: Or explain one by one?
Lin: Okay.
(1) Pain
Clinically, acupuncture is most commonly used to treat pain in cancer patients. Statistics show that up to 80% of patients have to endure the pain brought about by cancer itself and its treatment. If acupuncture is used in combination with Western medicine's painkillers, the effect is better than using painkillers alone, and it can also reduce the dosage and side effects of painkillers.
(2) Gastrointestinal discomfort
Chemotherapy drugs often cause patients to have gastrointestinal discomfort, such as nausea, vomiting, diarrhea, constipation, etc. Acupuncture can be used to prevent and treat symptoms such as nausea, vomiting, diarrhea, and constipation caused by chemotherapy, and can reduce the dosage of Western medicine's antiemetic drugs.
(3) Neuropathy
Some cancer patients need to use platinum-based, taxane-based and other chemotherapy drugs for treatment, which can easily lead to peripheral neuropathy, causing limb pain, numbness, and sensory dullness. Many patients take several months, or even years, to recover after chemotherapy, affecting daily activities and quality of life. Research shows that acupuncture can improve the symptoms of peripheral neuropathy, alleviate the pain and numbness of the patient's limbs during chemotherapy, and promote the recovery of the patient's limb sensation after chemotherapy.
(4) Fatigue
Statistics show that 70-90% of cancer patients have problems with cancer-related fatigue, and it is difficult to fully improve through rest. Research has found that acupuncture can significantly improve cancer-related fatigue. For cancer patients who are physically weak and unable to exercise, they can improve their fatigue through acupuncture.
(5) Hot flashes, night sweats or joint stiffness and pain
Breast cancer and prostate cancer patients often use Western medicine's hormone therapy to achieve the treatment and control of tumor growth. Hormone therapy can easily cause hot flashes, night sweats or joint stiffness and pain, causing great trouble to patients' lives. Research has found that acupuncture can effectively improve these side effects caused by drugs. For patients who need to undergo many years of hormone therapy, acupuncture is a cancer adjuvant treatment worth considering.
(6) Sleep disorders, emotional anxiety or depression
Acupuncture is also often used to improve sleep disorders, emotional anxiety or depression in cancer patients.
(7) Dry mouth, difficulty swallowing
Acupuncture can also help treat common clinical problems such as dry mouth and difficulty swallowing.
In summary, acupuncture therapy is not only effective in relieving various symptoms common in cancer patients, improving the quality of life of patients, but also can harmonize the patient's qi and blood and organ function, enhance the body's immune function, and help fight cancer. Acupuncture has the advantages of being safe and effective, and it does not interact with the drugs used in Western medicine, so it is worth using in clinical practice.
(Note: Suggested reference article:
Systematic literature review publication date: March 2016 https://www.hkiim.cuhk.edu.hk/ceim/tc/synopsis/detail/acupuncture-and-related-therapies/244 )
Wong: Thank you very much for accepting my interview and sharing so much.
Lin: You're welcome.
(January 2022)
