Traditional Chinese
Medicine and Acupuncture
A Primer
Key Concepts and Definitions
Paradigm Description
Victor S. Sierpina, MD, ABIHM,
ABFM
Professor
Family Medicine
Nicholson Professor of Integrative
Medicine
University of Texas
Treatments in Chinese
Medicine
Herbalism
Acupuncture
Diet and Exercise
Qi Gong and Tai Chi
Massage
Cupping
Moxibustion
Chinese Herbalism
Used to balance the Eight Conditions
Herbs generally used in combinations of
3-15gm/herb, RX contains 5-15 herbs
Over 500 common combinations
Xenophytic materials--minerals, shell,
animal extracts
Decoctions most common but also rx’d
as pills, powders, tinctures, poultices
Eight Conditions
“Ba Gang”
Yin and Yang
Interior and Exterior
Deficiency and Excess
Cold and Heat
Exercises for Health
Tai Chi
Chi Gong
Used to stimulate health,
prevent and treat disease,
injury, improve flow and quality
of Chi
Yin and Yang
Shady and sunny side of the
hill
Organizing concept in
Chinese thought, art,
medicine
YIN YANG
Negative Positive
Feminine Masculine
Nourishing Protective
Lower Upper
Cool Heat
Deficiency Excess
Inside Outside
Receptive Creative
Chi (Qi)
Omnipresent energy resulting from
interaction of opposing forces of
Yin/Yang
Vital energy
Bioelectromagnetic field
Observed through its effects
Provocative assertion in Western
scientific terms
XU SHI
(deficient) (excess)
Yin condition Yang condition
Cold symptoms Heat symptoms
Inadequate blood Flushing
flow Agitation/hyper
Slack muscles Inflammatory
Hypofunction illnesses
Degenerative Tense muscles
condition/dull pain Acute
Chronic illness pain/illness/injury
Case history
TRIGEMINAL
NEURALGIA
76 y/o on maximum
medical tx
(anticonvulsants,
opiates, NSAID’s)
without relief. Pain 8-
10/10 most days Raji M, Mishra D, Sierpina V. Trigeminal
neuralgia in an octogenarian: sustained
3-4 acupx tx reduced clinical response to acupuncture, EXPLORE:
pain to 2-3/10 Journal of Science and Healing 2005;1(1):46-
47.
History of Acupuncture
Used for several thousand years in
Orient with first documented application
in 2600BC with use of stone needles
Treatments based in natural philosophy
which included the concepts of TCM
including yin/yang, chi, five elements
NIH Consensus Panel--1997
“Clear evidence for acupuncture’s
efficacy for treating postoperative and
chemotherapy nausea and vomiting, the
nausea of pregnancy, and postoperative
dental pain.”
“Acupuncture may be an effective
adjunctive therapy for a number of pain
conditions:
NIH Consensus Panel (cont’d)
Acupuncture may be helpful in, but not
limited to the following:
– Stroke rehabilitation
– Addiction
– Headache
– Menstrual cramps
– Epicondylitis
Acupuncture
Fibromyalgia
Carpal tunnel syndrome
Asthma
Pain
Recent Literature
See syllabus handout for evidence
summary
Pain and non-pain conditions
Over 250 articles on acupuncture
published since Nov 2011
Methodology, quality of studies, number
of studies, other research challenges
often limits definitive conclusions
Cochrane Collaboration in past year—
over 14 reviews of acupuncture—mostly
indeterminate or negative meta-analyses
Cancer pain in Uterine fibroids
adults Dysmenorrhea (+
IBS limited evidence)
Schizophrenia Cephalic version of
Insomnia breech by
Restless legs moxibustion (+
syndrome limited evidence)
Vascular dementia Labor
pain(decreased
Induction of labor instrumental delivery
Mumps in children
Imputed Mechanisms of Action of
Acupuncture
Quantum wave,
Gating theory non-local effects
Endogenous Foreign body
opioids: endorphins, response
dynorphins Pattern of injury
Cytokines response
Neurostimulation: Increased local
peripheral, central circulation
Polarization of Sympathetic/parasy
fascia, interstitial mpathetic switch
fluid
What Can The Patient Expect?
Often 1st visit for assessment
RX sessions usually 30-60 minutes
Prob. > 10 or more treatments needed
Sometimes covered by insurance by
not usually
The acupuncturist may use:
Needles
Heat by burning “moxa”
Electric stimulation
Intradermal needles
Cupping
Lasers
When to Consider an Acupuncture
Treatment or Referral
Pain
Dental
Facial
Headache (incl. migraine)
Back (esp. low back)
Osteoarthritis (esp. knees)
Menstrual symptoms
WORLD HEALTH ORGANIZATION
INDICATIONS FOR ACUPUNCTURE
Orthopedic Disorders
Periarthritis humeroscapularis
Tennis elbow
Sciatica
Lumbar pain
Rheumatoid arthritis
Anti-emesis
Chemotherapy & Post Surgery
Substance Abuse
Severe ETOH, Cocaine & Opiate
Addictions
Non-pain Conditions
Chronic viral infections
(e.g. chronic fatigue syndrome)
Neurological disorders
Chronic GI problems
Chronic pulmonary disease
Non-pain Conditions
Mild to moderate anxiety and
depression
Genitourinary problems and
women’s health issues
Fatigue
Dermatological conditions
WORLD HEALTH ORGANIZATION
INDICATIONS FOR ACUPUNCTURE
Respiratory Tract Broncho-pulmonary
Acute sinusitis Disorders
Acute rhinitis Acute bronchitis
Common cold Bronchial asthma
Acute tonsillitis
WORLD HEALTH ORGANIZATION
INDICATIONS FOR ACUPUNCTURE
Disorders of the Disorders of the
Eye Mouth Cavity
Acute
Toothache
conjunctivitis Pain after tooth
Central retinitis
Myopia (in
extraction
Gingivitis
children)
Cataract (without Acute and chronic
complications) pharyngitis
WORLD HEALTH ORGANIZATION
INDICATIONS FOR ACUPUNCTURE
Gastrointestinal Disorders
Spasm of the esophagus and cardia
Hiccups
Gastroptosis
Acute and chronic gastritis
Gastric hyperacidity
Chronic duodenal ulcer
Acute and chronic colitis
Acute bacterial dysentery
Constipation
Diarrhea
Paralytic ileus
WORLD HEALTH ORGANIZATION
INDICATIONS FOR ACUPUNCTURE
Neurologic Disorders
Headache
Migraine
Trigeminal neuralgia
Facial paralysis
Paralysis after apoplectic fit
Paralysis caused by poliomyelitis
Meniere’s syndrome
Neurogenic bladder dysfunction
Nocturnal enuresis
Intercostal neuralgia
Peripheral
Training
DOM is typically a 4 year program,
didactic and clinical
Medical Acupuncture ~300 hours and
limited to MD’s, DO’s (no TCM
herbology)—practice under medical
license
Other professions include some
acupuncture in their curricula, e.g,
naturopathy, chiropractic
Review article on medical
acupuncture
Sierpina V, Frenkel M. Acupuncture: A
clinical review. Southern Medical
Journal. 2005; 98(3):330-37.
The Art of Diagnosis in
Chinese Medicine
Sub-Types of Chi
Yang Chi-- Jing Chi--
"respiratory Chi" , "meridian Chi",
from above, prana flows thru
Yin Chi--"food channels to all
Chi", from below, parts of the body
“Rong chi” Wei Chi--
Yuan Chi-- "protective Chi",
“hereditary chi”, first line of
inherited vital resistance on
energy surface of body
JING SHEN
Life essence “The awareness
Material basis of that shines out of
Chi our eyes when we
Congenital Jing is are truly awake”
inherited Spirit/
Acquired Jing is consciousness
nourished by “food Psychic energy
following One of the “Three
refinement” Treasures”: Chi,
Jing and Shen
BLOOD
Not same as Heart rules the
Western definition, blood, Liver stores
more closely the blood, Spleen
associated with regulates blood
meridians Imbalances:
Circulates through Deficient blood
vessels and Congealed blood
meridians
Yin substance
Fluids
Bodily fluids other than blood
Examples are sweat, saliva, gastric
juices, urine, mucus, semen, vaginal
secretions
Moisten and partially nourish tissues
including hair, bone, marrow, joints,
brain, skin, membranes; interacts with
blood, Chi
Imbalances are dryness, Yin or water
disturbances
Climatic Factors
WIND “Feng”
HEAT “Re”
DAMP “Shi”
COLD “Han”
DRYNESS “Zao”
ZANG FU
(solid organs) (hollow organs)
Liver Gall bladder
Heart/Master Small intestine
of Heart Stomach
Spleen Large intestine
Lung Bladder
Kidney Triple Heater
Five Elements and Meridians
FIRE--Heart/Small Intestine/Triple
Heater/Master of Heart
EARTH--Stomach/Spleen
METAL--Large Intestine/Lung
WATER--Bladder/Kidney
WOOD--Gall bladder/Liver
REFLEX SYSTEMS
Pulses
Tongue
Ear
Four Examinations
Looking
Listening/smelling
Questioning
Examination/palpation
Looking
Remain humble, recognize our
own inadequacies in knowing
another
Look with the spirit, mind’s eye,
not just physical eye; see the
patient’s Shen(spirit)
Body type, movement
Looking
Color-- (associations) face,
clothing; look from side, different
angles
Body language
Tongue diagnosis, secretions
Listening/Smelling
Sound of voice, shouting,
weeping, joy
Power and sonority of breathing
Listen with the inner ear, the
spirit to feeling and emotion
behind content
Listening/Smelling
Smell patient unobtrusively at
the back when removing drape
or gown
Practice enhancing sense of
smell
Recall associations, burnt,
sweet, acrid
Questioning
Preferences
–Colors
–Seasons
–Flavors
–Time day
Questioning
Emotions--may need to exaggerate your
asking to elicit predominant feeling
– Joy
– Sympathy
– Grief
– Fear
– Anger
Listen with the spirit, not just to words
Questioning
Type of pain, Yin or Yang
Sharp and shooting-Yang
Dull or aching-Yin
Disturbances in activity, sleep
Examination/palpation
Pulses
Triple Heater temperatures
Tender points
– Alarm Points
– Ah-Shi (trigger) Points
Skin and muscle texture
Handshake
Photo Credits
Tao Te Ching
Vintage Books—25th anniversary edition 1997
Gia Fu Feng (calligraphy and translation)
Jane English (black and white photography)
The Healthy Gut
• Food allergies and
sensitivities
• The relation between your
gut and your emotions
• Avoiding potentially
harmful prescription drugs
• Comprehensive elimination
diet
• Integrative treatment plans
for common gut conditions
