Acupuncture Techniques

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I have been away from my office for nearly two weeks, but it has been worth it. I have had the great pleasure of being one of only a few practitioners in an Acupuncture for Sports Medicine Apprenticeship Program. One of the few Americans leading the way in the field of Chinese Sports Medicine, Whitfield Reaves, has designed this apprenticeship to share the vast knowledge he has gained over his 30 years of treating Olympic athletes. On the gorgeous Hawaiian island of Maui I have been absorbing as much as I can about treating sports injuries and enhancing athletic performance. I have treated many athletes over the years at Queen Anne Acupuncture, including marathoners, tri-athletes, snowboarders, soccer players, yoga instructors, circus performers and even a competitive fencer. I have had success with most of these patients, but I am always looking to improve my treatments and the speed with which my patients heal from injuries so they can get back to the activities they love. I have confidence that the needle techniques and the refinement of my knowledge of anatomy during this apprenticeship will carry over into the successful treatment of my patients when I get back to work next week and for years to come.

Mahalo!

I have a fertility-turned-obstetric patient who just emailed me to cancel her appointment for this morning. She was in labor and wouldn’t be needing an induction treatment as we had planned. This is someone who had faithfully come in for treatment throughout her pregnancy, and to whom we applied pre-birth acupuncture from week 36 on. She went into labor 5 days after her due date.

This is typical of primigravidas (first time moms). Having pre-birth acupuncture most typically results in babies that come during the 40th-41st weeks. Rarely do I see those who come in weekly for this treatment get to week 42. The protocol is simple, and the hour spent in session gives the mom some much needed self-care time. Not only is the pre-birth acupuncture helpful for getting labor going in due time, but it has also been shown to reduce the overall time in early labor by an average of 2 hours. 2 hours might not sound like a lot, but believe me, to a woman in labor it is significant. In addition, there is strong anecdotal evidence that women who receive pre-birth acupuncture require less medical intervention during labor than women who do not. I encourage all of my obstetric patients to come in once a week from week 36 to week 41. Once we pass week 41, we can apply a stronger induction-style treatment 3 times in a week as these moms may be facing a decision to medically induce with Pitocin should they reach week 42. I do not actively induce moms before their due dates, and I find that those who receive pre-birth treatment rarely require it.

For acupuncturists interested in incorporating the pre-birth protocol into their obstetric practice, I use the following points as a base of treatment, and add any points that I feel will benefit the particular patient depending on other symptoms present and using a differential diagnosis.

Weesk 36-38: (using no stimulation) GB34, ST36, Sp6 (if there is a history of rapid uncontrolled labor, substitue with Ki8), Bl62, yin tang. If the baby’s position is not optimal, add Bl67 and Bl60

Weeks 38-40: (using no stimulation) GB34, St36, Sp6, Bl62 (again, add Bl67 and Bl60 if needed), yin tang, GB21

Week 41: (using strong stimulation) GB34, St36, Sp6, Bl62 Bl60,, Bl67, yin tang, GB21, LI4 Bl31, Bl32

These points can all be needled bilaterally in a seated position, or unilaterally in a side-lying position. I favor side-lying as many moms become quite relaxed and meditative.

 

 

 

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Shonishin is a Japanese acupressure technique that is well suited to babies and young children. Acupuncture channels and points are stimulated with a light stroking or pressing technique with small tools, sometimes even shells or stones. It can be used to treat all the typical childhood complaints such as colic, digestive problems, rashes, colds, etc. Even more effective, is the use of monthly shonishin on healthy young ones to help them maintain a state of wellness. It will calm them down, help them sleep better, and boost their immune function.

As you can see in the above picture, children enjoy the process of shonishin and might even enjoy “playing doctor” with it at home. It is a safe, painless, non-invasive way to help our babies and children maintain good health.

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I have always had faith in the wisdom of a pregnant body. For the most part, babies come when they’re ready. Unfortunately, there are circumstances in which a medical induction with pitocin or cytotec are indicated. If a woman or baby’s health is in jeapordy, induction becomes necessary. All too often, medical caretakes do not feel comfortable with a woman who hasn’t started labor by the 41st week and induction is recommended for no other reason than being “overdue.”

When a woman is facing medical induction with drugs, I do provide acupuncture induction to start labor naturally. Contractions initiated with Pitocin are more intense than natural contractions and often lead a woman straight to an epidural, which carries with it many risks. Naturally inducing labor with acupuncture does not have the intensifying effect.

In my experience, first time moms often need up to 3 treatments to get labor going, although I have seen many cases in which 1 treatment does the trick. It is a safe protocol, and worth trying before resorting to more invasive, less safe inductions with drugs.

Interestingly, women who have done prebirth acupuncture once a week from week 36 on, usually go not require even acupuncture induction, as they generally go into labor on their own by week 41.

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“It’s 5am and I’m sitting at the airport and am in complete amazement! I woke up with a full range of motion in my neck and not an ounce of pain. I haven’t even taken any advil yet.  I can hardly believe it! I am one happy girl.”

That is an email I received from a patient who had come in the day before with acute neck pain. Because she was flying the following day, she was desperate to get some relief from pain and the limited range of motion in her neck which had been plagueing her for 3 days. Advil took the edge off, but wasn’t giving her complete relief, and was doing nothing for her inability to turn her head to the right.

Upon palpation I found several very tight areas between her spine and her scapula on the right side, and also in the muscles on the right side of her neck. I did acupuncture locally, and also used a combination of points on her wrists and ankles on the acupuncture channels that traverse the upper back and neck.

The acupuncture certainly contributed to her quick recovery, but I think the key to treatment success in this case was the gua sha which I applied to her upper back following the acupuncture.

Gua sha is an ancient technique in which a smooth-edged tool, usually a ceramic soup spoon, is scraped along the skin in one area repeatedly. The technique stimulates blood flow and produces heat which releases toxins and helps muscles to relax. The feeling is one of a strong massage, and can leave reddish marks referred to as “petichiae”. Using gua sha on the muscles of my patient’s neck and upper back were the key to her relief from pain and return to normal range of motion. I use gua sha quite a bit in the spring when neck pain and spasm are a common phenomenon.

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Jian jing, Shoulder Well, is an important point located at the apex of the shoulders on the Gall Bladder meridian. This point is often tender and tight, especially when the body is stressed, or energy is ascending.

Stimulating GB 21 directs the qi downward, clearing headaches, necka nd shoulder pain, dizziness and helps lower blood pressure. Contraindicated during pregnancy, jian jing is an excellent point to help stimulate labor assisting your baby’s arrival.

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moxa

Moxibustion is a wonderful wintertime therapy as it disperses cold, eliminates damp and warms yang. It is one of the best methods for general health and well-being in the Chinese Medicine repertoire. Moxa used daily on the point ZuSanLi is said to prevent all illness and promote longevity. The sensation is generally one of warmth and relaxation, and very popular among patients of Chinese Medicine.

Moxibustion is a form of therapy that developed independently of acupuncture, and may actually pre-date it. There are areas in the northern, colder regions of China in which practitioners use moxibustion in lieu of acupuncture.

The moxa is made from the herb Ai Ye, or Mugwort, which is harvested and laid in the sun to dry. It is then crushed and passed through a sieve repeatedly until it maintains a fine, downy texture. In this form it is referred to as “moxa punk” and is formed into small cones.

The practitioner then places the cone on top of an acupuncture needle or directly onto the skin. The moxa is lit with a stick of incense and the warming and moving properties of the Ai Ye plant enter the point. A slice of ginger or garlic can also be placed between the moxa and the point, infusing the properties of these herbs into the body as well.

Moxa punk can also be made into rolls or small sticks which are placed in a metal tool called a Tiger Warmer. This tool is then moved along the course of a meridian, allowing the moxa to enter the body.

When a disease cannot be treated by needling it should be treated with moxa.” – Ling Shu

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Near the end of pregnancy, when the due date begins to loom, most babies will position themselves head down and facing the mother’s back. This is the ideal position for labor and delivery. When a baby is in this position the head descends and puts pressure on the mother’s cervix which helps initiate labor and leads to effective, productive contractions during labor. This position is also ideal for the descent of the baby through the birth canal and out into the world.

While turning head down is the norm, not all babies move into this position on their own. Giving birth to a breech baby who is butt down or feet down is possible, but it carries a higher risk to the baby and mother and most care providers are not willing to do it.

There are two choices in Western medicine when it comes to breech babies. One is to attempt a manual version from the outside. The midwife or OB will use their hands on the outside of the mother’s abdomen to try and turn the baby into the ideal position. This is done with the aid of an ultrasound machine while the heart rate of both baby and mother are monitored closely. It is not without risk and not all practitioners are willing to perform this technique. Some women find it to be painful and opt out of trying it. The second choice, when manual version is not an option, or is undesired, is to schedule a cesarean section.

Chinese medicine offers another option. 

There is a simple technique that can be quite successful if applied correctly and daily within a specific time period.

Moxibustion is applied to the point Zhiyin (BL-67) on both feet for 15 minutes every day.

A practitioner of Chinese Medicine can perform the technique once, showing the woman and a partner how it is done, and then the woman can have it done at home every day for up to 5 days. After 5 days, the pregnant woman should be checked to see if the baby has in fact turned. If not, another 5 days of moxa can be applied.

The ideal week of gestation for applying moxa is week 34, but anywhere between 30 and 38 can be done. If it is applied too early, the baby may turn back into the breech position, while attempting too late may not be successful if the baby doesn’t have enough amniotic fluid or room to make the move.

There have been several studies performed testing the efficacy of this technique. The success rates vary from 60% to 80% success, depending on the study. Most of these studies also conclude that the 34th week of pregnancy is the ideal time to perform moxibustion for turning breech babies.

I have personally seen this technique succeed and feel that it is usually worth trying when cesarean section is the only other option.

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Gua Sha, which literally means “friction for congestion”, is an ancient technique used to move stagnation and draw out toxins. It is both diagnostic and therapeutic.

The technique involves the use of a smooth-edged tool, typically a ceramic soup spoon, that is rubbed or scraped repeatedly over areas of the body creating heat and activity in that area. When this friction is applied in repeated, even strokes, the “sha” surfaces as tiny red dots, or petichiae. When a lot of sha appears, it tells the practitioner that there was a lot of stagnation in that area. This discoloration disappears within hours to a couple of days. Most patients find that it relieves mild to severe muscle tension, soreness, and pain in a similar way that cups do. Like cupping, gua sha is mainly used for musculoskeletal complaints, but can also be used to treat internal health problems.

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cuppingCupping is an ancient technique, likely predating acupuncture and the use of herbal medicines. Glass or plastic cups are kept in place on the skin by suction. A vacuum is created in the cup with fire or a pump. The cups may be left in place, but are sometimes moved across larger body areas, such as the back, giving the feeling of a moderate massage.

This technique invigorates the area, moving stagnation of qi and blood and drawing out toxins. Skin is not broken with this technique, however the technique may leave temporary marks which look like small “hickies”. Your practitioner is most likely to use cupping over sore, achy muscles, but they may be used to treat internal issues as well.

Cupping gained national media attention when actress Gwyneth Paltrow wore a strapless dress to a movie premier, revealing what appeared to be reddish-colored bruise marks on her back. Paltrow had been to her acupuncturist and received a cupping treatment.

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