INTRODUCTION

Acupuncture can be used for treating both pain and non-pain symptoms. However, there is a basic difference in treatment between these two types of symptom. When using the Integrative Neuromuscular Acupoint System (INMAS) to treat pain, it is possible to predict the progress and determine the outcome of the treatment: for example: Are the symptoms presented by the patient treatable? If treatable, how many sessions will be needed? How long will the relief last? When treating non-pain symptoms, it is not possible to make such predictions. Thus, the progress and prognosis of treating non-pain symptoms with acupuncture are not so straightforward.

Why is acupuncture effective for such a variety of different disorders? Unlike pharmaceutical therapy, acupuncture employs the same principles to treat different symptoms and disorders. In other words, it does not correct or target the underlying cause of a particular symptom or disease, but activates a series of general physiologic mechanisms to accelerate self-healing of healable symptoms or diseases. These physiologic mechanisms ensure that acupuncture therapy can be used to treat any completely or partially self-healable pathophysiologic condition, and consequently this includes conditions that do not manifest symptoms of pain.

Nevertheless, as each symptom has its particular features and each patient presents his or her own personal expression of the symptom or disease, a practitioner needs to pay close attention to the individual features exhibited in each case. The general healing mechanism of acupuncture has to be invoked for the specific symptoms, and although this general healing process can be triggered at most locations of the body, it is by needling a specific acupoint that we purposefully inoculate the healing mechanism into specific tissues or at a specific location. This is the essence of what acupuncture practitioners do in treating pain symptoms: needling the painful soft tissues to bring the self-healing mechanism to particular injured locations. The same strategy, however, is used to treat non-pain symptoms, and the INMAS system of homeostatic acupoints (HAs), symptomatic acupoints (SAs), and paravertebral acupoints (PAs) is equally efficacious.

As we have described in Chapters 1, 2, 3, 5, and 6, the HAs gradually become tender in a predictable pattern as the body’s homeostasis decreases, and our body manifests these acupoints to reflect its own pathophysiologic decline. The SAs pinpoint the particular nerves, muscles, and other soft tissues directly affected by the injury, and PAs are selected to assist the SAs. The PAs and SAs belong to the same spinal segment, and needling PAs relaxes the muscles and soft tissues and improves blood circulation at the location of the nerve root; this process helps to desensitize the sensitized nerve endings. Also, PAs are located closer to the autonomic ganglionic chain; clinical evidence has shown that needling PAs balances the mutual interaction between sympathetic and parasympathetic nerves.

In treating pain symptoms, it is very important to find the most effective SAs, and this is equally true when treating non-pain symptoms. The practitioner must locate the tender SAs generated by the diseased organ because of the viscerocutaneous reflex whereby the diseased organ is able to sensitize some of the peripheral nerve endings. When there is no pain, however, it is more difficult to find the SAs because some tender points are innervated by the spinal nerves from the same spinal segment as the diseased organ and other tender points may appear on the spinal nerves from other segments because of intersegmental communication inside the spinal cord.

Some diseases or diseased organs may not produce detectable tender acupoints on the body surface, especially at an early stage of the disease. In these cases, selecting proper PAs provides sound therapeutic results. For instance, PAs along vertebrae T1 to T7 should be selected for respiratory problems such as asthma and PAs along vertebrae T5 to T12 should be selected for stomach problems such as a gastric ulcer. Knowledge of segmental innervation of internal organs helps the practitioner to select the proper PAs (see Chapter 5).

In general, treating non-pain symptoms, including numbness or tingling, is more difficult than treating pain symptoms. For instance, when we treat a patient with infertility, we will either succeed or fail; partial success is not possible. Although when using INMAS for non-pain symptoms it is not possible to have the same degree of accuracy in prediction, the INMAS quantitative evaluation nonetheless provides useful guidance because it evaluates the healing potential of each patient. This chapter presents several non-pain disorders as examples of using INMAS for treating non-pain symptoms. The symptoms presented are a few samples selected by way of illustration. There is no doubt that INMAS will also be effective in evaluating and treating many more non-pain symptoms than we have described here.

ASTHMA

Asthma is a condition that causes recurrent attacks of dyspnea (shortness of breath or breathlessness), with airway inflammation and wheezing due to spasmodic constriction of the smooth muscles of the bronchi.

Acupuncture needling can relax the spasmodic constriction of the bronchi, accelerate the absorption of mucus by the lining of the bronchi, and reduce the inflammation.

SINUSITIS

Sinusitis is an inflammation of one or more of the paranasal sinuses. The inflamed and swollen mucous membrane of the paranasal sinuses partially or completely blocks the opening between the sinuses and the nasal passage. The mucus that accumulates in the blocked sinus causes pressure on the sinus walls resulting in discomfort, fever, pain and difficult breathing.

Sinusitis can be caused by air pollution, allergies, nose infection, tooth infection, infectious diseases such as pneumonia and measles, physical injury, etc.

Treatment Protocol

The patient takes the supine position. Use the following acupoints:

1. HAs: all those accessible in the supine position. Please note that H19 infraorbital and H23 supraorbital are tender. Their sensitivity and the size of the sensitive area indicate the severity of the symptoms.

2. SAs: carefully palpate the area around H19 and H23. To improve nasal congestion, the nostrils should also be needled as shown in Figure 13-1.

Figure 13-1 Needling method for sinusitis and Bell’s palsy. In the case of Bell’s palsy, all the affected facial muscles should be needled.

To avoid bruising the patient’s face, use needles 1.5 cm in length and 0.18 or 0.20 mm in diameter.

NAUSEA

Nausea is an unpleasant sensation of the epigastrium and abdomen associated with a tendency to vomit. It can be a symptom of minor or serious disorders such as food irritation, chemical toxins, or an imbalance of the autonomic nervous system.

Nausea is usually felt when nerves in the stomach or other parts of the body are irritated. The irritated nerves send signals to the brain center(s) that controls the vomiting reflex. Vomiting results when the signals are intensified.

In addition to stomach disorders, intense pain in almost any part of the body can produce nausea, and strong emotional changes also trigger it.

Acupuncture is very effective in treating nausea due to the following mechanisms:

Additional mechanisms may also be involved, and all of these factors work together to reduce nausea and vomiting.

Treatment Protocol

Use both prone and supine positions. Each treatment may use one or two positions. Use the following acupoints:

1. HAs: all those accessible in the position used.

2. PAs: along T5-T12.

3. SAs: palpate the front epigastric region to find tender points. Use needles 2.5 cm in length and insert the needles diagonally and caudally.

4. Empirical point: on the ventral side of the forearm, a point approximately 5 cm above the wrist between the tendons of palmaris longus and flexor carpi radialis (Figure 13-2). Use a needle that is 2.5 cm long and 2 cm deep.

Figure 13-2 Empirical acupoint on the forearm for nausea.

(From Jenkins D: Hollinshead’s functional anatomy of the limbs and back, ed 8, Philadelphia, 2002, WB Saunders, p 144.)

DIGESTIVE DISORDERS, STOMACH ACHE, AND GASTRIC ULCERS

All stomach, duodenum, and intestine disorders, including ulcers, can be treated or helped by acupuncture needling. The treatment protocol for this group of disorders is the same as for nausea.

SKIN DISORDERS

Urticaria (hives) is a vascular reaction of the skin characterized by the appearance of slightly elevated red or pale patches (wheals) with severe itching. It may be caused by food, infection, emotional stress, or an allergic reaction to an insect bite or plant contact.

Neurodermatitis is an extremely variable eczematous dermatosis (skin thickening). It is a response to prolonged scratching, rubbing, or pinching to relieve intense itching.

Other general symptoms of skin reaction to insect bites or poisonous plants may include swelling, pain, or itching.

All of these skin symptoms respond very well to acupuncture needling. Itching is mostly a response to chemical stimulation that irritates the nerve endings; this is the underlying cause of allergic reactions of the skin. In addition, itching may originate with inflammation or infection, which can irritate soft tissues of the skin, including nerve endings.

Psychogenic factors can cause noninflammatory irritation of the cutaneous nerves, which produces itching.

Acupuncture needling improves blood circulation, which accelerates the deactivation of the allergen or the metabolism of the toxins. Needling and needle-induced lesions also desensitize the nerve endings. All of these physiologic processes reduce itching and promote tissue repair and regeneration.

GYNECOLOGICAL DISORDERS

Premenstrual syndrome (PMS), or premenstrual tension, consists of symptoms that arise during the period before menstruation or in the early days of the menstrual period. The symptoms may begin at the time of ovulation and become worse or fluctuate until menses. PMS can affect virtually every system of the body and produce behavioral changes. Physical symptoms may include headache, vertigo, common colds, rhinitis, asthma, sinusitis, sore throat, abdominal bloating, nausea, food cravings, breast tenderness, back pain, joint pain, edema, cramps, and other discomforts. The emotional and psychological symptoms may include irritability, fatigue, sleeping disturbances, mood swings, depression, and altered libido.

Menopause normally takes place between the ages of 40 and 58. About 75% of American women reach their menopause by the age of 52. The most recognizable sign of the beginning of menopause is menstrual irregularity, with a gradual decrease in both the amount and duration of flow. In some cases, there may be more frequent and heavier bleeding or bleeding between periods. When menses have ceased for 6 to 12 months, menopause has taken place.

Hormone changes, especially an increased production of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone, are responsible for physical and psychological symptoms. The most commonly reported symptoms include hot flashes of the face, neck, and upper body; excessive perspiration at night; vaginal dryness; joint pain and back pain; sleeping disturbances; and other physiologic changes.

Infertility is considered a pathological disorder after 1 year of engaging with the same sexual partner without conception. About 35% of infertility cases are due to female factors, the same percent to male factors, and the remaining 30% to a combination of both female and male factors. There is a possibility that acupuncture may help infertile female patients if the patient is confirmed by medical evaluation to have no other physical pathology such as infection, obstruction in the ovarian tube, tumor, and so forth.

BELL’S PALSY

Bell’s palsy (facial palsy), a neuropathy of the facial nerve, is characterized by weak or paralyzed muscles of facial expression on one side of the face, inability to wrinkle the forehead and close one eye, and a drooping corner of the mouth on the affected side. The chewing muscles are also weakened or paralyzed so food and saliva dribble out the affected side of the mouth. The onset of Bell’s palsy is often fairly abrupt. Pain behind the ear can precede the palsy by a day or two (the facial nerve exits the skull through the stylomastoid foramen behind the ear lobe). Some patients also complain of pain in the jaw or on the entire side of the face.

The weak and paralyzed muscles of facial expression result from the condition of the facial nerve, but the cause of this neuropathy is unknown. Some cases may be caused by exposure to cold, infection of the face, inflammation or physical injury of the facial nerve, or inflammation of other associated soft tissues along the path of the facial nerve from the skull to the muscles, such as middle ear infection or inflammation of the parotid gland. These swollen tissues apply pressure on the facial nerve and disable its motor function, leading to paralysis of the facial muscles. Bone fracture or tumors may also affect the facial nerve with a similar result.

Bell’s palsy is usually a short-term problem, but individual recovery is variable. About 80% of patients with this disorder will show improvement within 2 to 3 weeks and complete recovery within a few months. However, some patients recover so slowly that there is no noticeable improvement even after 6 months or more. We have seen a musician, a trumpet player, who showed no sign of recovery after 2 years. If the recovery is delayed for a long time, part of the facial nerve may degenerate or die as a result of the interruption in the supply of nutrition and oxygen and lack of stimulation from the muscles.

There are other types of facial paralysis with a different etiology. A stroke also can cause one-sided facial paralysis, and if both sides of the face are simultaneously affected, it may be due to Lyme disease (a recurrent multisystemic disease caused by a viral infection from tick bites) or other causes.

Sufferers from Bell’s palsy can benefit substantially from acupuncture therapy because it promotes self-healing by reducing inflammation and swelling, and by increasing blood circulation and therefore the supply of nutrition and oxygen. Although most cases of Bell’s palsy will heal slowly without intervention, acupuncture can accelerate the process, reducing the suffering associated with speaking, chewing, swallowing, drinking, eye-closing, and sleeping.

SIDE EFFECTS OF CHEMOTHERAPY

All the side effects of chemotherapy can be reduced partially or completely by acupuncture therapy. These include digestive disorders (stomach upset, constipation, and diarrhea), skin irritation (rash, itching), headache, and ringing in the ears.

Chemotherapy imposes a physiologic stress on the body that interferes with the normal mutual interaction between the sympathetic and parasympathetic nervous systems. The side-effects vary according to the nature of the drug and the body of the patient, but usually the weakest part of the body shows the side-effects first.

The central mechanism of the relief of these side effects is probably the secretion of endorphins at spinal and brain levels under the stimulation of acupuncture, either manual or electrical. These endorphins circulate in the blood stream to the entire body.

The consensus development statement of the National Institutes of Health also indicates that “There is clear evidence that needle acupuncture is efficacious for adult post-operative and chemotherapy nausea and vomiting and probably for the nausea of pregnancy.”

UNUSUAL SYMPTOMS WITH UNKNOWN UNDERLYING CAUSE

Here we refer to unusual symptoms that would be classified as “origin unknown” by conventional medical professionals. Consider the example below.

A healthy 28-year-old man presented for treatment. Since the age of 15, every few weeks he experienced headaches lasting for a few hours, red skin rash all over the body, a sensation of discomfort in the testicles, strange changes in taste, and blisters on the lips. He has visited doctors in Germany and the United States, but no one could make a certain diagnosis. We did not see the symptoms when the patient came to our clinic, but we were fairly sure that we would be able to help him because he was a healthy, athletic young man. We used supine and prone positions for each treatment, needling all HAs. The patient received one treatment every week continuously for 4 months. He has not experienced any of these symptoms since the first treatment 2 years ago.

This example shows that health problems with unknown underlying causes can be helped by acupuncture therapy as long as the symptoms are pathophysiologically healable and the patient is reasonably healthy.

GENERAL HEALTH MAINTENANCE

Many patients come to an acupuncture clinic for health maintenance, and their experience is that the treatment helps them to feel more relaxed, physically fit, youthful, and mentally alert. These patients show more coordination in their physical movements and their bodies are practically pain free. In some cases, there may be remnant pain, but they are much more able to live comfortably with it.

No healthcare providers can give their patients health. Patients have to make a conscientious effort to regain their health, and after regaining it, the same effort is needed to maintain it.

Acupuncture is a very beneficial modality for health maintenance. Our clinical experience indicates that for people with chronic problems, such as high blood pressure, or even Alzheimer’s disease or cancer, regular acupuncture therapy—although it does not remove the problems—will keep the body more functionally stable, with less accumulation of stress. Just as acupuncture helps sick persons to regain their homeostasis without pharmaceutical intervention, it is even more effective in general health maintenance.

SUMMARY

Acupuncture therapy, in principle, is a nonspecific means of promoting physiological balance and thus stimulating the process of self healing (see Chapters 3 and 4). There is enormous potential in using acupuncture for both pain and non-pain symptoms; however, in the case of conditions that are not painful, it is more difficult to predict reliable prognoses.