Acupuncture: a medicine that diverges as the science accumulates.

Acupuncture: a medicine that diverges as the science accumulates.

Age cannot wither her, nor custom stale. Her infinite variety.
– William Shakespeare

This is not a typical post for me, but something I have been meaning to do to satisfy my own curiosity. I have wondered, how many variations of acupuncture are there? I suspected a lot, but I thought I would go looking and make a list. Since acupuncture is not based in reality but is instead a collection of pseudo-knowledge, there is no reason for acupuncture to have fidelity to fundamental concepts. I suspect in the US that in the future acupuncture will become less heterogenous as schools start teaching to the test that allows for acupuncture licensure. For now variation rules.

So this will be a list, with description and commentary. If a missed form of acupuncture is noted by others, and I am sure I have, I will expand the list in an addendum.

Chinese acupuncture

The Granddaddy of acupuncture. Readers of this blog are well aware of the underlying fantasy of meridians and acupoints that comprise classic Chinese acupuncture.

If you are a lumper you could call this one style of acupuncture. If a splitter, it is hard to know how many styles there are. There are variations in the points used, with the number expanding over time and location on the body. There are points on meridians, points off the meridians and points that wander around the body (A-shi points). Even Dong evidently has unique extra-points.

Similarly there are also minor branching meridians off the main qi highway. It seems that any point on the body has the potential to be an acupuncture point, at least as long as it is not on the male genitals.

There is also variability in how the needles are placed and manipulated. It appears that with traditional Chinese acupuncture no one needles the same way:

We observed significant differences in rotation amplitude and duration in motion samples among practitioners. GAMM showed marked variations in average regression curves of motion patterns among practitioners.

There is Professor Wu Lian-Zhong‘s technique:

which is characterized as soft, flexible, fast, plucking and activating antipathogenic qi.

Or that of Professor Li Yan-Fang:

hold the needle with the right hand, press gently along the running course of meridians with the left hand to promote qi circulation, hard pressing should be applied at acupoints to disperse the local qi and blood, insert the needle gently and quickly into the subcutaneous region with the right hand, and stop the insertion when patient has the needling sensation. While the fast needling is characterized with shallow insertion and swift manipulation: the left hand of the manipulator should press first along the running course of the meridian, and fix the local skin, hold the needle with the right hand and insert the needle quickly into the acupoint. Withdrawal of the needle should be done immediately after the reinforcing and reducing manipulations.

Or the slow needle aka the Eric Clapton technique:

From the basic factors of slow needle insertion, the requirements of this manipulation, main points of 4 steps (to straight the needle, to press softly, to twirl the needle and to hold without brute force).

Professor Wu Lian-zhong prefers the four needling method:

4 needling methods, oblique needling, horizontal needling, deep needling and transversal needling.

But is countered by Professor Zheng Kui-shan and his innovative needling methods of “warm reinforcing technique” and “cold reducing technique”.

And we cannot forget the stylings of Professor WU Xu’s:

The main technique posture is one-hand holding needle with middle finger for pressing, the needle is hold by thumb and index finger, and is assisted by middle finger.

I know how important the middle finger can be in some human interactions.

Perhaps not as elegant nor as good as Professor Chen Quan-xin’s proper application of reinforcing-reducing manipulation. There is also the prizing technique although there are those who prefer the twirling reinforcing-reducing method or perhaps instead the force feedback method. But I still go with Professor WU Lian-Zhongs:

needling technique of ascending the clear and descending the turbid, clinical evidence-based needling technique at special acupoints.

“Ascending the clear and descending the turbid” should have been the motto of the blog.

I suspect that all the variations of how to needle that I found on Pubmed represent a fraction of the variations on the theme of traditional Chinese acupuncture.

In addition to traditional Chinese acupuncture there are also a variety of personal schools of acupuncture, all with their own master:

These are limited to the hagiographic descriptions on Pubmed; I suspect there are many more but lack the Chinese language skills for deep investigation.

Even the Chinese wonder about the validity of these styles:

The expression of DOU Han-qing on “playing a role of meridians, collaterals, qi and blood” is not so accurate, which is suggested to modify as “attaching the importance to needles.” “Theory of heaven, human being and earth” “theory of acupuncture on qi regulation” and “the eight therapeutic methods in treatment of disease” in Jinzhenfu (Ode to Golden Needles) are valuable academically and suggested to be supplemented. The expression of XI Hong on “reinforcing and reducing technique by following or against the running course of meridian” and the expression of XU Feng on “the magic turtle eight techniques” are not concrete. It is required to elaborate them in detail.

Really, what could be more concrete than the magic turtle eight technique? I would have suggested that the magic turtle 8 has a hazy reply try again.

  • All the above could be combined with electricity making electro-acupuncture. Or
  • Laser acupuncture: using lasers instead of needles. Or
  • Acupressure using pressure of the fingers instead of needles.

Japanese acupuncture

Japanese acupuncture uses thinner needles at less depth with less manipulation. They also have different form of pseudo-diagnosis:

Chinese acupuncturists use the patient’s pulse, tongue, and face to make their diagnosis. Japanese acupuncturists rely more on palpatory findings of the pulse, abdomen, back and meridians. They also look at the tongue, but do so more to tell what’s going on in the stomach and from there make their diagnosis.

So I guess the Chinese are doing it all wrong.

The Japanese also have their subsytems including:

Korean acupuncture

Korean acupuncture also has many varieties:

  • hand
  • ear
  • and they often use the Saam style (originated by a monk) which only use four needles as well as a unique, constitutional, method of pseudo-diagnosis
  • motion style acupuncture
  • VST (Vertex Synchronizing Techhique) Acupuncture

Others

  • Hook Needle

    With the unique structure and manipulation techniques of blood-letting and cutting, hook needle serves as a role in dredging meridians, removing blood stasis, purging heat for resuscitation and relaxing synechial tissues. There are three needling techniques of hook needle: swift pricking, bleeding and pricking.

  • The painful-appearing Wonli Acupuncture

    directly approaching the intervertebral foramen and interlaminar space with acupuncture needles

    and digging out tissues. Ouch.

  • Ankle-wrist acupuncture where they only put needles in the ankle and wrist
  • Five Element Traditional Acupuncture
  • 3-Phase Hand Acupuncture
  • Micro Acupuncture Point Systems (MAPS), with multiple variations, mapping the acupuncture homunculus on different parts of the body:
  • Sonoacupuncture: some using ultrasound waves on the acupoints while others use various tuning forks. It is the close cousin of:
  • Music acupuncture, using music instead of needles for an effect that

    is similar to a cleaning shower or deep massage on quantum, cell and molecular level.

    I do love me my quantum cleansing shower in the morning. I have a shower box for my cat. I have yet to open it.

And of course there is:

And we finish up with:

  • Kiiko Matsumoto-style acupuncture
  • Bee venom acupuncture
  • Cat gut acupuncture
  • Acupuncture injection therapy
  • Bloodletting acupuncture, not to be used if worried about infection transmission since:

    The current situation is that acupuncturists have understanding insufficiency in hospital infection management, lack the sterile concepts and consciousness of disinfection and isolation. Aseptic technic principles aren’t strictly followed; disinfection and isolation systems are unsound; sanitary condition of hand of medical staff is unsatisfied.

  • Moxibustion
  • Last and least, the most ridiculous form, Tong Ren, aka voodoo acupuncture where:

    the Tong Ren practitioner uses a small human anatomical model as an energetic representation of the patient, tapping on targeted points on the model with a lightweight magnetic hammer.

    Really. Not a joke. Watch a video but not, I repeat NOT, with liquids in your mouth.

I am saddened to note that there is no beer acupuncture, although that may represent an opportunity for someone with fewer scruples than I.

So let’s see. All told that’s a minimum of 32 styles if a lumper, double or triple if you want to add electricity or lasers to an existing style. More if you add a particular style of needle manipulation. All equally valid and equally efficacious, right? So many permutations on a theme of pseudo-knowledge.

Dr. Novella refers to acupuncture as theatrical placebo. It would appear to be a multitude of one-act plays, all farce.

 

 

Posted by Mark Crislip

Mark Crislip, MD has been a practicing Infectious Disease specialist in Portland, Oregon, since 1990. He is a founder and  the President of the Society for Science-Based Medicine where he blogs under the name sbmsdictator.

He has been voted a US News and World Report best US doctor, best ID doctor in Portland Magazine multiple times, has multiple teaching awards and, most importantly,  the ‘Attending Most Likely To Tell It Like It Is’ by the medical residents at his hospital.

His growing multi-media empire can be found at edgydoc.com.