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Home > Newsletters > February 2008 > Acupuncture Styles

Acupuncture Styles

By Jake Paul Fratkin, OMD

Styles of Acupuncture:

Acupuncture originated in China, with its organization and description first found in the Nei Jing (Classic of Internal Medicine). The oldest existent copy of the Nei Jing dates back to 170 BC, but no one knows how old the art of acupuncture actually is. The Nei Jing describes the nature of qi (energy; pronounced chee in Chinese and ki in Japanese), its effects on the major organs, routes of the major acupuncture channels, the locations of points, techniques for stimulation, causes of disease and methods for treatment.

There are actually many different styles of acupuncture that have developed in China, Japan, Korea, Vietnam, and recently in England and France. In the United States, all of these styles can be found, as well as uniquely American syntheses of the various approaches. I practice traditional approaches from the Japanese and Chinese traditions.

All of the styles (with the exception of a new medical acupuncture system based on modern neurology and physiology) accept common principles. Fundamentally, health and disease are a reflection of the status of qi in the body. Qi, which is the body’s bio-energy, flows sequentially through 12 primary channels on each side of the body. Each channel feeds a primary organ (e.g. lung, heart, spleen-pancreas, kidney, etc.) as well as the musculoskeletal structures along its path. The qi of the channel keeps all tissue along its path healthy and vibrant. The lion’s share of a channel’s qi goes to its designated organ, allowing for healthy and normal functioning of that organ. Health is the maintenance of good quality qi and good circulation of qi and blood throughout the body, so that all the organs may function optimally.

Acupuncture channels surface at regular places at the acupuncture points. The Chinese liken this to a chimney, a hole dropping from the skin down into a channel. These points exist to aid homeostasis with the external environment, and the Chinese discovered that these points could be manipulated to affect health. Discovery of acupuncture channels and points probably goes back to deep meditation practices developed in Chinese monasteries.

Manipulation of acupuncture points regulates the energy within the channels. This manipulation is done by either metal needle or small burns performed with moxibustion, the burning of a specific herbal fluff. I believe that the miniscule injury caused by puncture or burn promotes healing at the site of the wound, which continues to be fed into the acupuncture channel. Also, the metal needle acts as an antenna to equalize the energy of the outer skin with the energy of the acupuncture channel.

Besides affecting the skin energetics, needles can also impact the plexus of nerve, blood vessel and fascia, allowing relaxation of internal spasm and greater flow of internal nerve and blood function. This is the basis for medical acupuncture. Bruce Pomerantz, MD, Ph.D., the Harvard trained scientist who discovered the relationship of acupuncture to endorphin release in 1975, has said, “I have spent the last 25 years proving that acupuncture treats pain. I shall spend the next 25 years proving that acupuncture promotes healing.”

Styles of Acupuncture:

JAPANESE ACUPUNCTURE
There are actually 30 different styles of acupuncture under the umbrella of Japanese acupuncture. The type that I follow belongs to the Meridian Therapy School. This classical approach is based on the 3rd century text Nan Jing (The Classic of Difficulties), and revived in Japan in the 1930s. Meridian Therapy proposes that health is dependent on an equal distribution and movement of qi throughout the channels. This is to say that all twelve acupuncture channels should have an equal amount of qi in them. Disease and disorder — whether it is due to organ weakness, trauma, toxic microbes or emotional stress — will be seen as excesses and deficiencies of energy in various channels. The job of the acupuncturist is to restore all twelve channels to equal levels. Then the body heals itself efficiently and quickly.

My clinical experience has shown me that the Japanese idea of balancing the acupuncture channels, or meridians, is more effective that the Chinese approach, offering benefits in half the number of treatments. When the channels are in equilibrium and balance, the body heals very quickly, despite the myriad array of different symptoms.

The status of the acupuncture channels — perceived as excesses or deficiencies — is diagnosed through pulse differentiation and skin palpation. Pulse diagnosis for Meridian Therapy can discern six pulses on each wrist, each corresponding to a different acupuncture channel. It is relatively easy to see certain channels as excess and other channels as deficient. In Meridian Therapy diagnosis, one of five different patterns of imbalance will emerge, and the acupuncturist treats the primary pattern with a few needles. This allows all the channels to come back into balance, lasting for 3 to 7 days, at which time another treatment is given. After 4-6 treatments, the body will tend to hold the balance for a longer period of time.

Skin palpation reveals which specific acupuncture points will effectively change the qi of the channel. This is done by feeling, and takes many years of experience to perfect. In my own case, I learned this first by muscle testing my own fingers at an acupuncture point, and eventually trained myself to feel places of excess and deficiency. In my treatments, I only place needles where the body indicates that it needs one.

Japanese acupuncture also includes Sawada style treatment, the use of acupuncture points known to have beneficial effect on health and Vitality regardless of meridian imbalances. These points can be treated with needles, or small pieces of moxa that are burnt on the acupuncture point. I also use Ishizaka spine stimulation, a 17th century technique that benefits the organs by stimulating spinal nerves.

Japanese style acupuncture uses very thin needles with very shallow insertion (about 2 mm), distinguishing it from Chinese style acupuncture, which uses heavier needles and deeper insertion. In fact, the Japanese approach is almost invisible, without pain or heavy sensation, and I frequently use it on children. The Japanese feel that very superficial stimulation — just below the skin — affects the energetics more effectively than deep needling.

The school of Meridian Therapy that I practice follows Shudo Denmai, a famous Japanese teacher and author. As part of my academic work, I teach Shudo Denmai style, and help edit the North American Journal of Oriental Medicine (NAJOM), a journal devoted to Japanese acupuncture.

Worsley style Five Element Acupuncture is based on the same point selections as Meridian Therapy, and was directly inspired by the 20th century teacher Yanagiya Sorei, a founder of the Meridian Therapy school. The Worsley School, however, never adapted the superficial needling techniques typical of Japanese style, nor did they learn the branch treatments offered by Sawada and others, allowing application for day-to-day symptoms and complaints. Instead, they focus on root treatment, and therefore offer treatments for constitutional enhancement and psychological disorders.

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CHINESE ACUPUNCTURE
In general, Chinese acupuncture refers to the style of acupuncture that has been taught in TCM (Traditional Chinese Medicine) schools in China since 1949, and is the main form of acupuncture taught in American acupuncture schools. Probably 85% of American practitioners, especially the newer ones of the last 15 years, practice Chinese acupuncture. This style uses thicker needles and deeper insertion than the Japanese style. In China, it is encouraged that each needle elicits a de qi response — that is, a deep, radiating sensation with each needle. Chinese patients depend on this reaction to know that the needle will have a good effect. In the hands of master Chinese practitioners, this technique is not very painful, though it can feel sore and distended.

The healing method of Chinese acupuncture differs significantly from Japanese. Although using the same acupuncture points and channels, Chinese style chooses points based on expected affects to a particular problem area. They often utilize a 3-point combination to address a particular complaint, known as local, distal, remote. For example, if the main complaint is stomach pain, the Chinese approach would choose a point local to the complaint on the abdomen, a distal point on the arm or leg that is on an acupuncture channel that directly crosses the area of complaint, and finally, a remote point on the arm or leg channel not directly related by channel to the complaint, but one that is known to have a beneficial effect on that area (e.g.: Ren 12, St 36, PC 6 for epigastric pain.)

This approach differs from the Japanese idea of balancing the qi (energy) of the channels as the healing method. Instead, the Chinese approach hopes to focus and direct qi from the needle towards the area of complaint, in effect promoting healing to an isolated area. The success of this approach is often enhanced by the qi gong ability of the practitioner, and in fact in China many acupuncturists are known by their qi gong ability and practice. (In my year of study in China, I learned this technique, which I now employ.)

A consequence of the Chinese method is that it needs to be directed towards a particular complaint. When illness is multi-layered or multifaceted, it is less efficient than the Japanese approach of systemic balance. In fact, in China, acupuncture is mostly used for isolated or focused complaints, and in particular, musculoskeletal pain and recovery from trauma. Here the deep needling, directed towards neuro-vascular-muscular bundles, can have remarkable effects. In this regard, application of electrical stimulation using microamperage current is useful. When I address musculoskeletal complaints, I tend to use the Chinese approach.

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THE TAIJI YIN YANG TREATMENT
I use Chinese acupuncture in another way, not related to modern TCM. This is a system of point choices developed in Taiwan and promoted by Drs. Chao Chen, Wei-Chieh Young (Yang, Weijie) and Richard Tan. Collectively, they call this approach Taiji Treatment, indicating that it balances the yin and the yang of the body. (In China, taiji refers to the familiar yin-yang symbol.)

I have adopted and synthesized the various Taiwan approaches, and call it the Tai Ji Yin Yang Treatment. This is a general balance of all the channels, created by treating all 12 acupuncture channels, but alternating yin and yang channels by limb. Like Japanese Meridian Therapy, it equalizes and tonifies the essential qi of the body, but in addition, it robustly circulates the qi. In my protocol, we use points on the front side from the primary channels; this works to tonify and balance the internal organs. The backside balances the points of the Eight Extraordinary Channels (a secondary channel network), and chooses points that, taken together, balance the musculoskeletal structure of the body. In this way the yin (the organs) and the yang (the structure) are brought into balance. In the taiji balance of both the primary channels and the eight extraordinary channels, we alternate chosen points on each limb — one leg uses only yin channel points, the other leg uses only yang channel points; one arm uses only yin channel points, the other arm uses only yang channel points. In this way, the energy is forced to spiral through the body.

In my approach, different from the Chinese originators, I use shallow Japanese needle technique with thin needles. Also, I muscle test and feel the skin so as to choose only those points requiring treatment. When I teach this system, however, I recommend treating points on every channel, which doesn’t require the muscle-testing technique.

I have found that this approach enhances the immune system, restores Vitality, and promotes healing throughout the body. After twenty-six years in practice, and deeply examining all of the numerous acupuncture approaches, I have come to the conclusion that this is the most effective form of acupuncture I can do. In fact, I do this treatment every time now, regardless of the complaint, because it benefits all complaints and symptoms. I may also add in other points to additionally address specific symptoms, but every patient receives this treatment for the foundation.

Patients who are sensitive to energetic flow within their body have expressed great reviews for this treatment, seeking it out on a regular basis. They feel the benefits immediately. Other patients feel the benefit sometime over the next 24 hours, as enhanced Vitality and well-being. Patients with a complex of physical complaints notice improvement of their symptoms after 3 or 4 treatments. In general, patients coming in for specific problems are recommended a series of 4 to 6 treatments at weekly intervals. For maintenance, receiving a Taiji Yin -Yang treatment once monthly is beneficial for maintaining energetic balance so as to cultivate health, Vitality and longevity. At this point in my career, I would like to be known as the acupuncturist who gives Taiji Yin-Yang treatments.

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PEDIATRIC ACUPUNCTURE
Pediatric acupuncture is highly developed in both China and Japan, and I am happy to have had the opportunity to study both systems in some depth. The Chinese approach uses either needles or massage (pediatric tui na). The needle approach uses the same point choices as the TCM used for adults, and frankly, is a bit painful for American pediatric patients. The tui na massage focuses on the whole body, is very gentle, and quite effective on infants.

Japanese shoneishin borrows from the Chinese whole body massage approach, but uses small tools to affect the acupuncture channels. These tools are used to scrape, tap, or comb the skin, and the approach I follow uses the idea of Meridian Therapy — to balance the yin and yang energy of the channels. It is a whole body treatment, and is used on children up to 3 years of age for conditions such as irritability, pain, teething, earache, colic, asthma, common cold, constipation or diarrhea, and fever. Shoneishin is very effective on infants. It is painless, and infants seem to genuinely enjoy it.

For older children, starting at age 5 or so, I will use very thin needles (the “greens”, our thinnest needle) to great therapeutic effect. Children, like adults, hardly sense that the needles are in place. I choose points according to Japanese Meridian Therapy system, or the Taiji Yin Yang Treatment. I only use needles on children when I have their permission and participation. For children between the ages of 3 and 5, or for older children fearful of needles, I use a laser device on the acupuncture points. Because children’s energy is large and pervasive, acupuncture or non-needle shoneishin or laser are all very effective.
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EUROPEAN ACUPUNCTURE
There are uniquely European approaches to acupuncture that are worth mentioning, even though I do not practice them. Looking at these systems explains some of the other acupuncture trends (besides Chinese and Japanese styles described above) currently available in the United States.

The French embraced acupuncture early in the 20th century, and medical doctors continue to make a specialty of it. There are three or four major schools there, most of which were inspired by Nguyen Van Nghi in the 1960s and 70s. Van Nghi (pronounced Van Ghee) came as an 18 year old to Marseille to study medicine, but he brought along classical texts from his native Vietnam. Basically self-taught, he created a system that specialized in secondary channel treatments. His most authentic follower in France is Dr. Tran Viet Tzung, but Van Nghi had other students who developed their own systems.

Dr. Mossad, a French Algerian, created a system of acupuncture dependent for diagnosis and point location on the original eight trigrams from the Yi Jing (I Ching). He passed his system on to Dr. Joseph Helms, an American who went on to create and lead the medical acupuncture movement in the United States, taught at UCLA. It is curious that American medical doctors wishing to study acupuncture for simple symptom control or treatment of musculoskeletal problems end up in this system, a very philosophical and complicated acupuncture approach. One would hope that other avenues of medical acupuncture will also emerge, such as TCM (see Chinese Acupuncture) or even a strict neurophysiological approach such as that advocated by Dr. Yuntiao Ma.

Other French approaches include the constitutional system of Yves Requena and the ear system developed by Nogier. Requena’s system takes a medical diagnosis such as glaucoma or hypertension, and then divides treatment according to six constitutional types. The constitutional types are determined by personality profile and hand morphology. It is a very effective and clever system, but has few practitioners in the United States. The Nogier ear system uses over one hundred acupoints strictly on the ear, corresponding to various physiological or anatomical locations of the body. It is quite popular in France, with some dedicated followers in the United States. The Chinese actually borrowed from Nogier and added ear acupuncture to TCM.

All told, one survey found 20% of French medical doctors practicing some form of acupuncture in their clinics on at least a part time basis.

The most enduring of several acupuncture systems that have emerged in England is Five Element acupuncture. Developed by J.R. Worsley, originally a physical therapist, this system borrows point choices from classical Nan Jing acupuncture (see Japanese Acupuncture). Five Element acupuncture has a loyal if not cult-like following, both among patients and practitioners, and is helpful for promoting constitutional health and treating emotional dysfunction. Unfortunately, as a medical approach, most practitioners are unable or unwilling to look beyond their system at broader acupuncture or naturopathic methods for facilitating symptom and disease control.


My name is Jake Paul Fratkin and I am a Doctor of Oriental Medicine. I have been in practice for more than 25 years, and specialize in Japanese style acupuncture and Chinese herbal medicine. I often support these therapies with nutritional medicine.

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