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 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. [TOP]
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. [TOP]
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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