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Acupuncture

Paolo Amori¹ and Liguori Aldo²

¹ Centro Studi per la Ricerca Multidisciplinare e Rigenerativa, Università degli Studi Guglielmo Marconi, Rome, Italy

² Department of Anatomic, Histologic, Forensic Medicine and Locomotor System Sciences, Faculty of Pharmacy and Medicine, Paracelso Institute, Sapienza University, Rome, Italy

Introduction

Acupuncture today in many Western countries is used with good results for the treatment of skin diseases. Numerous studies have been published on the mechanisms of acupuncture action, on its safety, and on its effectiveness in skin diseases such as itching, acne, psoriasis, urticaria, herpes zoster and post‐herpetic neuralgia, melasma, and others [1–4].

In this discussion, however, we will avoid comparing Western and Chinese Medicine. In fact, our aim is to provide a general view of the matter, with its peculiarities as it has developed over the centuries, becoming a complete medical system even if different from the Western one.

According to ancient Chinese philosophy, all observable phenomena in nature have a dual aspect. e.g. day and night, heat and cold, water and fire, etc. By observing phenomena, or things, we can compare one with the other according to their own characteristics. This is described by the Yin and Yang Theory. In general, all that is quiet, inward, descending, cold, and physical refers to yin, while all that is active, outward, ascending, warm, and functional refers to yang. Yin and yang have a relationship that is not absolute but relative, and they are interdependent to each other [5].

In Traditional Chinese Medicine (TCM), the different organs and functions of the body are described as belonging to the yin or yang.

Qi symbolizes the fundamental substance that constitutes the universe. Everything in the cosmos was generated by qi, more precisely by the “essential” qi. All phenomena are produced by the changes and movements of qi. Also the living beings are formed by qi, and their life’s activities are originated by the movements of qi [5]. So, in TCM, qi represents both the fundamental substances of the body that allow its vital activities, and its functional activities. In the body, qi is classified according to its origin and function.

The material world consists of five fundamental elements: Wood, Fire, Earth, Metal, and Water. All phenomena or things existing in nature, by analogy, may be classified as pertaining to one of these elements. Between the five elements there is a relationship of continuous movement and change, regulated by the Law of Movement of the Five Elements [5]. This law establishes that between the five elements there is a constant relationship of interpromotion, interaction, overaction, and counteraction. To promote means to grow. This relationship is known as “mother–son” relationship. So, each element that promotes another is the mother, and each element promoted by another is the son. To interact means keeping under control. Each element keeps under control the following one. To overact symbolizes launching an attack on a weak counterpart. It means that one element acts excessively on another which it normally acts on. To counteract means to oppose the action of the preceding element.

The internal organs of the human body (the Zang‐Fu) can also be attributed to the five elements, and the Law of Movement of the Five Elements can explain the physiological and pathological relationships among them [5, 6].

According to TCM, in the human body there are six Zang Organs, six Fu Organs, and six Extra Fu Organs. The Zang organs are the heart, pericardium, lung, spleen, liver, and kidney. The Fu organs are the small intestine, triple energizer, large intestine, stomach, gallbladder, and bladder. The Extra Fu organs, finally, are the brain, marrow, bones, vessels, uterus, and gallbladder. The latter, despite being a fu organ, not receiving food or water, and storing bile, is also counted among the Extra Fu Organs. The pericardium, a thin membrane that surrounds the heart, is normally considered as its appendix. The triple energizer symbolizes several functions of the zang‐fu. The zang organs, from a general point of view, transform and store essence, qi, blood, and body fluids. The fu organs, instead, receive and digest food and excrete the wastes [5, 6].

Normally, a state of equilibrium exists between the living being’s body and the surrounding environment. This equilibrium is actually a dynamic state of adjustment between the body’s normal physiological activities, and the exterior environmental stimuli. When the body manages to adapt to exterior stimuli, the individual remains in a state of health. When external stimuli are too strong and/or the body is unable to adapt properly, a state of disease is established. In other words, when environmental factors exceed the body’s ability to adapt, then disease begins [5, 6].

Pathogenic Factors

The factors that cause a disease, in TCM, can be divided into three groups: the six exogenous factors, the seven emotional factors, and the heterogeneous pathogenic factors. Each pathogenic factor produces a characteristic symptom and/or sign. Thus, by analyzing the clinical manifestation of a disease in an individual, TCM is able to recognize what pathogenic factor is involved in this disease [6–8].

Six Exogenous Factors

The six exogenous factors are similar to what happens in the nature that surrounds us: wind, cold, summer heat, dampness, dryness, and fire. These factors are able to cause illness when they act in an extreme or sudden way, or when the body’s resistance is poor. All of them attack the body from the outside to the inside, alone or in combination with each other. Under certain conditions, all of them can transform each other.

The prevailing exogenous pathogenic factor is the wind. Its most important characteristics are: to be a yang factor, which therefore often attacks the upper part of the body; to manifest it in gusts and change quickly; and to move fast. For example, the itching that appears in the upper body is a typical wind manifestation [9].

The cold is a yin pathogenic factor, characterized by contraction and stagnation. The cold can consume the body’s yang qi and cause loss of body heat. As a result, shiver, tremor, pallor, cold limbs, diarrhea, and polyuria may appear. An example of disease caused by cold (precisely, by wind‐cold) is Raynaud’s disease [6–9].

Summer heat is a yang pathogenic factor. Thus, it has upward direction and is characterized by dispersion. It can cause excessive sweating, with the consumption of body’s fluids. Often it is associated with dampness. Heat injuries can be red macules or yellowish abrasions, accompanied by fever, thirst, dry mouth, and scant and concentrated urine [6–9].

Heaviness, turbidity, viscosity, and stagnation are the characteristics of dampness. The general symptoms caused by dampness are a sense of heaviness in the head, a feeling of fullness in the chest, and a sticky mouth. All body discharges are turbid and suppurating. Vesicles, boils, edema, and erosions, often secreting and itchy, can occur on the skin. Features are the fixity and the swelling of the injuries [6–9].

Dryness is a pathogenic factor that consumes the body’s yin fluid, causing dryness of the nose, mouth, and throat, constipation, and reduction of diuresis. The skin will appear dry, wrinkled, chapped, thickened, and flaky. The hair will appear brittle and dry [6–9].

Fire is a yang pathogenic factor, having upward direction. It can consume the body’s yin fluid. The symptoms caused by fire are fever, thirst, sweating, headache, congestion of the eyes, constipation, and concentrated urine. The pathogenic fire raises the wind, causing blood troubles, such as hemorrhage. Pustules, papules, and crusts can be due to fire in the skin [6–9].

Seven Emotional Factors

The Seven Emotional Factors are joy, anger, melancholy, worry, grief, fear, and fright. These factors are nothing more than the normal emotional responses to external stimuli. However, if they are very intense or persistent, such as to overcome the normal adaptability of the individual, then they become a cause of illness [6–8].

There is a particular susceptibility of every internal organ to be struck by a certain emotion. For example, anger hits the liver, joy the heart, pain and melancholy the lung, worry the spleen, fear and fright the kidney. The heart, liver, and spleen are the internal organs most affected by emotional factors [6–8].

Heterogeneous Pathogenic Factors

The Heterogeneous Pathogenic Factors include improper diet, overstrain, stress, lack of physical exercise, traumatic injuries, phlegm, and stagnant blood [6–8].

Excessive food intake, or intake of contaminated food, may damage the gastrointestinal function. Insufficient food intake can instead cause a lack of qi and blood.

Overstrain and stress consume the body’s vital energy. Lack of physical exercise, on the other hand, can impair the circulation of qi and blood.

Dysfunction of water metabolism can cause condensation in a part of the body fluids, thus giving rise to phlegm. The phlegm is the conceptualization of both something that gives rise to solid masses, usually subcutaneous, and a functional alteration that manifests itself with symptoms such as expectoration of sticky mucus, feeling of fullness in the epigastric and abdominal regions, nausea and vomiting, and more.

Stagnant blood refers to both internal bleeding causing blood accumulations, and disorders characterized by localized pain, hemorrhages, ecchymosis, or petechiae.

Meridians and Acupuncture Points

TCM postulates that qi and blood spread through the whole body into channels that flow between bones and muscles, connecting all the zang‐fu and the body’s parts each other. These channels are called meridians (Jīngluò). Twelve main meridians and eight extraordinary meridians are described. There are also 15 collaterals, which run transversely and more superficially, constituting the branches of the meridians. The acupuncture points are distributed on the 12 main meridians and on two of the extraordinary meridians, the Governor Vessel (Du Mai) and the Conception Vessel (Ren Mai) meridians [5–8].

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