Page 321 Guide to Pain Management in Low-Resource Settings

Role of Acupuncture in Pain Management 309

Medical treatment starts with the analysis of the entire Qi of the channels rise close to the surface of the body.
system, and then focuses on the correction of patho- Twelve main channels have been described, six of which
logical changes through readjusting the functions of are yin and six which are yang, and numerous minor
the Zang-Fu organs. Evaluation of a syndrome not only channels, which form a network of energy channels
includes the cause, mechanism, location, and nature throughout the body. Each meridian is related to, and
of the disease, but also the confrontation between the named after, an organ or function. Th e main meridians
pathogenic factor and the body’s resistance. Th erefore, are lung, kidney, gallbladder, stomach, spleen, heart,
two people with an identical disease might be treated in small intestine, large intestine, gallbladder, urinary blad-
diff erent ways, and on the other hand, diff erent diseases der, san jiao (“triple warmer”) and pericardium. It is be-
may result in the same syndrome and be treated in simi- lieved that when Qi fl ows freely through these merid-
lar ways. Th is is true for some chronic diseases. Pain can ians, the body is balanced and healthy, but if the energy
be simply interpreted as a Qi stagnation and be treated becomes blocked, stagnant, or weakened, it can result in
pragmatically, with Chinese orthopedic acupuncture. physical, mental, or emotional ill health.
TCM also focuses on the “balance” within the
patient. According to this view, an imbalance in a per- What does a meridian look like?
son’s body can result from inappropriate emotional re- A meridian does not follow conventional anatomical
sponses such as excess anger, overexcitement, self-pity, structures, and the designation of meridians is only un-
deep grief, or fear. Environmental factors such as cold, derstandable in the context of TCM. Th e nomenclature
damp/humidity, wind, dryness, and heat can also cause follows a certain logic in this context. Th e localization of
imbalance, as do factors such as wrong diet, too much meridians (and acupuncture points) may diff er depend-
sex, overwork, and too much exercise. To restore the ing on the literature resource (which is also true among
balance, the acupuncturist stimulates the acupunc- practitioners in China).
ture points that will counteract that imbalance. In this
How are the various acupuncture
way, acupuncture is believed to rebalance the energy
points classifi ed?
system and restore health or prevent the development
of disease. Th e earliest written account of this system Although locations and functions of acupuncture points
is found in the Nei Jing (Th e Yellow Emperor’s Classic may vary according to diff erent authors, the main struc-
of Internal Medicine). Th is document is believed to be ture of classifi cation is rather uniform. First of all, acu-
from around 200 BCE to 200 CE and is one of the oldest puncture points are situated along 12 “organ-related”
comprehensive medical text books. meridians; then there are eight extraordinary meridians
in acupuncture that are considered to be reservoirs sup-
What is the idea behind the acupuncture points? plying Qi and blood to the 12 regular channels. Dotted

As described, the idea of harmony and balance is very along these meridians are more than 400 acupuncture
important in acupuncture. Th e concept that underlies points, which have been also classifi ed by the World
balance is the opposing principles of yin and yang. Th e Health Organization. Th ese are listed by name, num-
principle that each person is governed by opposing, but ber, and the meridian to which they belong. Besides the
complementary, forces of yin and yang, is central to all classifi cation, we fi nd by experience that points on the
Chinese thought. Yin and yang are the opposites that same meridian may have common eff ects. Another type
make the whole. Th ey cannot exist without each other, of acupuncture points are the “extra points.” Th ey have
and a situation or person could neither be 100% yin nor specifi c names and defi nite locations, but are not attrib-
100% yang. Life is possible only because of a balanced uted to the meridians. Th ey may be selected in certain
interplay between these forces. diseases. Ashi points (“tender spots”) are often used in
According to TCM, these complementary forc- patients with acute pain syndromes. Local tenderness
es of yin and yang infl uence the life energy or Qi (pro- when manually palpating the patients identifi es an Ashi
nounced “she”). Qi is thought to circulate throughout point. Th erefore, these points have no specifi c names
the body in invisible channels (other translations of the and defi nite locations. Ashi points are considered to
Chinese term jing luo include “conduit” and “meridian”). represent the earliest stage of acupuncture point evolu-
Th e acupuncture points (or holes, as the Chinese term tion in China and may be also considered as appropriate
xue is more aptly translated) are the locations where the acupuncture points for a physiological pain approach to