Acupuncture Supplies

Acupuncture Supplies

HISTORY AND GENERAL PRINCIPLES

Electro-acupuncture, the application of a pulsating electrical current to
acupuncture needles as a means of stimulating the acupoints, was developed
in China as an extension of hand manipulation of acupuncture needles around
1934. It is described, though only briefly, in most comprehensive texts of
acupuncture (1-4). The procedure for electro-acupuncture is to insert the
acupuncture needle as would normally be done, attain the qi reaction by hand
manipulation, and then attach an electrode to the needle to provide continued
stimulation. The benefits of using electrical stimulation are:

It substitutes for prolonged hand maneuvering. This helps assure that the
patient gets the amount of stimulation needed, because the practitioner may
otherwise pause due to fatigue. Electro-acupuncture may also help reduce
total treatment time by providing the continued stimulus. During
electro-acupuncture, the practitioner can attend to other patients.
It can produce a stronger stimulation, if desired, without causing tis sue
damage associated with twirling and lifting and thrusting the needle. Strong
stimulation may be needed for difficult cases of neuralgia or paralysis.
It is easier to control the frequency of the stimulus and the amount of stimulus
than with hand manipulation of the needles.
The main disadvantage of electrical stimulation of acupuncture needles is the
lack of direct practitioner participation in this aspect of acupuncture therapy and
the associated limited opportunity for the practitioner to respond to changes
that are taking place during treatment. However, for practitioners who, after
inserting and initially stimulating the needles, normally leave the patient to rest
undisturbed without performing prolonged needle manipulation,
electro-acupuncture can provide a significant benefit: replacing the missing
stimulus that is recommended by most experienced acupuncturists in China .

Although electro-acupuncture may be used as a component of nearly all
acupuncture treatments that require manipulation of the needles, according to
the Chinese literature, especially good results are expected from
electro-acupuncture treatment of neurological diseases, including chronic
pain, spasm, and paralysis. In patients with serious cardiac diseases,
however, the method should be used with caution. It is generally
recommended to avoid placing electrodes near the heart, as the heart can
respond adversely to electrical impulses, and the path between any two
electrodes should not cross the heart area, despite the low current that is
used. Some have suggested avoiding placing electrodes to needles on both
sides of the spinal cord (e.g., for Hua Tuo or bladder meridian points),
because of the possible effect of the electrical stimulus on the nervous
system. Points are generally selected in pairs for electrical pulse stimulation,
with 1-3 pairs at one time, and the pairs are usually on the same side of the
body.

THE USE OF ELECTRICAL STIMULATION DEVICES
The electro-acupuncture device is not intended to provide a significant current
between the acupuncture needles: it delivers less than a milliampere (modern
devices usually have an upper level of 0.6 milliampere), about the same as
that produced by a wristwatch battery. But, it will provide a significant voltage:
40-80 volts (with short spikes as high as 130 volts), which is the basis for the
patient response. In the commonly-used portable battery devices, this is
accomplished by boosting the voltage output of the battery, such as raising the
voltage from 9 volts to 45 volts. Thus, there is virtually no current transmitted
through the body, but there is enough of a local voltage stimulus for the patient
to feel an evident reaction at the point where the needle is inserted.

Duration of standard treatment with electro-acupuncture is usually 10-20
minutes and rarely exceeds 30 minutes. The electrical pulsing stimulus is
used in a few cases for an hour or more, especially for difficult to treat
neurological disorders. During the stimulation period, the patient may become
adapted to the stimulus (this will typically happen after the first minute or two),
with a gradual decline in response. The electrical output should then be
adjusted in frequency and/or intensity to resume the sensation. Variable
frequency output of the electro-acupuncture device is sometimes utilized in an
attempt to circumvent this adaptation.

Electro-acupuncture is normally administered with alternating current.
Therefore, the two electrodes in any pair are equivalent, even if they are color
coded to distinguish them. Some devices allow a direct current
(non-alternating) setting, but the use of this has been discouraged, as mild
adverse effects might occur if the pulsing of the current ceases for any reason
(i.e., device defect). Further, it has been suggested, though it remains to be
proven, that the adaptation to the direct current may be more rapid than to the
alternating current. When it is said in electro-acupuncture literature that "the
negative electrode is attached to what is considered the main point, while the
positive electrode is attached to a secondary point," the statement has no
relevance when using an alternating current.

The device to be used for electro-acupuncture (see Figure 1 for modern
example) must have good control over its voltage output to avoid excessive
electrical stimulation, namely an unexpected higher voltage pulse that causes
pain or muscular contraction, and to assure that the frequency and intensity is
maintained as set by the practitioner. Informal testing of devices has showed
that some are erratic in their output, so older devices, and those not produced
with adequate quality control measures, are to be avoided. A device commonly
used in China is the G6805 or G6805-2 electric stimulator.

The device should not be turned on until after the acupuncture needles are in
place and the electrodes connected. All changes in the electrical stimulus
should be carried out gradually. It is normal for the patient to experience
responses such as rhythmic spasm or weak twitching of the muscle
(frequently visible to the practitioner), as well as the usual "deqi" reactions of
acupuncture therapy: sensation of numbness, distention, and/or heaviness.
The stimulus intensity, set by a voltage-adjusting knob on the device, should
be in the range between the minimum amount needed for the patient to sense
its effect and the minimum amount that produces an uncomfortable reaction;
care should be taken to limit the muscle twitching to a mild response. Areas
that are particularly sensitive to electrical stimulation are the face and regions
below the elbow and knee. These areas should be treated initially with a very
low intensity voltage. Patients who have not had acupuncture previously should
receive standard acupuncture first to assure that they tolerate the treatment
well, before moving on to electro-acupuncture, which may yield a stronger
sensation.

The wave form (squared off or sharp; dense, sparse, mixed dense and
sparse, or interrupted; see Figure 2 for sample outputs) can provide slightly
different responses and must be tried for each patient to evaluate their
suitability. Claims that one form is tonifying and another is dispersing may not
be justified due to lack of adequate testing to support such differentiation of
effects. A continuous wave (frequency doesn't change over time) is most
similar to what acupuncturists in China attempt to administer by the manual
method. The overall frequency of stimulus (either by continuous wave or
pulses of dense waves) should be set similar to the frequency that would be
used in manual stimulation by twirling or lifting/thrusting. Frequencies as high
as 200 pulses per minute have been recommended for scalp acupuncture,
with low frequencies being more commonly mentioned for body acupuncture
(e.g., 50 or less). Different authors writing about electro-acupuncture present
differing opinions on the ideal frequency for various desired effects. All the
wave forms and frequencies are claimed to be of value in promoting circulation
of qi and blood and alleviating various symptoms, particularly pain.

Although some theories have been developed regarding the mechanism of
action of electro-acupuncture, there are no conclusive tests. The main function
of electro-acupuncture, as evidenced by the discussions in several clinical
reports in the Chinese medical literature, appears to be no more than
pulsation by voltage spikes serving as stimulus replacing a rhythmic physical
movement as stimulus at the site.

MEDICAL REPORTS FROM CHINA
The majority of journal articles from China on electro-acupuncture are devoted
to laboratory animal studies, mainly with mice or rabbits. Those studies have
limited relevance to humans because of difficulties matching points on these
animals with those on humans, and the possible unique effects of electricity in
small animals because of the close proximity of points, which can make the
effect of the electric voltage, current, and associated electromagnetic fields
more evident than would be the case in humans. It is rarely indicated by these
animal studies that the effects are different from standard acupuncture
manipulation, though it would be difficult to carry out prolonged manual
manipulation on small animals. Thus, electro-acupuncture animal studies
mainly provide a means of using an animal model to study acupuncture
therapy in general.

An extensive review of the Chinese acupuncture literature shows that most
clinical work with acupuncture is carried out with manual stimulus despite the
ready availability of electro-acupuncture devices. In clinical trials where
electro-acupuncture is used, there are few details, if any, reported about the
technique, other than the duration of stimulus and the frequency of the
electrical output. In one study of treatment of depression in which some
explanation was given (5), the authors stated that "The intensity of stimulation
was optimal when slight muscle twitching was visible, yet the patient was
comfortable and the stimulus tolerable. The frequency of stimulus chosen was
about 80-90 beats per minute. The duration of treatment was 1 hour each time,
once a day (except Sundays) for 5 weeks, altogether 30 needlings." The
authors expressed the belief, based on animal studies of electro-acupuncture,
that the treatment would promote production of neurotransmitters that would
alleviate the brain dysfunction. The same kind of biochemical response has
been suggested as the mechanism for standard (non-electric stimulated)
acupuncture.

Zheng Qiwei, an acupuncturist at the China Academy of Traditional Chinese
Medicine wrote an article on point selection for electro-acupuncture (6). He first
mentioned that electro-acupuncture is used the same as standard
acupuncture but that electro-acupuncture therapy "has certain peculiarities and
limitations because electro-acupuncture apparatus cannot be connected with
all the acupoints...." Also, he mentioned that electro-acupuncture is particularly
relied upon for treatment of pain, flaccidity syndromes, paralysis due to stroke,
and facial paralysis of various causes. These disorders often require extensive
manipulation of the needles, for which electro-acupuncture serves as a useful
substitute.

As to the treatment of pain, Zheng suggests that the following points can be
chosen (included, in some cases, is the "ashi" point, or point that is tender to
the touch, and not necessarily a meridian point location as listed below):

trigeminal neuralgia: zanzhu (BL-2) and yangbai (GB-14) for the first nerve
branch; sibai (ST-2) with xiaguan (ST-7) or quanliao (SI-18) for the second
branch; chengjiang (CV-24) and xiaguan (ST-7) for the third branch.
sciatica: points are selected from huantiao (GB-30), zhibian (BL-54),
yanglingquan (GB-34), xuanzhong (GB-39), yinmen (BL-37), and weizhong
(BL-40).
pain of greater occipital nerve: fengchi (GB-20) and an ashi point.
migraine: fengchi (GB-20) and shuaigu (GB-8).
periarthritis of the shoulder: select from jianyu (LI-15), jianliao (TB-14),
jianzhen (SI-9), naohui (TB-13), binao (LI-14) and quchi (LI-11).
injury of the knee joint ligaments: liangqiu (ST-34) and dubi (ST-35).
tennis elbow: quchi (LI-11) and ashi point.
kidney pain: jingmen (GB-25) and ashi point.
abdominal pain: bilateral tianshu (ST-25).
intestinal adhesion pain: local points on both ends of the operation scar.
bone fracture: use points at the center of the fracture and at the ends of the
fracture zone (e.g., for humerus fracture, jianyu (LI-15) and quchi (LI-11)
represent the ends of the fracture zone; for femoral fracture, xuehai (SP-10)
and biguan (ST-31) are the ends).

For flaccidity (wei) syndromes, he mentions the following points (note: when
large numbers of points are offered, he recommends to select either 2 or 4 of
the points to needle with electrical stimulus; the sets of points needled can
vary from day to day, alternating from one set to the other and back again):

paraplegia: select from biguan (ST-31), futu (ST-32), zusanli (ST-36), and jiexi
(ST-41) as one group; a second group is zhibian (BL-54), chengfu (BL-36),
yinmen (BL-37), weizhong (BL-40), chengshan (BL-57), and kunlun (BL-60).
hemiplegia: jugu (LI-16), jianyu (LI-15), jianliao (TB-14), binao (LI-14), quchi
(LI-11), waiguan (TB-5), shousanli (LI-10), and hegu (LI-4) are used for upper
extremity paralysis; huantiao (GB-30), biguan (ST-31), zusanli (ST-36),
yanglingquan (GB-34), sanyinjiao (SP-6), and jiexi (ST-41) for paralysis of the
lower extremities.
facial paralysis: do not use electro-acupuncture in the initial phase, as it may
cause spasm. It can be used at the later stage, for example: taiyang (extra
point) and zanzhu (BL-2) or sibai (ST-2) for incomplete closing of the eye;
yingxiang (LI-20 and quanliao (SI-18 or xiaguan (ST-7) for difficulty sniffing;
either dicang (ST-4) and jiache (ST-6) or xiaguan (ST-7 and dicang (ST-4) for
difficulty in blowing out the cheeks; and heliao (LI-19) and dicang (ST-4) for
deviation of the philtrum.

In addition to treatment of local points for pain or paralysis or other disorders,
distal points may also be selected along the course of the meridians that flow
through the area to be treated. In cases of one-sided ailments, such as
arthritis in one shoulder, tennis elbow, or trigeminal neuralgia, Zheng
considers it acceptable to select points on the opposite side of the body for
treatment in cases where the patient may not tolerate local treatment or where
local treatment might cause spasms.

Gu Yuehua, at the Nanjing College of Traditional Chinese Medicine described
the use of electro-acupuncture for treatment of acute abdomen (7). This is a
severe abdominal pain that can be due to several causes including renal or
gallbladder colic associated with stones, acute appendicitis, dysmenorrhea
(especially that due to endometriosis), and gastric spasms. Gu reported on
several recommended sets of points for electroacupuncture, as follows:

Gastric spasm: zhongwan (CV-12), juque (CV-14), and zusanli (ST-36); this
point set could be modified for cold syndrome-add liangmen (ST-21)-or hot
syndrome-add quchi (LI-11); for distending pain in the hypochondriac region,
add taizhong (LV-3). Points were treated bilaterally where that applies.
Bill iary colic: riyue (GB-24), burong (ST-19), juque (CV-14), dannang (extra-35),
and zusanli (ST-36). These points were all on the right side only.
Renal colic: shenshu (BL-23), jingmen (GB-25), sanyinjiao (SP-6), and fujie
(SP-14) all on the side affected; and yanglingquan (GB-34) bilaterally.
Dysmenorrhea: guanyuan (CV-4) and bilateral guilai (ST-29) and sanyinjiao
(SP-6); with obvious stagnation of qi and blood, add bilateral taichong (LV-3)
and diji (SP-8).

He noted that most points were punctured perpendicularly, but that riyue
(GB-24) and burong (ST-19) were punctured obliquely. The initial stimulus by
hand was with the reducing method, with swift lifting, slow thrusting, and large
amplitude rotation. After the needle sensation was felt and radiated to the
affected area, electro-stimulation was added. He used a dense-disperse wave
(alternating high frequency with low frequency output), with a frequency of 18
per minute (this is the frequency of dense wave outputs). The electrical
stimulation was given for 30-60 minutes, with an intensity that depended on
the patient's tolerance. The time required to get pain relief varied from an
average of 11 minutes for "functional pain" (as, for example, with gastric
spasms), to an average of 32 minutes for "organic pain" (as, for example, with
renal stones). Up to 60 minutes treatment might be needed in cases where
pain relief at the original site was attained, but there was still tenderness and
radiating pain with pressure.

A report of using electro-acupuncture plus moxibustion for sports injury was
made by Yang Jun of the Department of Acupuncture at the Anhui College of
Traditional Chinese Medicine (8). Femoral adductor syndrome (pain in the
pubic and medial femoral regions, exacerbated by walking or squatting) was
treated with the main points yinlingquan (SP-9), qugu (CV-2), yinlian (LV-11),
and an ashi point. Auxiliary points for the treatment included chengfu (BL-36),
ciliao (BL-32), fengshi (GB-31), and wuli (LV-10); all of the main points and one
or two auxiliary points were used for each treatment. After the needling
sensation was attained, electric stimulation was applied for 15 minutes. After
removing the needles, moxibustion was applied using cones on the main
points for 10-15 minutes. This treatment was given once every other day, with
10 sessions one course of treatment (hence, three weeks treatment time).
Yang differentiated the role of electro-acupuncture, which he said treated the
subjective symptoms by promoting the flow of qi and blood and relieving pain,
from that of moxibustion, which he said treated the root cause, by additionally
warming the channels and removing blood stasis.

For treatment of chronic shoulder-arm pain and numbness of various causes,
Liu Hongyan and Zhang Caihong claimed use of electro-acupuncture at
bingfeng (SI-12) was a useful treatment (9). As auxiliary points, hegu (LI-4)
would be added if the pain and numbness extended to the thumb and index
fingers; zhongzhu (TB-3) was used if it extended to the ring and small fingers;
and sanyinjiao (SP-6) was used when there had been a prolonged pain
syndrome and muscular atrophy as a result. After getting the needle
sensation, the electro-stimulation with dense wave was administered for 20
minutes once per day, with 10 days treatment constituting a course of therapy.
Although improvements could be noted after just one or four treatments for
many patients, some had to undergo one to two course of therapy or more to
get adequate relief.

In a report of acupuncture therapy for post-herpetic neuralgia (10), two groups
of points were selected: the Hua Tuo jiaji that corresponded to the painful area
to be treated by electric stimulation, and limb points selected on the basis of
syndrome differentiation to be treated by manual stimulation. Thus, patients
with diagnosis of qi stagnation and blood stasis were manually treated at
zhigou (TB-6), yanglingquan (GB-34), xuehai (SP-10), and sanyinjiao (SP-6);
patients with deficiency of yin were treated at laogong (PC-8), taixi (KI-3), and
fuliu (KI-7); while patents with stagnation of damp-heat were treated at quchi
(LI-11), yinlingquan (SP-9), and sanyinjiao (SP-6). For the Hua Tuo points,
needling was first performed unilaterally on the painful side, using 3-5 needles
with about 1 cun space between needles, using slight oblique insertion
towards the spine. After arrival of qi attained with lifting and thrusting, the
needles were connected to the electric stimulator device with continuous wave,
with 40-50 minutes stimulus. The limb points were then needled and
stimulated every few minutes over the same time period. Ten daily treatments
constituted a course of therapy, which could be repeated after a three day
interval.

In a study of electro-acupuncture therapy given to cancer patients after
chemotherapy (11), needles were applied to zusanli (ST-36), sanyinjiao
(SP-6), zhongwan (CV-12), and neiguan (PC-6). The method of therapy was
described as follows:

The patient was asked to take the supine position. After needling sensation
was attained, the needles were connected to the G-6805 electro-acupuncture
apparatus with disperse-tense wave at an intensity tolerable to the patient. The
treatment was given for 30 minutes once daily, five daily sessions constituting
one course of treatment, with an interval of 2 days between courses.

Four courses of therapy (four weeks, with 5 days therapy followed by 2 days off
each week) were administered to evaluate the effects, which were claimed to
be beneficial and involved an average 5-10% increase in subsets of T-cells
and a 15% increase in natural killer cell activity (however, there was not control
group for comparison). It was also claimed to improve appetite and sleep,
relieve tumor pain, and alleviate the gastro-intestinal reactions to
chemotherapy.