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 Acupuncture in PhysiotherapyHospital Authority
Coordinating Committee in PhysiotherapyHospital AuthorityMarch 2003
 
 
1
1. Introduction
 Acupuncture has been introduced as one of physiotherapy modalities in treating painsyndromes and neurological conditions in recent years. This paper describes thedevelopment of acupuncture in physiotherapy and the physiotherapists’ theoretical basis of acupuncture practice in the Hospital Authority settings. It also delineates the distinct practiceof acupuncture of the physiotherapists from those acupuncturists or practitioners of Traditional Chinese Medicine (TCM). The quality assurance system is also described in theend of the paper.
1.1 History of Acupuncture
It is generally believed that acupuncture is originated in China and has been practised formore than 2000 years. Acupuncture has also been practised in other East Asian countries - inJapan for over 1450 years, Korea for at least 1500 years, and Vietnam for about 2000 years(Birch & Kaptchuk, 1999). In China, acupuncture was first described in the
Yellow Emperor’s Classic of Internal Medicine
(
 Huang Di Nei Jing
 
黃帝內經
), which was dated inabout 200 BC. Acupuncture is rooted in the Daoist philosophy of change, growth, balanceand harmony, and its use is based on the principles of natural law and balance of Yin andYang (
陰陽
) and the Five Elements/Phases (
五行
).
1.2 Definition of Acupuncture
 The term “acupuncture” is a loose translation of the Chinese term “zhenjiu” (
針灸
) and wascoined in Europe in the late seventeenth century (Birch & Kaptchuk, 1999). Strictly speaking,acupuncture refers to the use of needles (
 Latin
“acus” means “needles” and “punctura” means“to puncture”; Rotchford & Kobrin, 2002) in treating or preventing symptoms and conditions(White & Ernst, 1999).
2. Theoretical Bases of Acupuncture
There are two major theoretical bases of acupuncture – Traditional Chinese Acupuncture(TCA) and Modern Acupuncture (MA) or Western Medical Acupuncture (British MedicalAssociation, 2000):
2.1 Traditional Chinese Acupuncture
 TCA is viewed as an integral part of the TCM. According to the TCM, the workings of thehuman body are controlled by a vital energy called “Qi” (
氣
), which circulates betweendifferent organs along the channels called meridians (
經絡
). When there is hindrance orobstruction of the flow of Qi through the meridians, illness will result. The goal of acupuncture is to restore the proper circulation of Qi along the meridians.
2.2 Modern Acupuncture/ Western Medical Acupuncture
Modern Acupuncture (MA) or Western Medical Acupuncture (WMA) is a more recentdevelopment practised by doctors and physiotherapists, who use acupuncture as an adjunctiveintervention on the basis of a clinical diagnosis (British Acupuncture Council, 2002). It isstated that “[t]he principal difference between a traditional eastern and western scientificacupuncture approach is the method of diagnosis and the relentless pursuit of a scientificrationale for treatment” (Filshie & Cummings, 1999, p.35). Based on modern concepts of neuroanatomy and physiology, acupuncture is known to produce analgesia effects atsegmental level by stimulating the A-delta afferents and at higher level by stimulating themid-brain to release enkephalin and endorphin, which activate a descending pain inhibitionsystem (Pomeranz, 1987, cited in LaRiccia, 2000).
 
 
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The differences of TCA and MA are contrasted and summarized as follows:
Traditional Chinese Acupuncture Modern Acupuncture(Western Medical Acupuncture)
1. Theroetical Basis
•
TCA as a part of the traditionalChinese medicine (TCM)
•
TCM is practiced through anholistic approach withemphasis on the unity of thehuman body and itsenvironment (British MedicalAssociation, 2000)
•
MA as "the scientificapplication of acupuncture as atherapy following orthodoxclinical diagnosis" (Filshie &Cummings, 1999, p.31)
•
Based on modern concepts of neuroanatomy and physiology(British Medical Association,2000)2. PatientAssessment
•
Based on 4 inspections:(1) Visual inspection (
望
)(2) Listening/smelling (
聞
)(3) Questioning (
問
)(4) Palpation (
切
)
•
Based on systematic evaluationof clinical history, physicalexamination and othersupplementary information(including radiographic andlaboratory findings) to reach aclinical diagnosis3. Selection of Acupoints
•
Based on meridian theory
•
Based on positive results of empirical studies for particularconditions
•
Using a combination of triggerpoints, tender points, segmentalpoints, and traditional points4. IntendedTherapeutic Effects
•
Restoration of free flow of "Qi"and balance of "Yin" and"Yang" inside the body
•
Acupuncture as a technique of sensory stimulation, whichtriggers complex responses inhuman body withneurophysiological andneuropharmacologicalmechanisms
•
Endorphin release as thehypothesized major mechanismfor analgesic effect of acupuncture
3. Efficacy and Safety of Acupuncture
 
3.1 Efficacy of Acupuncture
The efficacy of acupuncture has been equivocal, despite its practice for thousands of years.There are quite a number of systematic reviews in acupuncture for different conditions.However, there are many problems of existing systematic reviews in acupuncture (White et al,2002):
•
Incomplete literature search
•
Poorly described or inadequate inclusion criteria
•
Lack of definition of “acupuncture”
•
Inconsistent assessment of quality of studies
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