Getting to the Point: Acupuncture and Acupoint Therapies

Course #68030-


Study Points

  1. Describe the principles from traditional Chinese medicine (TCM) that guide the practice of acupuncture and some related acupoint therapies.
  2. Outline the various techniques of and available evidence regarding acupuncture.
  3. Discuss the approaches to and evidence of moxibustion.
  4. Review available research and techniques of acupressure.
  5. Identify uses and safety concerns of trans- cutaneous electrical acustimulation (TEAS).
  6. Compare and contrast the various acupoint techniques in terms of clinical uses and safety.

    1 . Which of the following statements regarding the concepts of yin and yang is most accurate?
    A) Yin and yang are not the same as good and bad.
    B) Yin and yang are considered complementary forces.
    C) Yang is masculine and represents tranquility, darkness, cold, wetness, and depth.
    D) Yin is the feminine side of nature and represents light, heat, activity, dryness, and height.

    HISTORY: A BRIEF GLIMPSE

    Yin is the feminine side of nature and includes tranquility, darkness, cold, wetness, and depth. Yang is masculine and represents light, heat, activity, dryness, and height. Yin and yang are not the same as good and bad. Instead, they are considered complementary forces [1].

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    2 . In traditional Chinese medicine (TCM) practices, what is the term used to describe energy, which if imbalanced or blocked is thought to cause disease?
    A) Meridian
    B) Qi
    C) Yin
    D) Yang

    HISTORY: A BRIEF GLIMPSE

    In TCM, it is thought that disease is caused by an imbalanced or blocked flow of energy, or qi. Additionally, there are 12 meridians that form a continuous pathway throughout the body; qi circulates through the body on these meridians (Figure 1).

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    3 . Theoretically, moxibustion
    A) opens 2 meridians.
    B) improves consciousness.
    C) removes heat, dryness, and activity.
    D) prevents the accumulation of qi, particularly the yen qi.

    HISTORY: A BRIEF GLIMPSE

    Another practice of TCM, moxibustion, involves burning an herb, usually mugwort (Artemisia vulgaris), above the skin or on the acupoints to introduce heat into an acupoint for therapeutic effects. Moxibustion may be performed by burning a cone, stick, or loose herb a short distance away from the skin. Additionally, the burning herb may be placed on the head of an acupuncture needle to increase the temperature gradient of the needle. Theoretically, moxibustion opens the 12 meridians and removes cold, dampness, and stagnation, which improves consciousness and prevents the collapse of qi, particularly the yang qi [4].

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    4 . What organization works with most states to validate the competency of acupuncture practitioners prior to licensure?
    A) Association for Traditional Chinese Practitioners (ATCP)
    B) National Center for Complementary and Integrative Health (NCCIH)
    C) American Association of Chinese Medicine and Acupuncture (AACMA)
    D) National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM)

    ACUPUNCTURE

    Most states in the United Stated regulate the practice of acupuncture, for which different degrees and certifications are available. The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) works with most states to validate the competency of acupuncture practitioners prior to licensure [2].

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    5 . In traditional "manual" acupuncture, the needles are inserted to a depth of
    A) 5–40 mm.
    B) 0.5–2 mm.
    C) 2.5–5 mm.
    D) 40–50 mm.

    ACUPUNCTURE

    In this practice, needles are inserted into acupoints. An acupuncture session may involve the insertion of up to 20 very fine needles which are kept in place for different durations, usually about 10 to 30 minutes. The needles can be inserted to a depth of 5–40 mm and can be stimulated by winding by hand [2].

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    6 . Which acupoint therapy may include a technique that employs the use of polydioxanone sutures for long-term mechanical stimulation?
    A) Acupuncture
    B) Acupressure
    C) Moxibustion
    D) Transcutaneous Electrical Acustimulation (TEAS)

    ACUPUNCTURE

    In this practice, medical threads, such as catgut or polydioxanone (PDO) sutures, are inserted into subcutaneous tissue or muscle at specific points, thus providing long-term chemical stimulation in addition to the mechanical stimulation provided by traditional acupuncture. Typically, PDO threads take approximately four weeks to reach 50% tensile strength and six months to be completely absorbed [2].

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    7 . Which of the following oncology associations include acupuncture and electroacupuncture as a potential treatment option for reducing post-cancer fatigue in their recommendations?
    A) National Comprehensive Cancer Network (NCCN)
    B) American Society of Clinical Oncology (ASCO)
    C) Society for Integrative Oncology
    D) All of the above

    ACUPUNCTURE

    The National Comprehensive Cancer Network (NCCN) guidelines for cancer-related fatigue list acupuncture as a potential nonpharmacologic treatment option for patients who have completed cancer treatment. Additionally, the American Society of Clinical Oncology (ASCO) and the Society for Integrative Oncology recommend acupuncture for patients who have finished cancer treatment and for cancer survivors [2].

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    8 . When compared with no treatment, standard therapy, or sham acupuncture, most preliminary clinical research and meta-analyses of clinical research show that for patients with fibromyalgia, acupuncture
    A) improves pain and stiffness and quality of life.
    B) shows no effect.
    C) may result in additional adverse effects, including joint stiffness.
    D) Improves fatigue but not pain or stiffness.

    ACUPUNCTURE

    Most preliminary clinical research and meta-analyses of clinical research show that acupuncture improves pain and stiffness and quality of life when compared with no treatment, standard therapy, or sham acupuncture, although older research shows that acupuncture is no different than sham acupuncture for reducing pain [2].

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    9 . What are the most common adverse effects of acupuncture?
    A) Dermatologic adverse effects
    B) Cardiovascular adverse effects
    C) Pulmonary adverse effects
    D) Ocular adverse effects

    ACUPUNCTURE

    Most commonly, acupuncture is associated with dermatologic adverse effects, such as bruising, swelling, and pain. Acupuncture in the eyes can cause trauma to the eyes such as perforation and traumatic cataract. There have been case reports of epidural and subdural hematomas from improper acupuncture, resulting in paresthesia, hemiparesis, quadriparesis, and sensory deficit. There have been case reports of pneumocranium, pneumothorax, hemothorax, acute respiratory and circulatory failure, and death due to inappropriate acupuncture practices. Acupuncture needles that are not removed after treatment might embolize and cause damage to internal organs [2].

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    10 . Which moxibustion technique may be scarring?
    A) Direct
    B) Electric
    C) Jade
    D) Thunder-fire

    MOXIBUSTION

    The ignited moxa cone is used directly to warm the skin surface at the acupuncture point. Direct moxibustion can be scarring, which involves burning moxa directly on the skin, or "warming," which involves burning moxa above the skin [4].

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    11 . Which of the following best characterizes the technique of thunder-fire moxibustion?
    A) Moxa-cigars held by a moxibustion box are ignited over the treatment site.
    B) An ignited moxa cone is separated from the skin by ingredients such as ginseng, salt, garlic, ginger, or aconite cake.
    C) A one-inch moxa stick is put on the handle of an acupuncture needle that has been inserted in the body.
    D) A jade stone is applied via heated knee pads.

    MOXIBUSTION

    Moxa-cigars held by a moxibustion box are ignited over the treatment site. The fire head is held about an inch away from the skin and burned for about 30 minutes. To maintain the heat and reduce smoke in the air, the moxibustion treatment is covered with a thick towel [4].

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    12 . For which GI condition does moxibustion have the most evidence of benefit?
    A) IBS-C
    B) IBS-D
    C) Crohn disease
    D) Ulcerative colitis

    MOXIBUSTION

    Moxibustion has been investigated in patients with diarrhea-predominant irritable bowel syndrome (IBS-D), constipation-predominant IBS (IBS-C), and inflammatory bowel diseases. Currently, there is not enough scientific evidence to support the use of moxibustion for Crohn disease and ulcerative colitis. Additionally, there is very limited evidence on use for constipation and gastritis.

    Moxibustion with or without acupuncture appears to be more effective than sham moxibustion, sham acupuncture, or various pharmaceutical agents for improving abdominal pain, discomfort, gas, bloating, and stool consistency. There were also overall improvements in stool form and symptom severity [4].

    Clinical research in patients with IBS-D shows that moxibustion three times weekly for six weeks produces adequate relief in about 77% to 82% of patients, compared with 37% to 42% of those given sham or placebo moxibustion. These data also suggest that beneficial effects lasted for up to an additional 18 weeks after treatment completion in up to 76% of patients [4].

    Thus far, the evidence on the use of moxibustion for IBS-D is promising, and patients may consider it as an adjunctive treatment option.

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    13 . Preliminary clinical research in adolescents with primary dysmenorrhea shows that beginning acupressure shortly after menstruation onset reduces the severity of dysmenorrhea for up to
    A) 30 minutes.
    B) two hours.
    C) 12 hours.
    D) three days.

    ACUPRESSURE

    Acupressure seems to reduce pain in adults and adolescents with primary dysmenorrhea. Preliminary clinical research in adolescents with primary dysmenorrhea shows that beginning acupressure shortly after menstruation onset reduces the severity of dysmenorrhea for up to two hours after treatment and improves pain and anxiety. Self-administration of acupressure also seems to help reduce pain in dysmenorrhea [3].

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    14 . In patients receiving routine hemodialysis, auricular acupressure has been associated with a beneficial effect on which comorbidity?
    A) Lower back pain
    B) Insomnia
    C) Fatigue
    D) Anxiety

    ACUPRESSURE

    Improvement in sleep was reported in small clinical studies, particularly in patients with hypertension or cancer, individuals who receive routine hemodialysis, and patients who are hospitalized or residing in long term care. Larger, higher quality studies are needed to determine which patients are more likely to benefit from treatment [3].

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    15 . Which acupoint treatment modality utilizes an FDA-cleared medical device for the treatment of nausea, retching, and vomiting?
    A) Acupressure
    B) Acupuncture
    C) Moxibustion
    D) Transcutaneous electrical acustimulation (TEAS)

    TRANSCUTANEOUS ELECTRICAL ACUSTIMULATION (TEAS)

    A specific acustimulation device (ReliefBand) has been used with apparent safety in clinical research with no reports of adverse effects. This device is commercially available and cleared by the U.S. Food and Drug Administration (FDA) for certain types of nausea, retching, and vomiting [5]. Note that FDA clearance and FDA approval are not interchangeable terms. "FDA cleared" typically refers to medical devices, which differs from the rigorous testing required for "FDA approval," which is generally applied to pharmaceutical drugs.

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    16 . In transcutaneous electrical acustimulation (TEAS), which common acupoint is used for gastrointestinal discomfort, stress, and fatigue?
    A) GV20 Bai Hui point on top of head
    B) P6 Neiguan point on wrist
    C) ST36 Zusanli point below the knee
    D) LI11 QuChi point on outside of elbow crease

    TRANSCUTANEOUS ELECTRICAL ACUSTIMULATION (TEAS)

    Common acupoints used for acustimulation are the P6 Neiguan point on the wrist, which is used for nausea and vomiting, and the ST36 Zusanli point below the knee, which is used for gastrointestinal discomfort, stress, and fatigue. These and other acupoints have been stimulated alone or in combination in clinical research [5].

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    17 . Which of the following statements regarding the use of acupuncture during pregnancy and labor is TRUE?
    A) Only upper extremity acupoints can be used safely.
    B) There have been reports of significant adverse effects.
    C) It is safe when used appropriately and performed with sterile needles.
    D) All of the above

    CONSIDERATIONS AND COMPARISONS

    Some clinical research shows that acupuncture has been used during pregnancy and labor without reports of significant adverse effects when used appropriately at most acupoints and performed with sterile needles. There is insufficient reliable information available about the use of electroacupuncture or laser acupuncture during pregnancy; avoid using. There is some concern that acupuncture at the SP6 acupoint on the inner ankle can increase the risk of early contractions and miscarriage [2].

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    18 . Which acupoint therapy has consistently been used safely during pregnancy in clinical research without significant adverse effects?
    A) Acupressure
    B) Acupuncture
    C) Moxibustion
    D) Transcutaneous Electrical Acustimulation (TEAS).

    CONSIDERATIONS AND COMPARISONS

    Acupressure

    This therapy has been safely used during pregnancy in clinical trials without significant adverse effects [3].

    Transcutaneous Electrical Acustimulation (TEAS)

    There is currently insufficient reliable information available; however, there is no reason to expect safety concerns when used appropriately [5].

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    19 . Which patient should be warned about worsening symptoms with the use of moxibustion?
    A) 25-year-old with chronic back pain due to a motorvehicle accident
    B) 47-year-old with uncontrolled asthma
    C) 62-year-old with diarrhea-predominant irritable bowel syndrome (IBS-D)
    D) 70-year-old with osteoporosis-related knee pain

    CONSIDERATIONS AND COMPARISONS

    Theoretically, moxibustion may exacerbate asthma symptoms. Clinical reports of respiratory discomfort and asthma exacerbation due to the smoke associated with moxibustion suggest that moxibustion may not be safe for use in patients with asthma. However, some research has suggested a possible beneficial effect of moxibustion in patients with asthma. Until more is known, use with caution [4].

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    20 . How would you explain the efficacy of acupuncture to a patient seeking alternative treatments for chronic back pain?
    A) It has been proven that acupuncture is more effective than standard treatments for reducing back pain.
    B) Most evidence suggests that acupuncture does not provide clinically relevant benefits in patients with back pain.
    C) Only electroacupuncture has demonstrated consistent benefit for reducing back pain.
    D) Research suggests that receiving more than five treatments with deep acupuncture may provide the most long-term benefit.

    CONSIDERATIONS AND COMPARISONS

    Most research shows that acupuncture seems to reduce back pain more than no treatment. However, it is unclear if acupuncture is more effective than sham acupuncture. Receiving more than five treatments with deep acupuncture seems to offer the most long-term benefit [2].

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