Dr. Stephen Kaufman Denver ,CO. 80224
(303) 756-9567

Dr. Kaufman has developed a new and more effective style of acupuncture, which has often helped patients who have not had success with other approaches of acupuncture. This method is often done without any needles at all, as many of our patients prefer it that way.

Acupuncture- Breakthroughs and Exciting New Developments!

Abstract:

In recent years, many physicians, particularly in Britain, have added to the understanding of acupuncture and developed new therapeutic innovations. Instead of mystical, vague and energetic theories, they have focused on pragmatic, results oriented techniques. This has resulted in new styles of acupuncture that are much simpler, scientifically defensible, and highly effective. They are also practically painless. A new technique developed by the author, Enter the Dragon acupuncture, is described, which often gives superlative results. These concepts have led to the development of osteopressure, a new way to effectively do acupuncture without needles ( a type of acupressure) with improved results.

Introduction:

Rick was a 30 year old man with a 12 year history of severe tendonitis in both forearms from playing a musical instrument. It was so bad that he had to give up playing. He has had much chiropractic care and acupuncture with very little relief. Upon examination the extensor tendons that attach near his elbow and wrist were exquisitely tender and inflamed on both sides. They had been like this for years! This was one of the worst tendonitis cases I had ever seen, and I told the patient that results would probably be pretty slow. However, after the first treatment with Enter the Dragon acupuncture, the swelling was completely gone! After 4 visits, the problem was completely resolved, the patient began playing his instrument 2 hours a day, and joined a band! He has had no recurrence in 2 years.

Dr. Jim is a 45 year old male who badly sprained his ankle hiking. It was swollen, extremely painful, and had very limited range of motion. He had iced it for several days but expected that it would need much more time to heal. Trigger point acupuncture as described in this article was applied to the most tender area of the injury. The treatment caused no pain at all. Within a few minutes the swelling was almost completely gone, the pain was much less and the range of motion was greatly improved. Several months later he was treated for a very painful neck with limited range of motion. Osteopressure was applied on several tender areas of the cervical spine. He had immediate relief of pain and restoration of normal movement.

Daniel is an active team athlete in his 30's. He has sustained many spinal injuries and has very long history of chronic low back pain. Previous chiropractic care had not helped much; applied kinesiological care had helped a great deal but he still had periodic flare ups of bad pain. Several treatments of Enter the Dragon acupuncture caused an immediate and remarkable disappearance of the back pain. This improvement has lasted for several months with no further pain.

Matilda is an eighty year old woman who has had pain in lower rib cage and diaphragm area for many years. It is always exacerbated by bending forward. She also has chronic heartburn. She has had much previous chiropractic and acupuncture treatment from several practitioners. She was treated with trigger point acupuncture to her lower abdomen and a large surgical scar on her posterior scapula. Within a few treatments her presenting complaints were almost totally relieved.

Mary is a seventy year old woman with a long history of lung disease. She developed pneumonia, was in great pain in her chest and back, and barely able to walk, in spite of being on antibiotics. Osteopressure without needles was applied to reflex areas along the spine. She experienced immediate and lasting relief and a quick resolution of all her respiratory symptoms.

Carol is a 60 year old woman who suffered several falls two years ago. She sustained a number of injuries but she had a lower back problem that persisted, in spite of excellent chiropractic , applied kinesiological, and acupuncture care. She would get relief but it never lasted very long. After applying Enter the Dragon acupuncture to her back she immediately regained her full range of motion, could bend normally without pain, and became pain free for the first time since her injuries.

I began studying acupuncture in 1973. At the time there were less than a dozen books available in English, so one could at least convince oneself that he was an expert fairly quickly! (This was before the founding of formal acupuncture schools and training in America.) All of the teachings that I was exposed to then were TCM (Traditional Chinese Medicine) acupuncture. It is my understanding that the situation is the same now, in that the vast majority of teaching in acupuncture schools and American practice consists of the Traditional Chinese Medicine approach. TCM was/ is based on a theory of Yin/Yang, Five Elements, energetic root causes of disease, etc. While these concepts may or may not be "true", in an objective sense, they are difficult to apply scientifically. Chi energy is impossible to objectively measure, even though many acupuncturists may feel they can subjectively perceive it. Unquestionably, then and now, acupuncture is an extremely effective, solid therapy. It can be very good at relieving symptoms.

Western and especially British physician/acupuncturists have recently stripped away a lot of the mysticism and dogma of traditional acupuncture in favor of a completely evidence based approach. I would like to sum up this approach here as a series of redefined concepts. These are extracted and based on the works of Mann¹, Baldry², Travell³, Campbell⁴, Gunn⁵, Seem⁶ , Filshie⁷ , Matsumoto, Tan, and others⁷ as well as my own observations.

This discussion does not intend to redefine the 5000 year old approach of TCM acupuncture, but rather to streamline and improve results in treating musculoskeletal pain. Treatment of visceral disorders is also amenable to this new approach, but it's a little more complex. We will limit the discussion here to treatment of musculoskeletal pain. I am not suggesting that these methods replace traditional Chinese acupuncture, but rather they provide some additional therapeutic tools. These approaches can be used together; they are certainly not counterproductive. The more tools a physician has, the better. One can practice trigger point acupuncture along with TCM, as Mark Seem does. One need never abandon previously successful protocols for new ones. It would be silly to throw away techniques that have been useful for 5000 years. (As Bruce Lee said, "a billion Chinese can't all be Wong" .

Discussion

Essentially, there are really only a few important issues in acupuncture. They are:

1) Where to place the needle!! In TCM acupuncture this is determined by many factors, including the pulse and abdominal palpation, inspection of the local area of pain, time of day, season, patient’s body type, diet, symptoms, etc. Traditional TCM theory is then applied to justify the selection of points. Most often, point selection and rationalization will vary among practitioners, sometimes widely. It is sometimes not obvious to one practitioner why certain points are chosen by another practitioner. In TCM, the points are selected based on the available data. It can be a very complex, abstruse process. The points themselves are often not even palpated. In contrast to that, trigger point acupuncturists first palpate the points to find them, and determine whether the points have specific patterns of radiation.

In the British approach, point selection is much simpler. The patient is examined for trigger points based on his pain syndrome, according to patterns originally discovered by Travell. For many forms of muscoloskeletal pain, the patient will have predictable exquisitely tender areas near the area of pain, which , when pressed, reproduce the patient’s pain. In one of the greatest (and unknown) works of the last century on pain management, Travell has mapped out, in two 800 page volumes, scores of these pain patterns. Like all true science, these patterns are predictable, consistent, verifiable and reproducible. These trigger points are the points to needle. They are often not very near the point of pain that the patient complains of, but several inches away. These points will be consistent from one practitioner to another, providing they are adequately trained in trigger point palpation and specific radiation patterns.

Another factor is selecting trigger points distal to the main points, that immediately neutralize the active trigger points. We have worked out an extremely effective protocol in this respect, with special emphasis on instantly neutralizing all spinal tender trigger points, including the associated points of TCM acupuncture. We also use this to neutralize active alarm points on the anterior of the body, related to visceral problems. This protocol is very simple to apply, easy to learn, and quite impressive to the patient. It strongly affects visceral as well as musculoskeletal function.

2) How deeply to insert the needle? TCM acupuncture usually inserts the needle from ½ inch to 2 inches or more. Japanese acupuncturists favor a much shallower insertion. In the British view, based on the neurophysiology involved, a depth of 5mm (1/5 inch) is all that is required. Most of the afferent fibers that produce the effect in acupuncture are near the surface of the skin. Deeper penetration is not necessary and may be counter-productive. In this regard, thin (36-40 gauge, or even thinner) needles are usually adequate, as against the thicker 32 gauge needles traditionally used by the older school. My patients often remark how much more comfortable it is to have acupuncture in this, almost painless, way. They often ask me if the needle has been inserted yet, or is it still in! They often can't feel the needle going in or being taken out.

3) How many needles to use? This can vary greatly among traditional acupuncturists. There is a feeling that fewer is better. Trigger point acupuncturists will use as many needles as there are active trigger points to treat, frequently a dozen or more. Sometimes they will use only one needle to sequentially treat several trigger points. I have developed an approach using up to 8 needles in key trigger points that I feel has given me exponentially improved results.

4) How long to leave the needles in? Almost all of the patients that I see that have been to TCM acupuncturists have been surprised that I leave the needles in for such a short time. In TCM the needles are usually left in place for 10-20 minutes, or even longer. As far as I can tell this is a traditional recommendation (“that’s what my teacher did.”) and has no objective basis. In trigger point acupuncture the needles are usually left in less than 3 minutes. Often it is less than a minute. It has been hypothesized that there is actually a diminishing return longer than five minutes: at 10-20 minutes the therapeutic effect is less, not more! I believe this relates to the accommodation process of the nervous system. If you walk into a room and smell something, within a few minutes your nervous system will accommodate to the stimulus of the smell, and you will not smell it anymore. Similarly, we get used to background noise. In the same way, the stimulus of the needle penetration in acupuncture causes it's strongest effect in the first 60 seconds of treatment. It then has a greatly diminished or even counter productive effect. To my patients who ask if leaving it in such a short time works as well, I ask them "How long does it take to turn on a light switch?" That may be what acupuncture does, by throwing a switch in the nervous system to allow neural pathways to fully initiate a healing response ( the "current of injury").

On subsequent visits most patients will have a steady diminution or elimination of the trigger points, with a consequent improvement in their myofascial pain syndrome. In my experience improvement is much more rapid and lasting than from TCM acupuncture. Additionally, the patient is pleased with the use of thinner needles, shallower insertion, and shorter retention of needles.

5) How big is the acupuncture point? In other words, how exact does the placement of the needle have to be in order to get results. I believe this is an extremely important question for the practitioner. I have observed that many acupuncturists seem to lack confidence in their method. This is especially common in chiropractors and physicians who have taken an additional course of acupuncture training and certification. I have always wondered about this , since I personally have found acupuncture to be one of the most effective therapies I know. I think I've finally figured it out. They have a lot of doubt about where they're putting the needle. Unconsciously or otherwise, they believe the intended "acupuncture point" is very small, and they fear they will not hit it with the needle. Therefore they doubt their effectiveness.

The Japanese school of acupuncture (8) (9) supports this concept and devotes much time to extremely exact identification of points. While there are many things I really like about the Japanese approach, I disagree with this for the most part. There may be a percentage of improvement by more narrow placement, especially in painful areas, but I believe for the most part one can treat a very large area. This is especially true for treatment of visceral problems. Trigger points, as we have been discussing, are probably best treated by needling the most tender areas, but even getting close seems to give most of the benefit.

I noticed decades ago as a budding young acupuncturist that most patients got results, in spite of my sloppy point placement. I soon realized that the area of effective treatment must be very large indeed for it to work so well. When patients used to ask me "How big is an acupuncture point? I used to answer " No bigger than a twenty dollar bill!" In fact, in many areas it's probably much larger than that. However, there are certain important exceptions, especially when doing trigger point acupuncture.

Felix Mann (1), the English physician who introduced acupuncture to the English speaking world in 1959 through his many wonderful books, in his most recent work disputes almost all the Chinese medical theory that he introduced! He feels that needle placement almost anywhere in the same part of the body as the desired point may be effective. In other words, he says that needling anywhere on the dorsum of the foot or almost anywhere below the knee will often give the effect of precisely needling Liver 3, an important acupuncture point! Anthony Campbell (4) agrees, as do most of the British medical acupuncturists, and labels them "acupuncture treatment areas" (ATAS's). They feel that although certain areas may require extreme discernment to find (usually the point of most tenderness within a trigger point or tender area), for the most part acupuncture treatment areas are quite large.

So, relax , all you young acupuncturists! You will get results as long as that needle gets anywhere near the classical point! (Perhaps this is the place to thank Felix Mann for his enormous contributions. It was through reading his books that I decided to become a doctor myself, and specifically developed a love of acupuncture.) While I do look for the most tender area to treat in a trigger point for maximum results, I know that the acupuncture gods will usually look with favor on my best effort. To paraphrase an old school saying ," 'Almost' only counts in horse shoes and hand grenades. And acupuncture".

Having said all this, I will now proceed to discuss one exception to the rule, which is ostopressure.

Osteopressure

A further refinement of trigger point acupuncture is to use a technique I refer to as osteopressure. After finding by palpation an active trigger point, press the trigger point in such a way that the muscle is pressed against the bone. This causes a very, sharp, needle like pain sensation. This can be done on several areas of the muscle, according to a specific protocol. I have found this to be a far superior way of doing acupressure or trigger point manipulation. It is very comfortable for the patient, uses no needles, and often produces instantaneous pain relief when done correctly. Speed and the proper vector are the key. These will vary depending on the area treated.

6) How many treatments to give? As many as it takes to get the patient well, of course! How do we know when to quit, if they do not respond? TCM acupuncture in chronic disorders is frequently given in multiples of ten sessions. At the other extreme, Baldry and Campbell suggest that results should be forthcoming in six visits at most. I suggest that the truth is probably somewhere in between. I have clearly seen patients who have not responded by six visits who were cured in several more, or even many more.

Jeremiah is a 50 year old man with two herniated discs and a long history of severe, sometimes incapacitating, back pain. He has had over 100 acupuncture treatments from two other classically trained TCM acupuncturists, with no lasting results. He has been to many orthodox and alternative healing practitioners, including chiropractors. He has a number of risk factors that exacerbate his low back pain. After several treatments utilizing Enter the Dragon acupuncture, his low back pain “has ceased to be much of a problem”.

Sebastion is a 55 year old man who has had ongoing TCM acupuncture treatment for a respiratory problem for 2 years, with minimal change. He had been diagnosed with chronic bronchitis, and found it hard to take a deep breath. After two sessions of Enter the Dragon acupuncture, his breathing became much deeper and easier. He said “this is the best breathing I’ve had since I was a kid!”.

Jerome was a middle aged man who came in with a case of pneumonia. Although on antibiotics for several days, he was not feeling any better, and had severe respiratory distress. One treatment using Enter the Dragon acupuncture to respiratory reflexes on his scapula produced instant, marked improvement and a resolution of his symptoms in several hours.

Benefits of this 21^st Century acupuncture include more rapid results, shorter treatment times, a higher degree of effectiveness, much greater patient comfort and acceptance, and a greater ability to scientifically apply treatment. Also, it is extremely easy to learn, if one is willing to temporarily suspend one's current concepts, and examine the clinical results. To quote my friend Dr. James Taylor, " this stuff works! " . (10)

1) Mann, Felix. M.D. Reinventing Acupuncture: A New Concept of Ancient Medicine. 1993.

2) Baldry, Peter. M.D. Acupuncture, Trigger Points, and Musculoskeletal Pain. 1993.

3) Travell, Janet,M.D. and Simon, David M.D. Myofascial Pain and Dysfunction: The Trigger Point Manual. 1992

4) Campbell , Anthony M.D. Acupuncture in Practice: Beyond Points and Meridians 2001.

5) Gunn, Chan M.D. Treatment of Chronic Pain 1996.

6) Seem, Mark. A New American Acupuncture 1993.

7) Filshie, Jacqueline, and White, Adrian. Medical Acupuncture : A Western Scientific Approach. 1998

8) Birch, Stephen, and Ida, Junko. Japanese Acupuncture, 1998.

9) Matsumoto, Kiiko, and Birch, Stephen. Hara Diagnosis: Reflections on the Sea. 1988

10) Taylor James, D.C. Personal communication.

Stephen J. Kaufman, D. C. , is a practicing chiropractic physician in Denver, Colorado. He has practiced chiropractic, applied kinesiology, myofascial and trigger point therapies, acupuncture, acupressure, Thought Field Therapy, yoga, and cranial osteopathy since 1978. He has developed many new techniques in soft tissue therapy and has published over 75 professional papers. He can be reached at (303) 756-9567.

2693 South Niagara St. ,Denver, CO., 80224. His informative website is www.kaufmantechnique.com