The practical application of electroacupuncture

David Mayor and Sean Walsh

DM practises in the UK, where he is an Honorary Research Fellow at the University of Hertfordshire.

SW practises in Sydney, Australia, and is the Program Director in Chinese Medicine at the University of Technology there

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1. Electroacupuncture –an overview

David Mayor

• Why use EA?• Definitions• A little history• Electricity basics• Contraindications• Conditions treated

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Why use electroacupuncture? Ahhhshi …

Manual acupuncture (MA)

Moxibustion

Cupping

Guasha

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Why use electroacupuncture? A CM approach

EA should be used cautiously in deficiency (xu) conditions.

Whenever acupuncture is indicated, if MA has not brought a response, strong stimulation is appropriate (or needles are not acceptable).

ApplicationsPainDrug withdrawalTissue repairModulates organ function

Regulatory effects on:Autonomic functionImmune system.

Excess (shi) conditionsBi and wei syndromes.

Stagnation of Qiand/or Blood

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DEFINITIONS

Acupuncture

The insertion of needles into the body at specific points

Electroacupuncture (EA)“The passage of a pulsed electrical current through the body tissues via one (or more) pairs of acupuncture needles for therapeutic purposes” (Adrian White, 1998)

Point or probe TENS (pTENS) Transcutaneous electrical acupoint stimulation (TEAS)

Laser acupuncture (LA)

A broad definition of EAcould include these.

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HISTORY – static electricity and electric fish

~600 BCE Thales first describes static electricity (amber, )~400 BCE Hippocrates uses electric fish (narke, )for arthritis and headache

47 CE Scribonius Largus uses electric fish (torpedo) for ‘gout’ and headache

amber

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Hippocrates

HISTORY – electrostatic machines

1660 Otto von Guericke and his sulphur globe electrostatic generator

1709 Francis Hauksbee’sfirst glass globe generator

Early acupuncture publications:1658 Jakob de Bondt1683 Willem Ten Rhijne1712 Engelbert Kaempfer 8

HISTORY – John Wesley and Hiraga Gennai

1759 Wesley publishes Desideratum: Or, electricity made plain and useful by a lover of mankind and of common sense

1764 Hiraga uses 'elekiter' (friction generator, エレキテル) in Japan for muscle spasm and paralysis

Wesley(1703-91)

Hiraga(1728-80)

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HISTORY – Alessandro Volta1795 Volta argues that ‘galvanic’ electricity (DC) results ‘from the simple contact of two different metals’, and is produced in the brain in a similar way.

1800 He invents the voltaic pile (battery), ‘an artificial electric organ’ that mimics ‘the natural electric organ’ of the torpedo.

1801 Galvanism already used for many different conditions.

Volta (1745-1827)

‘electric organ’of the torpedo,after John Hunter(1775)

Voltaic pile (battery)

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HISTORY – Louis-Joseph Berlioz1810 Berlioz is the first European to practise acupuncture.

1816 He proposes that needling might be enhanced by ‘galvanic shocks produced by Volta's apparatus’.

1823 Jean-Baptiste Sarlandièrefollows Berlioz's suggestion and creates ‘electropuncture’, using gold and silver needles.

At first he treats motor lesions with ‘Franklinism’ (static shocks), sensory disorders with Galvanism.

Berlioz (1776-1848)

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HISTORY – Michael Faraday & Duchenne de Boulogne1831 Faraday discovers induction.

1833 Duchenne starts to practise electrotherapy, initially using galvanic EA for motor disorders.

1846 Intermittent biphasic asymmetric ‘induction currents’ (Faradism) first used in medicine. …

Duchenne changes to ‘localised electrisation’ with surface electrodes, preferring Faradism to Galvanism.

Michael Faraday (1791-1867)

Guillaume Duchenne1806-1875

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Early Faradic current

HISTORY – EA to the 1970s. 1. France

de la Fuye’s‘Diathermopuncteur’

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1925 George Soulié de Morant uses galvanicand faradic EA, but prefers HF ‘electromassage’.

1930s DC and HF needle diathermy promoted in France by de la Fuye, Jules Verne’s nephew.

1951 Acupuncture analgesia (AA) first practised on animals (Jean Niboyet, 1913-1968).

1971 AA first used during surgery in Europe (France, Italy) and Japan.

1971-78 6,000-10,000 operations under AA (Germany).

Roger de la Fuye (1890-1961)

Soulié de Morant (1878-1955)

HISTORY – EA to the 1970s. 2. China

1934 Book on EA published.

1953 ‘acupuncture electrotherapy’ (DC) animal experiments conducted.

Neurological EA clinic opens in Xian.

1958 Manual AA used first (Shanghai), then EAA (Xian).Also auricular AA (Shanghai).

1966-70 400,000 surgical procedures with AA.

1972 Wen (Hong Kong) discovers that auricular EAA relieves drug withdrawal symptoms .....

Xian 1953

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UNDERSTANDING ELECTRICITY

Current Flow

Polarity (monophasic, biphasic) + &/or –

Frequency Tick or buzz

Amplitude/intensity Mmm or Ow!

Pulse duration Tap or thud

Waveform Square or spike

Mode Overall feel

Stimulation range ALS, TLS

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Electricity basics – current and charge

Current consists of a drift of charged electrons or ions.

Current is measured in ampères (amps, A), milliamps (mA) and microamps (µA).

1 A = 1,000 mA = 1,000,000 µA.

Charge is measured in coulombs.

EA: “The passage of a pulsed electrical current through the body tissues via one (or more) pairs of acupuncture needles for therapeutic purposes”

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Electricity basics – polarity and voltage

Like charges repel, opposites attract. A battery with two poles will enable current to flow.

The electromotive force of the battery that moves the electrons or ions is measured in volts (V) or millivolts (mV).

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Electricity basics – mono- and biphasic stimulation

A battery produces direct current (DC): the current flows one way between the two poles. Such a current is sometimes known as galvanic.

Monophasic current is DC chopped into pulses.

Biphasic current flows first one way and then the other

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Electricity basics – example of the Classic 4 output

Classic

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Electricity basics – frequency

The number of cycles of electricity per second is called the frequency, measured in Hertz (Hz).

In EA and TENS, 2-6 Hz is ‘low’frequency

In EA and TENS, about 50-200 Hz is ‘high’ frequency

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Electricity basics – amplitude

Peak amplitude in direct and biphasic currents

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Electricity basics – charge (pulse duration & current)

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Electricity basics – waveform I

Waveforms may be symmetrical …

… or asymmetrical.

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Electricity basics –waveform II

Some waveforms are asymmetrical and not ‘charge-balanced’

These should not be used for electroacupuncture!(but may be used for TEAS)

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Electricity basics – electrolysis

If current is not charge-balanced, electrolysis may occur.

Electrolysis using acupuncture needles and non-charge-balanced TENS(120 Hz, 250 µsec, 4.6 V, 4.5 hrs)

cathode anode

tip tipshaft shaft

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Electricity basics – some non-balanced waveforms

(Suited to short treatments ONLY)

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AS Super 4(Schwa-Medico)

ES-130 (Ito)

Electricity basics – mode ‘continuous’

DD

‘interrupted’

‘dense-disperse’

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Stimulation ranges – ALS and TLS

Acupuncture-like stimulation TENS-like stimulation

LOW frequency (2-6 Hz) HIGH frequency (50-200 Hz)

HIGH amplitude LOW amplitude

LONG pulse duration SHORT pulse duration

Midrange

15 (10-20) Hz

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MA, ALS and TLS – the issue of ‘dose’

Is ‘more’ better?

What is ‘more’?

AmplitudeFrequency

Pulse durationTreatment duration

Number of treatments

Modality (MA, EA, TEAS)

How many points …

?

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Needle depth and angle (movement)

Needle/pad location (heart and brain, neck, prosthesis)

Parameters (charge balance, amplitude) –Use the right machine for the job!

Other devices (pacemaker, defibrillator, insulin pump)

Particular conditions (cancer, seizures, cardiovascular, pregnancy)

Medication (opioid cross-tolerance, [postoperative amitriptyline])

Cautions and contraindications before you begin

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www.electroacupunctureknowledge.com

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Condition N studies Condition N studies Musculoskeletal conditions 1117 Addiction 255

Gastrointestinal 444Migraine/other headache 245

Gynaecology/obstetrics 414 Pain(orofacial) 233 Stroke (and other cerebrovascular) 341 ENT 222 Central nervous system (excluding stroke) 311

Arthritis and other bone disorders 216

Pain (primarily neurological in origin) 303

Pain – general (primarily nociceptive) 212

Cardiovascular 297 Dermatology 172

Postoperative care 288Peripheral vascular conditions 154

Peripheral motor disorders 261 And so on …

electroacupunctureknowlege.com – Conditions treated

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Local/segmental points: GB8, GB20, ST8, yintang (M‐HN‐3), taiyang (M‐HN‐9)Distal (‘big’) points: LR2, LR3, LI4Parameters: LF CW to tolerance, 20 mins

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Zooming in on some specific conditions

Migraine

Local/segmental points: GB8 (shuaigu), GB20 (fengchi), ST8 (touwei), yintang (M-HN-3), taiyang (M-HN-9)

Distal (‘big’) points: LR2 (xingjian), LR3 (taichong), LI4 (hegu)

Parameters: LF continuous, ‘to tolerance’, 20 mins

[Mayor, 2007-8]

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Local/segmental points: GB8, GB20, ST8, yintang (M‐HN‐3), taiyang (M‐HN‐9)Distal (‘big’) points: LR2, LR3, LI4Parameters: LF CW to tolerance, 20 mins

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Low back pain with sciatica

Local (segmental) points: BL23 (shenshu), BL25 (dachangshu),GV3 (yaoyangguan), GV4 (mingmen), huatuojiaji

Distal (segmental) points: along the affected channel (BL, GB or more rarely ST)

Parameters: LF continuous or DD, ‘to tolerance’, 20-30 mins

[Mayor, 2008]

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Zooming in on some specific conditions

Local/segmental points: GB8, GB20, ST8, yintang (M‐HN‐3), taiyang (M‐HN‐9)Distal (‘big’) points: LR2, LR3, LI4Parameters: LF CW to tolerance, 20 mins

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Peripheral facial paralysis

Local/segmental points: GB14 (yangbai), ST4 (dicang),ST6 (jiache), ST7 (xiaguan); also TE17 (yifeng), LI20 (yingxiang), ST2 (sibai), taiyang (M-HN-3)

Distal (‘big’) point: LI4 (hegu)

Parameters: initially LF, low intensity, 15-20 mins; later stronger (motor level), 20-30 mins

[Mayor, 2007]

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Zooming in on some specific conditions

Local/segmental points: GB8, GB20, ST8, yintang (M‐HN‐3), taiyang (M‐HN‐9)Distal (‘big’) points: LR2, LR3, LI4Parameters: LF CW to tolerance, 20 mins

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Osteoarthritis of the knee

Local/segmental points: GB-34 (yanglingquan), ST-34 (liangqiu)(or ST-36, zusanli), SP-9 (yinlingquan) and the two xiyan points, neixiyan and waixiyan (or ST-35, dubi).

Distal (‘big’) point: none

Parameters (EA): LF, 10 Hz or sometimes DD, 20-30 minsParameters (TEAS): LF, 10 Hz or HF (the latter for inflammation)

No consensus on ‘strong’ or ‘gentle’ stimulation for either EA or TEAS

[Mayor & Koppelman, in preparation]

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Zooming in on some specific conditions

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Thank you!

David F Mayorwww.welwynacupuncture.co.uk

www.electroacupunctureknowledge.com

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