contemporary medical acupuncture
TRANSCRIPT
Guan-Yuan Jin, MD, L.Ac.
International Institute of Holistic Medicine
Ace Acupuncture Clinic of Milwaukee
8412 W, Capitol Drive, Milwaukee, W153222, USA
Telephone: 414-438-9488
E-mail: [email protected]
~ ~ ~ - ~ q ~ - Contemporary Medical Acupunc tu re /~~@ �9 --:[t~.. ~~l~J~l~ ~ : ~ J : , 2007.6 ISBN 978-7-04-019257-8
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Copyright �9 2007 by
Higher. Education Press
4 Dewai Dajie, Beijing 100011, P. R. China
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,ISBN 978-7-04-019257-8
Printed in P. R. China �9
To our teachers and colleagues who have devoted themselves to clinical and laboratory studies of acupuncture as well as greatly contributed to the contemporary development of acupuncture theories and techniques, and to our loved ones, Songshou Jin and Ruiwen Mao, Dequan Xiang and Guangyu Geng, Jin Zheng and Bonnie X. Jin.
About the Authors
Guan-Yuan Jin, MD, L.Ac., is one of world's forefront medical acupuncturists
besides a physiologist and chronobiologist. With a rich clinical and research
experience of over 40 years in both Chinese medicine and Western medicine, he
has authored 18 academic/professional books, including representative works of
Clinical ReJlexology of Acupuncture and Moxibustion, Self-Healing with Chinese Medicine,
Acupuncture and Cybernetics, Whole Body Reflex Zones, Contemporary Chronomedicine,
and Biological Clock and Health. In the late 1960s, Dr. Jin began to study and practice
acupuncture and TCM by completing an apprenticeship under Master Jiao,
Mianzhai as well as Profs Zheng, Kuishan, Wei, Jia, etc. In 1982, he graduated from
Zhejiang Medical University, China, where he later taught Physiology and engaged
in numerous researches on acupuncture. After coming to US in the late 1980s, Dr. Jin
completed post-doctoral fellowship at Medical College of Wisconsin and became
one of 'grandfather' acupuncturists and Chinese herbologists certified by NCCAOM
(National Certification Commission for Acupuncture and Oriental Medicine), USA.
At his private practice (www.AceAcupuncture.com), Dr. Jin specializes in treating
intractable cases with acupuncture, Chinese herbs, and Qigong therapy, striving
for "Highest Successes with Least Sessions." Dr. Jin is currently an Honorary
Professor at Guangzhou University of TCM, China. As the president of Inter-
national Institute of Holistic Medicine, Dr. Jin is a strong advocate in raising
public awareness of TCM through lectures at local communities as well as
national and international conferences. From 1993-2005, he served as an
Acupuncture Advisor for the State of Wisconsin, and under his efforts, the
Governor of Wisconsin, and Mayors of Milwaukee and Brookfield proclaimed
"Acupuncture and Oriental Medicine Day" and "World Tai Chi and Qigong Day",
respectively.
O O NO
Jia-Jia x. Jin, OMD, L.Ar is a NCCAOM board certified and Wisconsin licensed
acupuncturist, Chinese herbologist, as well as Qigong instructor. She has been
working in the medical field for over three decades. Since coming to USA in
1990, she and her husband Dr. Jin co-founded Ace Acupuncture Clinic of
Milwaukee, one of the most reputable TCM clinics in the Midwest. Jia-Jia
specializes in caring for the pediatric, female, and elderly patients with gentle
needling techniques or acupressure. Jia-Jia was a co-author of Clinical Reflexology
of Acupuncture and Moxibustion, Self-Healing with Chinese Medicine, Contemporary
Chronomedicine, and Whole Body Reflex Zones, as well as an instructor in a series of
Dr. Jin's self-healing classes.
Louis L. Jin, MS, BS., has a unique background of both Information Technology
and Chinese Medicine. He holds a Master's degree in Computer Science and
Software Engineering, and has completed a four-year apprent icesh ip in
Acupuncture and Chinese Medicine under the tutelage of his father Dr. Jin. Louis
has been dedicating his efforts at advancing the modernizat ion of classical
diagnostic and therapeutic means in the field of TCM, such as developing com-
puterized technologies of tongue and pulse diagnoses, as well as investigating
scientific bases of Qigong therapy. Louis was a co-author of Whole Body Reflex
Zones, Clinical Reflexology of Acupuncture and Moxibustion, and Self-Healing with
Chinese Medicine, as well as an instructor in a series of Dr. Jin's self-healing classes.
Pre-publication REVIEWS
COMMENTARIES EVALUATIONS
"To create a textbook of acupuncture that includes both classic and modern
theories and therapy is a formidable task. The authors can rightly lay claim to the
premier position held by this textbook as the most authoritative and current source
of information about acupuncture, the meridian, and the whole body reflex zones,
a unique term originally coined by the authors. As a respected resource, it has
covered the key concepts and topics that acupuncture practitioners and students
will experience in their studies and working environment. The beginning part
introduces readers to the current challenges and modernization of acupuncture
therapy and its scientific bases, as well as acquaint with the concepts of meridians,
the whole body reflex zones, and reflexotherapy. The later part explains the
systemic or cybernetic method including the black box theory and its applications
in guiding clinical acupuncture and raising curative effects, as there may be an
uncertain outcome. The last part describes the indications of acupuncture, their
treatment, and rehabilitation. Advanced students will learn how to choose
acupoints and use appropriate techniques to attain optimal acupuncture effects.
Acceptance of acupuncture as both an art and a science helps to create an
integrating link between oriental medicine, contemporary medicine, and the
principles of holistic care, thus fostering the well-being, the care, and the cure of
patients worldwide."
Frances Talaska Fischbach, RN, BSN, MSN
Associate Professor of Nursing
University of Wisconsin-Milwaukee
Author of A Manual of Laboratory and Diagnostic Tests
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"After reading the manuscript carefully, I can say it is truly going to be an
outstanding book compared to its counterparts on acupuncture. It has abundant
contents and data, a distinct theme, innovative theories, and simple but in-depth
analyses. This book systemizes, summarizes, and develops the acupuncture
therapy and its theoretical basis, the meridian theory from the perspective of
contemporary acu-reflexology, making a great milestone toward modernizing
classical acupuncture. Today, as the "acupuncture fever" continues to prevail
worldwide, increasingly Western doctors are aspiring to learn and integrate
acupuncture into the mainstream of contemporary medicine. The publication of
this book will definitely provide them with an excellent reference. Moreover,
realizing the standardization of acupuncture therapy is an essential component
of propagating medical acupuncture internationally and making its prospective
progress. The authors of this book have made a penetrating analysis about how
to control the randomness of the acupuncture therapy and enhance its effectiveness
and reproducibility. Thus, this book is a must-read for all acupuncture practitioners,
medical professionals, and researchers in the field of acupuncture, as well as
students of TCM. "
Xuemin Shi
Academician of China Academy of Engineering
Vice President of China Association of Acupuncture
Professor & Vice President of Tianjin University of TCM, China
"The birth of Contemporary Medical Acupuncture fully reflects the authors' unique
background and expertise. Dr. Jin possesses a profound knowledge of both
Chinese medicine and Western medicine, and he has a rich clinical expertise of
acupuncture practice for many years, including over two decades of practice in
China and seventeen years of practice in the USA. These kinds of integration
between Chinese medicine and Western medicine, scientific research and clinical
expertise, plus his background on scientific methodology, make him a qualified
authority with full capability of clarifying classical acupuncture systemically and
scientifically through this book. Personally, I have a master-apprentice relationship
with Dr. Jin, and I am grateful to see that he has finally completed this masterpiece
for publication. This work is based on inheriting the meridian theory of Chinese
medicine as well as citing numerous scientific references through many years of
research. Its content is comprehensive and refreshing, and its recommended
methods are simple and practical. No doubt, the publication of this authoritative
book will promote the development of medical acupuncture, benefit our fellow
acupuncture practitioners, enhance the effectiveness of acupuncture therapy, as
well as have a profound influence on the academic exchange between Eastern
and Western medicine. It will certainly be a useful reference for anyone engaged
in academic study, scientific research, and clinic practice with acupuncture. "
Kuishan Zheng
Professor & Honorary Chair
Dept. of Acupuncture, Gansu College of TCM, China
Honorary President of Gansu Acupuncture Society o o ol
Forewords
Acupuncture, which originated in China more than 2 000 years ago, is the most
commonly used alternative medical procedure worldwide. America's keen
interest in this modality intensified in the 1970s. During this era, New York Times
reporter James Reston wrote a pivotal story about how Chinese practitioners
used needles to ease his postoperative pain. Since that time, physicians and their
patients have generated more inquiries about acupuncture. A 2002 com-
prehensive survey indicated an estimated 8.2 million of USA adults had used
acupuncture, according to study sponsor National Center for Comparative and
Alternative Medicine (NCCAM), a component of National Institutes of Health
(NIH). A similar national survey found that approximately one in 10 adults had
received acupuncture at least one time with good results.
The potential for acupuncture is vast, as a 1997 NIH Consensus Statement on
Acupuncture indicated. Documented results indicate that this procedure can
reduce the side effects of cancer treatment and provide analgesia during surgical
procedures. Patients with drug and nicotine addictions, stroke, asthma, and pain
benefit from alternative therapy. In January 2005, a NIH-funded clinical trial at
the Univerity of Maryland, Center Integrative Medicine (UMCIM), showed that
acupuncture could provide pain relief, while improving the function of patients
with osteoarthritis of the knee. Acupuncture clearly serves as an effective com-
plement to conventional care.
International academic and clinical studies, supplemented by the contributions
of acupuncture practitioners and physicians, have generated greater acceptance
of this treatment. For this reason, NCCAM and other NIH-affiliated research
institutions continue to fund a variety of research projects on acupuncture. These
a
efforts have received attention, not only from NIH, but also from many public or
private organizations. UMCIM received $10 million federal grant in October 2005
to build two new centers to study complementary and alternative medicine
(CAM), specifically acupuncture and Chinese herbal medicine for pain relief. The
university is also forming an international collaboration with Chinese scientists
to examine methods in treating bowel disorders.
Many medical schools nationwide are integrating acupuncture programs into
their curricula. For example, the University of Pennsylvania (UPenn) has initiated
collaborative undertakings with Tai Sophia Institute, a CAM school in Maryland,
USA. Since that time, the primary focus of the UPenn program has been to teach
medical students about holistic approaches. A number of other schools are
initiating their own CAM programs or working with consultants to this end. Many
faculty members and students in my school (Medical College of Wisconsin) are
interested in incorporating CAM programs into their practice or curricula.
Despite the growing interest and demand for knowledge about acupuncture,
there is a profound lack of availability of reference textbooks. Dr. Guan-Yuan Jin
has stepped forward to meet this need by writing Contemporary Medical
Acupuncture. Medical students and practitioners will find this book unique in
that it introduces the principles of contemporary medicine as a means of
understanding the mechanisms of an ancient therapy. It lends insight into its
theoretical basis by summarizing and reviewing the advances regarding the
meridians and specific mechanisms. Dr. Jin concludes that the former is simply a
system of physiological and pathological reflexes in the body and that acu-
puncture is actually a type of reflexotherapy. By utilizing the systems theory, he
outlines the entire acupuncture process and the specific factors that elicit
acupuncture 's therapeutic effectiveness. The book's emphasis on clinical
applications is particularly valuable in that he provides case studies and the latest
clinical trials in the West.
I believe that this book will significantly advance the clinical practice of
acupuncture because its cutting-edge material will promote academic research
in the area of acupuncture mechanisms. Because of Dr. Jin's work, and others
like him, acupuncture will progress from an ancient healing art to a modern
scientific therapy in the West, and across the globe.
Shi-Jiang Li, PhD
Professor of Biophysics
Medical College of Wisconsin, USA
A late night in March, I finally flew home after a 30-hour trip from Argentina,
and found a book entitled Clinical ReJlexology of Acupuncture and Moxibustion by
Prof. Jin and his colleagues delivered to my door. As I glanced through the first
few pages, novel perspectives about acupuncture therapy and the meridian theory
immediately caught my attention and I could not put it down until the wee hours
of the next morning, almost forgetting my fatigue due to the long trip.
In this book most theories and principles proposed by the authors are creative
and convincing. Especially the viewpoint of realizing the impending leap of
acupuncture from art to science through establishment and development of
contemporary medical acupuncture is indeed relevant. I could identify with Prof.
Jin as I had similar clinical experiences in the past. In early 1970s, I engaged in
numerous studies of clinical acupuncture, especially of the auricular acupuncture,
and experienced both its benefits and limitations. Since 1980s, in my medical
practice as a neurosurgeon, acupuncture has also been extensively applied to
rehabilitate patients with various cerebrovascular diseases. Currently, in my
hospital, like most hospitals in China, acupuncture therapy has become a routine
method of treatment in the fields of neurosurgery and neurology. However, we
also met those challenges of classical acupuncture mentioned in the book by Prof.
Jin. Thus, I believe that those acupuncture techniques with consistent or repro-
ducible effects will definitely benefit patients.
This summer, it was my pleasure to meet Prof. Jin in person at Milwaukee,
USA after attending an international conference in Hawaii. I was not only deeply
impressed with his rich expertise in medicine, including acupuncture, but also
awed by his expert knowledge in science, education, and methodology of the
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systems theory or cybernetics. His book Best Methods of Learning published in
1986 was just another example in applying a systems approach in the field of
education. Currently, he is dedicating his energy and enthusiasm to the study
of integrative medicine, and together, we are exploring potential research collabo-
rations.
In short, this book takes a systems approach to learning yet is comprehensive
enough to teach the fundamentals as well as venturing into the advanced concepts
of acupuncture. In my opinion, few today's acupuncture books are like this one
that is written in such concise, modern, evidence-based, and scientific language.
This book is suitable to all medical professionals, I highly recommend it as an
advanced textbook or reference guide to surgeons, physicians, and other medical
doctors interested in integrating acupuncture into their clinical practice and
research.
Feng Ling, MD
Professor & Director of Institute of Cerebrovascular Diseases
Director of Neurosurgery and Intervention Center at Xuanwu Hospital
Capital University of Medical Sciences, Beijing, China
Honorary Chair, Asia-Australian Society of Interventional Neuroradiology
In order to advance acupuncture and its theory, merely relying on the inheritance
isno longer sufficient; and it is time to strive for innovation. As one of such in-
novations, the book Contemporary Medical Acupuncture has unique features and is
still a gem among the existing boatload of books on acupuncture.
Never before have we seen a book like this one that applies the perspective of
acu-reflexology to clarify the meridian phenomena, summarize the meridian
theory, and guide the process of clinical acupuncture. The authors classified all
acupoints of the 14 meridians, extraordinary and new points distributed on body
surface into three main types of reflex zones: somatic, visceral and central, as
well as proposed that acupuncture therapy is actually a type of reflexotherapy.
The word reflex simply reveals the essence of meridians and the mechanism of
acupuncture. During acupuncture therapy, no medication has been administered
into the body, its therapeutic effectiveness are purely resulted from the reflex,
whether through the viscera-body surface correlation or the body surface-body
surface correlation. To propose the novel theory of acu-reflexology, Dr. Jin spent
almost 40 years in actively researching and applying to clinical studies. Because
he is one of my former pupils, his talent and creativity exhibited in the field of
acupuncture have impressed me for many years. You might have realized that
the theory of acu-reflexology is actually derived from the perspective of reflex
point, while the notion of ancient Ashi point is the primitive description about
the modern reflex point.
In the early 1960s, I began analyzing Ashi points including the relationship
between their appearance and the illness course in one of my articles published
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in the Journal of TCM. Later on, this article became the "media" that lead to my
discovery of Dr. Jin, who wrote a letter to me after reading the article. Our karma
in the field of acupuncture began ever since then. In his clinical practice, Dr. Jin
has paid great attention to the study of Ashi or reflex points. In scores of published
reports by Dr. Jin in 1970s, selecting reflex points, controlling the propagation of
needling sensations and the arrival of qi at the diseased region were the primary
factors for his successes. Accordingly, classical traveling courses of the meridians
and locations of acupoints becomes a mapping-system on the body surface that
could indicate reflex points or zones.
There are incisive discussions about the relationship of reflex points and
acupoints in this book. Most acupoints are reflex points, tender spots, electro-
permeable points with a low electrical resistance, or those sensitive to thermal
stimulation. On the other hand, reflex points mostly possess the features of
tenderness, low electrical resistance, or local hard nodules. Moreover, their locations
are mostly in accordance with those of classical acupoints. Of course, this does not
mean acupoints are just reflex points, as there is a large difference between them.
Many reflex points are located completely out of traveling courses of the meridians.
Therefore, the authors emphasized that point selection must not be tied up by the
meridians. As w~ know, a classical TCM statement better missing acupoints than
the meridian emphasized the importance of the meridians over acupoints during
point selection process. In Dr. Jin's book however, a complementary statement
better missing the meridian than reflex points to arose, namely, no matter where reflex
points may appear on the meridians or not, they all can be selected for acupuncture.
I strongly support the above perspective about reflex points. Not only locations
of reflex points have great individual differences in various patients or diseases,
but also their sensitivities may vary with disease courses and treatments. I recently
proposed the notion of dynamic points, namely, most acupoints possess dynamic
characteristics. Perhaps this notion can be used in conjunction with acu-reflexology
to clarify the relative specificity in actions of acupoints.
Jia Wei
Professor o/Acupuncture, Jiangxi College of TCM, China
Board Member of China Association o/Acupuncture
F o r e w o r d by Z h a o
It is well known that science means reducibility, reproducibility, and predictability.
In certain fields, various correlated phenomena could be reduced into a model or
a theory; based on theory and its methodology, others should reproduce same
expected results. Moreover, certain related but unclear mechanisms can be ex-
plained, and even unknown phenomena can be predicted. That is science. These
criteria posed enormous challenges to the ancient theory and practice of classical
acupuncture. Some phenomena related to acupuncture were reduced into yin
and yang and the meridians theory, in which qi, a kind of energy stream, flows
through the meridians that are composed of acupoints on the body surface. Under
such theories, the reproducibility and predictability of acupuncture therapy are
questionable. However, this book Contemporary Medical Acupuncture is a break-
through. The authors, Dr. Guan-Yuan Jin and his collaborators, have initiated
and led this revolution.
First, based on the knowledge of modem science and contemporary medicine,
combining their 40 years of clinical expertise and research accomplishments, the
authors have proposed a new concept of whole body reflex zones to replace the
meridians. This key concept has built a bridge between medical theories and
practices in the West and East while creating a very natural connection between
the ancient meridian system and contemporary recognition about physiological
and pathological functions of the human body. Moreover, it inherited the rational
but eliminated unscientific components of the meridian theory, and fttrther paved a
scientific platform for global discussion and exchange in the field of acupuncture.
Second, based on the systems and information theories as well as cybernetics,
O
the authors proposed a new approach or methodology to deal with the acupuncture
process. Black box, not new in computer science or in engineering fields, is actually
proper and innovative in dealing with the incredibly complex human body, as
well as the coupling system between patients and doctors. Let us consider the
following facts: the human body has not changed significantly in the past 40 000
to 50 000 years; our body consists of roughly 50 trillion cells, each cell has an
order of 1013 components, many of which are proteins. In order to simulate the
activity of a single protein, even using a computer of speed 10 ~5 calculations per
second, it would take several months. Black boxes always exist in our body no
matter how deeply recognitions about the body are progressing.
Third, authors have explicitly pointed out indications, effectiveness, and the
limitation of classical acupuncture. Indeed, in the ancient acupuncture therapy,
there are many uncertainties coexisting with its scientific core, as well as some
ambiguous terminologies, classical literature flavors, philosophic explanations,
superstitions, or fictional stories. This book has "filtered" and "thrown away" all
the "garbage" portions and given classical acupuncture a fresh, objective position
in contemporary medical field.
I am proud of the authors' contribution to the global community. They have
applied an internationally acceptable and simple language to describe and express
acupuncture theories and practice, which is indeed a very firm, important and
significant step.
Shensheng Zhao, PhD
Professor of Computer Science
Governors State University, IL, USA
Preface
Acupuncture, as a kind of ancient external therapy, is a jewel of traditional
Chinese medicine (TCM). Spanning over several thousands years of history since
the first usage of bianzhen (flint needle), it has made tremendous contributions
toward preventing and treating diseases as well as promoting the well-being of
the humankind. Even today, when contemporary medicine is highly developed,
the unique functions of acupuncture therapy still stand irreplaceable by any other
therapeutic means. The meridian theory is the basis of acupuncture therapy and
is the collection of wisdom, experience, and results of research from generations
of pioneering acupuncture practitioners. Ever since the beginning, when I first
started to learn acupuncture nearly four decades ago, I have paid much attention
to the inheritance of classical theories and techniques of acupuncture.
However, as I gained more experience through years of clinical acupuncture
and scientific research, especially after I graduated from studies of Western
medicine, my recognition about acupuncture has been evolved and deepened.
In current studies of the meridian theory and mechanisms of acupuncture,
the greatest challenge is that there have not been any special structures of the
meridians discovered that are unknown to anatomy. In addition, increasing
extraordinary points or newer points found later are excluded from the meridian
system, while most original acupoints have multiple functions that are complex
and uncategorized. In fact, the therapeutic intervention of acupuncture is a non-
specific physical stimulation compared with medications. Its curative effects can
be markedly influenced by many factors, either individual differences of pa-
tients or therapeutic techniques of acupuncture practitioners. Thus, classi-
cal acupuncture therapy involves great uncertainty in its curative effects. In
other words, various types of randomness during acupuncture restrict the
03
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reproducibility of such effects.
Reproducibility is one of the most distinguishable characteristics of science.
Obviously, given the current state of acupuncture therapy, to date, it shows a
less proportions of science component (the certainty of effectiveness) than art
component (the randomness of techniques). In order to integrate classical
acupuncture into contemporary medicine, the key is to raise its certainty of
effectiveness and to reduce its randomness of techniques, i.e., enlarge its
proportions of science. Modem scientific knowledge and methodologies must be
applied to examine this ancient therapy and to probe its rational core. Motivated
by this, I have engaged in numerous clinical acupuncture trials and dove into
many studies on the mechanisms of acupuncture as well as the essence of
meridians, and set my life-long goal to develop the field of contemporary medical
acupuncture.
Because contemporary medical acupuncture focuses on the latest, evidence-
based achievements in experimental or clinical aspects of acupuncture, it has
been widely accepted by many Western medical professionals. During the past
few decades, there have been numerous scientific studies on the clarification of
the essence of meridians and mechanisms of acupuncture as well as trials on the
clinical applications of acupuncture. However, until now, the majority of these
studies is rather scattered, localized, or limited in some aspects; often lack a central
theme and a scientific methodology that allows full integration of these achie-
vements. On the other hand, some research accomplishments, particularly from
China, are overly academic, thus become limited in guiding clinical acupuncture,
while high-quality clinical trials done in the West are almost completely dis-
associated from the meridian theory. Although there have already been several
pioneering books published on medical acupuncture, the objective of this book is
to instill a new vision into medical acupuncture from the systems level.
In the late 1970s, by studying the principles and methodology of systems theory
or cybernetics, I began to realize that applying a systems approach to develop
acupuncture and the meridian theory is a truly enlightened direction. Meanwhile,
the perspectives of systems theory just began to be used to simplify and advance
acupuncture in China. In 1976, along with my colleague Dr. Bao, Wenjun, we
proposed a new theory, information zone theory to extract the essence of meri-
dians. We also established a simplified model of the meridians and illustrated an
atlas of whole body information zones for clinical applications. The traveling
courses of meridians on the body surface composed of acupoints were considered
a type of manifestation within information zones. Our book entitled Acupuncture
and Cybernetics I~l published in 1978, has clarified the meridian system, mechanisms
of acupuncture, and the process of the acupuncture therapy, and so on.
Through over three decades of clinical applications, the rationality of whole
body information zones and their distribution rules have successfully passed the
test of practice. In 1998, we further adopted the term reflex zone, which is
recognized internationally, to replace the term i n f o r m a t i o n z o n e . In addition,
we reproduced a full-colored atlas entitled whole body reflex zones E21. In 2004,
our latest book entitled Clinical Reflexology of Acupuncture and Moxibustion I31 was
published in China. It applied the perspective of systems theory/cybernetics and
contemporary physiology, established a novel theory of acu-reflexology to
elucidate and simplify the meridian theory, and guided clinical treatments of
intractable cases. Since its publication, we have received numerous enthusiastic
reviews from our acupuncture peers and other medical professionals, which greatly
inspired us to complete this book on time. This book is a continuation and advance
of the above studies
Of course, since the mechanisms of acupuncture and the essence of meridians
are very complicated, many viewpoints proposed in this book may not be fully
developed, and some hypotheses may still need to be validated. However, we
deeply believe that by conducting further studies under the guidance of modem
science, the eventual integration of ancient acupuncture therapy and contem-
porary medicine will arrive shortly.
Synopses of the Units and Appendices
The pedagogical process of this book begins from the fundamental theories to
the methodology of acupuncture, then to its clinical applications. It is organized
into three main parts with three appendices.
Part One: Overviews of the current state and challenges of classical acupuncture
and its theoretical basis-the meridian theory. Examines the anatomophysiological
basis of the acupuncture therapy and extracts the essence of meridians. Proposes
the novel theory of acu-reflexology and clarifies the formation of meridians and
acupuncture mechanisms through a series of models and hypotheses. Introduces
classifications and distribution rules of whole body reflex zones, as well as analyzes
their relationships with the meridian system.
Part Two: Analyzes the coupling system of patient-acupuncturist and the entire
therapeutic process. Discusses acupuncture techniques, including the collection
of pathological information from the body surface, application of acupuncture
intervention, timely adjustments of the treatment plan, as well as control of various
influencing factors. Introduces the strategy to enhance clinical effectiveness and
covers advanced needling techniques, including increasing stimulation amount,
altering preexisting functional states of patients, point-associations, heat-or -,a
00~
cool-producing methods, and control of propagating needling sensations, and so
o n .
Part Three: Focuses on the treatment of common indications of acupuncture,
especially applying theories or principles introduced in previous units for in-
tractable cases. Presents up-to-date references on clinical trials of acupuncture
and case studies from our clinical expertise of 40 years. Contains treatment stra-
tegies for each indication of acupuncture and their mechanisms, the handling of
clinical scenarios, and predicted effectiveness.
Appendix A: Describes in detail and illustrates whole body reflex zones (vis-
ceral, somatic, and central zones) and their distribution territories, which are
mapped by the meridian system and their main acupoints.
Appendix B: Lists all 361 classical acupoints and most-commonly used extra-
ordinary points or new points, including their anatomic locations.
Appendix C: Provides a FAQ (Frequent Asked Questions) on the book.
Readership
By utilizing medical terminology and scientific methodology, this book can guide
both the clinical practice and scientific research of acupuncture, and is ideal for
both Western and Eastern medical professionals.
It is a practical, advanced, and valuable resource for acupuncture practitioners
who seek to sharpen clinical skills. It can help them either repeat the past successful
experiences or seek novel solutions for intractable cases.
It is an essential and comprehensive text for medical doctors, dentists, psych-
ologists, chiropractors who are interested in integrating acupuncture into their
clinical practice and research.
It may also serve as a suitable reference for medical students, TCM students,
and other healthcare professionals such as nurses, physical or occupational
therapists, massage therapists, and reflexologists who desire to learn more about
acupuncture.
Correspondence
All books of this nature and magnitude will invariably contain errors of omission
and commission. Any constructive comments, corrections, and suggestions about
the book as well as any proposals for collaborative research are welcome.
E-mail: [email protected]
Acknowledgments
This book is only made possible by numerous scientific achievements of many
internationally renowned acupuncture practitioners, physiologists, and clinical
practitioners. Our personal contribution is only a very small part among them.
Therefore, we salute those contributors who made substantial achievements in
the development of theories and techniques of acupuncture, especially those
authors of the references used in the book.
On behalf of the authors, I would also like to acknowledge experts who reviewed
the manuscript and have provided forwards: Profs. Shi-Jiang Li, Xuemin Shi,
Frances Talaska Fischbach, Feng Ling, Kuishan Zheng, Jia Wei, and Shensheng
Zhao. Finally, our special thanks go to Ms. Mary Ann Brennell, RN, Ms. Trudy
Munding, and Ms. Xin Yu for their dedicated efforts in editorial assistance of the
manuscript.
Guan-Yuan Jin, MD, L.Ac.
Contents
CHAPTER 1
1.1
1.2
1.3
1.4
CHALLENGES IN A D V A N C I N G CLASSICAL A C U P U N C T U R E ................................................ 3
THE CURRENT STATE OF A C U P U N C T U R E THERAPY ............................................................................. 3
METHODS OF STUDYING COMPLICATED SYSTEMS ............................................................................... 5
M O D E R N EXPRESSION OF A N C I E N T TERMINOLOGY ............................................................................ 7
A SYSTEMIC VIEW OF MEDICAL A C U P U N C T U R E ................................................................................... 9
CHAPTER 2
2.1
2.2
2.3
2.4
REFLEX ARCS: BASIS OF A C U P U N C T U R E .................................................................................. 12
HOMEOSTASIS A N D REFLEX ........................................................................................................................ 12
STIMULATION SIGNALS OF A C U P U N C T U R E .......................................................................................... 15
TISSUE STRUCTURES A N D SENSORY RECEPTORS OF ACUPOINTS .................................................. 17
AFFERENT PATHWAYS OF NEEDLING SENSATIONS ........................................................................... 24
2.5
2.6
2.7
2.8
2.9
2.10
STRETCH REFLEX A N D REACTIONS A R O U N D NEEDLES .................................................................... 26
INPUT LOCATIONS OF A C U P U N C T U R E STIMULATIONS .................................................................... 32
REFLEX CENTERS A N D A U T O N O M I C EFFERENT PATHS OF A C U P U N C T U R E ............................. 35
LONG REFLEXES OF NERVE-HUMORAL REGULATION ....................................................................... 37
THERAPEUTIC FUNCTIONS OF A C U P U N C T U R E ................................................................................... 39
ACUPUNCTURE ANESTHESIA ...................................................................................................................... 42
CHAPTER 3 REFLEX ZONES: ESSENCE OF THE MERIDIANS ........................................................................
3.1 CONTEMPORARY STUDIES OF THE MERIDIAN P H E N O M E N A .........................................................
3.2
3.3
3.4
3.5
REFERRED PAIN A N D VISCERA-BODY SURFACE CORRELATION ....................................................
RADIATING PAIN A N D BODY SURFACE-BODY SURFACE CORRELATION ....................................
REVOLUTIONIZE THE MERIDIAN THEORY .............................................................................................
REFLEX ZONE: A SUBSTITUTABLE CONCEPT FOR THE MERIDIAN ................................................ .
44
44
48
52
56
59
3.6
3.7
3.8
3.9
3.10
3.11
3.12
FORMATION OF REFLEX ZONES OR THE MERIDIANS ......................................................................... 62
CLASSIFICATION A N D DISTRIBUTION RULES OF REFLEX ZONES ................................................... 65
RELATIONSHIPS BETWEEN REFLEX ZONES A N D THE MERIDIANS ................................................ 74
LOCAL OVERLAPPING A N D LAYERING OF REFLEX ZONES .............................................................. 77
RELATIONSHIPS BETWEEN MICRO A N D MACRO REFLEX ZONES ................................................... 80
A SIMPLIFIED MODEL OF REFLEX ZONES OR THE MERIDIANS ........................................................ 82
REFLEXOTHERAPY: THE ASCRIPTION OF A C U P U N C T U R E ................................................................ 85
CHAPTER 4
4.1
4.2
4.3
4.4
M E C H A N I S M S OF A C U P U N C T U R E FUNCTIONS ..................................................................... 88
RELATIVE SPECIFICITY IN ACTIONS OF ACUPOINTS ........................................................................... 88
MECHANISMS OF REGULATORY FUNCTIONS OF A C U P U N C T U R E ................................................. 93
MECHANISMS OF A C U P U N C T U R E ANALGESIA .................................................................................... 96
M E C H A N I S M S OF A C U P U N C T U R E REHABILITATION ....................................................................... 108
CHAPTER 5 M E C H A N I S M S OF P R O P A G A T I O N OF NEEDLING SENSATIONS ....................................... 112
5.1
5.2
5.3
5.4
5.5
5.6
CLASSIFICATION OF P R O P A G A T I O N OF NEEDLING SENSATIONS ............................................... 112
P R O P A G A T I O N OF EXCITATION INSIDE NERVOUS CENTERS ........................................................ 114
ACTIVATION OF PERIPHERAL FACTORS ................................................................................................ 119
HYPOTHESIS: P R O P A G A T I O N OF MUSCLE TENSION WAVES ......................................................... 121
HYPOTHESIS: TRANSMISSION A M O N G SENSORY NERVE ENDINGS ............................................ 125
HYPOTHESIS: THE RETRIEVAL OF SENSORY MEMORY ..................................................................... 128
CHAPTER 6 BLACK BOX OF THE PATIENT ....................................................................................................... 135
CHAPTER 7 GATHERING REFLEX I N F O R M A T I O N FROM THE BODY SURFACE .................................. 138
7.1
7.2
7.3
7.4
SKIN TEMPERATURE ..................................................................................................................................... 139
APPEARANCE A N D TENSION OF LOCAL SOFT TISSUES ................................................................... 141
TENDER SPOTS ................................................................................................................................................ 142
ELECTRICAL RESISTANCE OF THE SKIN ................................................................................................. 144
CHAPTER 8 INPUT OF INTERVENING INFORMATION OF ACUPUNCTURE .......................................... 146
8.1
8.2
8.3
8.4
8.5
8.6
OPTIMAL STIMULATION LOCATIONS ..................................................................................................... 146
TYPES OF STIMULATION .............................................................................................................................. 149
INTENSITY A N D DURATION OF STIMULATION ................................................................................... 152
STIMULATION FEATURES OF BASIC NEEDLING METHODS ............................................................. 155
PROPERTIES A N D GENERATIONS OF NEEDLING SENSATIONS ..................................................... 157
SEPARATION OF EFFECTS A N D NEEDLING SENSATIONS ................................................................ 162
8.7 T R E A T M E N T C O U R S E A N D I N T E R V A L S B E T W E E N S E S S I O N S ......................................................... 163
C H A P T E R 9 F E E D B A C K P R I N C I P L E O F T R E A T M E N T 166
9.1
9.2
9.3
9.4
9.5
9.6
T H E A S S E S S M E N T O F A C U P U N C T U R E E F F E C T I V E N E S S .................................................................... 166
T I M E M O D E L S O F T H E E F F E C T I V E N E S S ....... .............. .... ........ . ....................... , ........................................ 169
I N D I C A T O R S O F R E V I S I N G T R E A T M E N T P L A N ................................................................................... 171
S E L F - C O N T R O L A N D I N S T A N T R E S P O N S E S .......................................................................................... 173
R A P I D L Y R E V I S I N G T R E A T M E N T P L A N ................................................................................................. 174
T H E F L O W C H A R T O F A C U P U N C T U R E T H E R A P Y .............................................................................. 175
C H A P T E R 1 0 F A C T O R S I N F L U E N C I N G E F F E C T I V E N E S S O F A C U P U N C T U R E ...................................... 179
10.1 T H E S E N S I T I V I T Y O F T H E B O D Y S U R F A C E ............................................ , .................................. , ............. 179
10.2 P R O P E R B O D Y P O S T U R E S ............................................................................................................................ 182
10.3 P S Y C H O L O G I C A L F A C T O R S ....................................................................................................................... 186
10.4 M E N T A L S T A T E O F T H E P A T I E N T .......................................................... .................................................. 187
10.5 T H E F I N G E R S T R E N G T H O F T H E P R A C T I T I O N E R ................................................................................ 189
10.6 P A I N L E S S N E E D L E - I N S E R T I O N T E C H N I Q U E S ...................................................................................... 190
10.7 T H E S E T T I N G S O F T H E R A P E U T I C E N V I R O N M E N T ............................................................................. 192
10.8 T H E O R D E R O F S T I M U L A T I O N ................................................. , .............................................. . .................. 193
10.9 T H E A R E A O F S T I M U L A T I O N ...................................................................................................................... 196
10.10 T H E SIZE O F N E E D L E S ................................................. ............................ ...... ,... ...................... ..................... 198
10.11 T H E A N G L E , D E P T H A N D D I R E C T I O N O F N E E D L I N G ....................................................................... 199
C H A P T E R 11 S T R A T E G I E S T O RAISE T H E R A P E U T I C E F F E C T I V E N E S S ..................................................... 203
11.1 S E L E C T I O N O F T E N D E R S P O T S ......................................................................................... 203
11.2
11.3
11.4
11.5
11.6
11.7
11.8
11.9
M U L T I P L E N E E D L E S A T A S I N G L E P O I N T ............................................................................................... 205
S I N G L E N E E D L E T H R O U G H M U L T I P L E P O I N T S ................................................................................... 207
I N T E G R A T I N G W I T H E L E C T R I C A L S T I M U L A T I O N ............................................................................. 210
T E C H N I Q U E S O F H E A T - P E N E T R A T I N G M O X I B U S T I O N .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
P R O L O N G I N G S T I M U L A T I O N ........................................................................ ......................................... 215
P O I N T - A S S O C I A T I O N S T H R O U G H M U L T I P L E P A S S A G E S ................................................................. 217
A L T E R P R E E X I S T I N G F U N C T I O N A L S T A T E S O F T H E P A T I E N T ....................................................... 223
M I S C E L L A N E O U S N E E D L E - M A N I P U L A T I O N T E C H N I Q U E S 227
C H A P T E R 12 A D V A N C E D N E E D L I N G T E C H N I Q U E S ................................................................................. 229
12,1
12.2
12.3
12.4
P O I N T - P R O B I N G A N D R E P E A T E D L Y N E E D L E - T H R U S T I N G M E T H O D S ........................................ 229
N E E D L E - M A N I P u L A T I O N S W I T H B O T H H A N D S ................................................. . ............................... 231
P O I N T - P R O B I N G W I T H E L E C T R O A C U P U N C T U R E .............................................................................. 232
N E R V E - S T I M u L A T I O N T E C H N I Q U E S ....................................................................................................... 233
12.5
12.6
12.7
12.8
12.9
PULSATING RESPONSES A N D PULSATING POINTS ............................................................................ 235
BLOOD VESSEL STIMULATION T E C H N I Q U E S ....................................................................................... 239
RESISTANCE-NEEDLING M E T H O D ........................................................................................................... 241
H E A T / C O O L - P R O D U C I N G T E C H N I Q U E S ............................................................................................... 243
CONTROL THE P R O P A G A T I O N OF N E E D L I N G SENSATIONS .......................................................... 245
CHAPTER 13 DISORDERS OF THE MUSCULOSKELETAL SYSTEM ............................................................. 253
13.1 F R O Z E N S H O U L D E R / S H O U L D E R PAIN .................................................................................................. 253
13.2 CERVICAL S P O N D Y L O P A T H Y / C H R O N I C N ECK PAIN ...................................................................... 256
13.3 STIFF N E C K / W H I P L A S H .............................................................................................................................. 259
13.4 L U M B A G O ......................................................................................................................................................... 262
13.5 HIP O S T E O A R T H R I T I S / G R O I N P A I N ........................................................................................................ 268
13.6 KNEE A R T H R I T I S / K N E E PAIN ................................................................................................................... 270
13.7 R H E U M A T O I D ARTHRITIS /ARTHRITIS OF SMALL JOINTS ............................................................... 274
13.8 FIBROMYALGIA .............................................................................................................................................. 277
13.9 T E N D O N I T I S / H E E L PAIN ............................................................................................................................ 279
13.10 TENNIS E L B O W / E P I C O N D Y L I T I S .............................................................................................................. 281
13.11 CARPEL T U N N E L SYNDROME ................................................................................................................... 284
13.12 T E N O S Y N O V I T I S / T R I G G E R F I N G E R / G A N G L I O N ................................................................................ 286
13.13 INJURED SOFT TISSUES OR SPRAINED ANKLE ..................................................................................... 289
13.14 SCIATICA ........................................................................................................................................................... 290
CHAPTER 14 DISORDERS OF THE NERVOUS SYSTEM .................................................................................. 295
14.1 INTERCOSTAL N E U R A L G I A / C H E S T P A I N ............................................................................................. 295
14.2 LATERAL FEMORAL C U T A N E O U S NEURITIS ........................................................................................ 298
14.3 PERIPHERAL N E U R O P A T H Y ....................................................................................................................... 299
14.4 REFLEX SYMPATHETIC DYSTROPHY ....................................................................................................... 301
14.5 TRIGEMINAL N E U R A L G I A .......................................................................................................................... 304
14.6 BELL'S PALSY ................................................................................................................................................... 307
14.7 FACIAL SPASM ................................................................................................................................................ 310
14.8 H E A D A C H E ...................................................................................................................................................... 312
14.9 A P O P L E X Y / H E M I P L E G I A ............................................................................................................................ 316
14.10 T R E M O R / P A R K I N S O N ' S DISEASE ............................................................................................................. 324
14.11 MULTIPLE SCLEROSIS ................................................................................................................................... 327
14.12 ALZHEIMER'S DISEASE ................................................................................................................................. 329
14.13 EPILEPSY ........................................................................................................................................................... 330
C H A P T E R 15
15.1
15.2
15.3
15.4
M E N T A L DISORDERS ................................................................................................................... 333
I N S O M N I A ........................................................................................................................................................ 333
N E U R O S I S / N E R V O U S N E S S / A N X I E T Y ..................................................................................................... 336
HYSTERIA .......................................................................................................................................................... 339
D E P R E S S I O N / S C H I Z O P H R E N I A / P S Y C H I A T R I C DISORDERS ........................................................... 340
C H A P T E R 16 DISORDERS OF O P H T H A L M O L O G Y ......................................................................................... 344
16.1 M Y O P I A / A M E T R O P I A ................................................................................................................................ 344
16.2 R E T I N O P A T H Y / OPTIC A T R O P H Y / G L A U C O M A .............................................................................. 347
C H A P T E R 17 DISORDERS OF O T O R I N O L A R I N G O L O G Y .............................................................................. 352
17.1
17.2
17.3
17.4
T I N N I T U S / N E U R O S E N S O R Y D E A F N E S S ................................................................................................. 352
MENIERE 'S DISEASE ...................................................................................................................................... 354
R H I N I T I S / S I N U S I T I S ...................................................................................................................................... 355
D Y S P H O N I A ..................................................................................................................................................... 357
C H A P T E R 18 D E N T A L DISORDERS ..................................................................................................................... 360
18.1 T O O T H A C H E / D E N T A L P A I N ..................................................................................................................... 360
18.2 D Y S F U N C T I O N OF T E M P O R O M A N D I B U L A R JOINT ............................................................................ 362
C H A P T E R 19 DISORDERS OF C I R C U L A T O R Y SYSTEM .................................................................................. 364
19.1
19.2
19.3
19.4
H Y P E R T E N S I O N .............................................................................................................................................. 364
A N G I N A P E C T O R I S / C O R O N A R Y ARTERY DISEASES ......................................................................... 367
A R R H Y T H M I A S ............................................................................................................................................... 369
R A Y N A U D ' S S Y N D R O M E ............................................................................................................................. 370
C H A P T E R 20 DISORDERS OF RESPIRATORY SYSTEM .................................................................................... 373
20.1 C O M M O N C O L D / T O N S I L L I T I S .................................................................................................................. 373
20.2 A S T H M A / B R O N C H I T I S ................................................................................................................................ 374
C H A P T E R 21 DISORDERS OF DIGESTIVE SYSTEM ..........................................................................................
21.1 N A U S E A / E M E S I S / H I C C U P S ........................................................................................................................
21.2
21.3
21.4
21.5
G A S T R I T I S / P E P T I C U L C E R / R E F L U X E S O P H A G I T I S ............................................................................
ULCERATIVE C O L I T I S / I R R I T A B L E BOWEL S Y N D R O M E / C R O H N ' S DISEASE ..............................
C H O L E L I T H I A S I S ............................................................................................................................................
HEPATITIS .........................................................................................................................................................
378
378
382
384
386
388
C H A P T E R 22 DISORDERS OF U R O G E N I T A L SYSTEM .................................................................................... 391
22.1 U R I N A R Y R E T E N T I O N .................................................................................................................................. 391
_< 2 2 . 2 N O C T U R N A L E N U R E S I S / N O C T U R I A / B E D W E T T I N G ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 9 2
2 2 . 3 U R I N A R Y I N C O N T I N E N C E .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 9 4
2 2 . 4 P R O S T A T I T I S / P R O S T A T E C A N C E R .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 9 6
2 2 . 5 I M P O T E N C E / P R O S P E R M I A ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 9 8
2 2 . 6 D Y S M E N O R R H E A / E N D O M E T R I O S I S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 0 0
2 2 . 7 M E N O P A U S E / H O T F L U S H .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 0 1
2 2 . 8 I N F E R T I L I T Y .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 0 2
2 2 . 9 M A L P O S I T I O N O F T H E F E T U S ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......... . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 0 5
2 2 . 1 0 H Y S T E R O M Y O M A ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , ........ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 0 7
C H A P T E R 23 D I S O R D E R S O F T H E S K I N ....... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 0 8
23 .1 H E R P E S Z O S T E R ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ' . ............. 4 0 8
2 3 . 2 U R T I C A R I A / P R U R I T U S / N E U R O D E R M A T I T I S / P S O R I A S I S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 1 0
2 3 , 3 A C N E ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 1 3
C H A P T E R 2 4 D I S O R D E R S O F E N D O C R I N E .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 1 5
2 4 . 1 O B E S I T Y ..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , ..... ......... 4 1 5
2 4 . 2 D I A B E T E S .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 1 9
2 4 . 3 T H Y R O I D D I S E A S E S .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ....~.... .............. ............. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 2 0
C H A P T E R 25 O T H E R D I S O R D E R S ............................ , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 2 4
25 .1 S M O K I N G C E S S A T I O N .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 2 4
2 5 . 2 A L C O H O L I S M ........................................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 2 7
2 5 . 3 D R U G A D D I C T I O N ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 2 9
2 5 . 4 H I V / A I D S ........................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 3 2
2 5 . 5 C A N C E R S .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 3 4
A P P E N D I X A T H E A T L A S O F W H O L E B O D Y R E F L E X Z O N E S .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 3 7
A P P E N D I X B I N D E X O F A C U P O I N T S A N D E X T R A O R D I N A R Y P O I N T S ....... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 5 3
A P P E N D I X C F R E Q U E N T A S K E D Q U E S T I D N S ( F A Q S ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 7 7
R E F E R E N C E S ............................................................................................................. , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 8 6
I N D E X ..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 2 1