Book: Complementary and Alternative Therapies for Nursing Practice (4th Edition)
ISBN-13: 9780133346503/ ISBN-10: 0133346501
Author: Karen Lee Fontaine RN MSN. Edition: 4
Publisher: Prentice Hall
Published: January 2014
Answer these 4 Question(s):
1. Discuss Acupuncture (How acupuncture works?).
2. What are the benefits of acupuncture? Is there any research study that support the evidence of acupuncture value? (Explain your answer / Examples).
3. Have you ever used acupuncture? Discuss your experience.
4. Provide at least 3 benefits of acupuncture.
The answer should be based on the knowledge obtained from reading the book attached in a word document (only the last part of the question is your opinion). If there are 4 questions in the discussion, you must answer all of them.
Remember, the internet may not have accurate information. Sometimes, part of the question may ask for your opinion. In this case, you give your opinion based on the knowledge obtained from studying the corresponding chapter.
• I am expecting to answer the question and justified it based on peer review literature or information in your book.
• I am expecting at least three paragraphs with five sentences in each paragraph (minimum of 400 words).
• APA style will be strictly enforced.
• If other References are used in addition to the book must have:
· Serial/journal articles
· Volume number, in italics.
· Issue number. This is bracketed immediately after the volume number but not italicized. Month, season or other designation of publication if there is no volume or issue number.
· Include all page numbers. Ex: 7(1),24 Sergiev, P. V., Dontsova, O. A., & Berezkin, G. V. (2015).
Acupuncture, acupressure, Jin Shin Jyutsu, Jin Shin Do, and reflexology are different forms of the same practice of stimulating points on the body to balance the body’s life energy. Jin Shin Jyutsu, Jin Shin Do, and reflexology are forms of acupressure, and in this chapter the term acupressure includes all the forms. Acupuncture and acupressure are based on the theory that applying pressure or stimulation to specific points on the body, known as acupuncture points, can relieve pain, cure certain illnesses, and promote wellness. Acupuncture uses needles, whereas acupressure uses finger pressure. Although the older of the two techniques, acupressure is not as powerful and could be considered the over-the-counter version of acupuncture. Acupressure is easy to learn and convenient for self-care, whereas acupuncture requires training to use the needles. Frequently, these practices are part of a holistic approach to wellness and are combined with diet, herbs, massage, mind–body techniques, and spiritual therapies. Used with great success on humans for thousands of years, acupuncture and acupressure are now available for cats, dogs, and horses through veterinarians trained in Traditional Chinese Medicine.
Acupuncture and acupressure started in China several thousand years ago. The practice spread to Korea around 300 a.d. and to Japan and Europe in the 17th century. In the late 19th century, a Canadian physician, Sir William Osler, became interested in acupressure techniques, but they remained largely unknown in North America until the 1970s. Accompanying President Richard Nixon on his trip to China in 1972, James Reston, a reporter for the New York Times, wrote about his experience with acupuncture for relief of pain following abdominal surgery in China. This article began the upsurge of interest in these therapies in the United States. At the present time, acupuncture and acupressure are practiced widely in Asia, the former Soviet Union, and Europe and are gaining in popularity in North America (Hunts, 2012).
Jin Shin Jyutsu (pronounced “jin-shin, jit-soo”) and Jin Shin Do are Japanese phrases meaning “the way of the compassionate spirit.” They are ancient practices that fell into relative obscurity until they were dramatically revived in the early 1900s by Master Jiro Murai in Japan. Dying from a termi- nal illness, he turned in desperation to Jin Shin Jyutsu and meditation. Within a week, he was completely well. He spent the remaining 50 years of his life researching and sharing his knowledge of this healing art, which he referred to as the art of happiness, the art of longevity, and the art of benevolence. After World War II, a Japanese American, Mary Burmeister, studied with Master Murai for many years and eventually returned to the United States with the “gift” of Jin Shin Jyutsu and Jin Shin Do. Today, thousands of students throughout the United States and around the world study and practice Jin Shin Jyutsu and Jin Shin Do (Waldeck, 2011).
Reflexology, an associated ancient practice, limits the use of acupressure points, or reflexes, to the feet, hands, and ears. William Fitzgerald, an Ameri- can physician, introduced reflexology to the West in 1913. He noted that there was less postoperative pain when pressure was applied to people’s feet and hands just before surgery. In spite of Fitzgerald’s work, it was the efforts of Eunice Ingham, a physical therapist, who expanded and refined Fitzgerald’s observations and found that reflexology not only reduced pain but provided other health benefits as well. Ingham mapped the specific reflex zones on the feet, hands, and ears that reflexologists use today. This work gave her the distinction of being the founder of modern reflexology in the West (Keet, 2009).
The United States has 53 schools and colleges of acupuncture approved by the Council of Colleges of Acupuncture and Oriental Medicine. The graduate-level program of 2,625 hours or 146 credits covers Oriental medicine, acupuncture theory, Chinese herbs, and biomedicine theory and includes 1,330 hours of clin- ical practice. The master’s-level program for practitioners seeking licensure only as an acupuncturist is a minimum of 3 years and 1,905 hours or 105 credits. There is also an herb certificate program of 450 hours of didactic instruction and 210 hours of clinical training in the use of Chinese herbs for those practitioners who already have a master’s degree in acupuncture. Forty-three states plus the District of Columbia require passing a national board exam as a prerequisite for licensure. In addition, each state has its own eligibility requirements.
An estimated 7,000 to 8,000 U.S. doctors now include acupuncture in their practice. Most are family physicians, anesthesiologists, orthopedists, and pain specialists. Few physicians are certified by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM), but most are certified by the American Academy of Medical Acupuncture (AAMA) instead. Even though acupuncture is used in China to treat many conditions, in the United States, conventional physicians have taken the technique out of context, basing it more on a biomedical model of diagnosis and treatment. Nationally, an estimated 15,000 nonmedical professionals practice acupuncture, including nurses, naturopathic physicians, and chiropractors.
Professionals using acupressure are usually physical therapists or massage therapists with special training in this field. Some nurses are trained in acupressure and use it to help clients sleep and to reduce levels of anxiety. Midwives may use acupressure techniques to promote relaxation during labor and reduce breast engorgement after delivery. No specific license or certification is needed to prac- tice any of the forms of acupressure, although practitioners of reflexology have the option to become certified by the American Reflexology Certification Board
Acupuncture, acupressure, Jin Shin Jyutsu, Jin Shin Do, and reflexology are treatments rooted in the traditional Eastern philosophy that qi, or life energy, flows through the body along pathways known as meridians. Like major power lines, the meridians connect all parts of the body. As vital energy flows through the meridians it forms tiny whirlpools close to the skin’s surface at places called hsueh, which means “cave” or “hollow.” In Traditional Chinese Medicine, these are acupuncture points; in India, marma points. These pressure points function somewhat like gates to moderate the flow of qi. Acupuncture needles inserted into these points or pressure on these points releases blocked energy and improves the circulation of qi in the body (Jevon, 2012).
In addition to the major meridians, the body has 360 to 365 classic points through which qi can be accessed. Most practitioners, however, focus on 150 points. The points themselves are metaphors for a person’s journey through life, with names such as “Spirit Gate,” “Great Esteem,” “Joining the Valleys,” and “Inner Frontier Gate.”
Meridians are associated with internal organs after which they are named: stomach, spleen, heart, small intestine, bladder, kidneys, gallbladder, liver, lungs, and large intestine. The triple-warmer meridian is associated with the thyroid and adrenal glands, the governing meridian with the spine, and the central meridian with the brain.
Chapters 2 and 4 present more detailed information regarding energy and meridians.
The meridians converge at many points in the body, called microsystems, that are reflexes to distant parts of the body. These microsystems are small local representations of the whole body and are located on the feet, hands, and ears. In other words, each individual part of the body has an associated reflex on the ear, the hand, and the foot. The reflexes are symmetric in that organs on the right side of the body are reflected in the right foot, and the left organs are reflected in the left foot. The reflexes also correspond in descending order: the brain reflexes are in the tips of the toes, the eyes and ears under the toes, the shoulders and lungs on the ball of the foot, the stomach and pancreas on the instep, the intestines and colon toward the heel, and the hips on the heel.
In the pressure point tradition, the mind, body, spirit, and emotions are never separated. Thus, the heart is not just a blood pump, but it also influences one’s capacity for joy, one’s sense of purpose in life, and one’s connectedness with others. The kidneys filter fluids, but they also manage one’s capacity for fear, one’s will and motivation, and one’s faith in life. The lungs breathe in air and breathe out waste products, but they also regulate one’s capacity to grieve, as well as one’s acknowledgment of self and others. The liver cleanses the body, and it also influences one’s feeling of anger as well as that of vision and creativity. The stomach has a part in digestion of food and influences one’s ability to be thoughtful, kind, and nurturing as well. These are just a few of the mind– body connections recognized by pressure point practitioners (Zhu, 2012).
VIEW OF HEALTH AND ILLNESS
Health is viewed as a state of harmony, or balance, of the opposing forces of nature, both internal and environmental. The body requires balanced yin and yang energy to function properly and to utilize its natural ability to resist dis- ease. It is believed that everything needed to maintain and restore health already exists in nature and that pressure point therapies free up energy and restore balance, thus enabling individuals to maintain or regain their health. Symptoms are caused by an imbalance of yin and yang in some part of the body, leading to excesses or deficiencies of life energy throughout the body. When the flow of energy becomes blocked or congested, people
experience discomfort or pain on a physical level, may feel frustrated or irritable on an emotional level, and may experience a sense of vulnerability or lack of purpose in life on a spiritual level. When the flow of energy is interrupted, the area cannot nourish or cleanse. If not corrected, these blocks and imbalances in energy channels can result in disease and eventually illness. The goal of care is to recognize and manage the disruption before illness or disease occurs. Qi can be thrown out of balance in a number of ways, including genetic vulnerability, accident or trauma, diet, lifestyle, emotional upset, spiritual distress, climate, or noxious agents. Pressure point practitioners bring balance to the body’s energies, which promotes optimal health and well-being and facilitates people’s own healing capacities.
The initial consultation involves a holistic assessment because no part of the self is considered a neutral bystander when the body is in a state of imbalance. A detailed medical history is an important part of the diagnostic process. Special attention is paid to the connection between body, mind, emotions, and spirit. Palpation is the major diagnostic method of pressure point therapies within the context of Traditional Chinese Medicine. Reading the pulses provides a remarkable amount of information about the person’s condition.
the feet, hands, and ears. If something feels unusual in the microsystems, the corresponding organ is examined in more detail. Chapter 4 discusses the diagnostic process of Traditional Chinese Medicine in greater detail.
Pressure point therapies consider symptoms to be an expression of the condition of the person as a whole. Thus, sessions focus not only on relieving pain and dis- comfort but also on responding to disruptions before they develop into illnesses.
To restore the flow of energy, acupuncturists insert sterile, hair-thin needles at points along the meridians. The needles are rotated, twirled, or accompanied by a weak electrical current and are often left in several minutes or longer. Acupuncturists also may apply heat or use finger pressure to alter the flow of qi. Clients feel little, if any, pain. Some people experience sensations of warmth, tingling, heaviness, or a dull ache. Western medical explanations of evidence now indicate that, in addition to restoring the flow of energy within the meridians, acupuncture reduces pain by triggering the release of endogenous opioids. Many of the analgesic effects of acupuncture can be partially or completely blocked by the use of opioid antagonists such as naloxone.
Acupuncture also stimulates the nervous system to release adrenocorticotropic hormone (ACTH), a chemical that aids in fighting inflammation; prostaglandins, which help wounds heal more quickly; and other substances that may promote nerve regeneration. Anti- emetic effects apparently stem from the increase in endorphins and ACTH, which inhibits the chemoreceptor trigger zone and the vomiting center in the brain.
Acupuncture also calms the upper gastrointestinal tract. Research has found that acupuncture is effective for nausea from morning sickness, motion sickness, postoperative nausea, and chemotherapy-induced nausea. Unlike drugs and surgery, acupuncture has virtually no side effects (Jingyi, 2012).
Jin Shin Jyutsu and Jin Shin Do
Jin Shin Jyutsu and Jin Shin Do can be applied as self-help and also by a trained practitioner, who places the fingertips over clothing on designated pressure points to harmonize and restore the energy flow. Rather than doing something to the body, Jin Shin encourages the body to “let go,” which is seen as the path to awakening one’s awareness of harmony within the self and the universe. A session generally lasts about an hour with the client lying on a table fully clothed. The practitioner’s hands act as “jumper cables” to “kick start” the correct flow of energy. A spot on the shoulder may be held at the same time as a spot on the knee. The practitioner uses special sequences of hand positions to stimulate the circulation of energy. The touch is gentle, is steady, and never involves force. It is generally pain free; any tenderness in a particular area is caused by a blockage and tends to dissipate as the area is held. Some people may feel hot or cold or feel a sensation in another part of the body than the one where the practitioner is working. Most people experience a sense of deep relaxation with Jin Shin Jyutsu and Jin Shin Do (Waldeck, 2011).
Most commonly, reflexologists manipulate the reflex zones on the feet, but the hands or ears may also be manipulated. A session usually lasts about 45 minutes with the client sitting comfortably in a chair and the practitioner using thumb and fingers in small, creeping movements over the sole of the foot.
This manipulation prompts the nervous system to speed up the body’s response to an afflicted area by stimulating the flushing of toxins from the area.
Pressure point therapies are widely used around the world to treat many conditions, including addiction, allergies, bronchitis, cerebral palsy, depression, diabetes, hemorrhoids, hepatitis, herpes, infertility, irritable bowel syndrome, nausea, premenstrual syndrome, stroke, and ulcers. In the United States, reduction of pain is a major therapeutic use, including pain from dental work, temporomandibular joint (TMJ) syndrome, migraine headaches, osteoarthritis, low back pain, sciatica, carpal tunnel syndrome, and sports injuries. Acupuncture can provide symptomatic relief from the pain of bursitis and is much safer than anti-inflammatory drugs and injections of steroids (Cross, 2012; Jevon, 2012).
Pressure point therapy is not appropriate for every ailment. It is not indicated for an acute or infectious illness or fever or if surgery is needed. Foot injuries need to heal before reflexology is used on the foot. If someone has a pace- maker, practitioners avoid stimulating the left chest zone. If someone has gall- stones or kidney stones, the gallbladder and kidney points are avoided. If the person is pregnant, uterine points are avoided.
In 1997, the National Institutes of Health (NIH) assembled a panel of experts in a scientific court known officially as a consensus conference. A panel of 12 experts was drawn from a variety of backgrounds, including biomedical research scientists, physicians, and others. The panel’s task was to listen to as much evidence as the acupuncture/pressure point research community could present in the first half of the 3-day conference. The panel’s conclusions included the following statement: “There is sufficient evidence of acupuncture’s value to expand its use into conventional medicine and to encourage further studies of its physiology and clinical value” (NIH, 1998). The panel determined that acupuncture was clearly effective for nausea and vomiting in , stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syn- drome, and asthma where acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program” (NIH, 1998). This panel focused only on data collected by means of randomized controlled clinical trials and therefore did not review data on technique, cost benefit, patient preference, or practitioner education.
• A Joanna Briggs Institute evidence summary (Moola, 2012) found that:
• in people undergoing surgery acupressure, acustimulation, and acupuncture reduces postoperative nausea and vomiting (Grade B).
• perioperative acupuncture is recommended to reduce nausea and vomiting in children having an adenoidectomy or tonsillectomy (Grade B).
• A Joanna Briggs Institute evidence summary found that owing to low methodological quality of current research, there is insufficient evidence that acupuncture reduces cancer pain in adults (Woodard, 2011).
The following is a small sample of recent research results:
• A Cochrane Database systematic review found that there was insufficient evidence that acupuncture can lessen the symptoms of depression (Smith, Hay, & MacPherson, 2010).
• A randomized controlled clinical trial found that acupuncture was effective in reducing menopausal symptoms compared with sham acupuncture (Sunay, Ozdiken, Arslan, Seven, & Aral, 2011).
• A review of the literature found evidence that acupuncture provided some relief to a number of women with primary dysmenorrhea, but it was not clear how acupuncture compared with conventional treatments (Cunningham & Tan, 2011).
• A randomized controlled trial found that foot reflexology improved the quality of sleep in postpartum women (Li, Chen, Li, Gau, & Huang, 2011).
• A randomized controlled trial found that among patients with advanced- stage breast cancer the reflexology group had significant improvement in physical functioning and reduced dyspnea compared with the control group. No differences were found in the health-related quality of life, depressive symptoms, state anxiety, pain, and nausea (Wyatt, Sikorskii, Rahbar, Victorson, & You, 2012).
INTEGRATED NURSING PRACTICE
If you are interested in incorporating pressure point therapies into your nursing practice, you may want to attend a weekend or weeklong program on reflexology, Jin Shin Jyutsu, or Jin Shin Do. Even without further education, you can incorporate hand, foot, or ear massages into your practice. This type of massage is easy to learn and nonintrusive. The procedure for a hand mas- sage is shown in Figure 12.3 in the chapter on massage therapy. These procedures can be modified for an ear massage. The hands, feet, and ears are fairly small. If you simply massage them, focusing on any tender spots you find, you are bound to send qi or energy to all parts of the body. Few people object to this type of massage. Even if the recipient has no particular physical com- plaints, this type of massage is wonderfully relaxing.
You can teach clients about a number of pressure points as you advocate self-help. Box 13.1 describes this process for nausea, headaches, hiccups, and carpal tunnel syndrome.
To ease tension and restore energy, try this pressure point:
To ease tension and restore energy, try this pressure point: Hold your left palm in front of you, fingers together. The fleshy spot between your thumb and index finger is a key pressure point. Using your right thumb, massage this spot in a circular motion for a slow count of 15. Then, switch hands and repeat the process. You can also teach clients several fingers holds to improve their general level of well-being. Explain that they should gently hold the appropriate finger on either hand while imagining the negative emotions melting away and physical symptoms easing
• Thumb. Corresponds to worrying, depression, anxiety. Physical symptoms may include stomachaches, headaches, skin problems, and nervousness.
• Index finger. Corresponds to fear, mental confusion, frustration. Physical symptoms are digestive problems and muscle problems such as backaches.
• Middle finger. Corresponds to anger, irritability, indecisiveness. Physical symptoms are eye or vision problems, fatigue, and circulation problems.
• Ring finger. Corresponds to sadness, fear of rejection, grief, negativity. Physical symptoms are digestive, breathing, or serious skin problems.
• Little finger. Corresponds to insecurity, effort, overdoing it, nervous- ness. Physical symptoms are sore throat and bone or nerve problems.
Clients can be taught acupressure for relief of nausea from a variety of causes. The pericardium 6 point is located in the midline of the inner wrist between two and three finger-widths up toward the elbow from the crease where the hand joins the wrist. People can stimulate this point using their own finger or apply an acupressure wristband to the point.
The following are several examples of how you can use pressure points to relieve discomfort or pain.
Once you think you have located one of the appropriate points, probe the area with a fingertip or pencil eraser in a tight circular motion in the general location. Points often feel tender, sore, or tingling. Press the point for 1 minute, then stop for a few seconds, and press again. Work the point for 5 to 20 minutes. If you are experiencing a headache, hiccups, or symptoms of carpal tunnel syndrome, experiment for yourself and find which points work best for you. Remember, only some of the points need to be worked to achieve relief.
There is only one point for nausea.
Nausea Point Hold your hand open, palm up. This point is 2 inches toward the elbow from the wrist crease and is centered in the groove between the two large tendons. Using the thumb and a finger, press firmly on this point on both sides of the wrist. Wrist bands can also be purchased that apply pressure to the correct spot. This procedure is safe during pregnancy and also helps with other types of nausea.
Point 1 -Hold your hand open, palm down, and find the point in the center of the fleshy webbing between the thumb and index finger.
Point 2- Find the point on the top of the foot in the valley between the big toe and second toe.
Point 3- This point is at the base of the back of the skull in the hollow above the two large vertical neck muscles.
Point 4- This point is in the hollow above the inner eyes, where the bridge of the nose meets the ridge of the eyebrows.
Point 5- Find the point between the eyebrows in the indentation where the bridge of the nose meets the forehead.
Point 6- This point is two finger-widths above the webbing of the fourth and fifth toes in the groove between the bones.
Point 1- Find the point in the indentation behind each earlobe.
Point 2- This point is located at the base of the throat in the center of the collarbone.
Point 3- Find this point on the center of the breastbone three thumb-widths up from the base of the bone.
Point 4- This point is located three finger-widths below the base of the breastbone in the pit of the abdomen. If you are healthy, do not press this point for more than 2 minutes. If you are not healthy, do not press this point at all.
Carpal Tunnel Syndrome
Point 1- Find the point in the middle of the inner side of the forearm, two and a half finger-widths below the wrist crease.
Point 2- This point is located in the middle of the inside of the wrist crease.
Point3- Find the point on the outside of the forearm, midway between the radius and ulna, two and a half finger-widths below the wrist crease.
When your feet ache, your whole body suffers. Here are instructions for a 10- to 15-minute foot massage to relax and soothe your feet and perhaps your entire body.
• Sit in a comfortable, quiet place where you will not be disturbed. You may want to have soothing music in the background.
• Pour a small amount of no greasy lotion or massage oil into your hands and rub them together.
• Begin massaging one foot, stroking each toe in an up-and-down motion. Then, mas- sage the entire foot using kneading, wringing motions until the lotion is absorbed.
• Holding your foot firmly in one hand, press the thumb of the other hand (slightly bent) on the sole of the foot near the heel. Apply even pressure with the thumb and “walk it” forward, little by little. Press one spot, move forward, press again, move forward, and so on.
• When you get to the toes, go back to the heel and trace another line from heel to toe. Continue this process until the entire sole of the foot has been worked.
• Repeat the entire process with the other foot.
Considering the Evidence
K. Linde, G. Allais, B. Brinkhaus, E. Manheimer, A. Vickers, & A. R. White, 2009, Acupuncture for tension-type headache, Cochrane Database of Systematic Reviews, Jan. 21 (1): CD007587. doi: 10.1002/14651858.C
What Was the Type of Research? Systematic review of randomized clinical control trials (RCTs) .
What Was the Purpose of the Research? To synthesize, appraise, and evaluate relevant RCTs on the effectiveness of an acupuncture intervention with clients experiencing episodic or chronic tension-type headaches.
A control group received standard care only or treatment of acute headache, a sham acupuncture intervention, or another intervention.
How Was the Research Done? The authors used a systematic review methodology to examine published and unpublished RCTs relevant to the purpose of this research. They employed a comprehensive search strategy using selected keywords and electronic databases to identify randomized clinical controlled trials focusing on the purpose of the review. Two reviewers identified the studies, appraised, extracted the data, and assessed risk of bias and quality of the acupuncture intervention. Eleven studies of methodological quality were identified as meeting the established inclusion criteria for this review. A total of 2,317 patients with tension-type headache were included in this review.
What Were the Findings of the Research? Acupuncture could be considered a nonpharmacologic intervention to give short-term relief (3 months) to patients experiencing frequent episodic or chronic tension-type head- aches. Acupuncture resulted in a small but significant decrease in tension-type headaches compared with sham therapy.
What Additional Questions Might I Have? Are there any adverse or harmful effects associated with acupuncture in persons living with tension headaches?
What would be the effect of acupuncture in combination with other complementary and alternative therapies in this client population? Could acupuncture have long-term effects for persons experiencing tension-type headaches?
How Can I Use This Study? This study has considerable clinical value for nurses caring for persons living with tension head- aches. Health care providers should recognize and support patients’ decisions to incorporate acupuncture in enhancing their quality of life. Nurses should be aware that previous research lacked support for acupuncture for tension-type headaches owing to an insufficient number of studies. However, additional clinical trials have found acupuncture to be an effective intervention, so nurses can have more confidence in this complementary and alternative therapy.