Yajuan Wang OMD, LAc, in Micro-Acupuncture in Practice, 2009 ELECTRO-ACUPUNCTURE THERAPY: Electro-acupuncture therapy is a technique that is done by inserting the acupuncture needles in the scalp and then connecting the electro-machine to stimulate the point. Use electro-stimulation instead of hand stimulation to treat disease. The electro-machine can perform fast rotation, stabilize the treatment, and control the stimulation. Select two or more points at the time of stimulation. The current level should be chosen based on the amount the patient can handle. Usually choose a small amount of current to stimulate the point for 1 to 2 minutes, and once the patient becomes accustomed to the stimulation, increase the current. Treatment time for electro-acupuncture therapy should be 10 to 20 minutes. Use electro-acupuncture for conditions such as headache, dizziness, tinnitus, deafness, seizures, chorea, facial spasm, hysteria, stroke, or aphasia. Treat the patient once daily or every other day for 10 treatments per course with 7 to 10 days between courses. Electro-acupuncture therapy should be used with caution for the following conditions:

Electro-Acupuncture Technique

Electro-acupuncture is a specialized therapeutic method in which a small electrical charge is applied to needles that are already inserted into specific points and have attained De Qi. Electro-acupuncture is advantageous in treating conditions that benefit from acupuncture and electrical stimulation.

Electro-acupuncture shares the same range of indications as filiform needling, so it can be used to treat a broad spectrum of conditions. The most notable conditions are all types of pain; Bi syndromes; Wei syndromes; disease conditions of the stomach, intestines, gallbladder, urinary bladder, and uterus; and injuries to the muscles, ligaments, and joints. It is also used in acupuncture anesthesia.

The micro-acupuncture system is widely used in electro-acupuncture, especially in the scalp acupuncture system, Jiaji acupuncture system, and back Shu system. There are good results when using electro-stimulation for central nerve disorders, especially with scalp acupuncture. It is also common to combine electro-acupuncture with the macro-acupuncture system.

Electro Waves

There are many different waves to choose depending on different conditions.

Dense Wave

This wave features a continuous frequency of from 50 to 100 pulsations per second, making it a relatively high-frequency pulsating current. It is able to decrease nerve reactions to produce controlled results, making it effective in stopping pain. The dense wave can also release muscle spasms and vessel spasms, making it beneficial in the treatment of circulatory problems and nervous tension.

Sparse Wave

This wave features a continuous low-frequency pulsating current. The amount of time between pulsations is sufficient to prevent accommodation of the tissues, allowing continual stimulation of the affected area. The sparse wave is used to provide stronger stimulation resulting in a vibrating sensation or muscle contraction. Sparse wave therapeutic effects are also known to last longer than those of other waves.

Dense-Sparse Wave

This wave combines the dense wave and the sparse wave, alternating between them about every 1.5 seconds. It is very difficult for the body to accommodate to this combination wave, so it is able to produce a strong reaction capable of exciting the nervous system, increasing metabolism, aiding circulation, improving nutrient uptake in the tissues, and helping the absorption of edema. The pain-control effects of this combination wave are also known to last a long time. This wave is clinically used for treating high blood pressure or any acute injury such as a sprained ankle, joint inflammation, muscle weakness, nerve pain, sciatic pain, and Bell's palsy.

Intermittent Wave

This wave features a pulsating current in an “on-off” pattern. There is a 1.5 second timeframe without any pulsating current when it is “off” and 1.5 seconds of stimulation with a dense wave when it is “on.” The intermittent current is difficult for the body to accommodate. The intermittent wave is capable of providing powerful stimulation resulting in a strong sensation and muscle contraction. Clinically, it is mainly used to treat paralysis and conditions of muscle weakness.

Serrated Wave

This wave's frequency is very stable and its pulsating current acts like a saw, occurring 20 to 25 times per minute. The frequency of this wave's pulsations are very close to that of the human respiratory rate, so it is commonly used to stimulate diaphragm nerves to assist artificial breathing. The serrated wave is known also to increase nerve-muscle activity, adjust vascular function, increase circulation, and help with fluid absorption.

Normally a dense wave or dense-sparse wave is used to stop pain. Use a dense-sparse wave to increase circulation, in addition a dense-sparse wave or serrated wave is used to increase absorption of fluid. Use the intermittent wave, serrated wave, or sparse wave to increase muscle activity. A sparse wave is used to stimulate connective tissues.

Serrated Wave

This wave's frequency is very stable and its pulsating current acts like a saw, occurring 20 to 25 times per minute. The frequency of this wave's pulsations are very close to that of the human respiratory rate, so it is commonly used to stimulate diaphragm nerves to assist artificial breathing. The serrated wave is known also to increase nerve-muscle activity, adjust vascular function, increase circulation, and help with fluid absorption.

Methods

When using electricity, choose a pair of points on one side of the body's midline. After setting the electro-machine's output to zero, apply the negative electrode to the main point and the positive electrode to the secondary point. Select the desired wave form and turn the electro-machine's power on, slowly increase the output until it reaches the desired level. Generally, electro-acupuncture is applied for 5 to 20 minutes. The appropriate amount of stimulation falls between the current of sensation threshold and the current of pain threshold. This is a very subtle range that needs careful adjusting to suit the patient and the treatment without causing needless discomfort.

Precautions

It is vital that the electrical path/circuit does not cross the heart or medulla. Inspect the electro-machine (e.g., contact wires, dials, settings, and batteries) before each use.

In addition, turn the output off to zero before use. When regulating the intensity of the electrical charge, any increase must be performed slowly and carefully. A sudden, rapid increase in the intensity of the electrical current can cause an abrupt, painful muscular contraction that may result in a bent or broken needle, or even cause the patient to faint. To avoid causing a short, do not allow the paired needles to come into contact with each other.

Warning For Patient Conditions

Electro-acupuncture is contraindicated for patients with cardiac pacemakers. Use caution with electro-acupuncture in pregnant women; in the area near or directly around the heart; near a recent scar, new skin, or cut; and directly over, through, or near a recently fractured bone.

Ear Needling Techniques

For electroacupuncture, use the needling techniques described in the previous section to detect the appropriate ear points and to insert needles into the skin.

Tape Needles Securely

In order to hold the inserted needles securely in place, tape the needles across the ear with medical adhesive tape. Without this tape, needles will tend to pull out the external ear when you attach the stimulating electrodes; the electrodes need to be held in place with protective tape. Fasten the electrode leads securely in place, either to the patient’s clothes or to office equipment.

Attach Electrode Leads

Use microgator clip electrode leads from an electronic stimulator to connect to the inserted needles . Because these moveable clips may pull out the inserted needles when attached, one must make sure that the needles are first securely taped in place. It is also wise to fasten the electrode wires to a secure anchor so that these wires will not drag on the needles and pull them out by accident.

Determine Electrode Pairs

One always needs to stimulate between two needles because electricity flows from a positive pole to a negative pole. It does not usually matter which pole of the stimulator is attached to which ear point, but if the patient reports any increase in pain, one can try switching the electrode leads to the opposite polarity.

Set Frequency Parameters

Preset the electrical frequency rate to either a slow 2 or 10 Hz frequency or to a parameter known as dense–disperse, in which 2 Hz frequencies are alternated with 100 Hz frequencies Lower frequencies (10 Hz or less) most affect enkephalins, endorphins, and visceral and somatic disorders, whereas higher frequencies (100 Hz or higher) affect dynorphins and neurological dysfunctions.

Adjust Current Intensity

Gradually raise the electrical current intensity to a perceptible level and then reduce it to a subpain threshold. The electrical stimulation intensity should not be overly uncomfortable.

Number of Sessions

As with auricular acupuncture without electrical stimulation, leave the needles in place and maintain the stimulation current for 10–30 min. Treat the patient one to three times a week for 2–10 weeks. Although more cumbersome to apply than needle insertion alone, electroacupuncture is typically more powerful and more successful in relieving pain and alleviating the problems of addiction.

Bioenergetics Acupuncture

Acupuncture and electroacupuncture have been found to be useful for neuropathic pain. Because beta endorphins are involved in the pathogenesis of both painful and painless neuropathy, acupuncture may exert its well-known effect by stimulating the production of endorphins in the central nervous system. Although acupuncture cannot easily be explained by known neurophysiological mechanisms, several studies have examined the effects of acupuncture in the treatment of various types of peripheral neuropathy, including diabetic, HIV-associated, chemotherapy-induced, and neuropathy of mixed origin. In randomized controlled studies, case series, and sham studies, acupuncture was shown to improve nerve conduction velocity, decrease numbness and pain (66%–87%), and improve symptoms more effectively than conventional medical treatment in peripheral neuropathy induced by chemotherapeutic drugs (66% vs. 40%), especially in moderate and severe sensory nerve disorders. In some cases (67%), patients were able to reduce or stop their pain medications. Neuroacupuncture has a positive effect on neuropathic pain and often results in the ability to reduce or stop pain medications.

Patients can receive six courses of classical acupuncture analgesia to both lower limbs over a 10-week period. In addition to classical acupuncture, a small, clinical, pilot study of biweekly electroacupuncture treatments for 4 weeks demonstrated a reduction in continuous pain from 32.9% to 15.9% and a decrease in the intensity of pain attacks from 59% to 44%. Electroacupuncturemay have a positive influence on nerve conduction velocity and may also relieve neuropathic pain. Electroacupuncture is performed in two cycles of five sittings each (10 sessions) at 2-day intervals. Most clinical studies provided one to two treatments per week for 10–20 weeks.

There is clinical evidence that an acupuncture subspecialty called neuroacupuncture (Chinese scalp acupuncture) has remarkable effects on central nervous systems disorders. A more comprehensive mixture of body acupuncture and neuroacupuncture (with or without electrical stimulation) can improve clinical outcomes by using the following protocol. In my clinical experience, this works very well. Neuroacupuncture points are the upper one-fifth sensory area (S 1/5) for the lower limbs, middle two-fifths sensory area (S 2/5) for the upper limbs, and foot motor and sensory areas; ear points: ShenMen, sympathetic, foot; body points: GB-40, GB-34, SP-10, SP-6, ST-44, LR-3, and Bafeng (extra point). Electrical stimulation can be used for the ear and body points at a frequency of 100 Hz at low intensity for 10–15 minutes in order to achieve an enhanced response.

Before such therapies can be recommended, a constitutional evaluation by a practitioner who is trained in acupuncture, or more specifically neuroacupuncture, should be considered because each modality is prescribed on the basis of the unique symptoms and physical characteristics of the patient. A comprehensive review of medical acupuncture and scalp acupuncture for physicians may be found in the various texts by Dr. Joseph Helms and Dr. Jason Hao.

5.8.1.3.38 Antinicotinic Therapy

Properly performed electroacupuncture treatment can be, perhaps, the most effective antinicotinic therapy. In our clinical material of dozens of patients with nicotine addiction, we have achieved an approximate 85% success rate of permanently ending an intensive smoking habit.

The most recommended classical APs to be stimulated in the case of nicotine addiction, subject to tenderness and “Acute”/“Subacute” readings on the OED device, are as follows (Figure 5.79): T 15 (can be stimulated bilaterally with TENS), G 43, G 8, P 6, L 7, and GV 20. However, an additional (nonclassical) AP called Yintang should also be used; it is located on the Governing Vessel (GV), between the eyebrows. For “heavy” smokers, another two “extra” points can be added, which are located symmetrically on the outer sides of nostrils on the verge of nasal bones.

The recommended antinicotinic therapy also includes a very important auricular acupuncture: on the left ear auricle, OPAs corresponding to the bronchi and the stomach should be stimulated (see Figure 4.8); on the right one, OPAs related to the lungs (lower lobes) and the gallbladder should be stimulated. Auricular electroacupuncture can be done with small standard needles (3–4 cm long), which can be connected to the electrostimulator (see Section 5.8.1.2.3) along with all the other needles inserted into corporal APs.

This treatment seems to block the nicotinic hunger. Therefore, 10 minutes after the beginning of such a stimulation, the patient (still under treatment) should be asked to smoke one or two cigarettes; this will be like the first cigarette in his or her life, with intensive perspiration, dizziness, nausea, and sometimes vomiting and even fainting occurring before the smoking is finished. Then, following the famous example of Pavlov’s dogs, the same procedure should be repeated three times per week, at least several times, until the patient develops a reflex permanently preventing him or her from attempting to smoke.

1.3 Overview of potentially relevant neurobiological effects of acupuncture

Manual acupuncture and electroacupuncture have been reported to result in measurable responses in the nervous system, including modulation of neurotransmitters and other endogenous substances (Ma, 2004). Investigation of a physiological mechanism of action of acupuncture has focused primarily on its analgesic effects. Earlier studies suggested that acupuncture analgesia is mediated by endogenous opioid peptides, with several studies demonstrating a block of the analgesic effect by naloxone, an opioid antagonist (Lin & Chen, 2008). Various endogenous substances have been suggested as mediators of the analgesic effects apparently elicited by acupuncture. These include serotonin (5-hydroxytryptamine), catecholamines, and gamma-aminobutyric acid (GABA) (Ma, 2004). Opioid peptides at mu-, delta-, and kappa-receptors are considered to play a pivotal role, but glutamate and cholecystokinin octapeptide are also thought to be involved (Zhao, 2008). Further evidence for the complexity of the effects of acupuncture was provided by a recent neuroimaging study, which indicated that multiple responses continue after needling has been terminated (Bai et al., 2010). The precise role of each of these substances in generating the effects of acupuncture is still to be fully elucidated and the implications for psychiatric disorders are less well defined and understood.