| The instruments of acupuncture It is widely known that acupuncture mainly works with needles. The other instruments used by an acupuncturist are mainly stimulation devices and point navigators. Needles Acupuncture points can actually be stimulated with various methods, from simple fingertip pressure to laser beams. Correspondingly, in the course of time, different therapy methods were developed. However, even today, 97% of all treatments are performed using needles. In the 5000-year history of acupuncture, it has remained the standard instrument of choice. There is a simple reason for this. For nearly every treatment, numerous acupuncture points have to be stimulated at the same time. This is best achieved using needles. There are different styles of acupuncture needles for every imaginable requirement. The correct choice of needle is practically a science in itself. Reusable and disposable needles Needle material Needle body Needle handle When to use guide tubes? Permanent needles Reusable and disposable needles Until a few years ago, reusable needles were employed, which were sterilized after use. Today, due to the risk of infection (hepatitis, AIDS, and other illnesses) and the cost of sterilization, disposable acupuncture needles have become standard. Acupuncture needles have to meet the standards laid down by the GMP (Good Manufacturing Practice) and the World Health Organization. Needle material In the past, needles were made out of gold or silver (or were at least gold or silver plated). It was said that precious metals had a very special or even mystical effect. A few acupuncturists adhere to the school of thought that suggests that using gold and silver can intensify or weaken effects. Modern acupuncture needles are made of stainless steel. In order to prevent allergic reactions, they contain little nickel. Needle body Acupuncture needles are categorized as "Chinese" or "Japanese" needles. However, this does not have anything to do with the country in which they were manufactured. It refers to their shape. "Chinese" needle bodies (top photo) are slightly fatter and taper in at the head. "Japanese" needles (bottom photo) are more delicate and have the same diameter along their entire length. Today, Japanese needles are mostly used - many of which are manufactured in China. Needle handle
			Twenty years ago, acupuncture needle handles were generally made of metal. They were either woven out of metal thread or wrapped with thin wire. Both designs are rooted in the tradition of acupuncture. Some treatments called for moxa herbs to be attached to the needle head and burned (Moxibustion). When using this technique, it was important that the acupuncturist have a secure and firm grip for inserting and manipulating the needles. "Manipulating" refers to a quick turning action accompanied by up and down movement used to stimulate acupuncture points. Today, most acupuncture needle handles are made of plastic. They can be equally well manipulated as metal needles. Furthermore, they are more hygienic because they are easier to clean during manufacturing. As with injection needles, different colors denote needle thickness. When to use guide tubes? In order to treat babies or especially sensitive patients, very thin, extremely elastic needles are used. Some of these have a diameter of just 0.1 millimeters. Only very experienced practitioners are adept at working with such needles. For this reason, doctors often use a guide tube to puncture the skin with the needle. The tube, which is a few millimeters shorter than the needle, is positioned on the skin so that the needle juts out a little at the top. The therapist then taps the needle handle lightly with his index finger so that the needle penetrates the skin in an absolutely straight line (thanks to the tube). This method is also used with nervous patients, as it is practically pain free if very high quality needles are used. Permanent needles Permanent needles remain inserted in the patient's skin for a long period of time (usually several days), thereby ensuring a constant acupunctural effect. There are two kinds of permanent needles: Permanent ear needles are comprised of a small metal cylinder connected to a conical end section by a steel pin. The cylinder is pressed against the patient's ear with a plastic injector. The conical section is pressed into the ear and kept in place with barbed hooks. The doctor then fastens the needle in place with an adhesive plaster. If this is not done properly, it can sometimes lead to infection of the treated area. Permanent body and ear needles are basically acupuncture needles, minus the handle. The upper part of the needle is twisted into a plate-like form, which makes it look like a very thin, sharp, thumbtack. A sterile plaster is generally already attached to the back of the plate. The therapist holds needle with a pair of tweezers on the plaster and places the tip on the acupuncture point. When the plaster is smoothed down, the needle automatically penetrates the skin. These permanent needles are practically pain free and very hygienic. They can be attached to the flat part of the ear or any part of the body. Stimulation instruments In addition to needles, other special instruments are also available for stimulating acupuncture points. Some of these are used along with needles to provide additional stimulation effects. They include electric stimulation devices, "search and stim" instruments as well as lasers. Electrical stimulation instruments As the name suggests, these instruments stimulate acupuncture points electrically. The doctor either uses electrodes, which are attached directly at the acupuncture points, or - as is more often the case, the stimulation device is connected to pre-positioned needles via crocodile clips so that electricity can flow directly into the acupuncture points. For each point, two electrodes or needles are attached, as each acupuncture point has a corresponding point on the other side of the body. The advantage of this method is that a therapist can control the stimulation of each point independently by adjusting the intensity of electricity as well as the pulse frequency, depending on whether a sedative or tonifying effect is required. There are various types of electrical stimulation instruments. The most important distinctions between them are: Voltage regulation: In the case of simple analog instruments, the electricity emitted is subject to fluctuations. Also, the electrical safeguards of the machine tend to be limited, depending on design. The advantage of digital instruments is that they allow electricity to flow evenly as set by the user. The electronics system controls electric current and corrects it when necessary. Size: The more channels an instrument has, the more acupuncture points it can stimulate simultaneously. Two needles can be connected per channel. Frequency band: The instrument should offer a treatment range of at least 2Hz to 60Hz. For special applications, low frequencies of 0.1Hz to 9.99Hz are necessary. Some instruments can measure changes in a patient during treatment. For example, some instruments measure electrical skin resistance and display this information for each connected acupuncture point. If the treatment is having an effect, the resistance in the skin will change. The therapist can recall these values at any time during a session. "Search and stim" devices In certain mail order catalogs it is still possible to find so-called "search and stim" devices. These small hand-held devices are equipped with a probe on the tip, which is supposed to simultaneously serve as an acupuncture point detector and stimulator. These devices were conceived for self-treatment by patients and generally do not meet the requirements of a professional acupuncture practice. The electricity emitted is generally too weak and the point-search sensor is too unreliable (see Point-search devices). Their effectiveness is therefore questionable. Laser devices Laser devices have proved to be highly successful in stimulating acupuncture points (also see Laser therapy). The lasers used are referred to as "diode lasers" with a 3mW to 180mW capacity. The most important factor in the effectiveness of a laser is its light color - which depends on its wavelength. · Laser diodes with a wavelength of 780 to 830 nm emit infrared, i.e. invisible light. Most of this light is absorbed by the surface of the skin. This means this type of laser does not penetrate sufficiently to reach many acupuncture points, unless a laser with a very high power output is used. · Lasers with a wavelength of 630 to 670 nm emit a red light which is visible to the human eye. Good infrared lasers for acupuncture usually have an output of 10mW to 30mW. There are also instruments with 50mW to 150mW output. These can be used to both stimulate acupuncture points and perform laser therapy (e.g. in sport medicine, dermatology). Tabletop devices and mobile hand devices (often in pen form) are available on the medical equipment market. Good devices are fully digital with adjustable timer and frequency settings (as with electrical stimulation devices). High-end devices not only offer pre-set frequencies (TMO, Nogier), but also allow free programming with over 1000 different frequencies. Point-search devices Electrical resistance on the surface of the skin above an acupuncture point is significantly lower than in the area surrounding the point. This means acupuncture points can be identified by using electricity. The principle is simple: An electrical current is sent through the body and measured. The measuring equipment is adjusted so that it only displays the areas of the skin that exert significantly less electrical resistance than the surrounding areas. In practice, however, it does not work quite as easily. This is because not only acupuncture points exert less electrical resistance, but also damp or damaged areas of the skin. There are four different types of search devices available on the market (nearly all in pen form), which compensate for this "interference factor" with varied success. The simplest and cheapest are the point-search models that cannot be adjusted in any way. Every deviation from the predefined norm produces an acoustic alarm. With a great deal of practice, one can learn to work with this instrument, but it is awkward and inaccurate. There are other devices where the measuring equipment can be manually adjusted to an infinitely variable sensitivity range. They are easy to operate. The disadvantage of this type of device is that it constantly requires manual readjustment in damp skin areas. This can prove time-consuming and bothersome. Instruments of this kind fall in the medium price range. Analog devices are very popular and do not require adjustment of any settings. These devices are designed with a light meter (made of numerous LEDs) and a simple acoustic signal generator. Both of these features are activated when the machine is switched on, however, to begin with at a very low level. If resistance drops during the measurement, more LEDs light up and a sound is emitted. The main drawback of these devices is their relative inaccuracy, as is also the case with the other analog devices, and the difficulty in telling the acupuncture points apart from damp or damaged skin. Additionally, the high-pitched tone - which in many devices cannot be switched off - is often annoying to both patient and therapist. The most powerful - and somewhat more expensive - solutions are digital devices with built-in memory. These devices are simply glided along the surface of the skin to measure an area. The measured value is saved as a reference value and can be called up with the press of a button (generally single-handed operation). The machine ultimately only shows those points within the measured area which differ from the reference value. A special type of point-search tool is the "search square" or "Cun-Meter." It gives the position of acupuncture points in Cun - two measurements which are derived from the anatomy of the patient. One Cun corresponds to the width of the patient's thumb. The device is set to the relevant width; the scale ranges from 0.5 to 2.5 Cun.