ADICIONAL 3: REHABILITACIÓN Y MANTENIMIENTO DE

How are ATAs to be named? Some writers, e.g. Mann and Gunn, avoid using acupuncture terminology altogether, but the difficulty with this is that one may become involved in clumsy circumlocutions. I therefore favour an admittedly inconsistent approach. When an ATA happens to coincide with a standard acupuncture point I use that name. Thus I refer to LR3, GB21 and so on, even though I don’t think one needs to needle these sites with the precision that the traditionalists insist on. Other sites don’t correspond to traditional points and then I sometimes use anatomical terminology (gluteus medius site, sacroiliac joint, greater trochanter of femur, etc.). I have also invented a few names for ATAs, as will appear in Part 3; however, I have been sparing with these neologisms and only use them when it is more or less unavoidable.

These principles form the basis of recording the treatment using ATA terminology. It is obviously essential to do this adequately, both for clinical purposes and because of medicolegal considerations. Some people advocate marking the sites on charts, and this is certainly an option if the charts are available; however, even so I think it is desirable to supplement the pictorial depiction with a verbal description.

As well as the site needled, I record the side (L or R), and in some cases the depth, although I generally do this only if it is in some way exceptional: either deep (periosteal) or superficial (minimalist or micro- acupuncture). Similarly, a moderate amount of manual stimulation is assumed; if none is done or (very rarely) strong stimulation is used I record that.

It is also important to record any immediate effects, such as an increase in the range of movement, and it is certainly essential to note any adverse effects such as fainting or other unusual phenomena. It is useful, although not essential, to use a visual analogue scale (VAS) to record the intensity of the symptoms.

Two examples follow.

(Comments are given in parentheses.)

Mrs B

(A 47-year-old woman who has had pain in the right side of her neck for three months. She is otherwise well.)

First visit

Complaint: pain in right side of neck (symptomatic description only; the cause of most back and neck pain is unknown and we should acknowledge this).

Finding on examination: rotation to R reduced to 45 degrees VAS = 6 (visual analogue scale – not essential)

TP ++ (moderately active trigger) at the level of C3 R

Treatment: GB21, GB20.5 LR; also above-mentioned TP (two classic acupuncture points on each side; also a trigger not corresponding to a classic point. See Part 3 for locations of these points.)

Effects: Faint! (Important to record this for future reference.)

Second visit

Result of first treatment: Initial aggravation; now better.

VAS = 3. Finding on examination: Neck rotation = 60 degrees (improved).

Feeling better in herself Fewer headaches

Treatment: Repeat needling, more lightly (in view of fainting previously).

Mr F

(A 60-year-old man, suffering for sciatica for some time.)

First visit

Complaint: Sciatica 6 months. Clinical findings: Lumbar spasm

Straight leg raising 50 degrees L, 80 degrees R. Tenderness of spine of L5. Gluteal TP +++ in R gluteal region (anatomical description of location of TP)

VAS = 6

Treatment: L5 periosteally (note depth). SIJ L (sacroiliac joint; standard ATA term). Gluteal TP: radiation down leg reproduces pain (important clinical fact).

Second visit

Result: Dramatically better for two days; now relapsing. Sleeping better than for many weeks.

VAS = 3

Choosing where to needle 69

The above features are recorded at every treatment. At follow-up one should also note the outcome of the previous treatment, with particular attention being paid to the way in which the symptoms evolved in the first few days. Was there an aggravation? If so, how long did it last? How severe was it? Was it followed by an improvement? How long did any improvement last? Have any new symptoms developed since the previous treatment?

The patient is re-examined physically at each attendance and changes in the number, tenderness, or distribution of trigger points are noted, as well as changes in the range of movement. The patient’s general state should also be considered, since changes in mood, sometimes long- lasting, can follow acupuncture.

Because acupuncture terminology is not standardized (at least, if one is not following the traditional system), it’s important to reach agreement on the descriptive system to be used within a unit, if more than one therapist is practising acupuncture. Even if you are working on your own, it’s essential, if only for medicolegal reasons, to have a standardized method of recording your treatment that could, if necessary, be explained clearly to someone else.

References

Baldry P.E. (1998) Acupuncture, Trigger Points, and Musculoskeletal Pain. Churchill Livingstone, Edinburgh.

Bekkering R. & van Bussel R. (1998) Segmental acupuncture. In: Medical Acupuncture:

a Western scientific approach (eds Filshie J. & White A). Churchill Livingstone,

Edinburgh.

Campbell A. (1999). Acupuncture: where to place the needles and for how long.

Acupuncture in Medicine, 17; 113–17.

Cummings M. (2000). Piriformis syndrome. Acupuncture in Medicine, 17; 108–21. During S. & Cation L. (2000) The educational value of autopsy in a residency training

program. Archives of Internal Medicine, 160; 997–9.

Gunn C.C. (1998) Acupuncture and the peripheral nervous system. In: Medical

Acupuncture: a Western scientific approach (eds Filshie J. & White A.). Churchill

Livingstone, Edinburgh.

Harris M.D. & Blundell J.W. (1991) Audit of necropsies in a British general hospital.

Journal of Clinical Pathology, 44; 862–5.

Hjorth L. et al. (1994) Importance of the autopsy rate. A comparison between clinical assessment and findings at autopsies during the periods: 1 July 1980–30 June 1981 and 1 July 1990–30 June 1991. Ugeschrift for Laeger, 156; 4459–61.

Mann F. (2000) Reinventing Acupuncture: a new concept of ancient medicine (second edition). Butterworth-Heinemann, London.

Needham J. & Gwei-Djen L. (1980) Celestial Lancets: a history of acupuncture and

moxa. Cambridge University Press, Cambridge.

Rao M.G. & Rangwala A.F. (1990) Diagnostic yield from 231 autopsies in a community hospital. American Journal of Clinical Pathology, 93; 486–90.