Acupuncture

History of acupuncture

To those people who are used to the Western tradition of medicine, the Chinese diagnosis of illness in terms of invasion of the body by wind, heat, or other factors may seem bizarre. You must remember, however, that this diagnosis is intended to be less a literal description of what is going on within the body (although it can sometimes be extremely accurate) than an indication of what form the treatment should take, since diagnosis and treatment are inextricably linked. When an acupuncturist puts a needle into a point that is specific for dispelling wind from the body, he doesn't expect a rush of air to occur, as though it was being released from a pricked balloon. What he does expect, however, is that when he has diagnosed a disease as being due to invasion by wind, the use of such wind-dispelling points will enable him to improve the patient's condition.

In Western medicine a single diagnosis does not necessarily mean that only one form of treatment is available to the patient. For example, a woman who has abnormally heavy periods maybe treated with hormone tablets or with a "scrape" of the uterus. A patient suffering from depression may be offered antidepressant tablets, electroconvulsive therapy, or psychotherapy. And if a condition is treated with medication, the doctor may be able to choose from among a large number of medications that work in different ways. But in acupuncture treatment is far more clear-cut. If a patient has a disease that has been caused by invasion by heat, then the treatment is to rid him of the excessive heat, to balance out any consequent imbalance of yin and yang, and to restore the flow of Chi to normal.

For a patient in whom an injury has caused a blockage of the normal flow of Chi (for example, a patient with a sprained ankle) and where pain is being caused by the blockage or by stagnant blood, the treatment is to release the block or disperse the blood. Naturally, this all sounds very unscientific, as well it might when you remember that these are the descriptions that have been used for more than two thousand years. However, it is the indication that these descriptions give us as to treatment that is important. And since in the hands of an expert a diagnosis-and the treatment that automatically follows from it-can produce remarkably beneficial results, it seems unimportant that the diagnosis is couched in terms that have no relevance to modern Western medicine.

The concepts of energy and Ying-Yang

The Chinese ideogram for "energy," pronounced ch'i, depicts the lid of a pot being raised by steam while on a fire. What is shown is not the steam but the force or energy of the steam. As with the falling apple of Newton, we see the effect (the lid being raised) but not the force causing the effect. This force, whether Newton's gravity or the Chinese ch'i, is extant though invisible. The Chinese consider good health to be a state of energy balance within the human body; therefore they regard body tissues and structures primarily in relation to the energy activating them. There is in this a superficial similarity to the Western medical concept that an organ's activity is sustained by chemical and neurological impulses-in effect, energy.

But the Chinese view energy not only as the force maintaining bodily processes but as the primary component of all physiological activities. Furthermore, this energy varies not only quantitatively but qualitatively, manifesting in the polar forms of yin and yang energy.

Energy in its basic, undifferentiated state-as potential rather than active force-is termed Tao, the One underlying all phenomena. Tao is manifest in all things through the dynamic interaction of the two polar energy-forces called yin and yang, antagonistic yet complementary in action. As the Nei Ching states: "The universe is an oscillation of the forces of yin and yang and their changes."

There is no absolute yin or yang. Each exists relative to the other, and their relativity and inseparability are symbolized by the inclusion, in the Chinese yin-yang symbol, of a small portion of each within the other. Neither can exist without the other. This relativity of yin and yang and the dynamic tension of their interaction are the basis of thought and expression in Chinese philosophy, religion, literature, and art, as well as medicine.

We may think of yin and yang as the negative and positive poles, respectively, within a galvanic current flow; each is separate and distinct in expression, but both are part of the current. The current itself cannot exist without the bipolarity of its elements. The Chinese have extrapolated from this to consider the feminine as yin, the masculine as yang. Cold, dark, the passive, that which is deep or hidden are yin; heat, light, the active, that which is on the surface are yang. The earth and moon are associated with yin, the sky and sun with yang. Water is considered yin, while fire is considered yang. This dualism persists through all things: foods, attitudes, personal characteristics, and so on. At the same time, yin and yang are constantly interacting and changing, for one never exists in isolation from the other. In terms of medicine, this interaction is the basis of the energy pervading and activating the body, and imbalance in the relative amounts of yin and yang energy is seen as the root of all pathology.

This dynamic force of energy is constantly circulating within the body by means of the meridians; its movement in the body is a necessary condition for life. Energy is constant of itself but varies in manifestation. The Chinese use a simple example to illustrate this "changing sameness." A vertical plank has a top and a bottom; on reversing the ends of the plank the bottom becomes the top, and vice versa. The plank remains the same, but its parts have different names according to their positions relative to the center, and their properties vary according to their relative positions. The top has a greater energy potential than the bottom because of the force generated by falling. Likewise, the energy of the body is constant but shows different aspects according to the way it is used and the modifications it undergoes.

Energy circulation: meridians and points

The energy giving life to the body and activating each organ circulates in well-defined channels, called ching in Chinese and written with an ideogram that denotes the warp in weaving. In English they are called meridians, a word borrowed from geography that indicates an imaginary line joining a series of points. This is an apt term in that, like geographical meridians, the acupuncture meridians exist not as continuous lines but rather as series of points following line like patterns.

There are twelve so-called "regular" meridians, having identical branches on each bilateral half of the body. For example, the meridian of the heart is composed of a series of points beginning on the chest and running along the inside of the arm to the end of the little finger. These points on the skin, particularly those on the inside of the arm, exhibit a noticeably increased sensitivity when the heart is disturbed either organically or functionally.

Ten of the regular meridians are identified with structural organs also recognized in Western medicine: the lungs (L), large intestine (LI), stomach (S), spleen-pancreas (SP), heart (H), small intestine (SI), bladder (B), kidneys (K), liver (Li), and gall bladder (GB). The other two, those of the triple heater (TH) and heart constrictor (HC), are related to body activity rather than to any specific organic body.

The triple heater controls the energy of respiration, the distribution of energy to the urogenital organs, and the energy of the sex drive. The heart constrictor is involved in the control of the blood vessels, down to the minute filtering portions of the kidneys, which in Chinese medicine are considered to have a direct bearing on sexual energy. (Any impairment in blood circulation, no matter how slight, adversely affects sexual energy, and the kidneys' vital function in filtering the blood means that the quality of sexual energy depends to a great extent on how efficient their action is.)

These twelve bilateral meridians are termed regular because energy circulates in them constantly in a specific direction and sequence, comprising the body's general energy-circulation system.

Two other meridians exist that are sometimes classified as regular meridians and sometimes as "extraordinary meridians." They are jen-mo (JM)), or the meridian of conception, a unilateral meridian on the anterior midline of the body; and tu-mo (TM), or the governor meridian, a unilateral meridian on the posterior midline of the body. Like the meridians of the triple heater and heart constrictor, they are free of any direct organ-structure relationship. Unlike the twelve bilateral meridians, however, they are not an integral part of the general energy-circulatory system but are related to it as secondary channels. Nevertheless, as with the bilateral meridians, energy does circulate in them constantly and in a prescribed direction.

Six true extraordinary meridians have also been identified: yang-oe, yang-tsiao-mo, tae-mo, yin-oe, yin-tsiao-mo, and tchrong-mo. These are "diversionary channels" through which energy flows only when pathological changes cause an excess of energy that the regular meridians cannot handle. The extraordinary meridians do not possess points exclusive to themselves but pass through certain points on the regular meridians, and energy does not flow through them in a consistent, invariable pattern. In addition, each possesses only one command point, called the master point, unlike the regular meridians, which have ten each.

A command point is a control point for energy flowing through a meridian and is therefore a major point in acupuncture treatment, though theoretically any point can be treated. It can be compared to the main lock of an irrigation system, which controls the entire flow of water in the main canal and its tributaries. The other points are like the locks of secondary canals, one or more of which may be opened to allow an extra flow of water to especially parched fields.

Jen-mo and tu-mo resemble the six extraordinary meridians in possessing only one such command point apiece. Having characteristics of both the regular and the extraordinary meridians, jen-mo and tu-mo are sometimes included in one group, sometimes in the other, depending on the properties under consideration.

The points on the meridians are not the only acupuncture points found on the skin. It has now been established that there are a number of effective acupuncture points outside the known meridians, called "extraordinary points beyond the meridians." So far they have not been associated with any specific organ or system, though the suggestion that they may be associated some-how with the endocrine system is being explored. The meridian points can be palpated by those with the proper training and are also electrically detectable. They invariably become sensitive in the presence of disturbed organ function. Several of the acupuncture points are known in Western medicine, such as McBurney's point on the abdomen, which is used in the diagnosis of appendicitis. In angina pectoris, for example, a typical acute pain shoots down the inside of the arm to the little finger; this follows exactly the path of the heart meridian.

Each of the twelve bilateral meridians carries a fixed number of points, ranging from nine on the heart and heart constrictor meridians to sixty-seven on the bladder meridian. Five of these on each meridian are called element points, because they are identified with the five elements-fire, earth, metal, water, and wood-and are used in acupuncture in accordance with the law of the five elements. Stimulation of these and the other command points regulates the flow of energy in the meridians.

In addition to the five element points there are five other points of equal importance on each of these meridians: the origin; lo, or passage; iu, or assentiment; mo, or alarm; and gueki points. These ten points comprise the command points of each bilateral meridian. In several of the meridians the earth point and origin point are identical; this is why the heart meridian, for example, can have ten command points and yet a total of only nine separate points.

The origin point is, as its name suggests, the point with which the meridian originates (which end of a meridian is its origin and which its terminus is determined by the direction of its energy flow, which may be either ascending or descending). This point reinforces the action of the other points on the meridian. If the energy in a meridian is depleted, the origin point is pricked in tonification. If the energy is in excess, the same point is pricked in dispersal.

The lo, or passage, point connects two meridians that are coupled at a pulse and is treated in order to balance the energy in such a pair of meridians. The iu, or assentiment, point is a diagnostic and treatment point for the visceral organs. The iu points of all the meridians are located on the bladder meridian.

The alarm, or mo, point becomes sensitive when the meridian on which it is located is disturbed and thus is a useful diagnostic indicator. The alarm point of a given meridian mayor may not be located on its own meridian.

The gueki point usually becomes sensitive when its meridian is involved in acute rather than chronic illness. Unlike the other command points, the gueki point is located at some depth in the muscle and therefore is difficult to detect electrically.

The meridians having only one command point-jen-mo, tu-mo, and the six extraordinary meridians-can be divided into two groups of four yin and four yang meridians. The yin meridians include jen-mo (24 single points), yin-oe (3 single and 5 bilateral points), yin-tsiao-mo (1 single and 2 bilateral points), and tchrong-mo (1 single and 11 bilateral points). The yang meridians include tu-mo (27 single points), yang-oe (2 single and 15 bilateral points), yang-tsiao-mo (1 single and 11 bilateral points), and tae-mo (1 single and 3 bilateral points).

The master points on pairs of these meridians are coupled for treatment purposes, a point on the upper extremity of one meridian being coupled with a point on the lower extremity of another, making four pairs of coupled master points: jen-mo (L 7) and yin-tsiao-mo (K 6); yin-oe (HC 6) and tchrong-mo (SP 4); tu-mo (SI 3) and yang-tsiao-mo (B 62); and yang-oe (TH 15) and tae-mo (GB 41).

These meridians can be treated at any of their points, but to treat the coupled master points effectively the two-metal contact method or its equivalent, such as the insertion of two needles, is necessary.

The needles and their use

The primary, though not the only, technique of acupuncture treatment is the insertion of needles at meridian points. The earliest "needles" were fish bones, bamboo splinters, and pointed stones, which gave way to true needles made of such metals as iron and copper. At present, most needles are made of silver, gold, or stainless steel. Their shapes and sizes vary somewhat from country to country, and sometimes even from region to region, but are more or less standardized.

Some of the ancient Chinese masters of acupuncture attributed particular qualities to the metal or color of the needle: silver (white) was thought to aid in dispersing excess energy and gold (yellow) in stimulating or tonifying depleted energy.

The acupuncturist considers type of metal, shape, diameter, and length of needle, as well as the treatment procedure to be used, in making his selection of needles. But regardless of the type of needle chosen, he is faced with one basic choice in treatment: to stimulate or to disperse the energy of the meridian. His procedures will vary, and with them his choice of needles, but his purpose will always be stimulation or dispersal - or sometimes both.

Following are the general rules of energy control in acupuncture with the common type of needle.

TO STIMULATE:

• Warm the needle (in former times the acupuncturist did this by holding the needle in his mouth for several minutes, but clearly this is no longer sanctioned).
• Massage the point to be treated before inserting the needle.
• Puncture superficially.
• Introduce the needle slowly, in stages, and withdraw it slowly.
• Puncture the points of the meridian in the same order as the direction of the flow of energy in the meridian.
• Introduce the needle as the patient exhales and withdraw it as he inhales.
• Keep the needle in place for three to ten minutes.

TO DISPERSE:

• Use large needles.
• Do not massage the point to be treated.
• Insert the needle relatively deeply.
• Introduce and withdraw the needle rapidly.
• Puncture the meridian points in the opposite order of the direction of the flow of energy in the meridian.
• Puncture as the patient inhales and withdraw as he exhales.
• Leave the needle in place for only a few seconds.
• Make the point bleed very slightly after withdrawing the needle (micro-bleeding).

Japanese needles are very delicate and are slid through a metal tube when inserted, to prevent their bending. The Chinese technique is to insert the needles without use of the guide tube.

No pain is felt in the insertion of even the largest acupuncture needles in the hands of a skilled practitioner. At most, a slight discomfort may occasionally be felt when the needle is inserted-but there should never be actual pain. Acupuncture students commonly practice extensively on themselves during their years of study in order to perfect their technique.

REACTIVE POINTS AND INTRACUTANEOUS- NEEDLES

As its name suggests, the reactive point is the most sensitive point in a painful area. Puncturing at this point was without doubt the earliest acupuncture technique and can be remarkably effective in cases of pain, often producing immediate relief. The patient indicates the area of greatest pain, which is lightly probed until the most sensitive point is found. This is then punctured in dispersal.

In Japan a variation of this technique uses tiny intracutaneous needles that can be left in place for a prolonged period. The patient is asked to indicate the most painful spot, which is marked. The intracutaneous needle is inserted there, penetrating only the first layer of skin, and held in place with adhesive tape. The patient then pinpoints the next most painful area, and the procedure is repeated; this continues as often as necessary. The needles remain until the next treatment.

The above method is used for localized pain. When dealing with pain over a large area, or when pain is accompanied by inflammation, swelling, or irritation of the skin, it is advisable to search for the most sensitive points on the periphery of the area, where intracutaneous needles are placed. Then the entire area is lightly and rapidly pricked without penetrating the skin.

MICRO-PUNCTURE

Whereas in pre-modern Western medicine bleeding took the barbaric form of draining the patient of considerable quantities of blood by the application of leeches, the Chinese directed a far gentler form of bleeding to specific points.

As the word "micro-puncture" implies, the amount of blood drawn never exceeds a few drops-no more than would be withdrawn in an ordinary blood test. Frequently just one drop of blood removed at the appropriate acupuncture point will give immediate and startling results. For example, one drop withdrawn from the finger terminal point of the small intestine meridian will instantly relieve certain cases of pain from a stiff shoulder. Some types of headache, such as hangover headache, respond to the same procedure applied to the finger terminal of the large intestine meridian.

Auxiliary techniques: moxibustion and massage

MOXIBUSTION

The burning of moxa, small cones of wormwood (Artemisia vulgaris), on the acupuncture points enjoys great popularity in Japan as a supplement to or even a substitute for needle therapy because moxa is very economical, can be self-administered, and is most effective in a cool, humid climate like Japan's. Moxa is a good deal simpler to apply than acupuncture needles. The cone is placed on the chosen point and ignited, usually by touching it with the burning end of an incense stick. There are three major types of moxa, each with a specialized application. Large moxas are about the size of a medium cherry, small moxas about the size of a rice grain, and minute moxas about the size of the ball of a ballpoint pen.

Large moxas are usually used for stimulation of energy, though at times also for dispersal, and are removed when the patient indicates that the sensation of heat is uncomfortable. Their application can be repeated several times in one treatment session.

Small moxas are usually left to burn all the way down to the skin, which is very painful and produces a blister. These can be used for either stimulation or dispersal of energy and can also be applied repeatedly at one session.

Minute moxa, often applied in a series of a hundred or more, are used in special situations; they are also left to burn all the way down to the skin. If they have been correctly applied (that is, if the diagnosis and treatment chosen are correct), the burning will actually cause a pleasant sensation. When the patient complains of pain or discomfort from this kind of moxa application, the treatment has reached the point of maximum effect and the session is ended. The treatment may be repeated at another session, but this is seldom necessary.

In both China and Japan, moxa is often applied through a needle. The cone is placed on the end of a needle placed at an acupuncture point, and the heat of the moxa is conducted through the needle. This produces a very agreeable sensation. This technique is used most frequently for pain relief and is consistently effective in relief of muscular pain, as well as referred pain from internal organs.

MASSAGE

Oriental massage is a therapeutic procedure in its own right but is mentioned here because some massage manipulations are used in acupuncture as part of diagnostic palpation and are also frequently used very briefly before and after an acupuncture session. Oriental massage techniques appear to have aspects in common with Western methods, but the similarities are more in appearance than in purpose or effect.

Western massage is characterized by general centripetal friction directed at increasing blood circulation. Chinese and Japanese massage, on the other hand, are used in acupuncture to stimulate points or entire meridians by digital pressure, elbow pressure, stamping, scratching, and so on. Mobilization of the spinal column and of all joints is also part of this system of massage; these techniques are used in the treatment of children, the aged, and the extremely debilitated.

Micro-massage (Acupuncture without needles)

In the first place micro-massage is a form of massage, because it is concerned with the massage of precise regions of the body. But it is miniaturized massage, for these 'regions' are cutaneous zones of very small area, less than a square centimeter -the dermotopes, improperly called' acupuncture points'.

The question arises of how an intervention of this kind, which is mechanically very feeble, can have results equal or even superior to those obtained with classical massage which 'works' the muscle or group of muscles or even the deeper layers of the organism? The fundamental difference between the two techniques -classical massage is a mechanical action, while micro-massage is an energizing action. In the same way that the electrologist stimulates the muscles by applying small electrodes to the 'motor points', the micro-masseur, like the acupuncturist, singles out venter points of the muscles, points of insertion, sensor or motor nerve points, ligamentary points, articular points and organic points.

In China, micro-massage is a technique which has been developed to perfection for a very long time. It is employed not only by specialists but also by the acupuncturists who, confronted by a child or squeamish patient who refuses the needles, will use it to treat the dermotopes indicated. Acupuncturists, in any case, have never thought of micro-massage as being inferior to the method with needles. The only difference is that about three sessions of micro-massage are needed to achieve the same result as is obtained from a single session of acupuncture. Finally, and in spite of the spectacular results so often obtained by it, Chinese micro-massage is completely harmless.

PERIDROMES

Starting with the principle that the organism is in harmony with its environment, Chinese entered on a painstaking study of the frontier which separates these two worlds -the skin. In fact, the skin possesses an internal microcosmic side and an external macrocosmic side, and must therefore, in the interests of the harmony mentioned, represent each element of the organism so as to put it in contact with the cosmos. Thus arose the idea of Tching, the ideogram of which indicates that it is something very thin, running longitudinally, which transports energy. There are twelve pairs of these lines disposed symmetrically on the human body, each pair corresponding to one of the twelve principal functions.

Every active organ, every organ which lives, produces energy, the chemical and electrical manifestations of which are known to us. The originality of the Chinese lay in showing that each function sends a part of its energy to the surface, channeled in its own pair of Tching. Thus the Tching seems to be a 'track of energy', a kind of invisible conductor, which follows a very precise pathway.

The internal pathways by which a function or an organ sends a portion of its energy to the surface have been minutely described by the Chinese and tally with central nervous or vegetative pathways, forming 'nodes' which correspond to the various plexi. So the energy of a function first follows an internal course, or cryptodrome, and then traverses the surface of the skin along the Tching or peridrome, which has the name of the particular function.

It is essential to have a good knowledge of the topography of the peridromes, because these lines pass through the dermotopes treated by acupuncturists and micro-masseurs. In keeping with what would logically be expected from the theory of Tao, this topography was soon confirmed by therapeutic experience.

Since Yang is that which is external and Yin is that which is internal, the back surface will be Yang and the front surface Yin. Indeed, embryology teaches us that foetal morphology implies an external (Yang) dorsal surface and an internal (Yin) ventral surface. Consequently, the Yang peridromes (relating to the Fou functions) will be posterior, while the Yin peridromes (relating to Tsang) will be anterior.

We are informed by Taoist teaching that the heavens, being intangible and in motion, are Yang, whereas the earth, being tangible and apparently immobile, is Yin. From this it is easy to conclude, with the Chinese, that whatever is above is Yang and whatever is below is Yin. The upper parts of the body (with the head and thorax, which contain the noble periodic Tsang functions) are more Yang than the lower parts (the abdomen and the organs of digestion and excretion) which are more Yin.

It is therefore only natural, from the point of view of Tao, that the proximal extremities of the peridromes, containing a noble energy, should be found at the top of the body. In addition to this, there are two parts to be distinguished within the top region: the head is more Yang (brain, mind) than the thorax (heart, lungs). Consequently, the proximal extremity of all Yang peridromes will be at the head, and that of all Yin peridromes will be at the thorax.

In locating the distal extremities of the twelve bilateral peridromes, the Yin-Yang hierarchy of functions comes into play. The peridromes associated with the most Yang of Tsang functions and with the most Yang of the Fou functions have their distal extremity in the hand and concern the upper limb (Yang); the peridromes associated with the most Yin of Tsang and Fou functions have their distal extremity in the foot and concern the lower limb (Yin).

Each peridrome has a definite direction, which determines which way the current of energy flowing through it will run, and decides the numbering of the dermotopes of which it is composed. It is possible, then, to distinguish four groups of three peridromes.

• The thorax-hand group comprises peridromes.
• The hand-head group comprises peridromes.
• The head-foot group comprises peridromes.
• The foot-thorax group comprises peridromes.

THE GENERAL TECHNIQUE OF MICRO-MASSAGE

Having discarded rotary massage, which is of doubtful origin, and of contradictory techniques, we shall confine ourselves to that which is tested and true: action along the peridrome, applied from the point of the dermotope outwards and ceasing a few centimeters distant from it. However, the question is to know whether the massage should be centripetal or centrifugal, and this point is one of extreme importance, since the direction of the massage determines whether the effect is anatropic or catatropic.

In the peridromes of the thorax-hand group, the proportion of Yang to Yin varies from 1 per cent (in the thorax) to 50 per cent (in the hand). Since our action must follow the natural tendency of the variation in energy, anatropic massage will be centrifugal here (towards the hand), in the direction of an increasing Yang ratio, while catatropic massage will be centripetal (towards the shoulder), in the direction of a decreasing Yang ratio.

In the peridromes of the hand-head group, the proportion of Yang to Yin varies from 50 per cent (in the hand) to 99 per cent (in the head). The anatropic massage will therefore be centripetal here (towards the face), in the direction of an increasing Yang ratio, and the catatropic massage will be centrifugal (towards the hand), in the direction of a decreasing Yang ratio.

In the peridromes of the head-foot group, the proportion of Yang to Yin decreases from 99 per cent (in the head) to 50 per cent (in the feet). Hence, here the anatropic massage will be centripetal (towards the face), in the direction of an increasing Yang ratio, and the catatropic massage will be centrifugal (towards the feet), in the direction of a decreasing Yang ratio.

In the peridromes of the foot-thorax group, the proportion of Yang to Yin decreases from 50 per cent (in the foot) to 1 per cent (in the thorax). Thus the anatropic massage will be centrifugal here (towards the foot), in the direction of an increasing Yang ratio, and the catatropic massage will be centripetal (towards the thorax), in the direction of a decreasing Yang ratio.

Determining the direction of passage

The rule which specifies the direction of the massage of a dermotope is called Yin-Souei in Chinese -up-stream or down-stream.

The pad of the right thumb is pressed into the peridrome at the dermotope, moves in the direction indicated and is released after traversing one or two centimeters. At that moment, the left thumb is placed on the dermotope (the point of departure) and acts in its turn, to be followed by the right thumb again, and so on. Thus the dermotope experiences a continuous action imparted by the alternate operation of the two thumbs.

It will bear frequent repetition, so it can be repeated here, that an anatropic effect results from rapid, light massage (effleurage), while forceful, deep, slow massage produces a catatropic effect.

Perhaps the idea will be more easily conveyed by the statement that the aim of anatropic massage is to give warmth to a dermotope lacking in energy, while strong, slow pressure (which must not heat the skin) is used to drain excess energy, expelling it from the point of pressure in the direction of the decreasing proportion of Yang.

Instruments

The genuine Chinese acupuncture needle is not that little pin of precious metal which is being imposed on the West, but a bimetallic instrument formed of a shaft of steel (iron) and a handle of copper. The essential bimetallism produces a thermo-electric couple which, according to the state of the Hsueh on which it acts, endows electrons (negative electricity) when there is excess energy (a positive electrical state) or, on the other hand, removes electrons when energy is deficient (a negative electrical state). But, in accordance with the principle exemplified by the amber rod when rubbed by a cloth or on the skin (it is from the Greek name for amber, elektron, that our word electricity is derived) -a principle on which numerous electrostatic machines are based -an insulator (dielectric) under the action of friction, donates electrons to or takes them away from the material with which it is rubbed.

A principle such as this would explain to a great extent the effects of Chinese micro-massage, given the electrical characteristics of the peridromes and dermotopes, the latter in fact being points of concentration of the peridromic potential.

Consequently, friction with a special instrument will be preferred to manual massage even when done with the nail. The instrument in question was initially a little ivory ball, which was later fitted with a handle to facilitate its manipulation. It is called Yuan Tchen -the blunt-tipped instrument.

The Yuan Tchen is especially adapted for cataropic treatments (slow and deep). It is equally possible to use it for light and rapid effleurages in anatropic treatments, but other methods and instruments are preferred to reinforce deficient energy in the dermotopes.