Patterns of Acupuncture Practice and Acupoint Usage in Brazil: The Fortaleza Experience

Article Outline

• Abstract
• 1.. Introduction
• 2.. Materials and Methods
  • 2.1.. Statistical analysis
• 3.. Results
• 4.. Discussion
• References
• Copyright

Abstract 

Objective

This study is aimed at providing quantitative data on acupoint usage in Fortaleza, Brazil.

Design

Medical records from 100 patients subjected to acupuncture treatments from January 2005 through June 2006 were randomly selected for study. Data collected included sex/age, visit numbers, acupoints used and point combination usage.

Settings

The Meireles Acupuncture Outpatient Clinic is part of the Brazilian Health System (SUS) and offers free acupuncture therapy to people living in Fortaleza, the fifth largest city in Brazil.

Results

Analysis of sex/age distribution showed that female patients were the majority (78%). Ages ranged from 15–88 years (mean, 52 years). The acupoint data were compiled to produce a histogram of the 30 most commonly used acupoints. These 30 points represented 68% of the total number of acupoints needled in Fortaleza. The same value was found in China Beijing Hospital of TCM. The total number of unique points used was 136 in different combinations, totaling 1109 acu-points (average usage, 11 points per patient). Taichong (67%) and Taixi (63%) were the most needled acupoints.

Conclusion

The data collected demonstrate that Brazilian medical acupuncturists have a clear cut preference for some specific acupoints, as do their Chinese colleagues.

Key Words:  acupoint , acupuncture therapy , Chinese medicine , medical records , outpatient health services

Back to Article Outline

1. Introduction 

Acupuncture is part of Traditional Chinese Medicine (TCM) and has been used in China for hundreds of years. It involves inserting fine needles into the skin at precise locations (acupuncture points) to treat various diseases or symptoms to improve health. A wide range of indications for using a specific acupuncture point is described in most acupuncture textbooks, along with different point combinations used for treating specific diseases. However, some point combinations are more frequently used by acupuncturists in general as there appears to be a tendency to have certain acupoints which are favorite core points [1].

Although acupuncture practice was introduced in Brazil almost two centuries ago when the first Chinese immigrants arrived here in 1810, nearly two hundred years passed before it was accepted as a recognized medical practice by the National Medical Council and the Brazilian Medical Society in 1998 [2]. The Meireles Acupuncture Outpatient Clinic (MAOC) is part of the Brazilian Health System (SUS) and offers free general medical care to people living in Fortaleza, the fifth largest city in Brazil. Treatments are free of charge and are offered to adult patients, both sexes, on a referral basis. Two physicians are assigned to the outpatient acupuncture clinic. Each day, seven to ten patients are given acupuncture treatments for multiple ailments. Besides medical services to the general population, the MAOC provides medical training for physicians who seek advanced training in acupuncture practice. As a general rule, three fellows attend the clinic 1 day each week for 60 weeks, as part of their training requirements towards fulfilling the prerequisites for acupuncture certification by the Brazilian Society of Medical Acupuncture (SMBA). The medical histories of each patient are fully discussed with the medical staff acupuncturists before the beginning of the acupuncture treatments, in order to ascertain the most suitable treatment for each case. At least one fully certified medical acupuncturist coordinates the discussion.

This study is aimed at providing quantitative data on acupoint usage in Fortaleza, Brazil. To our knowledge this article is the first attempt to investigate the tendencies of Brazilian medical acupuncturists and their use of certain points in routine everyday acupuncture practice.

Back to Article Outline

2. Materials and Methods 

Data were collected from MAOC medical files. The clinic has set aside three beds distributed in two rooms for acupuncture treatments. Two staff certified medical acupuncturists are responsible for treating the patients in this clinic. Both were originally trained as western physicians and later as medical acupuncturists.

Medical records from 100 patients submitted to acupuncture treatments were reviewed. The records of the first 100 patients treated at the MAOC from January 2005 through June 2006 (having undergone a minimum of three sessions) were selected. The great majority of patients were referred to the MAOC upon failure of standard occidental medical treatments. Most patients had suffered from different diseases for assorted periods of time. Data collected included the following variables; sex/age, visit numbers, acupoints used and point combination usage.

2.1. Statistical analysis 

The data obtained from the medical records of 100 patients were analyzed using Graphpad Prism 4.0 (GraphPad Software, San Diego California USA, www.graphpad.com). Results are listed as descriptive statistics (means, ranges and percentages).

Back to Article Outline

3. Results 

The general statistical compilation included data for the initial treatment of 100 patients, the average number of acupoints needled in the first treatment (11), and the total number of unique acupoints used (136) in all patients. The results of data acquisition in the MAOC are presented in figures and tables. Analysis of sex/age distribution showed that the majority were female patients (78%). The age range was 15–88 years (mean, 52 years).

The Figure depicts the 30 most used acupoints in 100 patients; LR3 (67%), Kl3 (63%) and ST36 (46%). CV17, GB20 and ST21 were the less used acupoints (10% each). The ten most commonly used acupoints in Beijing Hospital of Traditional Chinese Medicine (BJH), Wan Jing Hospital (WJH) and Fortaleza (MAOC) TCM acupuncture clinic were compared in order to detect a possible common usage pattern (Table 1). To allow an overview of the most frequent health disorders among MAOC patients, the results of data collection were compiled in larger groups according to their TCM diagnosis (Table 2). Table 3 correlates six different acupoint combinations used in patients with the six most frequent TCM diagnoses.

Table 1. The ten most commonly used acupoints in Beijing Hospital of Traditional Chinese Medicine (BJH), Wan Jing Hospital (WJH) and Fortaleza (MAOC) TCM acupuncture clinic

Values represent percentiles (%) for each acupoint used.

Table 2. Patients grouped according to TCM diagnosis

Table 3. Six most used acupoint combination in 100 patients (grouped by TCM diagnosis)

Back to Article Outline

4. Discussion 

In our country acupuncture practice was recognized as a medical specialty in 1998. Over the last 10 years, the same group of fully qualified medical acupuncturists have offered post-graduate training courses in acupuncture in the major cities of Brazil. The contents of such courses have been standardized to deliver the same acupuncture information. These courses last 2 years with a total of 720 hours, including 360 hours of actual supervised practice with real patients. At the end of their training, the new graduates are subjected to a board-like examination in order to qualify for acupuncture practice.

In order to appreciate the scope of acupuncture in a Brazilian public health service outpatient clinic, one of the authors (SBG) reviewed the medical records of 100 patients seen over a set time period (January 2005 through June 2006) in the largest public service acupuncture outpatient clinic in Fortaleza, Brazil (MAOC). A total of 183 records were examined. The first 100 records that fulfilled the inclusion/exclusion criteria were included in this study.

Analysis of sex/age distribution showed that female patients were in the majority (78%). Sixty-five patients were older than 45 years. Ages ranged from 15–88 years. Similar patterns were reported in the United Kingdom (69%) [3], Germany (63.8%) [4] and in Beijing (74.1%) [5].

Looking at the 30 most commonly used acupoints in Fortaleza (Figure) one may perceive that these points represented 68% of the total number of acupoints (1109) needled at the MAOC. The same value (68%) was found for the China Beijing Hospital of TCM and a slightly different value (63%) at Wan Jing Hospital [1]. The compiled data demonstrated that the Liver-3 acupoint was the most needled point (67%). The same acupoint was needled in 52% and in 36% in BJH and WJH, respectively. On the other hand the Large Intestine-4 acupoint was the first most needled acupoint 65% (in BJTCM) and 66% (in WJH) of all points needled in both hospitals in China [1] while it occupied position 8 (37%) in our study.

• 
  • View Large Image
  • Download to PowerPoint

• Figure. 

  Chart showing the 30 most commonly used acupoints in 100 patients treated at The Meireles Acupuncture Outpatient Clinic, Fortaleza, Brazil. Numbers on top of the bars represent percentages of used acupoints.

Point-combination in TCM is a term used to describe a collection of acupoints; usually no more than three to six points are selected to achieve some specific clinical effects. Among the 30 most commonly needled acupoints, Liver-3 (TAICHONG), Kidney-3 (TAIXI), YINTANG, Stomach-36 (ZUSANLI), Spleen-6 (SANYINJIAO), Pericardium-6 (NEIGUAN), Conception Vessel-12 (ZHONGWAN), Large Intestine-4 (HEGU), Heart-7 (SHENMEN), Small Intestine-3 (HOUXI), Triple Heater-3 (ZHONGZHU), Large Intestine-3 (HOUXI) and Bladder-62 (SHENMAI) were combined in groups of two: SHENMEN/TAIXI, ZHONGWAN/ZUSANLI and HOUXI/SHENMAI; groups of three: TAICHONG/TAIXI/SANYINJIAO and HOUXI/ZHONGZHU/SANYINJIAO; and a group of four: YINTANG/NEIGUAN/SHENMEN/SANYINJIAO. The acu-point combination Taichong/Taixi/Sanyinjiao was used in 27 patients. The prevailing diagnoses were Kidney Yin Deficiency (11 cases) and Liver Yang Deficiency (five cases). On the other hand, the point combination Shenmen/Taixi was used in 22 patients. Again, Liver Yang Hyperactivity was the prevailing diagnosis (eight cases). The acupoint combination Yintang/PC-6/HT-7/SP-6 was used in 11 patients, with six cases of Kidney Yin Deficiency. Further data analysis showed that Taixi, Sanyinjiao and Shenmen were used in 60% of all patients treated by acupoint combination. Although no reference was made to acupoint combination, the same acupoints were found among the ten most commonly used points in Beijing [1]. The efficiency of such combinations is beyond the scope of this paper and will not be discussed here.

Despite the fact that the inclusion of acupuncture as a medical specialty by the National Medical Council and the Brazilian Medical Society is quite recent in Brazil, is it possible to demonstrate that our medical acupuncturists also have a clear cut preference for some specific acupoints, like their Chinese colleagues. This is easily seen when we compare our data with the results of Napadow and Kaptchuk [5].

Back to Article Outline

References 

1. Napadow V , Liu J , Kaptchuk T . A systematic study of acupuncture practice: acupoint usage in an outpatient setting in Beijing, China . Complement Ther Med . 2004;12:209–216
   • View In Article
   • Abstract
   • Full Text
   • Full-Text PDF (370 KB)
   • CrossRef
2. Pai H . In: Acupuntura: de terapia alternativa a especialidade medica . São Paulo: CEIMEC; 2005;p. 192
   • View In Article
3. Wadlow G , Peringer E . Retrospective survey of patients of practitioners of traditional Chinese acupuncture in the U.K. . Complement Ther Med . 1996;4:1–7
   • View In Article
   • CrossRef
4. Melchart D , Linde K , Liao J , Hager S , Weidenhammer W . Systematic clinical auditing in complementary medicine: rationale, concept, and a pilot study . Altern Ther Health Med . 1997;3:33–39
   • View In Article
   • MEDLINE
5. Napadow V , Kaptchuk T . Patient characteristics for outpatient acupuncture in Beijing, China . J Altern Complement Med . 2004;10:565–572
   • View In Article
   • MEDLINE
   • CrossRef