Because the needles are so  fine there is little or no pain when they are  inserted. The needles are pushed beneath the skin either  directly, by tapping sharply on the top of an introducer  tube or by means of a spring-loaded injector ..see  diag. The acupuncturist twirls the needle back and  forth and or up and down until a feeling of heaviness and  numbness is felt by the patient. The needles can then be  left alone, stimulated for 7 seconds with a Ryodoraku  unit or attached to an electronic stimulator. This latter  device delivers an electric stimulus of varying  intensity, frequency and waveform. There are a number of  different settings available for application depending on  the need.

Treatment  Time ....................Except for Rydoraku, the  treatment time is generally 30 minutes. In Rydoraku an  electric current of 200 microamp is delivered to each  acupuncture point selected for seven (7) seconds -  treatment time is therefore only a few minutes.

There are 2 ways of using Laser in acupuncture

A time energy formula.
In this system a laser is applied to an acupuncture or tender point for a time that is dependent upon the energy or power of the laser unit. Since the power of a laser unit can vary between 5 milli watts and 100 milliwatts, a series of tables have been internationally formulated to provide the appropriate treatment time for any given laser unit. Further discussions and developments in laser acupuncture are reviewed in Roberta Chan's article on this Web site. It would seem that it is the heating/thermal effect of the unit that is most important .

2. Minimal Stimulus/Maximum effect.In this form of laser acupuncture a low powered laser unit (1 - 5 milliwatts) is applied to acupuncture points for between 20 & 30 seconds per acupuncture point.

It is felt that the acupuncture point, because it is extremely sensitive to low intensity stimulus should respond to such minimal stimulation. Clinical experience has supported this method.

Within this group, some laser acupuncturists have devised different types of laser units, all of which seem to have similar efficacy. There are 2 main types:

(i) Steady state - continuous stimulation

(ii)(a) pulsed laser

(ii)(b) pulsed diode - infra-red -visible light

Since the body is extremely sensitive to vibrations particularly below 10 Hz (see Becker) a number of units are available which utilise differing wavelengths of light and/or pulsed light waves as an acupuncture stimulus. Some have even gone one step further and incorporate music (particularly Baroque music).

Proponents of the fixed energy over time concepts insist that pulsed units only give half or a smaller fraction of stimulus energy (see article G. Greenbaum). None the less, those practitioners that use these pulsed units have excellent clinical results.

Microwave and Ultrasound. A microwave or ultrasound unit can be applied to acupuncture points adding an acupuncture effect to the heating/vibrating qualities of these units.

by BILL GILES & DAVID MITCHELL

In 1953, Dr Reinhold Voll,  a general practitioner of medicine and  an accomplished acupuncturist, developed his own system  of electrodermal testing which he called  Electro-acupuncture according to Voll (EAV). EAV has  greatly expanded the theoretical understanding and  practical application of modern acupuncture. The EAV  protocol involved measuring electrical parameters at  acupuncture points and then associating diagnostic  significance to them for acupuncture treatment.

In this procedure, Dr Voll  expanded Dr. Nakatani's electrical pulse diagnosis  concepts to attach diagnostic significance to individual  acupuncture points in line with classical Chinese  medicine. He assumed, using his acupuncture training,  that if the body was in health, then an acupuncture point  should be stable or balanced and should not show any  change from a standard electrical reading. His protocol  incorporated measurements of all of the classical  acupuncture points, approximately 600, (and 200 new  points) of the body to determine if the electrical  measurements on the majority of acupuncture points bore  any relation to the organs of the same-named meridians.

In other words, he set out  to determine if electrical measurements at some of the  points on a particular meridian would correlate with  dysfunction of the organ after which the meridian was  named. Dr Voll experimented with many thousands of  patients with known pathology and found by clinical  observation and pathological testing that indeed specific  points on meridians did relate to the state of functional  health of the meridian organ. For example, on the Large  Intestine meridian, which begins on the tip of the index  finger and courses up the arm to the face, each point  represents the function of a segment of the large  intestine. Large Intestine 1. on the left index finger  indicates the function of the sigmoid colon. He also  related chemical activity of particular endocrine glands.

There are points on Voll's  Pancreas meridian (which correlates with the classical  Spleen meridian) for exocrine efficacy of proteases,  amylases, lipases, maltases and nucleases. He also  determined that the measurement point of the endocrine  performance of the pancreas was not on the Pancreas  meridian but was a new point on the Triple Heater (San  Jiao) meridian and was located on the proximal phalanx of  the fourth finger. (R. Voll. M.D. Verification of  Acupuncture by means of Electropuncture According to Voll  pp 47-57. American Journal of Acupuncture (Special EAV  Issue) March 1975)

Dr. Voll made these  discoveries using a very sensitive voltmeter which he  called the Diatherapuncteur (forerunner of the Dermatron)  with an engineer, Dr Fritz Werner. An electrical circuit  is established between the instrument and the patient  holding a negatively charged tubular electrode. The  circuit is completed when a positively charged pen-like  probe is applied to an acupuncture point on the body.  When the circuit is complete a direct current of 8 to 10  micro amperes at a potential of one volt flows into the  acupuncture point. He had determined that these  electrical values were physiologically normal. Any change  in voltage potential would show on the voltmeter's gauge.  Dr Voll found that a 'healthy' acupuncture point showed  no change in voltage potential and he postulated that  this meant the acupuncture point had the energy to resist  the input force (voltage/current).

The instrument was  calibrated from 0 to 100 and was marked with the number  50 at the central position, indicating that the organ or  part of an organ associated with the acupuncture points  was free of pathological problems.

In a clinical situation he  found that the acupuncture points from healthy city  people measured between 65 and 80 units and have a  consistently steady reading. With more health conscious  individuals living in less polluted environments, the  ideal reading of 50 to 60 units was achieved. However as  long as a reading is steady and is not over 80 units and  not below 50 units, then the acupuncture point can be  taken as being healthy, and that part of the organ system  represented by that particular acupuncture point can be  considered as being healthy also.

Importantly, classical  acupuncture theory suggests that the acupuncture point  represents function only. Structural pathology will not  necessarily correlate with an abnormal reading of an  acupuncture point.

Dr. Voll published the  diagnostic evaluation of the measurement criteria in  1975. (Voll R. 1975 Twenty Years of Electroacupuncture  diagnosis in Germany. A Progress Report. pp 5-14.  American Journal of Acupuncture, March 1975)

The following is a précis  of the criteria:

'In EAV, the resistance  measurements depend on the following measurement  criteria:

(a) A stable measurement  value remaining constant over the entire measurement  period.

(b) A labile measurement  value decreasing its initial maximum value to reach a  final lower value. This phenomenon, referred to in EAV as  indicator drop, is the most important criteria for any  functional disturbances of an organ and can always be  reproduced.

(c) A measurement value  reaching the maximum slowly without any indicator drop is  an indication for organic fatigue as an initial stage of  insufficiency.

(d) A measurement value  reaching its maximum value over 90 very rapidly and  without subsequent indicator drop is referred to as  speeded indicator drop and is indicative of a chemical  intoxication.'

'The indicator drop is  explained as follows: in functionally disturbed organs  the bio-electric resistance to the measurement current is  decreased. The organ is not capable of maintaining a  constant resistance to the intruding current. The  decrease in bio-electric efficiency is revealed by the  indicator drop which manifests the state of equilibrium  between the stimulation by the measurement current and  the reactive capability of the organ. The indicator drop  is of special importance in electro-acupuncture  diagnostics. The difference between the maximum labile  and the minimum stable values requires differential  evaluation.'

'As a rule, the indicator  drop, after reaching the maximum value, occurs within 1  to 3 seconds. In a retarded indicator drop, indicative of  an incipient functional disturbance, the period of 3  seconds may be exceeded, such as in a beginning  odontogenic focal disturbance measurable on one of the  six maxillary measurements points. The interval for the  indicator drop from its initial maximum value to its  final minimum value depends on the intensity and scope of  the pathologic process in the organ to be measured. The  interval for the indicator drop usually is 10 to 20  seconds. When the measurement value restabilises itself  above 50, it is 20 to 30 seconds when the measurement  value drops to 30 and is more than 30 to 60 seconds when  the indicator drops to 20 or less.'

The speed of indicator  stylus change on the 0 to 100 scale is of some importance  also. A slow rise indicates fatigue of the associated  organ whereas a bouncing, rapid rise to the maximum value  is an indicator of toxicity in the organ, usually  chemical. Similarly, the rate of drop of the indicator  gives an idea of the stage of dysfunction of the organ.

The measurement of a  healthy acupuncture point will neither rise above the  normal reading (50-65) nor drop below the normal reading  even if the probe is kept on the point for an extended  time. This is because the healthy acupuncture point can  equally match the applied constant input current of the  instrument for any amount of time. If there is a gradual  rise with time it is always produced by artifact caused  usually by movement of the measurement stylus.'

By determining measurements  at each of the hundreds of main acupuncture points, Dr.  Voll developed his own system of analysis for acupuncture  treatment. He would sedate acupuncture points showing a  high reading and tonify ones with a low reading. Dr. Voll  used classical acupuncture needling techniques as well as  electrical stimulation of the needles. It needs to be  emphasised that EAV techniques were originally used for  selecting appropriate acupuncture points for needling  techniques. (During the 1960s a later version of the  Diatherapuncteur, the Dermatron was developed by the  Pitterling Electronic Company of Munich. Besides being  slightly more modern in appearance, it incorporated  electro-acupuncture treatment facilities for  convenience.)

The initial EAV protocol  involved the testing of up to 800 points. With time and  continued experimentation, specialisation occurred.  Symptoms indicative of problems in dermatology involved  the testing of only 18 points. Similarly cardiovascular  symptomatology involved the testing of 56 points.

Numbers of testing points  for fields of specialisation.

Orthopaedist 64  points

Dermatologist 18  points

Neurologist 135  points

Dentist 46 points

Ophthalmologist 20  points

"I diagnosed one  colleague as having chronic prostatitis and advised him  to take a homoeopathic preparation called Echinaceae 4X.  He replied that he had this preparation in his office and  went to get it. Wheh he returned with the bottle of  Echinaceae in his hand, I tested the prostrate  measurement point again and made the discovery that the  point reading which previously was up to 90 had decreased  to 64, which was an enormous improvement of the prostate  value. I had the colleague put the bottle aside and the  previous measurement value returned. After holding the  medication in his hand the measurement value went down to  64 again,and this pattern repeated itself as often as  desired."

From this incident, Voll  and other doctors started using the instrument to select  homoeopathic medications that brought high or low  instrument readings back to normal. This opened the way  for homoeopathic practitioners, who were not  acupuncturists, to use this instrument to select  medications and not use acupuncture.

A word of caution. In  modern conventional medicine we tend to conceptualise  mainly in structural terms. It must be re-emphasised that  an abnormal reading can not be blindly accepted as  representing structural pathology. There may indeed be  pathology but if the body compensates, there will be no  deviation. In many cases a deviation could occur with  dysfunction but no structural pathology be in existence!  Voll's research emphasised that many of the dysfunctional  readings preceded any pathological changes, sometimes by  many years.In clinical situations, a deviation from 50  units can only be interpreted as showing a change in  function that could include energetic, chemical and/or  physical changes from homoeostasis, or all three.
There are many excellent research papers on EAV including  a collection of Voll's original papers published by the  American Journal of Acupuncture ...

Voll,R: The Phemenon of  medicine testing in electroacupuncture according to Voll.  Am.J. Acupnct. 8:97-104,1980

Dr.Julia J. Tsuei has  published numerous papers on the scientific validity of  EAV in the Am.J.Acupunct and other reputable journals.  Her latest publication, in conjunction with physicist,  Prof.Kuo-Gen Chen, is the best summary of acupuncture  from a modern scientific- energetic viewport that I have  read. Read it yourself in

The Science of  Acupuncture-Theory and Practice . IEEE Engineering  in Medicine and Biology,May-June,1996,52-75

Fuller Royal in Nevada has  written extensively on Eav, Bioenergetic Medicine and  Acupuncture in the Am.J. Acupunct.

His website is well worth  visiting at

http://www.listensystem.com/royal

Dr. Nakatani was the first  person to measure the electrical activity of acupuncture  points and the first to formulate diagnostic and  treatment criteria from these measurements. Nakatani was  the first recorded acupuncturist to use electrical  stimulation of acupuncture points. Point location and  electrical stimulation has become the norm for most  acupuncturists world wide but the Ryodoraku detection,  analysis and point selection for electrical stimulation  is much less popular. This is unfortunate as Nakatani's  concepts provide an accurate pulse-organ diagnosis,  accurate location of required treatment points and a very  time efficient treatment regimen (generally only 7  seconds stimulation of each point is required. A classic  acupuncture treatment lasting an average of 30 minutes  would only take 2 - 3 minutes using Ryodoraku!)

The indications for  Ryodoraku are identical to those for acupuncture, but the  results are often faster. In particular acute pain and  acute traumatic swelling e.g. sports injury will often  respond during the initial treatment.

THEORY
A Ryodoraku unit called a "Neurometer" uses a  constant voltage of 12V (occasionally 21V will be used in  ear acupuncture) and a variable current (this current is  set to 200uA for treatment) . To provide consistency and  avoid artefacts because of dryness/wetness of skin a  moist electrode is used to locate the points of lowered  electrical resistance i.e. Ryodoten or Electro  permeable Points (EPP).

The moist electrode  consists of a small cup containing a plug of cotton wool  soaked in saline (sometimes alcohol is used). This is run  lightly over the skin until a high reading is seen on the  meter i.e. this area of low resistance, high conductivity  allows current to flow. An increase of 20-50 uA is  expected. . As in other forms of electro acupuncture  practice is required to achieve consistent results. Too  much pressure or repeated checking of a point can change  the electrical properties of the skin in that area and  lead to error. Computerised measuring Ryodoraku units are  available in Japan. These give a steady 3g electrode  pressure to the skin.

This EPP can then be  located exactly by using the fine probe in the two or  three headed point locater on the Ryodoraku unit see  diag.

Nakatani discovered that  the number of electro permeable points not only varied  with any disease process but also with the voltage of the  detector probe. Most of the traditional acupoints could  be located if a 21 volt circuit was used. However if a 12  volt circuit was used, there were other electrically  conductive points over the body, not associated with any  specific acupuncture points. He called these Responsive  Ryodo-pointsor Reactive Electropermeable  points (REPPs). These points often correspond  with trigger points or Ah Shi (tender to touch) points.  Nakatani theorised that they occurred along tracts of the  Autonomic Nervous system and were representative of  internal disorder/dysfunction and/or disease.

Nakatani showed that  needling these REPP, and stimulating them for 7-10 sec  with a 200uA charge would render them electrically inert  and produce symptom relief. Headaches, neck aches, back  aches and acute pains would often be relieved - sometimes  in minutes, sometimes over several days. This is a very  effective form of local or regional acupuncture but  Nakatani developed it further.

Using his knowledge of the  Ryodoraku pathways Nakatani formalised Ryodoraku  acupuncture. He used the same concepts of the twelve  paired acupuncture meridians or organ systems (Heart,  lungs, triple warmer,pericardium, large  intestine, small intestine on the upper limbs and gall  bladder, stomach, liver,kidney, bladder and spleen on  the lower limb ) and the two single midline meridians  (anteriorly, Conception Vessel and posteriorly, Governing  Vessel). However he did not use the classical names. He  assigned the letters "H" to each of the six  Ryodoraku on the upper limbs numbering them from one to  six. Similarly he assigned the letter "F" to  each of the six Ryodoraku on the lower limbs, numbering  them from one to six. Thus H3 represented the Heart  meridian on the upper limb; F6 represented the stomach  meridian on the lower limb.

To further confuse the  issue (at least as far as traditional acupuncturists were  concerned) Nakatani did not use either the Chinese name  nor the more commonly accepted, international numbering  of acupuncture points. [He numbered his Ryodo points  starting at the end of each limb]. Acupuncture uses  the Yin- Yang energy flow concepts to number its  acupuncture points. Thus energy flows outwards towards  the end of a limb along one meridian ad back to the trunk  along another meridian i.e. the meridians are paired off.  In the paired meridians Lung and Large Intestine energy  starts on the trunk in the Lung meridian so L1 (the first  Lung meridian acupuncture point)is on the anterior chest.  The first point for the Large Intestine meridian (LI. 1)  is on the index finger. In Nakatani's Ryodoraku  system both H11 (the first Ryodo point on the large  intestine Ryodoraku) and H51 (the first Ryodo point on  the lung Ryodoraku) are on the finger tips.

Nakatani believed this was  a much simpler way of representing and teaching  acupuncture. No knowledge of the complex acupuncture  nomenclature, philosophy and mnemonics was required. In  fact a therapist theoretically did not even have to  memorise the exact position of the acupuncture points.  He/She could use the Ryodoraku Neurometer to locate the  points.

In a further departure from  traditional acupuncture Nakatani compared readings from  Ryodoraku on the right side of the body with those of the  same Ryodoraku on the left side of the body. If one side  showed higher (or lower) reactivity than the other, he  would use a specific needling procedure to bring the EPP  readings to the same level. When the right and left  paired Ryodoraku [eg. right and left H1 (Lung) Ryodoraku]  had the same electrical reactivity, the body was balanced  for that organ system.

Initially, Nakatani  measured the electrical resistance of each and every EPP  along a meridian, added them together and divided by the  total number of EPP. This gave him an average energy  value for that meridian. This was obviously very time  consuming and, eventually, Nakatani discovered that there  was a point on each meridian that was representative of  the energy in that meridian. He named this point a Representative  Measuring Point (RMP). Thus there are 24 RMP -  six on each wrist and six on each foot.

These twenty four points  were measured and charted on a special chart, the left  side being compared with the right side for the paired  meridians.

LOCATION OF  REPRESENTATIVE MEASURING POINTS (RMP)

The representative points  for H1, H2, H3 (Lung, Pericardium and Heart respectively)  are found along the distal transverse skin crease on the  anterior (or palmarl) surface of the wrist. Each point is  a traditional acupuncture point eg. H3 is over L9 (Lung  9),

H2 = Pericardium7,
H3 = Heart 7,
H4 = Small Intestine 4,
H5 = Triple Warmer 4,
H6 = Large Intestine 5

See Chart ..............

For non  acupuncturists Nakatani devised a simple measurement  technique for locating the wrist points:

Place a thumb over the  anterior(palmar) surface of the patient's wrist at the  distal skin crease. Place the middle finger on the  opposite (dorsal) side of the wrist. Hold thumb and  middle finger firm and withdraw. Place thumb and middle  finger over either anterior or dorsal surface of the  wrist at the distal skin crease. There should be an equal  distance from radial or ulnar borders of the wrist and  the thumb/middle finger. The representative points H1,  and H3 anteriorly and H4, H6 dorsally are under the thumb  and middle fingers. H2 is centrally between H1, and H3.  H5 is closer to H4 than H6, being in the line of the ring  finger.

Four of the foot (F)  representative points are traditional acupuncture points.  The other two are between acupuncture points but are on  the appropriate meridian. The F3 (Kidney) representative  point is on the kidney meridian at the postero-inferior  tip of the medial malleolus and the F6 (Stomach)  representative point is on the stomach meridian half way  between Stomach 41 (S41) and Stomach 44 (St44) . See  photos.
Nakatani determined empirically, from testing thousands  of patients, that the average/normal value for the  Ryodoraku varied

1. from one person to  another

2. from one Ryodoraku to  another

3. throughout the day

4. with changes in  environmental temperature

5. body temperature.

He devised a weighed scale  on which the 24 representative readings could be charted  then a 1.4 cm ruler could be placed horizontally to cover  the maximum number of charted values and two parallel  lines drawn. Values within the lines were considered  normal for that individual. Values above the top line or  below the bottom line indicated a need for acupuncture  needling in one or more points along that Ryodoraku).  Nakatani later simplified this ruler technique. He  discarded the 1.4.cm ruler concept and instead drew one  horizontal line just below the three highest readings and  one just above the three lowest readings. He then needled  and electrically stimulated points in each of the  Ryodoraku outside of the parallel lines i.e. the three  highest and three lowest .

Ryodoraku Patient  Assessment Chart. This chart contains
(1) A chart originally devised by Nakatani for entering  the values obtained by measuring each of the 24  representative points for the Ryodoraku.

(2) Diagrams indicating the  position of each of the representative points.

(3) Space to enter  diagnosis/room temperature/body temperature

(4) A table of commonly  used points for sedation or tonification of each  Ryodoraku. Experienced acupuncturists will note these  points are the classical Luo -Connecting Points for  transferring energy from one meridian to include another.  This table was devised by Dr Gerald Gibb, a New Zealand  rheumatologist, considered by many to be the father of  New Zealand acupuncture. Dr Gibb worked with Nakatani in  Japan for two years and is a mine of information not only  on Ryodoraku but also on every aspect of acupuncture.

TECHNIQUE / PROCEDURE  for RYODORAKU ASSESSMENT AND TREATMENT.

(1.)Soak cotton wool plug  in saline and insert into cup on end of probe. Leave  approx 1mm protruding.

(2.) Touch the hand  electrode with the probe and adjust the meter to 200.

(3.) Have patient hold the  hand electrode.

(4.) Run probe lightly over  each of the 24 representative Ryodo points and enter the  value for each one on the Ryodoraku chart.

(5.) On the chart draw a  line just below the three highest readings and another  line just above the three lowest readings.

(6.) For the three highest  readings select one or more of the sedation points for  each Ryodoraku from the table below the Ryodoraku chart.  Similarly for the three lowest readings select one or  more of the tonification points for the respective  Ryodoraku.

(7.) Point by point insert  an acupuncture needle into each of the selected points  and touch the metal part of the probe to the needle  allowing current to flow for seven seconds.

(8.) Where symptoms or  signs are localised run the cotton wool soaked probe  lightly over the skin within that area. Checking for any  REPPs (Reactive Electropermeable Points) with the dial  set for 12 volts. Needle any REPPs found and apply the  metal head of the probe to the shaft of the needle for  seven seconds.

TREATMENT CONSIDERATIONS
Originally Nakatani followed the traditional Chinese  acupuncture concepts of sedating the high points and  tonifying or stimulating the low points. Thus stimulation  involved inserting a needle superficially, leaving it for  3 - 4 seconds then removing without any electrical  stimulation. Sedation required strong manual stimulation  followed by a 7 second burst of 200mA current. In many  cases Nakatani found that this differentiation was not  needed and that electrical stimulation for 7 seconds at  200m A helped both low and high points. The body somehow  only took in the amount of energy it needed.

The second modification  involved the use of substitution points instead of  General Regulatory Points (GRP). Nakatani found that the  GRP points on his original charts and on Gibb's  modification were around fingertips and tips of toes -  all very painful and consequently not very popular with  patients. He reasoned, and later proved empirically, that  other points could just as easily be representative entry  points for a meridian. These points were located just  distal to the elbow and the knee. As Kenyon ( Modern  Techniques of Acupuncture) says

If Ryodoraku treatment is  carried out using the chart points as indicated then only  the most tolerant patients will return for further  treatment. The use of so-called substitution points gets  round this problem. There is one for each meridian. On  the arms they are situated in a band around the top of  the forearm at the level of Large Intestine 10. On the  leg they are situated in a band around each calf at the  level of Bladder 57 (i.e., at the level of maximum girth  of the calf,) The object of sedating or stimulating any  meridian by use of the same point, i.e. the substitution  points, is achieved entirely by the needling technique as  described above. For stimulation, superficial needling  leaving the needle in only for 3 seconds without  electrical stimulation is used. For sedation, deep  needling with manual manipulation and the application of  a 200mA current for 10 seconds is used. The use of these  points makes Ryodoraku much more acceptable from the  patient's point of view. Lastly, local treatment is used  on the REPPs detected around the site of the patient's  problem.

.......it is remarkable  that stimulation at 200mA which often cannot be felt and  is passed for such a short time can be so effective. This  is another finding in favour of an energy flow/meridian  mode of action as opposed to the more popular  neurological and neuro-endocrinological explanations  which currently swamp academic medical interest in  acupuncture."

SPECIAL  EFFECT POINTS

Arthur Rothwell,  International Academy of Clinical Acup.(Aus)
71,Hawthorn Rd.,FOREST  HILL,Vic. 3131 

Ryodoraku Neurometers are  now manufactured in Australia and are available from  Arthur Rothwell. Current price is approx A$675 plus  handling.

There is further  information on Ryodoraku Acupuncture on the web at http://www.osaka-med.ac.jp/~ane005

The TENS units have become  popular in pain clinics because they are cheap, compact  and can be carried in the patient's pocket or clipped to  a belt. The duration and intensity of stimulus can be  varied according to the patient's needs

The injection of local anaesthetic/vitamin B12  into an acupoint can enhance an acupuncture effect.  Homoeopathic substances can be dropped onto the skin and  the needle pushed through the drop carrying a minute  amount into the acupoint

(1) SHIATSU

(2) MOXIBUSTION
The Chinese often applied a burning incense  stick directly to the skin over an acupuncture point. As  this produced pain and scarring, it became less commonly  used and most times nowadays the burning incense or moxa  is placed on one end of a short cylinder or stick and the  other end is placed on the skin over the acupuncture  point. The heat from the burning moxa is transferred down  the shaft of the cylinder or stick to the acupuncture  point. It is still not clear whether there is an active  ingredient in the moxa that might be carried through the  warmed/burnt skin or whether the inhalation of the fumes  is the extra active ingredient.

(3) CUPPING.
A bamboo or glass cup is applied to the skin  after a partial vacuum has been created (e.g. by using a  vacuum pump or by holding a lighted taper in the mouth of  the cup until the oxygen has been consumed). The cup  draws skin and subcutaneous tissues up into the mouth of  the cup producing a red wheal. The early acupuncturists  interpreted this redness with an accumulation of Qi