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March 26, 2016
Table of Contents

1 Introduction
acupuncture

Wikipedia

 

Acupuncture is the procedure of inserting and manipulating needles into various points on the body to relieve pain or for therapeutic purposes. The earliest written record of acupuncture is the Chinese text Shiji (??????, English: Records of the Grand Historian) with elaboration of its history in the second century BCE medical text Huangdi Neijing (????????????, English: Yellow Emperor's Inner Canon ). Different variations of acupuncture are practiced and taught throughout the world.

Acupuncture has been the subject of active scientific research both in regard to its basis and therapeutic effectiveness since the late 20th century, but it remains controversial among medical researchers and clinicians. Research on acupuncture points and meridians is preliminary and has not conclusively demonstrated their existence or properties. Clinical assessment of acupuncture treatments, due to its invasive and easily detected nature, makes it difficult to use proper scientific controls for placebo effects.

Evidence supports the use of acupuncture to control some types of nausea and pain

The World Health Organization and the United States' National Institutes of Health (NIH)




Antiquity

Acupuncture's origins in China are uncertain. One explanation is that some soldiers wounded in battle by arrows were cured of chronic afflictions that were otherwise untreated, and there are variations on this idea. In China, the practice of acupuncture can perhaps be traced as far back as the Stone Age, with the Bian shi , or sharpened stones. In 1963 a bian stone was found in Duolun County, Inner Mongolia, China pushing the origins of acupuncture into the Neolithic age. Hieroglyphs and pictographs have been found dating from the Shang Dynasty (1600-1100 BCE) which suggest that acupuncture was practiced along with moxibustion.

Despite improvements in metallurgy over centuries, it was not until the 2nd century BCE during the Han Dynasty that stone and bone needles were replaced with metal. The earliest records of acupuncture is in the Shiji (??????, in English, Records of the Grand Historian) with references in later medical texts that are equivocal, but could be interpreted as discussing acupuncture. The earliest Chinese medical text to describe acupuncture is the Huangdi Neijing, the legendary Yellow Emperor's Classic of Internal Medicine (History of Acupuncture) which was compiled around 305–204 B.C.

The Huangdi Neijing does not distinguish between acupuncture and moxibustion and gives the same indication for both treatments. The Mawangdui texts, which also date from the second century BC (though antedating both the Shiji and Huangdi Neijing ), mention the use of pointed stones to open abscesses, and moxibustion but not acupuncture. However, by the second century BCE, acupuncture replaced moxibustion as the primary treatment of systemic conditions.

In Europe, examinations of the 5,000-year-old mummified body of ??tzi the Iceman have identified 15 groups of tattoos on his body, some of which are located on what are now seen as contemporary acupuncture points. This has been cited as evidence that practices similar to acupuncture may have been practiced elsewhere in Eurasia during the early Bronze Age.

Middle history

Acupuncture spread from China to Korea, Japan and Vietnam and elsewhere in East Asia.

Around ninety works on acupuncture were written in China between the Han Dynasty and the Song Dynasty, and the Emperor Renzong of Song, in 1023, ordered the production of a bronze statuette depicting the meridians and acupuncture points then in use. However, after the end of the Song Dynasty, acupuncture and its practitioners began to be seen as a technical rather than scholarly profession. It became more rare in the succeeding centuries, supplanted by medications and became associated with the less prestigious practices of shamanism, midwifery and moxibustion.

Portuguese missionaries in the 16th century were among the first to bring reports of acupuncture to the West. Jacob de Bondt, a Danish surgeon travelling in Asia, described the practice in both Japan and Java. However, in China itself the practice was increasingly associated with the lower-classes and illiterate practitioners.

The first European text on acupuncture was written by Willem ten Rhijne, a Dutch physician who studied the practice for two years in Japan. It consisted of an essay in a 1683 medical text on arthritis; Europeans were also at the time becoming more interested in moxibustion, which ten Rhijne also wrote about. In 1757 the physician Xu Daqun described the further decline of acupuncture, saying it was a lost art, with few experts to instruct; its decline was attributed in part to the popularity of prescriptions and medications, as well as its association with the lower classes.

In 1822, an edict from the Chinese Emperor banned the practice and teaching of acupuncture within the Imperial Academy of Medicine outright, as unfit for practice by gentlemen-scholars. At this point, acupuncture was still cited in Europe with both skepticism and praise, with little study and only a small amount of experimentation.

Modern era

In the early years after the Chinese Civil War, Chinese Communist Party leaders ridiculed traditional Chinese medicine, including acupuncture, as superstitious, irrational and backward, claiming that it conflicted with the Party's dedication to science as the way of progress. Communist Party Chairman Mao Zedong later reversed this position, saying that "Chinese medicine and pharmacology are a great treasure house and efforts should be made to explore them and raise them to a higher level."

Acupuncture gained attention in the United States when President Richard Nixon visited China in 1972. During one part of the visit, the delegation was shown a patient undergoing major surgery while fully awake, ostensibly receiving acupuncture rather than anesthesia. Later it was found that the patients selected for the surgery had both a high pain tolerance and received heavy indoctrination before the operation; these demonstration cases were also frequently receiving morphine surreptitiously through an intravenous drip that observers were told contained only fluids and nutrients.

The greatest exposure in the West came when New York Times reporter James Reston, who accompanied Nixon during the visit, received acupuncture in China for post-operative pain after undergoing an emergency appendectomy under standard anesthesia. Reston was so impressed with the pain relief he experienced from the procedure that he wrote about acupuncture in The New York Times upon returning to the United States. In 1973 the American Internal Revenue Service allowed acupuncture to be deducted as a medical expense.

In 2006, a BBC documentary Alternative Medicine filmed a patient undergoing open heart surgery allegedly under acupuncture-induced anaesthesia. It was later revealed that the patient had been given a cocktail of weak anaesthetics that in combination could have a much more powerful effect. The program was also criticised for its fanciful interpretation of the results of a brain scanning experiment.

Acupuncture anesthesia for surgery has fallen out of favor with scientifically trained surgeons in China. A delegation of the Committee for the Scientific Investigation of Claims of the Paranormal reported in 1995: We were not shown acupuncture anesthesia for surgery, this apparently having fallen out of favor with scientifically trained surgeons. Dr. Han, for instance, had been emphatic that he and his colleagues see acupuncture only as an analgesic (pain reducer), not an anesthetic (an agent that blocks all conscious sensations).




Traditional Chinese medicine

Traditional Chinese medicine (TCM) is based on a pre-scientific paradigm of medicine that developed over several thousand years and involves concepts that have no counterpart within contemporary medicine. In TCM, the body is treated as a whole that is composed of several "systems of function" known as the zang-fu (??????). These systems are named after specific organs, though the systems and organs are not directly associated.

The zang systems are associated with the solid, yin organs such as the liver while the fu systems are associated with the hollow yang organs such as the intestines. Health is explained as a state of balance between the yin and yang, with disease ascribed to either of these forces being unbalanced, blocked or stagnant.

The yang force is the immaterial qi, a concept that is roughly translated as " vital energy ". The yin counterpart is Blood, which is linked to but not identical with physical blood, and capitalized to distinguish the two. TCM uses a variety of interventions, including pressure, heat and acupuncture applied to the body's acupuncture points (in Chinese ??? or xue meaning "cavities") to modify the activity of the zang-fu .

Acupuncture points and meridians

Classical texts describe most of the main acupuncture points as existing on the twelve main and two of eight extra meridians (also referred to as mai ) for a total of fourteen "channels" through which qi and Blood flow. Other points not on the fourteen channels are also needled. Local pain is treated by needling the tender "ashi" points where qi or Blood is believed to have stagnated.

The zang-fu of the twelve main channels are Lung, Large Intestine, Stomach, Spleen, Heart, Small Intestine, Bladder, Kidney, Pericardium, Gall Bladder, Liver and the intangible San Jiao. The eight other pathways, referred to collectively as the qi jing ba mai , include the Luo Vessels, Divergents, Sinew Channels, ren mai and du mai though only the latter two (corresponding to the anterior and posterior sagittal plane of the torso respectively) are needled. The remaining six qi jing ba mai are manipulated by needling points on the twelve main meridians.

Normally qi is described as flowing through each channel in a continuous circuit. In addition, each channel has a specific aspect and occupies two hours of the "Chinese clock".

The zang-fu are divided into yin and yang channels, with three of each type located on each limb. Qi is believed to move in a circuit through the body, travelling both superficially and deeply. The external pathways correspond to the acupuncture points shown on an acupuncture chart while the deep pathways correspond to where a channel enters the bodily cavity related to each organ.

The three yin channels of the hand (Lung, Pericardium, and Heart) begin on the chest and travel along the inner surface of the arm to the hand. The three yang channels of the hand (Large Intestine, San Jiao , and Small Intestine) begin on the hand and travel along the outer surface of the arm to the head. The three yin channels of the foot (Spleen, Liver, and Kidney) begin on the foot and travel along the inner surface of the leg to the chest or flank.

The three yang channels of the foot (Stomach, Gallbladder, and Urinary Bladder) begin on the face, in the region of the eye, and travel down the body and along the outer surface of the leg to the foot. Each channel is also associated with a yin or yang aspect, either "absolute" ( jue- ), "lesser" ( shao- ), "greater" ( tai- ) or "brightness" ( -ming ).

A standard teaching text comments on the nature and relationship of meridians (or channels) and the Zang Fu organs:

The theory of the channels is interrelated with the theory of the Organs. Traditionally, the internal Organs have never been regarded as independent anatomical entities. Rather, attention has centered upon the functional and pathological interrelationships between the channel network and the Organs. So close is this identification that each of the twelve traditional Primary channels bears the name of one or another of the vital Organs.

In the clinic, the entire framework of diagnostics, therapeutics and point selection is based upon the theoretical framework of the channels. "It is because of the twelve Primary channels that people live, that disease is formed, that people are treated and disease arises." (Spiritual Axis, chapter 12) . From the beginning, however, we should recognize that, like other aspects of traditional medicine, channel theory reflects the limitations in the level of scientific development at the time of its formation, and is therefore tainted with the philosophical idealism and metaphysics of its day. That which has continuing clinical value needs to be reexamined through practice and research to determine its true nature.

The meridians are part of the controversy in the efforts to reconcile acupuncture with conventional medicine. The National Institutes of Health 1997 consensus development statement on acupuncture stated that acupuncture points, Qi, the meridian system and related theories play an important role in the use of acupuncture, but are difficult to relate to a contemporary understanding of the body. Chinese medicine forbade dissection, and as a result the understanding of how the body functioned was based on a system that related to the world around the body rather than its internal structures. The 365 "divisions" of the body were based on the number of days in a year, and the twelve meridians proposed in the TCM system are thought to be based on the twelve major rivers that run through China. However, these ancient traditions of Qi and meridians have no counterpart in modern studies of chemistry, biology and physics and to date scientists have been unable to find evidence that supports their existence. Singh & Ernst , 2008, p. 52-3 .

Traditional diagnosis

The acupuncturist decides which points to treat by observing and questioning the patient in order to make a diagnosis according to the tradition which he or she utilizes. In TCM, there are four diagnostic methods: inspection, auscultation and olfaction, inquiring, and palpation.

  • Inspection focuses on the face and particularly on the tongue, including analysis of the tongue size, shape, tension, color and coating, and the absence or presence of teeth marks around the edge.

  • Auscultation and olfaction refer, respectively, to listening for particular sounds (such as wheezing) and attending to body odor.

  • Inquiring focuses on the "seven inquiries", which are: chills and fever; perspiration; appetite, thirst and taste; defecation and urination; pain; sleep; and menses and leukorrhea.

  • Palpation includes feeling the body for tender "ashi" points, and palpation of the left and right radial pulses at two levels of pressure (superficial and deep) and three positions Cun, Guan, Chi (immediately proximal to the wrist crease, and one and two fingers' breadth proximally, usually palpated with the index, middle and ring fingers).

Other forms of acupuncture employ additional diagnostic techniques. In many forms of classical Chinese acupuncture, as well as Japanese acupuncture, palpation of the muscles and the hara (abdomen) are central to diagnosis.

Traditional Chinese medicine perspective

Although TCM is based on the treatment of "patterns of disharmony" rather than biomedical diagnoses, practitioners familiar with both systems have commented on relationships between the two. A given TCM pattern of disharmony may be reflected in a certain range of biomedical diagnoses: thus, the pattern called Deficiency of Spleen Qi could manifest as chronic fatigue, diarrhea or uterine prolapse. Likewise, a population of patients with a given biomedical diagnosis may have varying TCM patterns. These observations are encapsulated in the TCM aphorism "One disease, many patterns; one pattern, many diseases". (Kaptchuk, 1982)

Classically, in clinical practice, acupuncture treatment is typically highly individualized and based on philosophical constructs as well as subjective and intuitive impressions, and not on controlled scientific research.

Criticism of traditional Chinese medicine theory

Felix Mann, founder and past-president of the Medical Acupuncture Society (1959???1980), the first president of the British Medical Acupuncture Society (1980), and the author of the first comprehensive English language acupuncture textbook Acupuncture: The Ancient Chinese Art of Healing first published in 1962, has stated in his book Reinventing Acupuncture: A New Concept of Ancient Medicine :

and...

Felix Mann tried to join up his medical knowledge with that of Chinese theory. In spite of his protestations about the theory, he was fascinated by it and trained many people in the west with the parts of it he borrowed. He also wrote many books on this subject. His legacy is that there is now a college in London and a system of needling that is known as "Medical Acupuncture". Today this college trains Doctors and western medical professionals only.

Medical acupuncture has caused much controversy amongst traditional practitioners; the British Acupuncture Council wished for it to be called 'treatment using needles', and removing from it the title 'Acupuncture', as it is so different to traditional methods but have had to retract this after pressure from the medical profession. Mann proposed that the acupuncture points related to the nerve endings and he reassigned the points different uses. He altered the theory so that the treatments given are no longer individual to each client, a central premise of traditional theory. Traditionally the needle combinations differ according to the age of the client, the length of time they had the condition, the type of pain they experience and their health history. In medical acupuncture none of this is addressed and the presenting symptom is treated using a set group of points.

A report for CSICOP on pseudoscience in China written by Wallace Sampson and Barry Beyerstein said:

George A. Ulett, MD, PhD, Clinical Professor of Psychiatry, University of Missouri School of Medicine states:

According to the 1997 NIH consensus statement on acupuncture:

A systematic review of acupuncture for pain found that there was no difference between inserting needles into "true" acupuncture on traditional acupuncture points versus "placebo" points not associated with any TCM acupuncture points or meridians. The review concluded that "A small analgesic effect of acupuncture was found, which seems to lack clinical relevance and cannot be clearly distinguished from bias. Whether needling at acupuncture points, or at any site, reduces pain independently of the psychological impact of the treatment ritual is unclear."




Most modern acupuncturists use disposable stainless steel needles of fine diameter (), sterilized with ethylene oxide or by autoclave. These needles are far smaller in diameter (and therefore less painful) than hypodermic injection needles since they do not have to be hollow for purposes of injection. The upper third of these needles is wound with a thicker wire (typically bronze), or covered in plastic, to stiffen the needle and provide a handle for the acupuncturist to grasp while inserting. The size and type of needle used, and the depth of insertion, depend on the acupuncture style being practiced.

Warming an acupuncture point, typically by moxibustion (the burning of a combination of herbs, primarily mugwort), is a different treatment than acupuncture itself and is often, but not exclusively, used as a supplemental treatment. The Chinese term zh??n j??u (??????), commonly used to refer to acupuncture, comes from zhen meaning "needle", and jiu meaning "moxibustion". Moxibustion is used to varying degrees among current schools of oriental medicine. For example, one well-known technique is to insert the needle at the desired acupuncture point, attach dried moxa to the external end of an acupuncture needle, and then ignite it. The moxa will then smolder for several minutes (depending on the amount adhered to the needle) and conduct heat through the needle to the tissue surrounding the needle in the patient's body. Another common technique is to hold a large glowing stick of moxa over the needles. Moxa is also sometimes burned at the skin surface, usually by applying an ointment to the skin to protect from burns, though burning of the skin is general practice in China.

An example of acupuncture treatment

In Western medicine, vascular headaches (the kind that are accompanied by throbbing veins in the temple s) are typically treated with analgesics such as aspirin and/or by the use of agents such as niacin that dilate the affected blood vessels in the scalp, but in acupuncture a common treatment for such headaches is to stimulate the sensitive points that are located roughly in the centers of the webs between the thumbs and the palms of the patient's hands, the h?? g?? points. These points are described by acupuncture theory as "targeting the face and head" and are considered to be the most important points when treating disorders affecting the face and head. The patient reclines, and the points on each hand are first sterilized with alcohol, and then thin, disposable needles are inserted to a depth of approximately 3???5 mm until a characteristic "twinge" is felt by the patient, often accompanied by a slight twitching of the area between the thumb and hand.

In the clinical practice of acupuncturists, patients frequently report one or more of certain kinds of sensation that are associated with this treatment:

  • Extreme sensitivity to pain at the points in the webs of the thumbs.

  • In bad headaches, a feeling of nausea that persists for roughly the same period as the stimulation being administered to the webs of the thumbs.

  • Simultaneous relief of the headache.

Indications according to acupuncturists in the West

The American Academy of Medical Acupuncture (2004) states: "In the United States, acupuncture has its greatest success and acceptance in the treatment of musculoskeletal pain." They say that acupuncture may be considered as a complementary therapy for the conditions in the list below, noting: "Most of these indications are supported by textbooks or at least 1 journal article. However, definitive conclusions based on research findings are rare because the state of acupuncture research is poor but improving." For example, drug detoxification is suggested but evidence is poor.

Veterinary acupuncture

The evidence base for the use of acupuncture on animals is weak, and requires more rigorious research to test the small amount of existing data that is promising but unconvincing.




Acupuncture points and meridians

Though numerous theories have been proposed, no research has established any consistent anatomical structure or function for either acupuncture points or meridians. It has been proposed that trigger points were related to acupuncture points, but the two are rarely consistently found together, identified trigger points are rarely used by acupuncturists and when they are used, they are not used for the same indications. Because of the reaction of the tissues to needle sticks, the loose connective tissue s found between and within muscles has also been proposed, but no firm conclusions have yet been established. The nervous system has been evaluated for a relationship to acupuncture points, but no structures have been clearly linked to them. Controversial studies using nuclear imaging have suggested that tracers may be used to follow meridians and are not related to veins or lymphatic tissues, but the interpretation of these results is unclear. The electrical resistance of acupuncture points and meridians have also been studied, but the evidence is considered only "suggestive" and insufficient to support any theories about the electrical properties of either.

Possible neural mechanism of action

The neural mechanisms underlying acupuncture-induced analgesia are unknown but may involve recruitment of the body's own pain reduction system, and an increased release of endorphins, serotonin, norepinephrine, or GABA.




Study design

One of the major challenges in acupuncture research is in the design of an appropriate placebo control group.

Blinding of the practitioner in acupuncture remains challenging. One proposed solution to blinding patients has been the development of "sham acupuncture", i.e. , needling performed superficially or at non-acupuncture sites. Controversy remains over whether, and under what conditions, sham acupuncture may function as a true placebo, particularly in studies on pain, in which insertion of needles anywhere near painful regions may elicit a beneficial response.

An analysis of 13 studies of pain treatment with acupuncture, published in January 2009 in the journal BMJ , concluded there was little difference in the effect of real, sham and no acupuncture.

Evidence-based medicine

There is scientific agreement that an evidence-based medicine (EBM) framework should be used to assess health outcomes and that systematic reviews with strict protocols are essential. Organizations such as the Cochrane Collaboration and Bandolier publish such reviews. In practice, EBM is "about integrating individual clinical expertise and the best external evidence" and thus does not demand that doctors ignore research outside its "top-tier" criteria. Scientific disagreement over multiple aspects of acupuncture research is not uncommon.

The development of the evidence base for acupuncture was summarized in a review by researcher Edzard Ernst and colleagues in 2007. They compared systematic reviews conducted (with similar methodology) in 2000 and 2005: "The effectiveness of acupuncture remains a controversial issue. ... The results indicate that the evidence base has increased for 13 of the 26 conditions included in this comparison. For 7 indications it has become more positive ( i.e. favoring acupuncture) and for 6 it had changed in the opposite direction. It is concluded, that acupuncture research is active. The emerging clinical evidence seems to imply that acupuncture is effective for some but not all conditions."

For acute low back pain there is insufficient evidence to recommend for or against either acupuncture or dry needling, though for chronic low back pain acupuncture is more effective than sham treatment but no more effective than conventional and alternative treatments for short-term pain relief and improving function. However, when combined with other conventional therapies, the combination is slightly better than conventional therapy alone. Conducting research on low back pain is unusually problematic since most patients have experienced "conventional care" - which is itself relatively ineffective - and have low expectations for it. As such, conventional care groups may not be an adequate scientific control and may even lead to nocebo effects that can further inflate of the apparent effectiveness of acupuncture.

There are both positive and negative reviews regarding the effectiveness of acupuncture when combined with in vitro fertilisation.

A Cochrane Review concluded that acupuncture was effective in reducing the risk of post-operative nausea and vomiting with minimal side effects, though it was less than or equal to the effectiveness of preventive antiemetic medications. A 2006 review initially concluded that acupuncture appeared to be more effective than antiemetic drugs, but the authors subsequently retracted this conclusion due to a publication bias in Asian countries that had skewed their results; their ultimate conclusion was in line with the Cochrane Review - acupuncture was approximately equal to, but not better than preventive antiemetic drugs in treating nausea. Another Cochrane Review concluded that electroacupuncture can be helpful in the treatment of vomiting after the start of chemotherapy, but more trials were needed to test their effectiveness versus modern antivomiting medication.

There is moderate evidence that for neck pain, acupuncture is more likely to be effective than sham treatment and offers short-term improvement compared to those on a waiting list.

There is evidence to support the use of acupuncture to treat headaches that are idiopathic, though the evidence is not conclusive and more studies need to be conducted. Several trials have indicated that migraine patients benefit from acupuncture, although the correct placement of needles seems to be less relevant than is usually thought by acupuncturists. Overall in these trials acupuncture was associated with slightly better outcomes and fewer adverse effects than prophylactic drug treatment.

There is conflicting evidence that acupuncture may be useful for osteoarthritis of the knee, with both positive, and negative results. The Osteoarthritis Research Society International released a set of consensus recommendations in 2008 that concluded acupuncture may be useful for treating the symptoms of osteoarthritis of the knee.

A systematic review of the best five randomized controlled trials available concluded there was insufficient evidence to support the use of acupuncture in the treatment of the symptoms of fibromyalgia.

For the following conditions, the Cochrane Collaboration has concluded there is insufficient evidence to determine whether acupuncture is beneficial, often because of the paucity and poor quality of the research, and that further research is needed: chronic asthma,

Bell's palsy,

cocaine dependence,

depression ,

rimary dysmenorrhoea (incorporating TENS ,

epilepsy,

glaucoma,

insomnia,

Positive results from some studies on the efficacy of acupuncture may be as a result of poorly designed studies or publication bias. Edzard Ernst and Simon Singh state that as the quality of experimental tests of acupuncture have increased over the course of several decades (through better blinding, the use of sham needling as a form of placebo control , etc.) the results have demonstrated less and less evidence that acupuncture is better than placebo at treating most conditions.

Neuroimaging studies

A 2005 literature review examining the use of functional magnetic resonance imaging and positron emission tomography to study changes in brain activity caused by acupuncture concluded that neuroimaging data to date show some promise for being able to distinguish the cortical effects of expectation, placebo, and real acupuncture. The studies reviewed were mostly small and pain-related, and more research is needed to determine the specificity of neural substrate activation in non-painful indications.

Medical organizations

Citing research that had accumulated since 1993, in 1997 the American Medical Association (AMA) produced a report that stated there was insufficient evidence to support acupuncture's effectiveness in treating disease, and highlighted the need for further research. The report also included a policy statement that cited the lack of evidence, and sometimes evidence against, the safety and efficacy of alternative medicine interventions, including acupuncture and called for "Well-designed, stringently controlled research...to evaluate the efficacy of alternative therapies."

Also in 1997, the United States National Institutes of Health (NIH) issued a consensus statement on acupuncture that concluded that despite research on acupuncture being difficult to conduct, there was sufficient evidence to encourage further study and expand its use.

In 2003 the World Health Organization's Department of Essential Drugs and Medicine Policy produced a report on acupuncture. The report was drafted, revised and updated by Zhu-Fan Xie, the Director for the Institute of Integrated Medicines of Beijing Medical University , and contained, based on research results available in early 1999, a list of diseases, symptoms or conditions for which it was believed acupuncture had been demonstrated as an effective treatment, as well as a second list of conditions that were possibly able to be treated with acupuncture. Noting the difficulties of conducting controlled research and the debate on how to best conduct research on acupuncture, the report was described as "...intended to facilitate research on and the evaluation and application of acupuncture. It is hoped that it will provide a useful resource for researchers, health care providers, national health authorities and the general public." The report was controversial; critics assailed it as being problematic since, in spite of the disclaimer, supporters used it to claim that the WHO endorsed acupuncture and other alternative medicine practices that were either pseudoscientific or lacking sufficient evidence-basis. Medical scientists expressed concern that the evidence supporting acupuncture outlined in the report was weak, and that the report was evidence " the WHO has been infiltrated by missionaries for alternative medicine". The report was also criticized in the 2008 book Trick or Treatment for, in addition to being produced by a panel that included no critics of acupuncture at all, containing two major errors - including too many results from low-quality clinical trials, and including a large number of trials originating in China where, probably due to publication bias, no negative trials have ever been produced. In contrast, studies originating in the West include a mixture of positive, negative and neutral results. Ernst and Singh, the authors of the book, described the report as "highly misleading", a "shoddy piece of work that was never rigorously scrutinized" and stated that the results of high-quality clinical trials do not support the use of acupuncture to treat anything but pain and nausea.

The National Health Service of the United Kingdom states that there is "reasonably good evidence that acupuncture is an effective treatment" for nausea, vomiting, osteoarthritis of the knee and several types of pain but "because of disagreements over the way acupuncture trials should be carried out and over what their results mean, this evidence does not allow us to draw definite conclusions". The NHS states there is evidence against acupuncture being useful for rheumatoid arthritis, smoking cessation and weight loss, and inadequate evidence for most other conditions that acupuncture is used for.




Because acupuncture needles penetrate the skin, many forms of acupuncture are invasive procedures, and therefore not without risk. Injuries are rare among patients treated by trained practitioners. In most jurisdictions, needles are required by law to be sterile , disposable and used only once; in some places, needles may be reused if they are first resterilized, e.g. in an autoclave. When needles are contaminated, risk of bacterial or other blood-borne infection increases, as with re-use of any type of needle.

Several styles of Japanese acupuncture use non-inserted needling , making for an entirely non-invasive procedure. In non-inserted needling the needle is brought to the skin, but never penetrates it, and various other acupuncture tools are used to tap or stroke along the meridians. Notable examples of these styles are T??y??hari and the pediatric acupuncture style Sh??nishin.

Adverse events

Estimates of adverse event rates due to acupuncture range from 671 to 1,137 per 10,000 treatments, generally minor. However, a 2010 systematic review concluded that acupuncture has been associated with numerous deaths, most commonly due to pneumothorax, but with adequate training fatalities can be avoided.

Other injury

Other risks of injury from the improper insertion of acupuncture needles include: Nerve injury, resulting from the accidental puncture of any nerve, Brain damage or stroke, which is possible with very deep needling at the base of the skull, Pneumothorax from deep needling into the lung, Kidney damage from deep needling in the low back, Haemopericardium, or puncture of the protective membrane surrounding the heart, which may occur with needling over a sternal foramen (a hole in the breastbone that occurs as the result of a congenital defect.), Risk of terminating pregnancy with the use of certain acupuncture points that have been shown to stimulate the production of adrenocorticotropic hormone ( ACTH) and oxytocin, and with unsterilized needles and lack of infection control: transmission of infectious diseases.

The risk can be reduced through proper training of acupuncturists. Graduates of medical schools and (in the US) accredited acupuncture schools receive thorough instruction in proper technique so as to avoid these events.

Omitting modern medical care

Receiving alternative medicine as a replacement for standard modern medical care could result in inadequate diagnosis or treatment of conditions for which modern medicine has a better treatment record.

Concern has also been expressed that unethical or naive practitioners may induce patients to exhaust financial resources by pursuing ineffective treatment. Profession ethical codes set by accrediting organizations such as the National Certification Commission for Acupuncture and Oriental Medicine require referrals to make "timely referrals to other health care professionals as may be appropriate." In Canada, public health departments in the provinces of Ontario and British Columbia regulate acupuncture.

Compared with other treatments

Commenting on the relative safety of acupuncture compared with other treatments, the NIH consensus panel stated that "(a)dverse side effects of acupuncture are extremely low and often lower than conventional treatments." They also stated "the incidence of adverse effects is substantially lower than that of many drugs or other accepted medical procedures used for the same condition. For example, musculoskeletal conditions, such as fibromyalgia, myofascial pain , and tennis elbow... are conditions for which acupuncture may be beneficial. These painful conditions are often treated with, among other things, anti-inflammatory medications (aspirin, ibuprofen, etc. ) or with steroid injections. Both medical interventions have a potential for deleterious side effects but are still widely used and are considered acceptable treatments."




Acupuncturists may practice herbal medicine and manipulative therapy ( tuina), or be a licensed physician or naturopath who incorporates acupuncture in a simplified form. In many states, medical doctors are not required to have any formal training to perform acupuncture. Over 20 states allow chiropractors to perform acupuncture with less than 200 hours training. The typical amount of hours of medical training by licensed acupuncturists is over 3,000 hours. License is regulated by the state or province in many countries, and often requires passage of a board exam.

In the US, acupuncture is practiced by a variety of healthcare providers. Those who specialize in Acupuncture and Oriental Medicine are usually referred to as "licensed acupuncturists", or L.Ac.'s. The abbreviation "Dipl. Ac." stands for "Diplomate of Acupuncture" and signifies that the holder is board-certified by the NCCAOM. Professional degrees are usually at the level of a Master's degree.

A poll of American doctors in 2005 showed that 59% believe acupuncture was at least somewhat effective. In 1996, the United States Food and Drug Administration changed the status of acupuncture needles from Class III to Class II medical devices, meaning that needles are regarded as safe and effective when used appropriately by licensed practitioners. As of 2004, nearly 50% of Americans who were enrolled in employer health insurance plans were covered for acupuncture treatments.

Canadian acupuncturists have been licensed in British Columbia since 2003. In Ontario, the practice of acupuncture is now regulated by the Traditional Chinese Medicine Act, 2006, S.O. 2006, chapter 27. The government is in the process of establishing a college whose mandate will be to oversee the implementation of policies and regulations relating to the profession.

In the United Kingdom, acupuncturists are not a regulated profession. Voluntary self-regulation allows patients to find acupuncture practitioners with a level of training and who adhere to a professional code of practice. The principle body for professional standards in traditional/lay acupuncture is the British Acupuncture Council, The British Medical Acupuncture Society is an inter-disciplinary professional body for regulated health professional using acupuncture as a modality and then there is the Acupuncture Association of Chartered Physiotherapists.

In Australia traditional/lay acupuncture is not a regulated health profession. traditional/lay acupuncture or Chinese Medicine was not included in the National Health Regulation Law. Acupuncture will not be recognised as profession in Australia but as a modality either within Chinese Medicine / traditional Asian healing systems or within the scope of practice of regulated health professions. The practice of acupuncture is governed by a range of state / territory laws relating to consumer protection and infection control. Victoria is the only state of Australia with an operational registration board. Currently acupuncturists in New South Wales are bound by the guidelines in the Public Health (Skin Penetration) Regulation 2000, which is enforced at local council level. Other states of Australia have their own skin penetration acts.

In New Zealand traditional/lay acupuncture is not a regulated health profession. Osteopaths have a scope of practice for Western Medical Acupuncture and Related Needling Techniques. The state-owned Accident Compensation Corporation reimburses for acupuncture treatment by registered healthcare practitioners and some traditional/lay acupuncturists that belong to voluntary professional associations.

Many other countries do not license acupuncturists or require them to be trained.




  • Acupoint therapy

  • Acupressure

  • Auriculotherapy

  • Colorpuncture

  • Electroacupuncture

  • Pressure point

  • Susuk




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This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "acupuncture".


Last Modified:   2010-11-25


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