Acupuncture, a component of Traditional Chinese Medicine (TCM), has been
practiced in China for nearly 5,000 years. It seeks to restore the proper flow
of qi (pronounced "chee"), or life energy, in the body by
stimulating certain points with special acupuncture needles. Central to the
philosophy of acupuncture is the idea that all symptoms of illness are evaluated
within the holistic context of an interconnected body, mind, and spirit.
Although acupuncture has been known as an alternative modality in the United
States for less than 30 years, there are now approximately 10 million
acupuncture treatments provided in this country annually (Dean et al. 2000).
The earliest written records documenting the existence of acupuncture date
from 200 BC (Dean et al. 2000). While knowledge of the practice spread along
Arab trade routes toward the West, up until the 1970s it was largely unknown in
the United States outside of immigrant Chinese communities.
Acupuncture gained the attention of the American public after President
Nixon's trip to China in 1972 (Ceniceros and Brown 1998). Traveling with Nixon
was a New York Times reporter, James Reston, who received acupuncture in
China after undergoing an emergency appendectomy. He was so impressed with the
procedure's ability to relieve his postoperative pain that he wrote about his
experience upon returning to the United States. Acupuncture was thrown into the
media spotlight for the first time.
Acupuncture was formally recognized as part of mainstream medicine's range of
healing options in 1997, when the National Institutes of Health issued a
statement documenting its safety and efficacy for a range of health conditions.
However, many conventional physicians remain unfamiliar with the theory and
indications of acupuncture (Ceniceros and Brown 1998).
Meridian lines, which do not seem to correlate to any anatomical
structures in the body, are believed to be energy pathways along which an
individual's life force, or qi, flows. It is postulated that each
meridian connects to one specific organ, or group of organs, that governs
particular bodily functions (Vickers and Zollman 1999). When too little or too
much qi exists in a meridian because qi is stagnant or blocked, illness results
(Vickers and Zollman 1999). By applying needles to certain points along the
meridian lines, acupuncture seeks to restore equilibrium and health by
correcting the flow of qi (Ceniceros and Brown 1998). Evidence suggests that
meridians exist, because these pathways appear to correlate with increased
electric current conductance, electrical intensity, radioisotope movement, and
viscerocutaneous reflexes (Ergil 2000). Acupuncture points, or the specific
locations where needles are inserted, are places where the energy pathway is
close to the surface of the skin (Ceniceros and Brown 1998). Although
acupuncture points have not been included in Western documentation of anatomical
structures, measurements in skin electrical resistance and sodium and potassium
concentrations seem to indicate that they exist. Interestingly, they also
correspond to motor and trigger points previously identified in the body (Ergil
2000). Acupuncture needles have been found to transmit ionic charges,
electromagnetic effects, and microvolt currents (Ergil 2000).
There are currently six different schools of acupuncture thought in the
United States today (Ceniceros and Brown 1998). Practitioners of TCM-based
acupuncture take into account a person's medical history, speech, appearance,
body odor, pulse qualities, and tongue characteristics (Vickers and Zollman
1999) when formulating a diagnosis and determining needle placement (Ceniceros
and Brown 1998). French energetic acupuncture is based on a bioenergetics
theory. Practitioners use needles as electrodes to influence the circulation of
electrolytes in the body (Ceniceros and Brown 1998). Korean hand acupuncturists
believe that the hands and feet are regions of concentrated qi; applying
acupuncture needles to these areas is effective for the entire body (Ceniceros
and Brown 1998). The five-element theory of acupuncture holds that there are
five elements in the universe—wood, fire, earth, water,
and metal—and that these correspond to the internal
organs and produce a specific sequence of circulating energy in the body
(Ceniceros and Brown 1998). Auricular acupuncture is based on the idea that the
ear is a microcosm of the body; applying acupuncture needles to certain points
on the ear affects corresponding organs (Ceniceros and Brown 1998).
Myofascially-based acupuncturists palpate the meridian lines in search of tender
points, which indicate areas of abnormal energy flow. Acupuncture needles are
then applied to those locations (Ceniceros and Brown 1998).
|Mechanism of Action|
Research indicates that acupuncture may produce its complex effects on a wide
variety of systems by modulating the activity of the limbic system and
subcortical structures of the brain (Hui et al. 2000). In particular, it is
theorized that stimulated nerve fibers transmit signals to the spinal cord, thus
activating parts of the central nervous system (Ceniceros and Brown 1998). The
spinal cord releases the endorphins enkephalin and dynorphin; the mid-brain
releases serotonin and norepinephrine; and the pituitary gland releases
adrenocorticotropic hormone and beta-endorphins, all of which mediate pain
response (Ceniceros and Brown 1998). A study employing brain imaging confirmed
that acupuncture increases the pain threshold, which offers one explanation for
its ability to produce long-term results (Lee et al. 1999). In addition,
acupuncture increases circulation and body temperature by stimulating the
autonomic nervous system (Ceniceros and Brown 1998). Furthermore, it affects
white blood cell activity, reduces cholesterol and triglyceride levels, and
regulates glucose levels in the blood. In general, acupuncture transmits its
effects via electric, neurologic, humoral, lymphatic, and electromagnetic wave
pathways (Dean et al. 2000).
Some researchers believe that meridians are pathways for the body's
bioelectrons, the positive and negative electrons that comprise the body's cells
(Udani and Ofman 1999). Abnormal bioelectron activity disturbs cellular function
and results in disease; the stimulation from acupuncture restores normal
bioelectron movement and therefore health (Udani and Ofman 1999).
Still another theory is that meridians follow neuromagnetic fields produced
by the peripheral and central nervous systems (Udani and Ofman 1999).
Superconducting Quantum Interference Devices (a technology known as SQUIDs) have
been used to map out these fields (Udani and Ofman 1999), which influence
physiologic states, circadian rhythms, immune function, and endocrine gland
activity (Ergil 2000).
A visit to an acupuncturist includes an extensive medical history based on
Chinese theories of disease and health, which may contain questions that, from a
Western perspective, seem unrelated to the presenting complaint (Dean et al.
2000). In addition, the acupuncturist takes a lengthy series of pulses on the
wrists, examines the tongue, and palpates for tender spots along the meridian
lines (Dean et al. 2000). The patient then lies down and the acupuncturist
inserts needles in specific locations. Sometimes electric currents, laser beams,
or moxibustion—a procedure that burns the herb
Artemisia vulgaris (mugwort) either directly on or above the
skin—may be used to enhance needle treatment. The
patient is left alone in the room for 15 to 20 minutes to allow the needles to
continue to stimulate the acupuncture points. A full treatment generally lasts
anywhere from 15 to 60 minutes (Dean et al. 2000). At the end of the session,
the needles are removed and the patient may be given herbal remedies to use at
home (Vickers and Zollman 1999). Follow-up visits and schedules are determined
according to the symptoms, the condition, and the response of the individual.
In 1997, the National Institutes of Health published the Consensus
Statement on Acupuncture. It concluded that acupuncture is an effective
treatment for postoperative and chemotherapy nausea and vomiting and for
postoperative dental pain. It also suggested that acupuncture may be a useful
complementary or alternative treatment for addiction, stroke rehabilitation,
headaches, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain,
osteoarthritis, low back pain, carpal tunnel syndrome, and asthma (NIH 1997).
Acupuncture for addictions may be most effective when combined with behavioral
modification and/or psychopharmacology. One theory is that the release of
endorphins triggered by acupuncture helps to reduce drug cravings, withdrawal
symptoms, and anxiety. Acupuncture is now used as an adjunct therapy in over 300
private and government-sponsored smoking cessation programs (Udani and Ofman
The American Academy of Medical Acupuncture states that acupuncture can also
treat sports injuries, sprains, strains, whiplash, thoracic pain, neck pain,
sciatica, nerve pain due to compression, overuse syndromes, reflex sympathetic
dystrophy, phantom limb pain, pain resulting from spinal cord injuries, cancer,
sinusitis, allergies, tinnitus, sore throats, high blood pressure,
gastroesophageal reflux, hyperacidity, ulcers, constipation, diarrhea, spastic
colon, urinary incontinence, bladder and kidney infections, premenstrual
syndrome, infertility, endometriosis, abnormal menses, memory problems,
insomnia, multiple sclerosis, sensory disturbances, depression, anxiety, and
other psychological disorders (Dean et al. 2000).
Studies have shown that acupuncture is more effective for rheumatoid
arthritis than certain pharmaceuticals, produces positive long-term results for
chronic tension headaches, and is effective for low back pain as well as
exercise-induced asthma (Ceniceros and Brown 1998).
Acupuncture may be effective for gastrointestinal disorders,
such as acute and chronic gastritis, spastic colon, hyperacidity, acute and
chronic colitis, pain from duodenal ulcer disease, constipation, and diarrhea,
since it influences gastric motility and secretions (Ergil 2000). It may have
applications for immunology as well (Ergil 2000).
The need for nonpharmaceutical therapies for nausea and vomiting during
pregnancy has led to the development of acupressure wrist bands, which stimulate
a point on the wrist that produces an antiemetic effect (Chez 1999).
|Risks, Side Effects, Adverse
Risks associated with acupuncture include a delayed or missed diagnosis
and/or deterioration if the recipient is not seeing a medical doctor at the same
time. Although extremely rare, bacterial and viral infections, including HIV and
hepatitis B and C, may occur if unclean needles are used (Peuker et al. 1999)
instead of the sterile, single-use needles almost universally used today. Side
effects can include a temporary increase in symptoms such as syncope and vertigo
(Dean et al. 2000).
Adverse outcomes are rarely reported, but there have been some serious
complications associated with acupuncture. Due to a lack of thorough knowledge
of normal anatomy and possible anatomical variations, placement of needles has
caused damage to thoracic and abdominal viscera, peripheral and central nervous
systems, and blood vessels (Peuker et al. 1999). Other adverse outcomes
reported include viscera laceration, nerve compression, hematoma, sepsis,
transverse myelopathy, thermal burns (from moxibustion), scarring, endocarditis,
spinal cord injury, and broken needles left in the body (Ceniceros and Brown
1998). Adverse outcomes reported from auricular acupuncture include otitis
externa and perichondritis (Ceniceros and Brown 1998). On extremely rare
occasions, acupuncture has caused death due to pneumothorax or cardiac tamponade
(Peuker et al. 1999).
Some physicians and practitioners recommend avoidance of treatment during
pregnancy (Dean et al. 2000). However, if an acupuncturist has seen a patient
before her pregnancy and is familiar with her anatomical structures, he or she
may choose to provide treatment if the need arises (Dean et al. 2000).
Respiratory-tract illnesses, eye disorders, gingivitis, pharyngitis,
paralytic ileus, Ménière's disease, nocturnal enuresis, neurogenic bladder
dysfunction, and cervicobrachial syndrome may also respond to acupuncture
Possible applications for the future that require additional investigation
include treatment for polycystic ovary syndrome to help regulate ovulation
(Stener-Victorin et al. 2000), and temporomandibular joint disorder (TMJ)
(Ernst and White 1999). A research grant has also recently been awarded to study
the application of acupuncture soon after a stroke, given some earlier promising
NIH-supported information; in Traditional Chinese Medicine, acupuncture is used
following a stroke to improve mobility and quality of life (Business Wire
|Training, Certification, and
There are more than 50 acupuncture schools in the United States (Dean et al.
2000). An acupuncture degree requires three to four years of education in
addition to at least two years of undergraduate study. Most states require
acupuncturists to pass a national exam administered by the National
Certification Commission for Acupuncture and Oriental Medicine (NCCAOM). NCCAOM
grants a diploma in acupuncture (Dipl Ac NCCAOM) upon passing and maintains
records of an acupuncturist's continuing education (Dean et al. 2000).
Currently, 40 states license acupuncturists or regulate acupuncture practice
(National Acupuncture and Oriental Medicine Alliance 2000).
For a copy of the NIH Consensus Statement, contact the organization at
888-644-2667 or visit its website at
http://odp.od.nih.gov/consensus/cons/107/107-intro.htm. For referral
information, contact the American Association of Oriental Medicine at
888-500-7999 or on the web at www.aaom.org, or the American Academy of Medical
Acupuncture in Los Angeles, California at 800-521-2262 or on the web at
Business Wire. Unprecedented grant enables Emperor's College, USC and Daniel
Freeman Hospitals to study effect of acupuncture on stroke rehabilitation. April
12, 2000;15:39. Accessed on July 11, 2000 at
Ceniceros S, Brown GR. Acupuncture: a review of its history, theories, and
indications. South Med J. 1998;91(12):1121-1125.
Chez RA. Acupressure and other therapies for nausea and vomiting in
pregnancy. In: Saltmarsh N, ed. The Physician's Guide to Alternative
Medicine. Atlanta, Ga: American Health Consultants; 1999:211-214.
Dean CF, Mullins M, Yuen J. Acupuncture. In: Novey DW, ed. Clinician's
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The Physician's Integrative Medicine Companion. Newton, Mass: Integrative
Medicine Communications; 2000:18-28.
Ernst E, White AR. Acupuncture as a treatment for temporomandibular joint
dysfunction. Arch Otolaryngol Head Neck Surg. 1999;125:269-272.
Hui KK, Liu J, Makris N, et al. Acupuncture modulates the limbic system and
subcortical gray structures of the human brain: evidence from fMRI studies in
normal subjects. Hum Brain Mapp. 2000;9:13-25.
Lee H, Liu W, Hung D, et al. Human brain fMRI correlates of
acupuncture-induced analgesia: preliminary findings. Presented at:
85th Scientific Assembly and Annual Meeting of the Radiological
Society of North America; December 1, 1999; Chicago, Ill.
Micozzi MS, ed. Fundamentals of Complementary and Alternative
Medicine. New York, NY: Churchill Livingstone Inc.; 1996:204-213.
National Acupuncture and Oriental Medicine Alliance. List of states with
statutes, regulations, and bills in progress: jurisdictions with acupuncture and
oriental medicine statutes. Accessed on June 27, 2000 at
NIH Consensus Statement Online. Acupuncture. November 3-5, 1997;15(5):1-34.
Accessed on July 11, 2000 at dowland.cit.nih.gov/odp/consensus/107/107intro.htm.
Peuker ET, White A, Ernst E, Pera F, Filler TJ. Traumatic complications of
acupuncture. Arch Fam Med. 1999;8:553-558.
Stener-Victorin E, Waldenstrom U, Tagnfors U, Lundeberg T, Lindstedt G,
Janson PO. Effects of electro-acupuncture on anovulation in women with
polycystic ovary syndrome. Acta Obstet Gynecol Scand. 2000;79:180-188.
Udani J, Ofman J. Use of acupuncture in smoking cessation. In: Saltmarsh N,
ed. The Physician's Guide to Alternative Medicine. Atlanta, Ga: American
Health Consultants; 1999:245-247.
Vickers A, Zollman C. ABC of complementary medicine: acupuncture. BMJ.
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