Acupuncture 

Objectives: After completion of this course the student will be able to define acupuncture and know its uses, background, FDA requirements and be familiar with clinical studies related to acupuncture.

Acupuncture is one of the oldest, most commonly used medical procedures in the world. Originating in China more than 2,000 years ago, acupuncture became widely known in the United States in 1971 when New York Times reporter James Reston wrote about how doctors in Beijing, China, used needles to ease his abdominal pain after surgery. Research shows that acupuncture is beneficial in treating a variety of health conditions.

In the past two decades, acupuncture has grown in popularity in the United States. In 1993, the U. S. Food and Drug Administration (FDA) estimated that Americans made 9 to 12 million visits per year to acupuncture practitioners and spent as much as $500 million on acupuncture treatments.¹ In 1995, an estimated 10,000 nationally certified acupuncturists were practicing in the United States. By the year 2000, that number had doubled. Currently, an estimated one-third of certified acupuncturists in the United States are medical doctors.²

This course provides general information about acupuncture, summaries of  research findings on acupuncture, information for the health consumer, a list of additional information resources, and a glossary that defines terms underscored in the text. It also lists books, journals, organizations, and Internet resources to help you learn more about acupuncture and traditional Chinese medicine.

Acupuncture Theories

Traditional Chinese medicine theorizes that the more than 2,000 acupuncture points on the human body connect with 12 main and 8 secondary pathways, called meridians. Chinese medicine practitioners believe these meridians conduct energy, or qi, between the surface of the body and internal organs.

Qi regulates spiritual, emotional, mental, and physical balance. Qi is influenced by the opposing forces of yin and yang. According to traditional Chinese medicine, when yin and yang are balanced, they work together with the natural flow of qi to help the body achieve and maintain health. Acupuncture is believed to balance yin and yang, keep the normal flow of energy unblocked, and restore health to the body and mind.

Traditional Chinese medicine practices (including acupuncture, herbs, diet, massage, and meditative physical exercises) all are intended to improve the flow of qi.³

Western scientists have found meridians hard to identify because meridians do not directly correspond to nerve or blood circulation pathways. Some researchers believe that meridians are located throughout the body's connective tissue;⁴ others do not believe that qi exists at all.^5,6 Such differences of opinion have made acupuncture a source of scientific controversy.

Preclinical Studies

Preclinical studies have documented acupuncture's effects, but they have not been able to fully explain how acupuncture works within the framework of the Western system of medicine.^{7,8,9,10,11,12}

Mechanisms of Action

Several processes have been proposed to explain acupuncture's effects, primarily those on pain. Acupuncture points are believed to stimulate the central nervous system (the brain and spinal cord) to release chemicals into the muscles, spinal cord, and brain. These chemicals either change the experience of pain or release other chemicals, such as hormones, that influence the body's self-regulating systems. The biochemical changes may stimulate the body's natural healing abilities and promote physical and emotional well-being.¹³ There are three main mechanisms:

1. Conduction of electromagnetic signals: Western scientists have found evidence that acupuncture points are strategic conductors of electromagnetic signals. Stimulating points along these pathways through acupuncture enables electromagnetic signals to be relayed at a greater rate than under normal conditions. These signals may start the flow of pain-killing biochemicals, such as endorphins, and of immune system cells to specific sites in the body that are injured or vulnerable to disease.^14,15

    

2. Activation of opioid systems: Research has found that several types of opioids may be released into the central nervous system during acupuncture treatment, thereby reducing pain.¹⁶

    

3. Changes in brain chemistry, sensation, and involuntary body functions: Studies have shown that acupuncture may alter brain chemistry by changing the release of neurotransmitters and neurohormones in a good way. Acupuncture also has been documented to affect the parts of the central nervous system related to sensation and involuntary body functions, such as immune reactions and processes whereby a person's blood pressure, blood flow, and body temperature are regulated.^3,17,18

Conditions Appropriate for Acupuncture Therapy

Clinical Studies

According to an NIH consensus panel of scientists, researchers, and practitioners who convened in November 1997, clinical studies have shown that acupuncture is an effective treatment for nausea caused by surgical anesthesia and cancer chemotherapy as well as for dental pain experienced after surgery. The panel also found that acupuncture is useful by itself or combined with conventional therapies to treat addiction, headaches, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, lower back pain, carpal tunnel syndrome, and asthma; and to assist in stroke rehabilitation.¹⁹

Increasingly, acupuncture is complementing conventional therapies. For example, doctors may combine acupuncture and drugs to control surgery-related pain in their patients.²⁰ By providing both acupuncture and certain conventional anesthetic drugs, doctors have found it possible to achieve a state of complete pain relief for some patients.¹⁶ They also have found that using acupuncture lowers the need for conventional pain-killing drugs and thus reduces the risk of side effects for patients who take the drugs.^21,22

Outside the United States, the World Health Organization (WHO), the health branch of the United Nations, lists more than 40 conditions for which acupuncture may be used.²³ The table below lists these conditions.

Currently, one of the main reasons Americans seek acupuncture treatment is to relieve chronic pain, especially from conditions such as arthritis or lower back disorders.^24,25 Some clinical studies show that acupuncture is effective in relieving both chronic (long-lasting) and acute or sudden pain, but other research indicates that it provides no relief from chronic pain.²⁷ Additional research is needed to provide definitive answers.

FDA's Role

The FDA approved acupuncture needles for use by licensed practitioners in 1996. The FDA requires manufacturers of acupuncture needles to label them for single use only.²⁸ Relatively few complications from the use of acupuncture have been reported to the FDA when one considers the millions of people treated each year and the number of acupuncture needles used. Still, complications have resulted from inadequate sterilization of needles and from improper delivery of treatments. When not delivered properly, acupuncture can cause serious adverse effects, including infections and puncturing of organs.¹

NCCAM-Sponsored Clinical Research

Originally founded in 1992 as the Office of Alternative Medicine (OAM), the NCCAM facilitates the research and evaluation of unconventional medical practices and disseminates this information to the public. The NCCAM, established in 1998, supports nine Centers, where researchers conduct studies on complementary and alternative medicine for specific health conditions and diseases. Scientists at several Centers are investigating acupuncture therapy.

Researchers at the NCCAM Center at the University of Maryland in Baltimore conducted a randomized controlled clinical trial and found that patients treated with acupuncture after dental surgery had less intense pain than patients who received a placebo. ²⁰ Other scientists at the Center found that older people with osteoarthritis experienced significantly more pain relief after using conventional drugs and acupuncture together than those using conventional therapy alone.²⁹

Researchers at the Minneapolis Medical Research Foundation in Minnesota are studying the use of acupuncture to treat alcoholism and addiction to benzodiazepines, nicotine, and cocaine. Scientists at the Kessler Institute for Rehabilitation in New Jersey studied acupuncture to treat a stroke-related swallowing disorder and the pain associated with spinal cord injuries.

The OAM, now the NCCAM, also funded several individual researchers in 1993 and 1994 to conduct preliminary studies on acupuncture. In one small randomized controlled clinical trial, more than half of the 11 women with a major depressive episode who were treated with acupuncture improved significantly.³⁰

In another controlled clinical trial, nearly half of the seven children with attention deficit hyperactivity disorder who underwent acupuncture treatment showed some improvement in their symptoms. Researchers concluded that acupuncture was a useful alternative to standard medication for some children with this condition.³¹

In a third small controlled study, eight pregnant women were given a type of acupuncture treatment, called moxibustion, to reduce the rate of breech births, in which the fetus is positioned for birth feet-first instead of the normal position of head-first. Researchers found the treatment to be safe, but they were uncertain whether it was effective.³² Then, researchers reporting in the November 11, 1998, issue of the Journal of the American Medical Association conducted a larger randomized controlled clinical trial using moxibustion. They found that moxibustion applied to 130 pregnant women presenting breech significantly increased the number of normal head-first births.³³

Acupuncture and You

The use of acupuncture, like many other complementary and alternative treatments, has produced a good deal of anecdotal evidence. Much of this evidence comes from people who report their own successful use of the treatment. If a treatment appears to be safe and patients report recovery from their illness or condition after using it, others may decide to use the treatment. However, scientific research may not substantiate the anecdotal reports.

Lifestyle, age, physiology, and other factors combine to make every person different. A treatment that works for one person may not work for another who has the very same condition.  Do not rely on a diagnosis of disease by an acupuncturist who does not have substantial conventional medical training. If you have received a diagnosis from a doctor and have had little or no success using conventional medicine, you may wish to ask your doctor whether acupuncture might help.

Finding a Licensed Acupuncture Practitioner

Doctors are a good resource for referrals to acupuncturists. Increasingly, doctors are familiar with acupuncture and may know of a certified practitioner. In addition, more medical doctors, including neurologists, anesthesiologists, and specialists in physical medicine, are becoming trained in acupuncture, traditional Chinese medicine, and other alternative and complementary therapies. Friends and family members may be a source of referrals as well. In addition, national referral organizations provide the names of practitioners, although these organizations may be advocacy groups for the practitioners to whom they refer. See Acupuncture Information Resources for a list of these organizations.

Check a practitioner's credentials.

A practitioner who is licensed and credentialed may provide better care than one who is not. About 30 states have established training standards for certification to practice acupuncture, but not all states require acupuncturists to obtain a license to practice. Although proper credentials do not ensure competency, they do indicate that the practitioner has met certain standards to treat patients with acupuncture.

The American Academy of Medical Acupuncture can give you a referral list of doctors who practice acupuncture. The National Acupuncture and Oriental Medicine Alliance lists thousands of acupuncturists on its Web site and provides the list to callers to their information and referral line. The Alliance requires documentation of state license or national board certification from its listed acupuncturists. The American Association of Oriental Medicine can tell you the state licensing status of acupuncture practitioners across the United States as well. To contact these and other organizations, see Acupuncture Information Resources.

Check treatment cost and insurance coverage.

Reflecting public demand, an estimated 70 to 80 percent of the nation's insurers covered some acupuncture treatments in 1996. An acupuncturist may provide information about the number of treatments needed and how much each will cost. Generally, treatment may take place over a few days or several weeks. The cost per treatment typically ranges between $30 and $100, but it may be appreciably more. Physician acupuncturists may charge more than nonphysician practitioners.¹³

Check treatment procedures.

To find out about the treatment procedures that will be used and their likelihood of success. You also should make certain that the practitioner uses a new set of disposable needles in a sealed package every time. The FDA requires the use of sterile, nontoxic needles that bear a labeling statement restricting their use to qualified practitioners. The practitioner also should swab the puncture site with alcohol or another disinfectant before inserting the needle.

Some practitioners may use electroacupuncture; others may use moxibustion. These approaches are part of traditional Chinese medicine, and Western researchers are beginning to study whether they enhance acupuncture's effects.

During your first office visit, the practitioner may ask you at length about your health condition, lifestyle, and behavior. The practitioner will want to obtain a complete picture of your treatment needs and behaviors that may contribute to the condition. This holistic approach is typical of traditional Chinese medicine and many other alternative and complementary therapies.

Let the acupuncturist, or any doctor for that matter, know about all treatments or medications you are taking and whether you have a pacemaker, are pregnant, or have breast or other implants. Acupuncture may be risky to your health if you fail to tell the practitioner about any of these matters.

The Sensation of Acupuncture

Acupuncture needles are metallic, solid, and hair-thin, unlike the thicker, hollow hypodermic needles used in Western medicine to administer treatments or take blood samples. People experience acupuncture differently, but most feel minimal pain as the needles are inserted. Some people are energized by treatment, while others feel relaxed.³⁴ Some patients may fear acupuncture because they are afraid of needles. Improper needle placement, movement of the patient, or a defect in the needle can cause soreness and pain during treatment.³⁵ This is why it is so important to seek treatment from a qualified acupuncture practitioner.

As important research advances continue to be made on acupuncture worldwide, practitioners and doctors increasingly will work together to give you the best care available.

For More Information

For more information about acupuncture research sponsored by different parts of NIH, contact the respective Information Office or Clearinghouse. Call the NIH operator for assistance at 301-496-4000.

For more information about research on acupuncture, contact the NIH National Library of Medicine (NLM), which has published a bibliography of more than 2,000 citations to studies conducted on acupuncture. The bibliography is available  by writing the NLM, 8600 Rockville Pike, Bethesda, MD 20894. The NLM also has a toll-free telephone number: 1-888-346-3656.

Glossary of Terms

Acupuncture
An ancient Chinese health practice that involves puncturing the skin with hair-thin needles at particular locations, called acupuncture points, on the patient's body. Acupuncture is believed to help reduce pain or change a body function. Sometimes the needles are twirled, given a slight electric charge (see electroacupuncture), or warmed (see moxibustion).

Attention deficit hyperactivity disorder
A syndrome primarily found in children and teenagers that is characterized by excessive physical movement, impulsiveness, and lack of attention.

Clinical studies

(Also clinical trials, clinical outcomes studies, controlled trials, case series, comparative trials, or practice audit evidence.) Tests of a treatment's effects in humans. Treatments undergo clinical studies only after they have shown promise in laboratory studies of animals. Clinical studies help researchers find out whether a promising treatment is safe and effective for people. They also tell scientists which treatments are more effective than others.

Electroacupuncture

A variation of traditional acupuncture treatment in which acupuncture or needle points are stimulated electronically.

Electromagnetic signals

The minute electrical impulses that transmit information through and between nerve cells. For example, electromagnetic signals convey information about pain and other sensations within the body's nervous system.

Fibromyalgia

A complex chronic condition having multiple symptoms, including muscle pain, weakness, and stiffness; fatigue; metabolic disorders; allergies; and headaches.

Holistic

Describes therapies based on facts about the "whole person," including spiritual and mental aspects, not only the specific part of the body being treated. Holistic practitioners may advise changes in diet, physical activity, and other lifestyle factors to help treat a patient's condition.

Meridians

A traditional Chinese medicine term for the 14 pathways throughout the body for the flow of qi, or vital energy, accessed through acupuncture points.

Moxibustion

The use of dried herbs in acupuncture. The herbs are placed on top of acupuncture needles and burned. This method is believed to be more effective at treating some health condititions than using acupuncture needles alone.

Neurohormones

Chemical substances made by tissue in the body's nervous system that can change the structure or function or direct the activity of an organ or organs.

Neurological

A term referring to the body's nervous system, which starts, oversees, and controls all body functions.

Neurotransmitters

Biochemical substances that stimulate or inhibit nerve impulses in the brain that relay information about external stimuli and sensations, such as pain.

Opioids

Synthetic or naturally occurring chemicals in the brain that may reduce pain and induce sleep.

Placebo

An inactive substance given to a participant in a research study as part of a test of the effects of another substance or treatment. Scientists often compare the effects of active and inactive substances to learn more about how the active substance affects participants.

Preclinical studies

Tests performed after a treatment has been shown in laboratory studies to have a desirable effect. Preclinical studies provide information about a treatment's harmful side effects and safety at different doses in animals.

Qi

(Pronounced "chee.") The Chinese term for vital energy or life force.

Randomized controlled clinical trials

A type of clinical study that is designed to provide information about whether a treatment is safe and effective in humans. These trials generally use two groups of people; one group receives the treatment and the other does not. The participants being studied do not know which group receives the actual treatment.

Traditional Chinese medicine

An ancient system of medicine and health care that is based on the concept of balanced qi, or vital energy, that flows throughout the body. Components of traditional Chinese medicine include herbal and nutritional therapy, restorative physical exercises, meditation, acupuncture, acupressure, and remedial massage.

Yang

The Chinese concept of positive energy and forces in the universe and human body. Acupuncture is believed to remove yang imbalances and bring the body into balance.

Yin

The Chinese concept of negative energy and forces in the universe and human body. Acupuncture is believed to remove yin imbalances and bring the body into balance.

References

1. Lytle, C.D. An Overview of Acupuncture. 1993. Washington, DC: United States Department of Health and Human Services, Health Sciences Branch, Division of Life Sciences, Office of Science and Technology, Center for Devices and Radiological Health, Food and Drug Administration.

2. Culliton, P.D. "Current Utilization of Acupuncture by United States Patients." National Institutes of Health Consensus Development Conference on Acupuncture, Program & Abstracts (Bethesda, MD, November 3-5, 1997). Sponsors: Office of Alternative Medicine and Office of Medical Applications Research. Bethesda, MD: National Institutes of Health, 1997.

    

3. Beinfield, H. and Korngold, E.L. Between Heaven and Earth: A Guide to Chinese Medicine. New York, NY: Ballantine Books, 1991.

4. Brown, D. "Three Generations of Alternative Medicine: Behavioral Medicine, Integrated Medicine, and Energy Medicine." Boston University School of Medicine Alumni Report. Fall 1996.

5. Senior, K. "Acupuncture: Can It Take the Pain Away? " Molecular Medicine Today. 1996. 2(4):150-3.

6. Raso, J. Alternative Health Care: A Comprehensive Guide. Buffalo, NY: Prometheus Books, 1994.

7. Eskinazi, D.P. "National Institutes of Health Technology Assessment Workshop on Alternative Medicine: Acupuncture." Journal of Alternative and Complementary Medicine. 1996. 2(1):1-253.

8. Tang, N.M., Dong, H.W., Wang, X.M., Tsui, Z.C., and Han, J.S. "Cholecystokinin Antisense RNA Increases the Analgesic Effect Induced by Electroacupuncture or Low Dose Morphine: Conversion of Low Responder Rats into High Responders." Pain. 1997. 71(1):71-80.

9. Cheng, X.D., Wu, G.C., He, Q.Z., and Cao, X.D. "Effect of Electroacupuncture on the Activities of Tyrosine Protein Kinase in Subcellular Fractions of Activated T Lymphocytes from the Traumatized Rats." Acupuncture and Electro-Therapeutics Research. 1998. 23(3-4):161-170.

10. Chen, L.B. and Li, S.X. "The Effects of Electrical Acupuncture of Neiguan on the PO2 of the Border Zone Between Ischemic and Non-Ischemic Myocardium in Dogs." Journal of Traditional Chinese Medicine. 1983. 3(2):83-8.

11. Lee, H.S. and Kim, J.Y. "Effects of Acupuncture on Blood Pressure and Plasma Renin Activity in Two-Kidney One Clip Goldblatt Hypertensive Rats." American Journal of Chinese Medicine. 1994. 22(3-4):215-9.

12. Okada, K., Oshima, M., and Kawakita, K. "Examination of the Afferent Fiber Responsible for the Suppression of Jaw-Opening Reflex in Heat, Cold and Manual Acupuncture Stimulation in Anesthetized Rats." Brain Research. 1996. 740(1-2):201-7.

13. National Institutes of Health. Frequently Asked Questions About Acupuncture. Bethesda, MD: National Institutes of Health, 1997.

14. Dale, R.A. "Demythologizing Acupuncture. Part 1. The Scientific Mechanisms and the Clinical Uses." Alternative & Complementary Therapies Journal. April 1997. 3(2):125-31.

15. Takeshige, C. "Mechanism of Acupuncture Analgesia Based on Animal Experiments." Scientific Bases of Acupuncture. Berlin, Germany: Springer-Verlag, 1989.

16. Han, J. S. "Acupuncture Activates Endogenous Systems of Analgesia." National Institutes of Health Consensus Conference on Acupuncture, Program & Abstracts (Bethesda, MD, November 3-5, 1997). Sponsors: Office of Alternative Medicine and Office of Medical Applications of Research. Bethesda, MD: National Institutes of Health, 1997.

17. Wu, B., Zhou, R.X., and Zhou, M.S. "Effect of Acupuncture on Interleukin-2 Level and NK Cell Immunoactivity of Peripheral Blood of Malignant Tumor Patients." Chung Kuo Chung Hsi I Chieh Ho Tsa Chich. 1994. 14(9):537-9.

18. Wu, B. "Effect of Acupuncture on the Regulation of Cell-Mediated Immunity in Patients With Malignant Tumors." Chen Tzu Yen Chiu. 1995. 20(3):67-71.

19. National Institutes of Health Consensus Panel. Acupuncture. National Institutes of Health Consensus Development Statement (Bethesda, MD, November 3-5, 1997). Sponsors: Office of Alternative Medicine and Office of Medical Applications of Research. Bethesda, MD: National Institutes of Health, 1997.

20. Lao, L., Bergman, S., Langenberg, P., Wong, R., and Berman, B. "Efficacy of Chinese Acupuncture on Postoperative Oral Surgery Pain." Oral Surgery, Oral Medicine, Oral Pathology. 1995. 79(4):423-8.

21. Lewith, G.T. and Vincent, C. "On the Evaluation of the Clinical Effects of Acupuncture: A Problem Reassessed and a Framework for Future Research." Journal of Alternative and Complementary Medicine. 1996. 2(1):79-90.

22. Tsibuliak, V.N., Alisov, A.P., and Shatrova, V.P. "Acupuncture Analgesia and Analgesic Transcutaneous Electroneurostimulation in the Early Postoperative Period." Anesthesiology and Reanimatology. 1995. 2:93-8.

23. World Health Organization. Viewpoint on Acupuncture. Geneva, Switzerland: World Health Organization, 1979.

24. Bullock, M.L., Pheley, A.M., Kiresuk, T.J., Lenz, S.K., and Culliton, P.D. "Characteristics and Complaints of Patients Seeking Therapy at a Hospital-Based Alternative Medicine Clinic." Journal of Alternative and Complementary Medicine. 1997. 3(1):31-7.

25. Diehl, D.L., Kaplan, G., Coulter, I., Glik, D., and Hurwitz, E.L. "Use of Acupuncture by American Physicians." Journal of Alternative and Complementary Medicine. 1997. 3(2):119-26.

26. Levine, J.D., Gormley, J., and Fields, H.L. "Observations on the Analgesic Effects of Needle Puncture (Acupuncture)." Pain. 1976. 2(2):149-59.

27. Ter Reit, G., Kleijnen, J., and Knipschild, P. "Acupuncture and Chronic Pain: A Criteria-Based Meta-Analysis." Clinical Epidemiology. 1990. 43:1191-9.

28. U.S. Food and Drug Administration. "Acupuncture Needles No Longer Investigational." FDA Consumer Magazine. June 1996. 30(5).

29. Berman, B., Lao, L., Bergman, S., Langenberg, P., Wong, R., Loangenberg, P., and Hochberg, M. "Efficacy of Traditional Chinese Acupuncture in the Treatment of Osteoarthritis: A Pilot Study." Osteoarthritis and Cartilage. 1995. (3):139-42.

30. Allen, John J.B. "An Acupuncture Treatment Study for Unipolar Depression." Psychological Science. 1998. 9:397-401.

31. Sonenklar, N. Acupuncture and Attention Deficit Hyperactivity Disorder. National Institutes of Health, Office of Alternative Medicine Research Grant #R21 RR09463. 1993.

32. Milligan, R. Breech Version by Acumoxa. National Institutes of Health, Office of Alternative Medicine Research Grant #R21 RR09527. 1993.

33. Cardini, F. and Weixin, H. "Moxibustion for Correction of Breech Presentation: A Randomized Controlled Trial." Journal of the American Medical Association. 1998. 280:1580-4.

34. American Academy of Medical Acupuncture. Doctor, What's This Acupuncture All About? A Brief Explanation for Patients. Los Angeles, CA: American Academy of Medical Acupuncture, 1996.

35. Lao, L. "Safety Issues in Acupuncture." Journal of Alternative and Complementary Medicine. 1996. 2(1):27-9.

MEDCEU Continuing Education Courses CEU for Nurses and Healthcare Professional

 Home Page