Acupuncture

Definition

Acupuncture, one of the main forms of therapy in traditional Chinese medicine (TCM), has been practiced for at least 2,500 years. In acupuncture, certain points on the body are stimulated by the insertion of fine needles. Unlike the hollow hypodermic needles used in mainstream medicine to give injections or to draw blood, acupuncture needles are solid. The points can be needled between 15° and 90° relative to the skin's surface, depending on treatment.

Acupuncture is thought to restore health by removing energy imbalances and blockages in the body. Practitioners of TCM believe that there is a vital force or energy called qi (pronounced "chee") that flows through the body and between the skin surface and the internal organs, along channels or pathways called meridians. There are 12 major and eight minor meridians. Qi regulates the spiritual, emotional, mental, and physical harmony of the body by keeping the forces of yin and yang in balance. Yang is a principle of heat, activity, brightness, outwardness, while yin represents coldness, passivity, darkness, interiority, etc. TCM does not try to eliminate either yin or yang, but rather keep them in harmonious balance. Acupuncture may be used to raise or lower the level of yin or yang in a specific part of the body in order to restore the energy balance.

Acupuncture was virtually unknown in the United States prior to President Richard Nixon's trip to China in 1972. A reporter for the New York Times named James Reston wrote a story for the newspaper about the doctors in Beijing who used acupuncture to relieve his pain following abdominal surgery. By 1993, Americans were making 12 million visits per year to acupuncturists, and spending $500 million annually on acupuncture treatments. By 1995, there were an estimated 10,000 certified acupuncturists practicing in the United States; as of 2000, there were 20,000. About a third of the credentialed acupuncturists in the United States as of 2002 are MDs.

Acupuncture's record of success has stimulated a number of research projects investigating its mechanisms as well as its efficacy. Research has been funded not only by the National Center for Complementary and Alternative Medicine (NCCAM), but also by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Institute of Dental Research, the National Institute of Neurological Disorders and Stroke (NINDS), and the National Institute on Drug Abuse. In 1997, a consensus panel of the National Institutes of Health (NIH) presented a report in which it described acupuncture as a sufficiently promising form of treatment to merit further study. In 2000, the British Medical Association (BMA) recommended that acupuncture should be made more readily available through the National Health Service (NHS), and that family doctors should be trained in some of its techniques.

Purpose

The purpose of acupuncture in TCM is the rebalancing of opposing energy forces in different parts of the body. In Western terms, acupuncture is used most commonly as an adjunctive treatment for the relief of chronic or acute pain. In the United States, acupuncture is most widely used to treat pain associated with musculoskeletal disorders, but it has also been used in the treatment of headaches, other painful disorders, and nausea and vomiting. In addition to these disorders, acupuncture has been used to treat a variety of disorders such as asthma, infertility, depression, anxiety, HIV infection, and fibromyalgia, although its efficacy in relieving these disorders is largely unproven. Acupuncture should not be used to treat traumatic injuries and other emergency conditions requiring immediate surgery. Also, while it appears to have benefits in relieving symptoms such as pain under the proper circumstances, it has not been shown to alter the underlying course of a disease.

The exact mechanism by which acupuncture works is not known. Studies have demonstrated a variety of physiologic effects such as release in the brain of various chemicals and hormones, alteration of immune function, blood pressure, and body temperature.

Precautions

The risk of infection in acupuncture is minimal if the acupuncturist uses sterile disposable needles. In the United States, the Food and Drug Administration (FDA) mandates the use of sterilized needles made from nontoxic materials. The needles must be clearly labeled as having their use restricted to qualified practitioners.

Patients should also inquire about the practitioner's credentials. People who would prefer to be treated by an MD or an osteopath can obtain a list of licensed physicians

who practice acupuncture in their area from the American Academy of Medical Acupuncture. With regard to non-physician acupuncturists, 31 states have established training standards that acupuncturists must meet in order to be licensed in those states. In Great Britain, practitioners must qualify by passing a course offered by the British Acupuncture Accreditation Board.

People seeking acupuncture treatment should provide the practitioner with the same information about their health conditions and other forms of treatment that they would give their primary care doctor.

As is true with other forms of medical treatment, a minority of patients do not respond to acupuncture. The reasons for nonresponsiveness are not known at the present stage of research.

Description

In traditional Chinese practice, the needles are twirled or rotated as they are inserted. Many patients feel nothing at all during this procedure, while others experience a prickling or aching sensation, and still others a feeling of warmth or heaviness.

The practitioner may combine acupuncture with moxibustion to increase the effectiveness of the treatment. Moxibustion is a technique in which the acupuncturist lights a small piece of wormwood, called a moxa, above the acupuncture point above the skin. When the patient begins to feel the warmth from the burning herb, it is removed. Cupping is another technique that is a method of stimulation of acupuncture points by applying suction through a metal, wood, or glass jar, and in which a partial vacuum has been created. Cupping produces blood congestion at the site, and the site is thus stimulated.

In addition to the traditional Chinese techniques of acupuncture, the following are also used in the United States:

Electroacupuncture. In this form of acupuncture, the traditional acupuncture points are stimulated by an electronic device instead of a needle.
Japanese meridian acupuncture. Japanese acupuncture uses thinner, smaller needles, and focuses on the meridians rather than on specific points along their course.
Korean hand acupuncture. Traditional Korean medicine regards the hand as a "map" of the entire body, such that any part of the body can be treated by stimulating the corresponding point on the hand.

Western medical acupuncture. Western physicians trained in this style of acupuncture insert needles into socalled trigger points in sore muscles, as well as into the traditional points used in Chinese medicine.

Ear acupuncture. This technique regards the ear as having acupuncture points that correspond to other parts of the body. Ear acupuncture is often used to treat substance abuse and chronic pain syndromes.

A standard acupuncture treatment takes between 45 minutes to an hour and costs between $40 and $100, although initial appointments often cost more. Chronic conditions usually require 10 treatment sessions, but acute conditions or minor illnesses may require only one or two visits. Follow-up visits are often scheduled for patients with chronic pain. As of 2000, about 70–80% of health insurers in the United States reimbursed patients for acupuncture treatments.

Preparation

Apart from a medical history and physical examination, no specific preparation is required for an acupuncture treatment. In addition to using sterile needles, licensed acupuncturists will wipe the skin over each acupuncture point with an antiseptic solution before inserting the needle.

Aftercare

No particular aftercare is required, as the needles should not draw blood when properly inserted. Many patients experience a feeling of relaxation or even a pleasant drowsiness after the treatment. Some patients report feeling energized.

Risks

Most complications from acupuncture fall into one of three categories: infections, most often from improperly sterilized needles; bruising or minor soft tissue injury; and injuries to muscle tissue. Rarely, serious side effects from improper application of the needle may result in pneumothorax and cardiac tamponade.

Normal results

Normal results from acupuncture are relief of pain and/or improvement of the condition being treated.

Abnormal results

Abnormal results from acupuncture include infection, a severe side effect, or worsening of the condition being treated.

Resources

BOOKS

Pelletier, Kenneth R., MD. "Acupuncture: From the Yellow Emperor to Magnetic Resonance Imaging (MRI)." Chapter 5 in The Best Alternative Medicine. New York: Simon and Schuster, 2002.

Reid, Daniel P. Chinese Herbal Medicine. Boston, MA: Shambhala, 1993.

Svoboda, Robert, and Arnie Lade. Tao and Dharma: Chinese Medicine and Ayurveda. Twin Lakes, WI: Lotus Press, 1995.

PERIODICALS

Cerrato, Paul L. "New Studies on Acupuncture and Emesis (Acupuncture for Relief of Nausea and Vomiting Caused by Chemotherapy)." Contemporary OB/GYN 46 (April 2001): 749.

Kemper, Kathi J., et al. "On Pins and Needles—Pediatric Pain: Patients' Experience with Acupuncture." Pediatrics 105 (April 2000): 620–633.

Kirchgatterer, Andreas. "Cardiac Tamponade Following Acupuncture." Chest 117 (May 2000): 1510–1511.

Nwabudike, Lawrence C., and Constantin Ionescu-Tirgoviste. "Acupuncture in the Treatment of Diabetic Peripheral Neuropathy." Diabetes 49 (May 2000): 628.

Silvert, Mark. "Acupuncture Wins BMA Approval (British Medical Association)." British Medical Journal 321 (July 1, 2000): 637–639.

Vickers, Andrew. "Acupuncture (ABC of Complementary Medicine)." British Medical Journal 319 (October 9, 1999): 704–708.

ORGANIZATIONS

American Academy of Medical Acupuncture/Medical Acupuncture Research Organization. 5820 Wilshire Boulevard, Suite 500, Los Angeles, CA 90036. (800) 521-2262 or (323) 937-5514; Fax: (323) 937-0959. (May 9, 2004.) <http://www.medicalacupuncture.org>.

American Association of Oriental Medicine. 433 Front Street, Catasaqua, PA 18032. (610) 266-1433; Fax: (610) 264-2768. (May 9, 2004.) <http://www.aaom.org>.

National Center for Complementary and Alternative Medicine (NCCAM) Clearinghouse. P.O. Box 7923, Gaithersburg, MD 20898. (888) 644-6226; TTY: (866) 464-3615; Fax: (866) 464-3616. (May 9, 2004.) <http://www.nccam.nih.gov>.