A key component of traditional Chinese medicine, acupuncture dates back nearly 5,000 years to around 2700 B.C. The Yellow Emperor’s Classic of Internal Medicine, a treatise on traditional Chinese medicine believed to have been written in the 2nd or 3rd century BC, contains the first written reference to acupuncture. The yellow emperor of the title was actuallya composite of numerous Chinese physicians whose medical knowledge was passed down and finally collected in book form.

Acupuncture began to attract wide spread attention in the western world after President Richard Nixon’s visit to China in 1972. During that trip, New fork Times reporter James Reston underwent an emergency appendectomy and wrote an article on the acupuncture anesthesia that was used during the procedure. His article piqued the interest of American doctors, who began traveling to China to observe this procedure first hand. They discovered a medical practice that was used not only as a substitute for surgical anesthesia but also as a treatment for pain and numerous disorders.

Today, acupuncture is practiced in a variety of mainstream medical settings and is a widely accepted treatment for pain and certain addictions. According to the World Health Organization, there are about 10,000 acupuncture practitioners in the United States, of whom approximately 3,000 are medical doctors. Americans are estimated to spend $500 million and make 9 to 12 million office visits per year for acupuncture treatments.

In November 1997, a National Institutes of Health (NIH) consensus panel reported clear evidence that needle acupuncture is effective in treating post operative dental pain as well as nausea and vomiting due to surgery, chemotherapy, and pregnancy. The 12-member panel also listed a number of conditions for which acupuncture might be used as an adjunctive therapy or an acceptable alternative therapy. These included (but were not limited to) addiction, stroke rehabilitation, low back pain, menstrual cramps, headache, tennis elbow, fibromyalgia, carpal tunnel syndrome, and asthma.

To promote greater public access to acupuncture, the panel also urged insurance companies and governmental insurance programs, including Medicare and medical, to reimburse for appropriate acupuncture treatments.

In another sign of acupuncture’s growing acceptance the U.S Food and Drug Administrations FDA) recently removed acupuncture needles from its list of experimental medical device and now regulates them just as it does scapels, ringes, and other common medical instruments.

Acupuncture is based on the same principle that underlies traditional Chinese medicine: the existence of a vital life force - qi - that circulates in the body through channels known as meridians. The 12 major meridians are believed to be connected to specific organ systems.

(There is also a network of collateral and minor meridians.) The meridians, used in both diagnosis and treatment, act as a road map that allows the practitioner to locate specific acupuncture points (acupoints).

Benefits And Uses of Acupuncture

According to Chinese theory, an organ that is experiencing an energy imbalance or diseased state may manifest signs or symptoms at its corresponding meridian. Such symptoms may include pain or aching, a change in skin temperature, sensitivity to touch, or alterations in skin texture or color along a portion of the channel. These symptoms help the practitioner determine which organ systems are affected and, thus, which acupoints to use in the treatment. The stimulation of these points by acupuncture needles is believed to balance, release, or enhance the flow of qi and thus relieve pain or restore health.

The World Health Organization has listed more than 100 conditions that may benefit from treatment with acupuncture, including neurologic disorders (migraines, Meniere’s disease, trigeminal neuralgia, peripheral neuropathy), GI disorders (colitis, gastritis, ulcers, diarrhea, constipation, hiccups), pulmonary and respiratory conditions (bronchitis, asthma, sinusitis, rhinitis), eye disorders (myopia, conjunctivitis, central retinitis), sciatica, and various rheumatoid and arthritic conditions. In China, acupuncture is commonly used as a surgical anesthetic.

In the United States, acupuncture is used by millions of people primarily to relieve or prevent pain, to relieve nausea and vomiting, and as an adjunctive method to overcome drug and alcohol addictions. (More than 300 substance abuse programs in the United States use acupuncture.) Some practitioners claim acupuncture can improve immune system function and reduce symptoms in patients with acquired immunodeficiency syndrome (AIDS).

How the treatment is performed?

Acupuncture as practiced in the United States today isn’t a monolithic body of knowledge similar to Western biomedicine; rather, it’s based on a number of medical traditions from China, Korea, Japan, England, and France. A practitioner trained in a school following the main land Chinese model will practice differently from one trained in the Japanese model. The underlying theory of all the schools is identical, but the vast tradition of Chinese medicine allows for quite divergent emphases in practice. Thus, a practitioner may emphasize the five phases theory, the eight principles theory, or the three yin three yang theory in making a diagnosis. These different diagnostic frameworks result in very different approaches to therapy in each model.

A visit to an acupuncturist is usually similar to a visit to a traditional Chinese medicine practitioner, except that herbs may not be prescribed and the treatment will be done at the time of the visit. Before treatment begins, the practitioner determines the patient’s overall condition by the traditional Chinese methods of diagnosis: inspecting, listening, smelling, questioning, and palpating. The assessment includes intensive pulse measurements and questions about eating and sleeping habits, digestive complaints, urine color, and stress. Treatment is based on the results of the assessment, which indicate the balance of qi flow in the network of channels. However, the particular channels and points chosen for treatment may also be influenced by the practitioner’s style and experience as well as the specific school of acupuncture in which he was trained.

The basic technique is similar in all schools of acupuncture. Very fine filiform needles made of solid metal usually stainless steel are inserted into the skin. The needles (usually no more than 10 or 12) are placed in designated acupoints on the body, depending on the patient’s diagnosis. Although most acupoints are located on a meridian, a number of points located away from any channel have been discovered to have therapeutic effects; these are called miscellaneous points. The needles are typically kept in place for 20 to 30 minutes and may be set in motion or connected to low-voltage electric generators to enhance their intended effects.

Because the needles are so fine and aren’t hollow, the patient feels relatively little pain compared to the insertion of tunneling needles used for injections. Strict standards of sterilization are required for non disposable needles and implements, although it has become customary to use single-use disposable needles.

In addition to inserting needles, acupuncturists commonly use other treatments involving the acupoints, including moxibustion and cupping. In moxibustion, a small piece of an herb called moxa (Artemisia vulgaris, commonly known as mugwort) is burned either on the needle tip or on another substance that is then placed over the designated acupoint. This supplementary technique is intended to stimulate or increase the flow of qi in the body. Cupping olves the placement of glass or bamboo cups on the skin to create a vacuum suction, which is believe to draw out pathogenic substances. some acupuncturists don’t use needles at all; instead they substitute electrostimulation, ultrasonic waves, or laser beams for the metal needles. In Chinese massage, or acupressure, the practitioner applies deep finger pressure to the acu points. A modern variation on acupuncture, called auriculotherapy, was developed in France after World War II and involves inserting needles at specific points on the outer ear that are believed to affect other regions of the body. This method is being used in the United States to treat alcohol, tobacco, and drug addiction.

Side Effects of Acupuncture

The 1997 NIH consensus panel reported that the incidence of adverse effects from acupuncture treatment is lower than that for many accepted medical procedures used for the same conditions. For example, the steroids and nonsteroidal antiinflammatory drugs commonly used to treat painful musculoskeletal conditions, such as fibromyalgia and epicondylitis, can cause serious adverse effects, yet the evidence supporting their usefulness is no more compelling than that supporting acupuncture.

Because of the slight chance of life threatening reactions such as pneumothorax, the NIH panel urged acupuncture practitioners to take appropriate safeguards, including carefully explaining the procedure to their patients and following FDA guidelines on needle sterility.

Bruising from hitting veins and capillanes does occur. Fainting may occur either from fear of needles or vasovagal reactions. Skin infection can occur around the needle site.

Clinical considerations

If Your patient is considering acupuncture, inform him that he can obtain a referral from the NCCA.

Research summary

Although acupuncture is one of the most widely researched of all the alternative and complementary therapies, most of the published reports have been case studies that don’t meet modern scientific standards for assessing efficacy. Doubleblind randomized studies are difficult to perform for acupuncture because the treatments are so individualized; two people with the same disease label would probably be treated differently.

Despite these problems, the 1997 NIH consensus panel concluded that the data in support of acupuncture are as strong as those for many accepted Western medical therapies. The panel also encouraged practitioners to make acupuncture part of a comprehensive management program for asthma, addiction, and smoking cessation.

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