Acupuncture

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Definition

Acupuncture is one of the main forms of treatment in traditional Chinese medicine. It involves the use of sharp, thin needles that are inserted in the body at very specific points. This process is believed to adjust and alter the body's energy flow into healthier patterns, and is used to treat a wide variety of illnesses and health conditions.

Description

The original text of Chinese medicine is the Nei Ching, The Yellow Emperor's Classic of Internal Medicine, which is estimated to be at least 2,500 years old. Thousands of books since then have been written on the subject of Chinese healing, and its basic philosophies spread long ago to other Asian civilizations. Nearly all of the forms of Oriental medicine which are used in the West today, including acupuncture, shiatsu, acupressure massage, and macrobiotics, are part of or have their roots in Chinese medicine. Legend has it that acupuncture developed when early Chinese physicians observed unpredicted effects of puncture wounds in Chinese warriors. The oldest known text on acupuncture, the Systematic Classic of Acupuncture, dates back to 282 A.D. Although acupuncture is its best known technique, Chinese medicine traditionally utilizes herbal remedies, dietary therapy, lifestyle changes and other means to treat patients.

In the early 1900s, only a few Western physicians who had visited China were fascinated by acupuncture, but outside of Asian-American communities it remained virtually unknown until the 1970s, when Richard Nixon became the first U.S. president to visit China. On Nixon's trip, journalists were amazed to observe major operations being performed on patients without the use of anesthetics. Instead, wide-awake patients were being operated on with only acupuncture needles inserted into them to control pain. During that time, a famous columnist for the New York Times, James Reston, had to undergo surgery and elected to use acupuncture instead of pain medication, and he wrote some convincing stories on its effectiveness.

Today acupuncture is being practiced in all 50 states by over 9,000 practitioners, with over 4,000 MDs including it in their practices. Acupuncture has shown notable success in treating many conditions, and over 15 million Americans have used it as a therapy. Acupuncture, however,

remains largely unsupported by the medical establishment. The American Medical Association has been resistant to researching it, as it is based on concepts very different from the Western scientific model.

Several forms of acupuncture are being used today in America. Japanese acupuncture uses extremely thin needles and does not incorporate herbal medicine in its practice. Auricular acupuncture uses acupuncture points only on the ear, which are believed to stimulate and balance internal organs. In France, where acupuncture is very popular and more accepted by the medical establishment, neurologist Paul Nogier developed a system of acupuncture based on neuroendocrine theory rather than on traditional Chinese concepts, which is gaining some use in America.

Chinese medicine views the body as a small part of the universe, and subject to universal laws and principles of harmony and balance. Chinese medicine does not draw a sharp line, as Western medicine does, between mind and body. The Chinese system believes that emotions and mental states are every bit as influential on disease as purely physical mechanisms, and considers factors like work, environment, lifestyle and relationships as fundamental to the overall picture of a patient's health. Chinese medicine also uses very different symbols and ideas to discuss the body and health. While Western medicine typically describes health in terms of measurable physical processes made up of chemical reactions, the Chinese use ideas like yin and yang, chi, the organ system, and the five elements to describe health and the body. To understand the ideas behind acupuncture, it is worthwhile to introduce some of these basic terms.

YIN AND YANG. According to Chinese philosophy, the universe and the body can be described by two separate but complementary principles, that of yin and yang. For example, in temperature, yin is cold and yang is hot. In gender, yin is female and yang is male. In activity, yin is passive and yang is active. In light, yin is dark and yang is bright; in direction yin is inward and downward and yang is outward and up, and so on. Nothing is ever completely yin or yang, but a combination of the two. These two principles are always interacting, opposing, and influencing each other. The goal of Chinese medicine is not to eliminate either yin or yang, but to allow the two to balance each other and exist harmoniously together. For instance, if a person suffers from symptoms of high blood pressure, the Chinese system would say that the heart organ might have too much yang, and would recommend methods either to reduce the yang or to increase the yin of the heart, depending on the other symptoms and organs in the body. Thus, acupuncture therapies seek to either increase or reduce yang, or increase or reduce yin in particular regions of the body.

CHI. Another fundamental concept of Chinese medicine is that of chi (pronounced chee, also spelled qi). Chi is the fundamental life energy of the universe. It is invisible and is found in the environment in the air, water, food and sunlight. In the body, it is the invisible vital force that creates and animates life. We are all born with inherited amounts of chi, and we also get acquired chi from the food we eat and the air we breathe. The level and quality of a person's chi also depends on the state of physical, mental and emotional balance. Chi travels through the body along channels called meridians.

THE ORGAN SYSTEM. In the Chinese system, there are twelve main organs: the lung, large intestine, stomach, spleen, heart, small intestine, urinary bladder, kidney, liver, gallbladder, pericardium, and the "triple warmer," which represents the entire torso region. Each organ has chi energy associated with it, and each organ interacts with particular emotions on the mental level. As there are twelve organs, there are twelve types of chi which can move through the body, and these move through twelve main channels or meridians. Chinese doctors connect symptoms to organs. That is, symptoms are caused by yin/yang imbalances in one or more organs, or by an unhealthy flow of chi to or from one organ to another. Each organ has a different profile of symptoms it can manifest.

THE FIVE ELEMENTS. Another basis of Chinese theory is that the world and body are made up of five main elements: wood, fire, earth, metal, and water. These elements are all interconnected, and each element either generates or controls another element. For instance, water controls fire and earth generates metal. Each organ is associated with one of the five elements. The Chinese system uses elements and organs to describe and treat conditions. For instance, the kidney is associated with water and the heart is associated with fire, and the two organs are related as water and fire are related. If the kidney is weak, then there might be a corresponding fire problem in the heart, so treatment might be made by acupuncture or herbs to cool the heart system and/or increase energy in the kidney system.

The Chinese have developed an intricate system of how organs and elements are related to physical and mental symptoms, and the above example is a very simple one. Although this system sounds suspect to Western scientists, some interesting parallels have been observed. For instance, Western medicine has observed that with severe heart problems, kidney failure often follows, but it still does not know exactly why. In Chinese medicine, this connection between the two organs has long been established.

MEDICAL PROBLEMS AND ACUPUNCTURE. In Chinese medicine, disease as seen as imbalances in the organ system or chi meridians, and the goal of any remedy or treatment is to assist the body in reestablishing its innate harmony. Disease can be caused by internal factors like emotions, external factors like the environment and weather, and other factors like injuries, trauma, diet, and germs. However, infection is seen not as primarily a problem with germs and viruses, but as a weakness in the energy of the body which is allowing a sickness to occur. In Chinese medicine, no two illnesses are ever the same, as each body has its own characteristics of symptoms and balance. Acupuncture is used to open or adjust the flow of chi throughout the organ system, which will strengthen the body and prompt it to heal itself.

A VISIT TO THE ACUPUNCTURIST. The first thing an acupuncturist will do is get a thorough idea of a patient's medical history and symptoms, both physical and emotional. This is done with a long questionnaire and interview. Then the acupuncturist will examine the patient to find further symptoms, looking closely at the tongue, the pulse at various points in the body, the complexion, general behavior, and other signs like coughs or pains. From this, the practitioner will be able to determine patterns of symptoms which indicate which organs and areas are imbalanced. Depending on the problem, the acupuncturist will insert needles to manipulate chi on one or more of the twelve organ meridians. On these twelve meridians, there are nearly 2,000 points which can be used in acupuncture, with around 200 points being most frequently used by traditional acupuncturists. During an individual treatment, one to twenty needles may be used, depending on which meridian points are chosen.

Acupuncture needles are always sterilized and acupuncture is a very safe procedure. The depth of insertion of needles varies, depending on which chi channels are being treated. Some points barely go beyond superficial layers of skin, while some acupuncture points require a depth of 1-3 in (2.5-7.5 cm) of needle. The needles generally do not cause pain. Patients sometimes report pinching sensations and often pleasant sensations, as the body experiences healing. Depending on the problem, the acupuncturist might spin or move the needles, or even pass a slight electrical current through some of them. Moxibustion may be sometimes used, in which an herbal mixture (moxa or mugwort) is either burned like incense on the acupuncture point or on the end of the needle, which is believed to stimulate chi in a particular way. Also, acupuncturists sometimes use cupping, during which small suction cups are placed on meridian points to stimulate them.

How long the needles are inserted also varies. Some patients only require a quick in and out insertion to clear problems and provide tonification (strengthening of health), while some other conditions might require needles inserted up to an hour or more. The average visit to an acupuncturist takes about thirty minutes. The number of visits to the acupuncturist varies as well, with some conditions improved in one or two sessions and others requiring a series of six or more visits over the course of weeks or months.

Costs for acupuncture can vary, depending on whether the practitioner is an MD. Initial visits with non-MD acupuncturists can run from $50-$100, with follow-up visits usually costing less. Insurance reimbursement also varies widely, depending on the company and state. Regulations have been changing often. Some states authorize Medicaid to cover acupuncture for certain conditions, and some states have mandated that general coverage pay for acupuncture. Consumers should be aware of the provisions for acupuncture in their individual policies.

— Douglas Dupler

Dictionary: ac·u·punc·ture  (ăk'yʊ-pŭngk'chər)

Source

A procedure used in or adapted from Chinese medical practice in which specific body areas are pierced with fine needles for therapeutic purposes or to relieve pain or produce regional anesthesia.

To subject to acupuncture.

[Latin acus, needle + PUNCTURE.]

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.

Rebecca Frey, PhD

Rosalyn Carson-DeWitt, MD

Acupuncture is perhaps most helpfully defined in general as the insertion of one or more needles into the body with therapeutic intent. The advantage of this wide definition is that it covers the many current different variants of this ancient practice, without being specifically tied to any one of them. At the broadest level, the most critical difference of approach lies between classical Oriental forms of acupuncture and those rooted more in modern Western biomedicine. Most of the main differences in practice are based on this dichotomy, although there are significant distinctions both between and within these two traditions, in terms of such issues as the model used to explain the operation of acupuncture and the scope of its practice. There are also debates in both traditions about the number and location of the acupuncture points themselves.

What is not in dispute, however, is that acupuncture has a history spanning well over 2000 years, taking its origin from ancient China. One of the oldest known books on acupuncture here is the Yellow Emperor's classic of internal medicine (the Nei Jing), which is held to date back many hundreds of years bc. From China, acupuncture spread to such local cultural areas as Korea and Japan, where it became incorporated into mainstream medicine by the seventh and eighth centuries ad. By the sixteenth and seventeenth centuries knowledge of it had reached Europe, mainly through missionaries and ships' surgeons who had witnessed its use in the East, but who had only a rudimentary understanding of its operation.

In the early nineteenth century it began to be practised by a number of doctors in Britain and the US. It went into something of a decline in most countries in the Western world thereafter — and even, briefly, in China in the modernization period under the Kuomintang in the first half of the twentieth century. However, the advent of ‘ping-pong’ diplomacy between China and the West in the first half of the 1970s, associated with dramatic television pictures of open-heart surgery being carried out by the Chinese with the use of ‘acupuncture anaesthesia’, led to spiralling public interest. This interest has continued to grow in both medical and non-medical circles up to the present day, alongside other complementary and alternative therapies—resulting in increasing numbers of acupuncturists and its widespread employment in the West in pain clinics and other settings.

In its classic application within traditional Chinese medicine, acupuncture is seen as being underpinned by the interplay of yin and yang; disease is seen as deriving from the disequilibrium of such opposing forces. In this conceptualization, drawing on Taoist philosophy, acupuncture treatment for the sick is used to correct imbalances and to maintain equilibrium in the healthy to prevent illness. This involves manipulating the patient's Qi, the life force, by stimulating needles strategically placed at selected acupuncture points which lie on the 12 main meridians that run along the body and connect with central internal organs. Typically, the needles are placed in sites at a distance from the condition itself. In this frame of reference — and as employed in China and many other Oriental societies — acupuncture is seen as something of a panacea, which can deal with a wide range of disorders spanning from asthma and ulcers to depression and angina.

Acupuncture, though, is characteristically used very differently in Western biomedicine — mainly as a more narrowly defined remedy for pain and for addictions of various kinds. The traditional Chinese philosophies about acupuncture are usually seen as problematic within this framework, not least because there is no consistent correspondence between biomedical conceptions of the physical structures of the body and the classical acupuncture points and the meridians along which they are held to run. Indeed, within more Westernized approaches, needling often occurs in situ rather than at a distance. Other explanations of its operation have also typically been sought by Western doctors, generally based on neurophysiology. Initially the ‘gate-control’ theory was widely adopted, centred on the notion that the stimulation of the larger nerve fibres can block pain. More recently, however, emphasis has shifted to the notion that endorphins — opiates of a type naturally produced by the body — are released by acupuncture, thus giving rise to its analgesic effects. However, neither theory adequately explains the long-term relief of chronic pain nor the wider therapeutic effects traditionally claimed for acupuncture.

From a conventional Western perspective, many studies of acupuncture to date have been methodologically unsound — although its proponents might point to the difficulties of evaluating its efficacy through randomized trials in view of its holistic, classical Oriental origins. Current evidence based on trials of its efficacy in treating pain is growing, though, even if rigorous trials of acupuncture for other disorders are few and far between and are not always supportive of the claimed benefits. Another important issue in the West is the regulation of acupuncture practice and whether it should be formally restricted either to doctors or to those appropriately trained in acupuncture, given that it is an invasive technique. In untutored hands, acupuncture has occasionally given rise to a number of complications, such as Hepatitis B and AIDS, and the puncturing of the heart and lungs, which carry potentially fatal consequences.

It should be stressed in conclusion that, even as discussed here, there are difficulties in clearly defining the boundaries of acupuncture. There are, for example, associated forms of treatment which do not employ needles, but which use acupuncture points. These range from the traditional application of finger pressure, through shiatsu and the burning of a herb, moxa, at such points, to the stimulation of acupuncture points using electrodes, as with techniques such as TENS (transcutaneous electrical nerve stimulation) in modern medical practice. Equally, there are surgical techniques, like suturing and the injection of medicinal substances, that are closer to the definition of acupuncture in so far as they involve needles, but are not conventionally regarded as such. Notwithstanding these definitional issues, though, acupuncture in both its traditional and modern forms looks as if it will continue to be important in the foreseeable future in both the contemporary Western and Eastern worlds, where it is being subjected to increasing use and scientific study.

— Mike Saks

Bibliography

• Lewith, G., Kenyon, J., and Lewis, P. (1996). Complementary medicine: an integrated approach. Oxford University Press.
• Lu Gwei-Djen and Needham, J. (1980). Celestial lancets: a history and rationale of acupuncture and moxa. Cambridge University Press.
• Mole, P. (1992). Acupuncture: energy balancing for body, mind and spirit. Element, Longmead.
• Saks, M. (1995). Professions and the public interest: medical power, altruism and alternative medicine. Routledge, London

An ancient Chinese system of healing in which symptoms are relieved by inserting 3 to 20 thin needles through the skin and muscle at certain points in the body. The points are plotted along the body on lines determined by tradition. Selected points are stimulated by rotating the needle or by passing an electric current through it. The precise mechanism of acupuncture is unknown, but it is thought that the needles act as an external stimulus, encouraging the release of natural chemical painkillers, called endorphins. These are believed to initiate self-healing within the body.

Acupuncture is used in the Far East as an alternative to anaesthesia for some major operations. It is gaining popularity in the West as a technique for the relief of pain and the treatment of ailments such as arthritis, backpain and depression. If you feel you might benefit from the services of an acupuncturist, choose carefully. Many acupuncturists are not medically qualified. If an acupuncture is not performed properly there is a real danger of infection. Acupuncture has also been used to treat overweight people, and special ‘acupressure’ ear rings are marketed as weight-loss aids, but there is no evidence that they are effective.

A method of producing analgesia or altering the function of a system of the body by inserting fine, wirethin needles into the skin at specific sites on the body along a series of lines or channels called meridians. The needles may be twirled, energized electrically, or warmed. Acupuncture originated in the Far East and has gained increasing attention in the West since the early 1970s.

Definition

Acupuncture is one of the main forms of treatment in traditional Chinese medicine. It involves the use of sharp, thin needles that are inserted in the body at very specific points. This process is believed to adjust and alter the body's energy flow into healthier patterns, and is used to treat a wide variety of illnesses and health conditions.

Origins

The original text of Chinese medicine is the Nei Ching, The Yellow Emperor's Classic of Internal Medicine, which is estimated to be at least 2,500 years old. Thousands of books since then have been written on the subject of Chinese healing, and its basic philosophies spread long ago to other Asian civilizations. Nearly all of the forms of Oriental medicine which are used in the West today, including acupuncture, shiatsu, acupressure massage, and macrobiotics, are part of or have their roots in Chinese medicine. Legend has it that acupuncture developed when early Chinese physicians observed unpredicted effects of puncture wounds in Chinese warriors. The oldest known text on acupuncture, the Systematic Classic of Acupuncture, dates back to 282 A.D. Although acupuncture is its best known technique, Chinese medicine traditionally utilizes herbal remedies, dietary therapy, lifestyle changes and other means to treat patients.

In the early 1900s, only a few Western physicians who had visited China were fascinated by acupuncture, but outside of Asian-American communities it remained virtually unknown until the 1970s, when Richard Nixon became the first U.S. president to visit China. On Nixon's trip, journalists were amazed to observe major operations being performed on patients without the use of anesthetics. Instead, wide-awake patients were being operated on with only acupuncture needles inserted into them to control pain. During that time, a famous columnist for the New York Times, James Reston, had to undergo surgery and elected to use acupuncture instead of pain medication, and he wrote some convincing stories on its effectiveness.

Today acupuncture is being practiced in all 50 states by more than 9,000 practitioners, with about 4,000 MDs including it in their practices. Acupuncture has shown no-table success in treating many conditions, and more than 15 million Americans have used it as a therapy. Acupuncture, however, remains largely unsupported by the medical establishment. The American Medical Association has been resistant to researching it, as it is based on concepts very different from the Western scientific model.

Several forms of acupuncture are being used today in America. Japanese acupuncture uses extremely thin needles and does not incorporate herbal medicine in its practice. Auricular acupuncture uses acupuncture points only on the ear, which are believed to stimulate and balance internal organs. In France, where acupuncture is very popular and more accepted by the medical establishment, neurologist Paul Nogier developed a system of acupuncture based on neuroendocrine theory rather than on traditional Chinese concepts, which is gaining some use in America.

Benefits

The World Health Organization (WHO) recommends acupuncture as an effective treatment for over forty medical problems, including allergies, respiratory conditions, gastrointestinal disorders, gynecological problems, nervous conditions, and disorders of the eyes, nose and throat, and childhood illnesses, among others. Acupuncture has been used in the treatment of alcoholism and substance abuse. In 2002, a center in Maine received a unique grant to study acupuncture treatment for substance abuse. Although recognizing that acupuncture had been used before for helping those with abuse, this study sought to show that ear acupuncture's effects on relaxation response helped those abusing drugs and alcohol better deal with the anxiety and life circumstances thought to lead them to substance abuse.

Acupuncture is an effective and low-cost treatment for headaches and chronic pain, associated with problems like back injuries and arthritis. It has also been used to supplement invasive Western treatments like chemotherapy and surgery. Acupuncture is generally most effective when used as prevention or before a health condition becomes acute, but it has been used to help patients suffering from cancer and AIDS. In 2002, the National Institutes of health announced that pain from certain musculoskeletal conditions like fibromyalgia could be helped by acupuncture. Acupuncture is limited in treating conditions or traumas that require surgery or emergency care (such as for broken bones).

Description

Basic Ideas of Chinese Medicine

Chinese medicine views the body as a small part of the universe, and subject to universal laws and principles of harmony and balance. Chinese medicine does not draw a sharp line, as Western medicine does, between mind and body. The Chinese system believes that emotions and mental states are every bit as influential on disease as purely physical mechanisms, and considers factors like work, environment, lifestyle, and relationships as fundamental to the overall picture of a patient's health. Chinese medicine also uses very different symbols and ideas to discuss the body and health. While Western medicine typically describes health in terms of measurable physical processes made up of chemical reactions, the Chinese use ideas like yin and yang, chi, the organ system, and the five elements to describe health and the body. To understand the ideas behind acupuncture, it is worthwhile to introduce some of these basic terms.

YIN AND YANG. According to Chinese philosophy, the universe and the body can be described by two separate but complementary principles, that of yin and yang. For example, in temperature, yin is cold and yang is hot. In gender, yin is female and yang is male. In activity, yin is passive and yang is active. In light, yin is dark and yang is bright; in direction yin is inward and downward and yang is outward and up, and so on. Nothing is ever completely yin or yang, but a combination of the two. These two principles are always interacting, opposing, and influencing each other. The goal of Chinese medicine is not to eliminate either yin or yang, but to allow the two to balance each other and exist harmoniously together. For instance, if a person suffers from symptoms of high blood pressure, the Chinese system would say that the heart organ might have too much yang, and would recommend methods either to reduce the yang or to increase the yin of the heart, depending on the other symptoms and organs in the body. Thus, acupuncture therapies seek to either increase or reduce yang, or increase or reduce yin in particular regions of the body.

CHI. Another fundamental concept of Chinese medicine is that of chi (pronounced chee, also spelled qi). Chi is the fundamental life energy of the universe. It is invisible and is found in the environment in the air, water, food and sunlight. In the body, it is the invisible vital force that creates and animates life. We are all born with inherited amounts of chi, and we also get acquired chi from the food we eat and the air we breathe. The level and quality of a person's chi also depends on the state of physical, mental and emotional balance. Chi travels through the body along channels called meridians.

THE ORGAN SYSTEM. In the Chinese system, there are twelve main organs: the lung, large intestine, stomach, spleen, heart, small intestine, urinary bladder, kidney, liver, gallbladder, pericardium, and the "triple warmer," which represents the entire torso region. Each organ has chi energy associated with it, and each organ interacts with particular emotions on the mental level. As there are twelve organs, there are twelve types of chi which can move through the body, and these move through twelve main channels or meridians. Chinese doctors connect symptoms to organs. That is, symptoms are caused by yin/yang imbalances in one or more organs, or by an unhealthy flow of chi to or from one organ to another. Each organ has a different profile of symptoms it can manifest.

THE FIVE ELEMENTS. Another basis of Chinese theory is that the world and body are made up of five main elements: wood, fire, earth, metal, and water. These elements are all interconnected, and each element either generates or controls another element. For instance, water controls fire and earth generates metal. Each organ is associated with one of the five elements. The Chinese system uses elements and organs to describe and treat conditions. For instance, the kidney is associated with water and the heart is associated with fire, and the two organs are related as water and fire are related. If the kidney is weak, then there might be a corresponding fire problem in the heart, so treatment might be made by acupuncture or herbs to cool the heart system and/or increase energy in the kidney system.

The Chinese have developed an intricate system of how organs and elements are related to physical and mental symptoms, and the above example is a very simple one. Although this system sounds suspect to Western scientists, some interesting parallels have been observed. For instance, Western medicine has observed that with severe heart problems, kidney failure often follows, but it still does not know exactly why. In Chinese medicine, this connection between the two organs has long been established.

MEDICAL PROBLEMS AND ACUPUNCTURE. In Chinese medicine, disease as seen as imbalances in the organ system or chi meridians, and the goal of any remedy or treatment is to assist the body in reestablishing its innate harmony. Disease can be caused by internal factors like emotions, external factors like the environment and weather, and other factors like injuries, trauma, diet, and germs. However, infection is seen not as primarily a problem with germs and viruses, but as a weakness in the energy of the body that is allowing a sickness to occur. In Chinese medicine, no two illnesses are ever the same, as each body has its own characteristics of symptoms and balance. Acupuncture is used to open or adjust the flow of chi throughout the organ system, which will strengthen the body and prompt it to heal itself.

A VISIT TO THE ACUPUNCTURIST. The first thing an acupuncturist will do is get a thorough idea of a patient's medical history and symptoms, both physical and emotional. This is done with a long questionnaire and interview. Then the acupuncturist will examine the patient to find further symptoms, looking closely at the tongue, the pulse at various points in the body, the complexion, general behavior, and other signs like coughs or pains. From this, the practitioner will be able to determine patterns of symptoms which indicate which organs and areas are imbalanced. Depending on the problem, the acupuncturist will insert needles to manipulate chi on one or more of the twelve organ meridians. On these twelve meridians, there are nearly 2,000 points that can be used in acupuncture, with around 200 points being most frequently used by traditional acupuncturists. During an individual treatment, one to 20 needles may be used, depending on which meridian points are chosen.

Acupuncture needles are always sterilized and acupuncture is a very safe procedure. The depth of insertion of needles varies, depending on which chi channels are being treated. Some points barely go beyond superficial layers of skin, while some acupuncture points require a depth of 1-3 in (2.5-7.5 cm) of needle. The needles generally do not cause pain. Patients sometimes report pinching sensations and often pleasant sensations, as the body experiences healing. Depending on the problem, the acupuncturist might spin or move the needles, or even pass a slight electrical current through some of them. Moxibustion may be sometimes used, in which an herbal mixture (moxa or mugwort) is either burned like incense on the acupuncture point or on the end of the needle, which is believed to stimulate chi in a particular way. Also, acupuncturists sometimes use cupping, during which small suction cups are placed on meridian points to stimulate them.

How long the needles are inserted also varies. Some patients only require a quick in and out insertion to clear problems and provide tonification (strengthening of health), while some other conditions might require needles inserted up to an hour or more. The average visit to an acupuncturist takes about 30 minutes. The number of visits to the acupuncturist varies as well, with some conditions improved in one or two sessions and others requiring a series of six or more visits over the course of weeks or months.

Costs for acupuncture can vary, depending on whether the practitioner is an MD. Initial visits with non-MD acupuncturists can run from $50-$100, with follow-up visits usually costing less. Insurance reimbursement also varies widely, depending on the company and state. Regulations have been changing often. Some states authorize Medicaid to cover acupuncture for certain conditions, and some states have mandated that general coverage pay for acupuncture. Consumers should be aware of the provisions for acupuncture in their individual policies.

Precautions

Acupuncture is generally a very safe procedure. If a patient is in doubt about a medical condition, more than one physician should be consulted. Also, a patient should always feel comfortable and confident that their acupuncturist is knowledgable and properly trained.

Research & General Acceptance

Mainstream medicine has been slow to accept acupuncture; although more MDs are using the technique, the American Medical Association does not recognize it as a specialty. The reason for this is that the mechanism of acupuncture is difficult to scientifically understand or measure, such as the invisible energy of chi in the body. Western medicine, admitting that acupuncture works in many cases, has theorized that the energy meridians are actually part of the nervous system and that acupuncture relieves pain by releasing endorphins, or natural pain killers, into the bloodstream. Despite the ambiguity in the biochemistry involved, acupuncture continues to show effectiveness in clinical tests, from reducing pain to alleviating the symptoms of chronic illnesses, and research in acupuncture is currently growing. The Office of Alternative Medicine of the National Institute of Health is currently funding research in the use of acupuncture for treating depression and attention-deficit disorder.

Training & Certification

Medical acupuncture has evolved in America which uses traditional methods mainly as surgical techniques and pain management, and not as part of Chinese medicine overall. Medical acupuncture is performed by an MD or an osteopathic physician (DO). Currently 23 states allow only this type of acupuncture. Practitioners get their training as part of conventional medical school programs. As any MD can legally perform acupuncture, The American Academy of Medical Acupuncture (AAMA) was chartered in 1987 to support the education and correct practice of physician-trained acupuncturists. Its members must be either MDs or DOs who have completed proper study of acupuncture techniques. Address: 5820 Wilshire Blvd., Suite 500, Los Angeles, CA 90036, (323) 937-5514, http://medicalcupuntcture.org

For traditional acupuncturists, The National Commission for Certification of Acupuncturists (NCCA) conducts certification exams, promotes national standards, and registers members. Most states that license acupuncturists use the NCCA standards as certification. Address: 11 Canal Center Plaza, Ste. 300, Alexandra, VA 22314, (703) 548-9004, http://www.nccaim.org.

The American Association of Acupuncture and Oriental Medicine (AAAOM) is the largest organization for practitioners, with more than 1,600 members. Address: 1925 W. County Rd B2, Roseville, MN 55113, (651) 631-0204, http://www.aaaom.org.

Resources

Books

Fleischman, Dr. Gary F. Acupuncture: Everything You Ever Wanted To Know. New York: Barrytown, 1998.

Kakptchuk, Ted. The Web That Has No Weaver: Understanding Chinese Medicine. New York: Congdon and Weed, 1983.

Requena, Yves, MD. Terrains and Pathology in Acupuncture. Massachusetts: Paradigm, 1986.

Periodicals

American Journal of Acupuncture. 1840 41st Ave., Suite 102, P.O. Box 610, Capitola, CA 95010.

Assefi, Nassim. "Acupuncture for Fibromyalgia." Alternative Medicine Alert. (February 2002): 13.

Savage, Lorraine. "Grant to Study Acupuncture"s Effectiveness on Patients Suffering from Substance Abuse." Healthcare Review. (March 19, 2002): 16.

Other

American Association of Oriental Medicine. http://www.aaom.org/ (December 28, 2000).

North American Society of Acupuncture and Alternative Medicine. http://www.nasa-altmed.com/ (December 28, 2000).

[Article by: Douglas Dupler; Teresa G. Odle]

For more information on acupuncture, visit Britannica.com.

An ancient Chinese system of healing in which symptoms are relieved by inserting anywhere from 3 to 20 needles through the skin and muscle at certain points in the body The points are plotted along the body on lines determined by tradition. Selected points are stimulated by rotating the needle or by passing an electric current through it. The precise mechanism of acupuncture is under active investigation. Until recently, it was thought that each needle acts as an external stimulus which encourages the release of chemicals, natural painkillers called endorphins, that are believed to initiate self-healing within the body. However, in January 2006, a BBC television programme reported that comparison of images of brains of subjects with and without acupuncture indicated that the acupuncture deactivates areas of the brain that control pain. The report was based on research carried out by neuroscientists at Hull York Medical School using Magnetic Resonance Imaging. Acupuncture is used in the Far East as an alternative to anaesthesia for some major operations. In the West, the use of acupuncture to relieve pain associated with some sports injuries is gaining popularity, but researchers note that pain relief does not occur consistently or reproducibly in most people, and does not operate at all in some people. In the UK, the NHS (National Health Service) Direct 2005 website noted that for some people acupuncture can help relieve both physical symptoms and mental conditions. However, it warns that acupuncture cannot renew damaged parts of the body, such as broken bones or diseased organs, and recommends that if a serious condition is suspected, it should be thoroughly investigated before acupuncture treatment is started.

An ancient Chinese medical system over five thousand years old, recently revived in China and demonstrated to Western doctors. It is based on the belief that subtle energy flows in the body related to the cosmic principles of Yin and Yang. Yin relates to shadow, moon, passivity, softness, femininity; Yang denotes sunlight, activity, masculinity, hardness. The balance of these energies in the human body affects health and disease. Acupuncture therapy alters these energy flows by inserting needles at key points for varying periods of time. Anesthesia for surgical operations can also be effected by acupuncture. Both ancient Chinese and Hindu medical systems are related to a philosophical or mystical view of the universe, and the concept of Yin and Yang and subtle energy flows has much in common with the kundalini energy of the Hindu yoga system. In hatha yoga, the system of asanas, or physical positions, affect the vital energies in the body through muscular tension and relaxation. Comparison may also be made with the theories of Wilhelm Reich and his concept of orgone energy.

Special developments of acupuncture include shiatsu and acupressure, a form of acupuncture without needles, and acupuncture charts locating ear and hand points. Dr. Lester Sacks, a Los Angeles doctor, introduced a system of ear acupuncture in which a special "gun" fires a surgical staple into the ear near a particular acupuncture point, to help patients who want to lose weight or stop smoking, drinking, or taking drugs. Whenever the patient feels his craving coming on, he wiggles the staple, and the craving apparently subsides.

A simple device for self-treatment of acupuncture points on the back is the "MA-roller," a specially shaped wooden rod, on which the patient lies. It is marketed by Great Earth Therapeutics, Forest Row, Sussex, England.

Acupuncture came into the West in 1928 when Soulie de Morant, the French consul in China, returned home with the texts he had translated into French and persuaded several doctors to examine the practice. Interest grew steadily throughout Europe and America after World War II. The Acupuncture International Association was founded in 1949 by a group of nonconventional physicians in the United States. J. R. Worsley established the Chinese College of Acupuncture in England in 1960. However, the major opening for acupuncture in the West came in the early 1970s, when the United States reestablished friendly relations with the People's Republic of China. In 1973 the National Institute of Health sponsored an Acupuncture Research Conference, a signal of official approval for the testing of acupuncture's claims. Over the next few years a host of acupuncture texts appeared, acupuncture associations formed, and journals initiated.

The literature of acupuncture is extensive, and there are now several journals devoted to the subject, including Acupuncture News, American Journal of Acupuncture, and Journal of the Acupuncture Association of Great Britain. The American Association of Acupuncture and Oriental Medicine may be contacted at 1424 16th St. NW, Washington, DC 20036. There is also an International Veterinary Acupuncture Society at 2140 Conestoga Rd., Chester Springs, PA 19425.

Sources:

Academy of Traditional Chinese Medicine. An Outline of Chinese Acupuncture. New York: Pergamon Press, 1975; Peking: Foreign Language Press, 1975.

Austin, Mary. Acupuncture Therapy. 2nd ed. New York: ASI Publishers, 1972.

Dubrin, Stanley, and J. Keenan. Acupuncture and Your Health. Chatsworth, Calif.: Books for Better Living, 1974.

Hashimoto, M. Japanese Acupuncture. New York: Liveright Publishing, 1968; London: Thursons, 1966.

Mann, Felix. Acupuncture. New York: Random House, 1963; London: W. Heinemann Medical Books, 1962.

Matsumoto, Teruo. Acupuncture for Physicians. Springfield, Ill.: Thomas, 1974.

McGarey, William. Acupuncture and Body Energies. Phoenix, Ariz.: Gabriel Press, 1974.

Nanking Army Ear Acupuncture Team. Ear Acupuncture: A Chinese Medical Report. Emmaus, Pa.: Rodale Press, 1974.

Nightingale, Michael. The Healing Power of Acupuncture. New York: Javalin Books, 1986.

A technique, which originated in China, for curing disease, relieving pain, or bringing about partial anesthesia by inserting needles into the body at specific points.

The Chinese practice of inserting needles into specific points (acupoints) along the ‘meridians’ of the body and manipulated to relieve the discomfort associated with painful disorders, to induce surgical anesthesia, and for preventive and therapeutic purposes. It is proposed that acupuncture produces its effects by the conduction of electromagnetic signals at a greater-than-normal rate, thus aiding the activity of pain-killing biochemicals, such as endorphins and immune system cells, at specific sites in the body. Studies have also shown that acupuncture may alter brain chemistry by changing the release of neurotransmitters and neurohormones and affecting sensory perception and involuntary body functions. In recent years, the techniques have been adapted for use in veterinary medicine.

• a. instruments — includes cups for vacuum creation, needles, hot needles, moxibustion, electronic heating devices, coolant spray, ultrasound, electroacupuncture machines, laser equipment.
• a. points — See accumulation points, alarm points, association points, auricular points, diagnostic points, horary points, local points, luo points, sedation points, source points, special action points, tonification points.