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Acupuncture (from Lat. acus, "needle" (noun), and pungere, "prick" (verb)) or in a major Chinese dialect, zhēn jǐu (針灸), is a technique intended to promote health and well-being, that entails the insertion, into the body of its subject, of very thin needles. These needles are applied by trained practitioners into areas described as "acupuncture points".
Acupuncture in China is traced as far back as the 1st millenium BCE, and archeological evidence has been identified with the period of 202 BCE - 220 CE. Its practice spread centuries ago into many parts of Asia; in modern times it is a component of traditional Chinese medicine (TCM), and forms of it are also described in the literature of the traditional medicine of India.
In the West, it has adherants (including some medical practitioners), who consider it part of complementary and/or alternative medicine. The traditional theory of acupuncture at least superficially conflicts with Western medical knowledge. The consensus of Western-trained medical doctors and medical-research specialists
Historically, TCM generally presumed that warming an acupuncture point, typically by moxibustion (the burning of mugwort) was a stronger treatment than
acupuncture. The term zhēn jǐu (針灸), for acupuncture comes from zhen meaning "needle", and
jiu meaning "moxibustion". Moxibustion is still used in the 21st century, to degrees that vary among the schools of TCM, including attaching burning mugwort to
the needle during acupuncture.
Most modern acupuncturists use disposable stainless steel needles of very fine diameter, sterilized with ethylene oxide or by autoclave.
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Traditional Chinese medical theory holds that acupuncture works by redirecting qi "vital energy" in the body. Pain or illnesses are treated by attempting to remedy local or systemic accumulations or deficiencies of qi. Pain is considered to indicate blockage or stagnation of the flow of qi, and an axiom of the medical literature of acupuncture is "no pain, no blockage; no blockage, no pain".
While it is claimed by some that there is no physical evidence for the existence of qi or for its claimed effects, and that acupuncture is therefore a pseudoscience or metaphysical belief, many patients experience the sensations of stimulus known in Chinese as "deqi" ("obtaining the qi") This was historically considered to be evidence of effective treatment. Often deqi takes the form of a propagation of sensation along the trajectory of the so-called acupuncture "channels" or meridians. Research into the phenomena of "deqi" has mostly been conducted in China and Japan.
Treatment of acupoints may be performed along the 12 main or 8 extra meridians located throughout the body. 10 of the main meridians are named after organs of the body (Heart, Liver etc.) two after so called body functions (Heart Protector or Pericardium, and San Jiao, "triple heater"). The two most important of the eight "extra" meridians are situated on the midline of the anterior and posterior of the trunk and head.
The acupuncturist will decide which points to treat by thoroughly questioning the patient, and utilizing the diagnostic skills of traditional Chinese medicine, such as observation of the left and right radial pulse.
There are various schools of acupuncture theory, including
Although accepted as a medical treatment in Asia for millennia, acupuncture's arrival in the West has sparked much controversy. Acupuncture has eluded scientific explanation to some degree. However, in 1997, the NIH issued a consensus statement on acupuncture that concluded that
The NIH statement noted that
and added that
The NIH consensus statement noted that
However,
Acupuncture is an invasive technique, therefore it is not without risk. Hematoma may result from accidental puncture of any circulatory structure. Nerve injury can result from the accidental puncture of any nerve. Brain damage or stroke is possible with very deep needling at the base of skull. Also rare but possible is pneumothorax from deep needling into the lung, and kidney damage from deep needling in the low back. Needles that are not properly sterilized can transfer diseases such as HIV and hepatitis. Severe injury from acupuncture is extremely rare, but not unheard-of. Well-trained, licensed and experienced acupuncturists are less likely to injure a patient. The NIH consensus panel made the following statement about the risks associated with acupuncture: “Adverse side effects of acupuncture are extremely low and often lower than conventional treatments.”
The National Council Against Health Fraud has concluded:
Reference: Sampson W and others. Acupuncture: The position paper of the National Council Against Health Fraud. Clinical Journal of Pain 7:162-166, 1991.
A Consensus Development Conference held in 1997, sponsored among others by the National Institutes of Health stated:
In short, the treatment and diagnosis of acupuncturists are not based on contemporary medical science.
Three Dutch epidemiologists have analyzed 51 controlled studies of acupuncture, in which acupuncture was used to treat chronic pain. Their conclusion was that
Reports of acupuncture used to treat various addictions (heroin, cigarettes, alcohol) were also analyzed. The conclusion was that
References: Ter Riet G, Kleijnen J, Knipschild P.: ‘Acupuncture and chronic pain: A criteria-based meta-analysis. Clinical Epidemiology 43:1191-1199, 1990’ and (from the same authors) ‘A meta-analysis of studies into the effect of acupuncture on addiction. British Journal of General Practice 40:379-382, 1990.’
The University of Heidelberg has developed a “fake needle” to use as placebo-needle. It is a needle with a blunt tip that can slide into the handle, giving the illusion that it penetrates the skin. In tests, volunteers did not notice that the needle did not actually penetrate their skin (Reference: Streitberger K, Kleinhenz J. Introducing a placebo needle into acupuncture research. Lancet 352:364-365, 1998). They used this needle in 2004 in a study of postoperative nausea and vomiting (PONV) in women who underwent breast or gynecologic surgery. The group consisted of 220 women. Acupuncture was applied on the acupuncture point “Pericardium 6 (P6),” which is on the inside of the forearm. Part of the group was treated with real needles, the other part (the control group) with the fake needles. They reported: 'We could not prove our hypothesis that acupuncture is more effective than placebo acupuncture in the prevention of PONV.' (or to put it more plainly) 'There was almost no difference in the occurrence of PONV between acupuncture (38.7%) and placebo (40.3%) in the subgroup of patients having breast surgery. ' (Reference: Streitberger K and others: Acupuncture compared to placebo-acupuncture for postoperative nausea and vomiting prophylaxis: A randomised placebo-controlled patient and observer blind trial. Anesthesia 59:142-149, 2004.)
What is less often remarked upon is that the Heidelberg study above went on to comment:
They noted that previous studies found that acupuncture worked particularly well on gynaecological surgery. They also pointed out that
but that, again, this result had to be viewed with caution as
A more recent 2004 meta-analysis of the effects the same (P6) acupoint on Post-Operative Nausea and Vomiting (PONV) stated that
(Allocation concealment prevents researchers from (unconsciously or otherwise) influencing which participants are assigned to a given intervention group.)
The reviewers concluded:
Of course, this meta-analysis has been criticised for the lack of allocation concealment in any of the trials.
Acupuncture as a therapeutic intervention is widely practiced in the United States. While there have been many studies of its potential usefulness, many of these studies provide equivocal results because of design, sample size, and other factors. The issue is further complicated by inherent difficulties in the use of appropriate controls, such as placebos and sham acupuncture groups. However, promising results have emerged, for example, showing efficacy of acupuncture in adult postoperative and chemotherapy nausea and vomiting and in postoperative dental pain. There are other situations such as addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma, in which acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program. Further research is likely to uncover additional areas where acupuncture interventions will be useful.
Another Cochrane meta-analysis probably sums up the status quo best:
This would seem to sum up the current state of the debate. The jury is still out on the effectiveness of acupuncture, with existing evidence slightly favouring the proposition that it can be effective in some cases for some conditions. However, almost all the research on the effectiveness of acupuncture is of poor quality and can be criticised on various grounds. Much more research (of a much higher quality) needs to be done before the effectiveness of acupuncture is generally accepted within the medical community.
See: http://nccam.nih.gov/health/acupuncture/
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