Acupuncture Overview


Acupuncture has been an essential part of medicine for thousands of years in the East, yet even as it catches on in the West, physicians in this part of the world have yet to figure out exactly how this ancient technique works. Whatever the mechanisms, acupuncture does appear to work. Scientific studies are offering real evidence that it can ease pain and treat ailments ranging from osteoarthritis to migraine headaches.

The technique of acupuncture involves placing hair-thin needles in various pressure points (called acupoints) throughout the body. Stimulating these points is believed to promote the body's natural healing capabilities and enhance its function.

East Meets West

Two very different theories exist as to how acupuncture works. According to Chinese philosophy, the body contains two opposing forces: yin and yang. When these forces are in balance, the body is healthy. Energy, called "qi" (pronounced "chee"), flows like rivers along pathways, or meridians, throughout the body. This constant flow of energy keeps the yin and yang balanced. However, the flow of energy can sometimes be blocked, like water getting stuck behind a dam. A disruption in the flow of energy can lead to illness.


needles entering the skin
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Acupuncture needles entering the skin. See more acupuncture pictures.

Approximately 2,000 different acupuncture points lie along the body's meridians. The idea behind acupuncture is that stimulating these points with acupuncture needles or pressure relieves obstructions in the flow of energy, enabling the body to heal.

In the Western view, acupuncture likely works by stimulating the central nervous system (the brain and spinal cord) to release chemicals called neurotransmitters and hormones. These chemicals dull pain, boost the immune system and regulate various body functions.

Acupuncture Schools of Thought

Several different types of acupuncture exist, all originating from different parts of the world. In the United States, practitioners most often use the type of acupuncture based on Traditional Chinese Medicine, which restores the natural flow of energy by stimulating pressure points throughout the body that correspond to various organ systems.

Japanese acupuncture is more subtle than its Chinese counterpart. Its needles are thinner and shorter, and they barely pierce the skin. Japanese acupuncture is divided into two forms: root and local. Root acupuncture addresses the total energy imbalance in the body, while local acupuncture treats specific symptoms.

Five Element acupuncture is an ancient Chinese technique used to treat problems of both the body and the mind. It is based on the idea that health, just like everything else in the universe, is governed by the five elements: water, wood, fire, earth, and metal. Restoring a balance of these elements in the body, the theory goes, will result in good health.

points of the ear
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Acupuncture points of the ear

Auricular acupuncture was developed in France, and it focuses all of the body's acupuncture points in just the ear. Two hundred points line the ears, and each point is connected to an area or areas of the body. When a point is stimulated, it creates electrical impulses that flow, via the brain, to a specific part of the body. For example, if the point on the ear that correlates to the knee is stimulated, it will affect pain or symptoms in the knee. Auricular acupuncture is believed to be just as effective as whole body acupuncture, because stimulating the ear is thought to affect chi flow throughout the body.

Korean hand acupuncture is similar to auricular acupuncture, except that the focal point is the hand, rather than the ear. Points on the hand meridians, when stimulated, correspond to various parts of the body.

Sticking It To Your Pets

People love their pets. They dress them in fur coats and throw them outrageous birthday parties. Now, some people are indulging their pets in alternative therapies to help them feel their best.

Dogs, cats, horses, and even birds and rabbits are getting acupuncture to treat conditions ranging from pain to skin problems to urinary tract disorders. Although pet acupuncture may seem like a modern indulgence, the Chinese actually began pampering their pets with it during the Jin Dynasty (136-265 A.D.). In the 1970s the practice began catching on in the United States.

Pet acupuncture isn’t much different from the human variety. Needles are placed in specific pressure points throughout the animals’ body that correspond to the affected areas. Although pets can’t say how they’re feeling during the procedure, some vets claim that acupuncture has a calming effect on animals. The American Veterinary Medical Association recognizes acupuncture as a legitimate treatment, and some pet insurance plans will even cover the costs. 

Acupuncture Styles and Related Techniques

Traditional acupuncture involves placing needles at specific pressure points throughout the body. Several different variations of this technique exist, however. Some practitioners add heat or electrical stimulation to enhance the treatment effects, while others substitute pressure for needles.

Electroacupuncture sends an electrical current through the needles to stimulate pressure points during acupuncture.

Sonopuncture applies sound waves to the acupuncture points. The vibrations stimulate pressure points in a more subtle way than needles. Sonopuncture is often combined with acupuncture.

Acupressure follows the same principle as acupuncture, but it uses pressure rather than needles. The therapist presses on the patient's acupoints with his or her fingers, and holds for a few seconds.

moxa paper
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Moxa wrapped in paper prepared to be lit
and placed to the skin.

Moxibustion uses heat to stimulate acupoints. The heat is generated by burning an herb called moxa, which comes from the mugwort plant. There are two types of moxibustion: direct and indirect. In direct moxibustion, a piece of the herb about the size of a grain of rice is placed directly on the skin and burned at an acupuncture point. Because this can be painful and can leave scars, many practitioners today opt for indirect moxibustion, in which the piece of moxa is wrapped in paper, lit and held close to the skin. Sometimes moxa is wrapped around the acupuncture needles and lit to add extra stimulation to the acupuncture treatment.

Cupping places heated jars or cups over the skin. Suction pulls the skin into the cups, creating a vacuum-like effect that stimulates the acupuncture points.

What Conditions can Acupuncture Treat?

Acupuncture is used to treat several different medical and psychological conditions, with varying degrees of success. These conditions include:

Addiction

Asthma
Bronchitis (acute)

Cancer pain and nausea control after chemotherapy

Carpal tunnel syndrome

Chest infections

Constipation

Diarrhea
Headaches (including migraines)

Fibromyalgia

Low-back pain
Menstrual cramps

Osteoarthritis

Post-surgical pain and nausea
Shoulder pain

Sinusitis

Spastic colon
Stress and anxiety

Stroke rehabilitation

Tennis elbow
Urinary problems

Acupuncture can either be used on its own, or combined with traditional medical treatments (such as surgery or medication) or alternative remedies (such as chiropractic manipulation and herbal therapies).

The Evidence on Acupuncture

The research so far on acupuncture has been mixed, but several studies have indicated that it's effective for treating certain conditions. Here are a few highlights of the research so far:

  • Osteoarthritis. A 2004 study in the "Annals of Internal Medicine" found that acupuncture significantly reduced pain and improved function in people with osteoarthritis of the knee that couldn't be helped by medicine. The study included 294 patients with chronic osteoarthritis. After eight weeks, participants who received acupuncture reported far less pain in their affected knee than those who didn't receive the treatment.
  • Fibromyalgia. A 2006 Mayo Clinic study of 50 patients found that acupuncture significantly improved the symptoms of fibromyalgia, a condition that causes muscle pain, fatigue, and joint stiffness.
    women doing acupuncture
    Photo courtesy of Dreamstime
    Acupuncture can help women
    with breast cancer going
    through chemotherapy.

  • Chemotherapy-induced nausea. A 2000 study in the "Journal of the American Medical Association" found that electroacupuncture plus an anti-nausea medication relieved nausea and vomiting caused by chemotherapy better than medication alone. The study included 104 women with breast cancer who had been given high-dose chemotherapy. Women in the electroacupuncture group had a third of the vomiting episodes of those in the medication group. An earlier analysis of 11 studies also found acupuncture to be effective for nausea related to chemotherapy, as well as surgery and pregnancy.
  • In-vitro fertilization. A trio of 2006 studies in the "Fertility and Sterility Journal" suggested that acupuncture may help women who are undergoing in-vitro fertilization (IVF) procedures. When women had acupuncture before and after embryo transfer, they were anywhere from eight percent to 18 percent more likely to get pregnant than women who had sham acupuncture (outlined below) or no treatment. The only caveat -- one of the studies found that women who had acupuncture were slightly more likely to miscarry.
  • Bladder control problems. A report in the July 2005 issue of Obstetrics & Gynecology found that acupuncture may relieve overactive bladder. Out of a group of 74 women, those who were treated with acupuncture for bladder control had 30 percent fewer urgent trips to the bathroom, compared with only 3 percent fewer trips in the group that received sham acupuncture.

Despite the favorable research, some experts caution that it's difficult to test acupuncture in a clinical setting. In part, this is because any valid clinical study will include a control group that is given a sham treatment (placebo). In the case of acupuncture, the placebo consists of needles inserted in random points, rather than at actual pressure points. This can lead to what's called the placebo effect -- when study participants believe that they've received the real treatment and expect their symptoms to improve. As evidence, a 2006 study in the "British Medical Journal" found that acupuncture reduced the number of days patients suffered from tension headaches, but sham acupuncture in the study had almost the exact same results.

Also, the quality of the research conducted so far on acupuncture hasn't been consistent. Many of the studies in the past have been small, and have focused on short-term, rather than long-term results. Larger controlled trials are needed to truly prove acupuncture's effectiveness, some experts say.

Acupuncture Points and Acupuncture Needles

Acupuncture, like any type of treatment, begins with a consultation. The acupuncturist will ask about your medical history and any conditions you're currently experiencing. Then, he or she will examine you and identify the organ(s) involved in your problem.

The next step is to map the pressure points on the appropriate meridian(s) that correspond to your ailment.

Twelve main meridians run throughout the body. Each meridian contains a number of pressure points. To represent each point, the initials of the meridian are followed by a number (e.g., LI 19 or GB 1).

Bladder (UB)

Gall bladder (GB)
Heart (HT)

Kidney (KD)

Liver (LV)

Lung (LU)

Large intestine (LI)

Pericardium (PC)
Small intestine (SI)

Spleen (SP)

Stomach (ST)
Triple heater (TH)

Needles may be placed in the immediate area of the problem, or at distant sites in other parts of the body. For example, low-back pain is treated by stimulating acupoint UB 54 in the bladder meridian. Often, points in different areas of the body (front and back, left and right side, or above and below the waist) are stimulated simultaneously to increase the treatment effectiveness.

What You Can Expect During Acupuncture

When the acupuncturist is ready to begin your treatment, he or she will swab the chosen points on your body with alcohol or another disinfectant to cleanse the area, and will then insert between three and 15 needles in your skin. How deep the needles go can vary from less than a quarter of an inch to three inches.

acupuncture needles
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Acupuncture needles
The needles are hair-thin and made of solid stainless steel. You may feel slight pain while the needles are inserted, but once they're in the skin, you shouldn't feel any discomfort. Some people say they feel relaxed during an acupuncture treatment.

The needles will stay in your body from 5 to 20 minutes. While the needles are in your skin, the acupuncturist may twirl, heat, or electrically stimulate them.

Most people have acupuncture once a week for about 12 weeks, although the number of sessions can vary depending on the problem being treated. In the beginning, you may have to visit more often, and then, as your symptoms improve, you can begin spacing the visits further and further apart.

How much your treatment costs will depend on the acupuncturist's experience, the number of treatments, and the city in which you live, but the typical range is $60 to $120 per session. Many private insurance companies will cover the cost, but Medicare will not pay for acupuncture.

How Safe is Acupuncture?

Acupuncture is considered to be very safe. In 1996, the U.S. Food and Drug Administration began classifying acupuncture needles as medical instruments, and it now requires that acupuncturists use only sterile, disposable needles. Also, acupuncturists will swab the acupuncture areas first with an antiseptic, so there is very little risk of infection. It's very important to visit a licensed practitioner, however, because poorly sterilized needles can transmit infectious diseases.

The most common side effects with acupuncture are soreness, slight bleeding, irritation or bruising at the needle site. Some people may feel tired or lightheaded after a session. In very rare cases, more serious complications can occur if the acupuncture needles pierce the kidney, lungs or another organ.

Despite its general safety, acupuncture isn't for everyone. People who have a bleeding disorder or who are taking blood thinners (such as Heparin and Coumadin) should not have the treatment. It's also not recommended for people who have pacemakers, implanted electrical devices or infusion pumps.

Finding an Acupuncturist

acupuncturist
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Make sure your acupuncturist is licensed.
Locating an acupuncturist should start with a visit to your medical doctor. Your physician can diagnose your problem and determine whether acupuncture might be helpful for treating it. If your doctor thinks acupuncture might be effective, ask for a referral to a licensed acupuncturist.

When it comes to picking a practitioner, you have two choices: a medical doctor who is trained in acupuncture, or a certified acupuncturist. There are approximately 3,000 doctors who perform acupuncture, and 6,500 licensed acupuncturists practicing in the United States.

About 40 states have training standards for acupuncture certification (for individual state requirements or to find a licensed acupuncturist in your area, visit the National Certification Commission for Acupuncture and Oriental Medicine. Generally, medical doctors are required to have 200 to 300 hours of acupuncture training in addition to their medical degrees, while certified acupuncturists must have 2,000 to 3,000 hours of training in an accredited master's degree program. Most states also require that acupuncturists pass the board exam from the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM).

The History of Acupuncture

Acupuncture is one of the oldest medical treatments in existence, originating in China more than 2,500 years ago. Its philosophy is rooted in the traditional teachings of Taoism, which promotes harmony between humans and the world around them, and a balance between yin and yang.

Several pivotal texts throughout the centuries helped promote acupuncture's tenets. The earliest mention of acupuncture can be found in the "The Nei Jing (Yellow Emperor's Classic of Internal Medicine)" by Huang Di, which dates back to around 300 B.C. The book describes various diseases, their origins and descriptions of acupuncture points. In 260 A.D., the well-known physician Huang-Fu Mi compiled a 12-volume text describing acupuncture, called the "Zhen Jiu Jia Yi Jing (Comprehensive Manual of Acupuncture and Moxibustion)." His book describes many of the acupoints that are used today, with an explanation of where and how deeply to insert each needle.

The earliest acupuncturists used needles made from stone and bone. Later, needles were made from metal (bronze, gold, and silver). Originally, there were only 365 pressure points in the body, each of which corresponded to a different day of the year. Eventually, that number grew to more than 2,000 different points.

symbol for health with needles.
Photo courtesy of Dreamstime
Acupuncture is thought to have started in China.
By the early 19th century, travelers to China were introducing acupuncture to the West. Doctors in Europe and the United States began experimenting with the technique. One of acupuncture's biggest early proponents in the West was a French scholar named George Soulie de Morant. He traveled to China at the turn of the 20th century. When he returned to France after nearly two decades, he introduced French physicians to the classical acupuncture texts and techniques.

Acupuncture became popular in the United States in the 1970s, buoyed by President Nixon's trip to China. The first known mention of acupuncture in the American media was an article by "New York Times" reporter James Reston, in which he described how acupuncture relieved his pain after appendix surgery.

In the last three decades, acupuncture has caught on and has gained credibility in the United States. Today, there are established guidelines that govern its use, and organized societies of trained acupuncture professionals. According to the 2002 National Health Interview survey-the biggest survey of complementary and alternative medicine to date-an estimated 8.2 million American adults have tried acupuncture.

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