Acupuncture Overview

Acupuncture Overview

Introduction

Acupuncture is one of the oldest, most commonly used medical procedures in the world. Originating in China more than 2,000 years ago, acupuncture began to become better known in the United States in 1971, when New York Times reporter James Reston wrote about how doctors in China used needles to ease his abdominal pain after surgery. Research shows that acupuncture is beneficial in treating a variety of health conditions.

In the past two decades, acupuncture has grown in popularity in the United States. A Harvard University study published in 1998 estimated that Americans made more than five million visits per year to acupuncture practitioners. The report from a Consensus Development Conference on Acupuncture held at the National Institutes of Health (NIH) in 1997 stated that acupuncture is being "widely" practiced--by thousands of physicians, dentists, acupuncturists, and other practitioners--for relief or prevention of pain and for various other health conditions.

Although the general term Traditional Chinese Medicine (TCM) usually refers to Chinese Acupuncture, other quite similar modalities include Five Element Acupuncture, Japanese Acupuncture, Korean Acupuncture, and Auricular Acupuncture.

NIH has funded a variety of research projects on acupuncture. These grants have been awarded by the National Center for Complementary and Alternative Medicine (NCCAM), the Office of Alternative Medicine (OAM, NCCAM's predecessor), and other NIH Institutes and Centers.

This fact sheet provides general information about Chinese Acupuncture, Japanese Acupuncture, Korean Acupuncture, Five Element Acupuncture, Auricular Acupuncture, research summaries, a glossary that defines terms underlined in the text, and a resource section.

Acupuncture Theories

Chinese Acupuncture

Traditional Chinese medicine theorizes that there are more than 2,000 acupuncture points on the human body, and that these connect with 12 main and 8 secondary pathways called meridians. Chinese medicine practitioners believe these meridians conduct energy, or qi (pronounced "chee"), throughout the body.

Qi is believed to regulate spiritual, emotional, mental, and physical balance and to be influenced by the opposing forces of >yin and yang. According to traditional Chinese medicine, when yin and yang are balanced, they work together with the natural flow of qi to help the body achieve and maintain health. Acupuncture is believed to balance yin and yang, keep the normal flow of energy unblocked, and maintain or restore health to the body and mind.

Traditional Chinese medicine practices (including acupuncture, herbs, diet, massage, and meditative physical exercise) all are intended to improve the flow of qi.

Western scientists have found meridians hard to identify because meridians do not directly correspond to nerve or blood circulation pathways. Some researchers believe that meridians are located throughout the body's connective tissue; others do not believe that qi exists at all. Such differences of opinion have made acupuncture an area of scientific controversy.

Five Element Acupuncture

Based on the five elements of natural phenomena (wood, fire, earth, metal, and water) the Five Element Acupuncture focuses more on the ability of a person's psycho-spiritual nature to heal disease. As a specialty practice it requires extensive training beyond the Traditional Chinese Acupuncture. The style of the needling is similar to Japanese Acupuncture, which uses minimum stimulation.

Japanese Acupuncture

The Japanese Acupuncture also requires advanced training beyond the Traditional Chinese Acupuncture. The techniques are focused on providing the greatest effect with the least stimulation. This typically involves using thinner needles on fewer acupuncture points. The stimulation is minimal, with shallower insertions and sometimes just barely touching the skin with the needle. The abdomen is used as a basic diagnostic tool by many practioners of Japanese Acupuncture.

Korean Acupuncture

Korean Acupuncture emphasizes one's basic constitution or body type for diagnosis. In addition to techniques which are unique to Korean Acupuncture, practioners utilize techniques from the Japanese Acupuncture and Traditional Chinese Medicine, along with the Five Element Acupuncture.

In Korean Hand Acupuncture, a subset of Korean Acupuncture, the hand is seen as a microsystem of the body, with each part of the entire body represented in the hand. A diagnosis may be made of any part of the body, and conditions anywhere in the body may be treated by treating only the hands.

Auricular Acupuncture

Auricular Acupuncture has developed into both a specialty area of its own and an adjunct area to the other acupuncture modalities. Using the ear as a representation, or microcosm, of the whole body, practioners of Auricular Acupuncture can diagnose and treat the entire body, including psychological issues, by focusing on the ear. This method is successfully and extensively used in alcohol and drug detox centers to help people overcome additions.

Mechanisms of Action

Several processes have been proposed to explain acupuncture's effects, primarily those on pain. Acupuncture points are believed to stimulate the central nervous system (the brain and spinal cord) to release chemicals into the muscles, spinal cord, and brain. These chemicals either change the experience of pain or release other chemicals, such as hormones, that influence the body's self-regulating systems. The biochemical changes may stimulate the body's natural healing abilities and promote physical and emotional well-being. There are three main mechanisms:

  1. Conduction of electromagnetic signals: Western scientists have found evidence that acupuncture points are strategic conductors of electromagnetic signals. Stimulating points along these pathways through acupuncture enables electromagnetic signals to be relayed at a greater rate than under normal conditions. These signals may start the flow of pain-killing biochemicals, such as endorphins, and of immune system cells to specific sites in the body that are injured or vulnerable to disease.
  2. Activation of opioid systems: Research has found that several types of opioids may be released into the central nervous system during acupuncture treatment, thereby reducing pain.
  3. Changes in brain chemistry, sensation, and involuntary body functions: Studies have shown that acupuncture may alter brain chemistry by changing the release of neurotransmitters and neurohormones. Acupuncture also has been documented to affect the parts of the central nervous system related to sensation and involuntary body functions, such as immune reactions and processes whereby a person's blood pressure, blood flow, and body temperature are regulated.

Preclinical studies have documented acupuncture's effects, but they have not been able to fully explain how acupuncture works within the framework of the Western system of medicine.

According to the NIH Consensus Statement on Acupuncture:

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.

Increasingly, acupuncture is complementing conventional therapies. For example, doctors may combine acupuncture and drugs to control surgery-related pain in their patients. By providing both acupuncture and certain conventional anesthetic drugs, some doctors have found it possible to achieve a state of complete pain relief for some patients. They also have found that using acupuncture lowers the need for conventional pain-killing drugs and thus reduces the risk of side effects for patients who take the drugs.

Currently, one of the main reasons Americans seek acupuncture treatment is to relieve chronic pain, especially from conditions such as arthritis or lower back disorders. Some clinical studies show that acupuncture is effective in relieving both chronic (long-lasting) and acute or sudden pain, but other research indicates that it provides no relief from chronic pain. Additional research is needed to provide definitive answers.

Acupuncture and You

The use of the various acupuncture modalities, like the use of many other Complementary and Alternative Medicine (CAM) treatments, has produced a good deal of anecdotal evidence. Much of this evidence comes from people who report their own successful use of the treatment. If a treatment appears to be safe and patients report recovery from their illness or condition after using it, others may decide to use the treatment. However, scientific research may not support the anecdotal reports.

Lifestyle, age, physiology, and other factors combine to make every person different. A treatment that works for one person may not work for another who has the very same condition. You as a health care consumer (especially if you have a preexisting medical condition) should discuss any CAM treatment, including acupuncture, with your health care practitioner. Do not rely on a diagnosis of disease by an acupuncture practitioner who does not have substantial conventional medical training. If you have received a diagnosis from a doctor and have had little or no success using conventional medicine, you may wish to ask your doctor whether acupuncture might help.

The Sensation of Acupuncture

Acupuncture needles are metallic, solid, and hair-thin. People experience acupuncture differently, but most feel no or minimal pain as the needles are inserted. Some people are energized by treatment, while others feel relaxed. Improper needle placement, movement of the patient, or a defect in the needle can cause soreness and pain during treatment. This is why it is important to seek treatment from a qualified acupuncture practitioner.

Glossary of Terms

Anecdotal Evidence
Data based on reports of usually unscientific observation. Anecdotes are often accounts of an individual's personal experience.

Attention Deficit Hyperactivity Disorder
A syndrome primarily found in children and teenagers that is characterized by excessive physical movement, impulsiveness, and lack of attention.

Clinical Trials
Tests of a treatment's effects in humans. Clinical trials help researchers find out whether a promising treatment is safe and effective for people. They also tell scientists which treatments are more effective than others.

Electroacupuncture
A variation of traditional acupuncture treatment in which acupuncture or needle points are stimulated electronically.

Electromagnetic Signals
The minute electrical impulses that transmit information through and between nerve cells. For example, electromagnetic signals convey information about pain and other sensations within the body's nervous system.

Fibromyalgia
A chronic disorder characterized by widespread musculoskeletal pain, fatigue, and multiple tender points. "Tender points" refers to tenderness that occurs in precise, localized areas, particularly in the neck, spine, shoulders, and hips. People with this syndrome may also experience sleep disturbances, morning stiffness, irritable bowel syndrome, anxiety, and other symptoms.

Major Depressive Episode
A period of depression during which a person experiences a combination of symptoms that interfere with the ability to work, study, sleep, eat, and enjoy once pleasurable activities. Symptoms vary, but may include persistent feelings of sadness, anxiety, "emptiness," hopelessness, guilt, restlessness, or suicidal thoughts. People may also experience persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain.

Meridians
A traditional Chinese medicine term for the 20 pathways throughout the body for the flow of qi, or vital energy, accessed through acupuncture points.

Moxibustion
The use of dried herbs in acupuncture. Generally, moxibustion in the United States involves the use of sticks of compressed herb(s) and is an adjunct to acupuncture rather than a part of acupuncture.

Neurohormones
Chemical substances made by tissue in the body's nervous system that can change the structure or function or direct the activity of an organ or organs.

Neurotransmitters
Biochemical substances that stimulate or inhibit nerve impulses in the brain that relay information about external stimuli and sensations, such as pain.

Opioids
Synthetic or naturally occurring chemicals in the brain that may reduce pain and induce sleep.

Placebo
An inactive pill or sham procedure given to a participant in a research study as part of a test of the effects of another substance or treatment. Scientists use placebos to get a true picture of how the substance or treatment under investigation affects participants. In recent years, the definition of placebo has been expanded to include such things as aspects of interactions between patients and their health care providers that may affect their expectations and the study's outcomes.

Preclinical Studies
Preclinical studies provide information about a treatment's harmful side effects and safety at different doses in animals. These studies are normally performed in animals.

Qi
The Chinese term for vital energy or life force. Pronounced "chee."

Randomized Controlled Clinical Trial
A type of clinical trial using two groups of people; one group (treatment group) receives the treatment and the other (control group) does not. Participants are assigned to either the treatment group or the control group at random, to prevent bias in the research.

Yang
The Chinese concept of positive energy and forces in the universe and human body. Acupuncture is believed to remove yang imbalances and bring the body into balance.

Yin
The Chinese concept of negative energy and forces in the universe and human body. Acupuncture is believed to remove yin imbalances and bring the body into balance.

This document has been excerpted from source material provided to the public by the National Center for Complementary and Alternative Medicine. NCCAM has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your primary health care provider. We encourage you to discuss any decisions about treatment or care with your health care provider. The mention of any product, service, or therapy in this information is not an endorsement by NCCAM. NCCAM Publication No. D003 - December 2004.

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