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Acupuncture

Acupuncture (from Lat. acus, 'a needle', and pungere, 'to prick') is the practice of inserting very thin needles in particular points on the body to improve health and well-being, and is one component of traditional Oriental medicine. It has long been used by the Chinese for a wide variety of health complaints, and is practised throughout Asia. The practice of acupuncture is at least 2000 years old. Forms of acupuncture are also described in the literature of the traditional medicine of India.

In China, acupuncture is known as zhen1 jiu3 (針灸). Zhen means needle, jiu means to cauterize by burning a herb called moxa[?] (艾絨). Historically, it was generally understood that to cauterize an acupuncture point was a stronger treatment than to needle the point. In modern times, the cauterization of acupoints (known as "moxibustion") has been largely supplanted by methods of indirect heating. Needling of points is performed with fine-gauge sterile disposable stainless steel needles.

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 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, many patients experience the sensations of stimulus known in Chinese as "deqi" ("obtaining the qi"} and 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". Research into the phenomena of "deqi" has mostly been conducted in China and Japan.

Treatment of acupoints may be performed locally at the site of a particular problem, or at locations elsewhere on the body that are considered to be helpful based on either theoretical or empirical considerations.

Although accepted as a medical treatment in Asia for centuries, acupuncture's arrival in the United States has sparked controversy at times. However, in 1997, the NIH issued a consensus statement on acupuncture that concluded that "there is sufficient evidence of acupuncture's value to expand its use into conventional medicine and to encourage further studies of its physiology and clinical value."

The NIH statement noted that "the data in support of acupuncture are as strong as those for many accepted Western medical therapies", and added that "the incidence of adverse effects is substantially lower than that of many drugs or other accepted medical procedures used for the same condition. As an example, musculoskeletal[?] conditions, such as fibromyalgia[?], myofascial[?] pain, and tennis elbow[?]... are conditions for which acupuncture may be beneficial. These painful conditions are often treated with, among other things, anti-inflammatory medications (aspirin, ibuprofen, etc.) or with steroid injections. Both medical interventions have a potential for deleterious side effects but are still widely used and are considered acceptable treatments. The evidence supporting these therapies is no better than that for acupuncture."

The NIH consensus statement noted that "there is clear evidence that needle acupuncture is efficacious for adult postoperative and chemotherapy nausea and vomiting and probably for the nausea of pregnancy... There is reasonable evidence of efficacy for postoperative dental pain... reasonable studies (although sometimes only single studies) showing relief of pain with acupuncture on diverse pain conditions such as menstrual cramps, tennis elbow, and fibromyalgia..." However, "acupuncture does not demonstrate efficacy for cessation of smoking and may not be efficacious for some other conditions."

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NCAHF Position Paper on Acupuncture

In 1990 The National Council Against Health Fraud issued the NCAHF Position Paper on Acupuncture. This report states that:

Richardson and Vincent analyzed 28 studies of effect of acupuncture on pain, all published between 1973 and 1986 in English language peer-reviewed journals. Fifteen showed no difference in effectiveness between acupuncture and control groups. Thirteen showed some effectiveness for acupuncture over control groups, but not all controls were the same. (Some were compared to sham acupuncture, some to medical therapy, etc.) Overall, the differences were small.

The NCAHF Task Force on Acupuncture evaluated the above studies, as well as more recent ones, and found that reported benefits varied inversely with quality of the experimental design. The greater the benefit claimed, the worse the experimental design. Most studies that showed positive effects used too few subjects to be statistically significant. The best designed experiments - those with the highest number of controls on variables - found no difference between acupuncture and control groups. In 1989, three Dutch epidemiologists reported similar conclusions about 91 separate clinical trials of acupuncture for various disorders. They also found that the stricter the controls, the smaller the difference between acupuncture and control groups.

Acupuncture is being used in drug and alcohol rehabilitation programs. Because there are serious flaws in the way studies on rehabilitation have been performed, the results cannot be considered valid. A successful medical procedure should be consistently effective in a large majority of trials, and be repeatable in the hands of most therapists. Acupuncture does not satisfy these basic criteria.

(Permission to reprint is granted with proper citation)

Bibliography

Acupuncture. NIH Consensus Statement Online 1997 Nov 3-5; month, day]; 15(5):1-34.

Richardson PH, Vincent CA. The evaluation of therapeutic acupuncture: concepts and methods. Pain 24:1-13, 1986.

Richardson PH, Vincent CA. Acupuncture for the treatment of pain. Pain 24:1540, 1986.

Ter Riet G et al. The effectiveness of acupuncture. Huisarts Wet 32:170-175, 176-181, 308-312, 1989.

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