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Acupuncture

The practice of acupuncture originated in China 5,000 years ago. Today it is widely used throughout the world and is one of the main pillars of Chinese medicine.

There are many different varieties of the practice of acupuncture, both in the Orient and in the West. The most common forms available to westerners are as follows: traditional Chinese medicine (TCM) usually combines acupuncture with Chinese herbs. Classical acupuncture (also known as five element acupuncture) uses a different needling technique and relies on acupuncture independent of the use of herbs. Japanese acupuncture uses smaller needles than the other varieties. Medical acupuncture refers to acupuncture practiced by a conventional medical doctor. Auricular acupuncture treats the entire body through acupuncture points in the ears only. Electroacupuncture uses electrical currents attached to acupuncture needles.

Aside from needles, other methods of stimulation are also considered forms of "acupuncture." These include use of heat from the burning of herbs placed on the points ("moxibustion"), and the placement of herbal pastes on specific points.

Research into the effectiveness of acupuncture has special challenges. These include the diversity of approaches, the practice of individualizing treatment for each patient, differing skill levels between practitioners, and difficulty separating out the effects of acupuncture from placebo effects (i.e., how the patient's beliefs and expectations affect their perception of symptoms).

Based on acupuncture's long history of use as well as the limited research available, both the World Health Organization and the National Institutes of Health have identified many conditions for which it may be recommended. However, many common uses do not yet have formal scientific evidence to support them.

Theory

Chinese medicine theory holds that the human body contains a network of energy pathways through which vital energy, called "chi" (also spelled "qi"), circulates. These pathways are called "meridians."

The meridians contain specific "points" which function somewhat like gates or way stations, through which chi flows as it circulates through the body. Acupuncture needles are inserted into these points to regulate the flow of chi through the meridians.

Illness and symptoms are believed to be caused by problems in the circulation of chi through the meridians (e.g., blockage or impairment of proper flow). Good health is considered an indication of the proper circulation of chi - a state of "balance" or "harmony."

Chi is believed to have subtle qualities (sometimes referred to as "elements"), which can be in balance or out of balance, causing symptoms.

Western science has determined that the meridians and points identified in Chinese Medicine coincide with anatomical features that can be observed with scientific instruments. For example, electrically-charged particles called "ions" have been found to flow through "ionic streambeds" that correspond with the meridians just beneath the surface of the skin. Acupuncture points have been found to emit light, which can be detected with sensitive laboratory equipment.

The chi (vital energy, life force) proposed by Chinese medicine theory is not electricity and is not directly detectable with scientific instruments. Western science has studied electrical phenomena (ions, electrons, electrical energy) that occur with acupuncture. These phenomena are detectable and appear to accompany the circulation of chi through the body.

Acupuncture has been shown to effectively treat some health conditions, including pain. However, the mechanism of action remains unclear. Endogenous opioid-mediated mechanisms of electroacupuncture as used in China only appear to explain how acupuncture works in part. Acupuncture is purported to also affect the brain's reward systems and blood flow in skin, muscle, and nerve. Research has shown regional effects on neurotransmitter expression as well. However, the existence of "chi" cannot be directly confirmed.

One of the challenges in reviewing acupuncture and other complementary practices is the lack of placebo or sham-group in most clinical trials. Some experts argue that blinding and placebo controls are not necessary, since when they are used, they are often not true shams. Recent study investigated a sham retractable type acupuncture needle, and found that the applicability of "placebo" needling may be influenced by inter-tester variability, as well as the patient's knowledge and experience of acupuncture, acupuncture point selection, the visual impact of needling, and so on.

Evidence Table (Click Here to view Natural Standard evidence-based validated grading rationale™.)

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.	Grade
Dental procedures (pain) Results of acupuncture in postoperative dental pain have been promising and supported by numerous studies.	B
Endoscopy procedure pain There is good evidence from several studies supporting use of acupuncture to reduce pain and discomfort during endoscopy.	B
Fibromyalgia There is evidence from several studies suggesting acupuncture may help with pain relief in fibromyalgia.	B
Nausea and vomiting (chemotherapy-induced) Evidence from several small studies supports use of acupuncture at a specific point on the wrist (P6) to help chemotherapy patients reduce nausea and vomiting.	B
Nausea and vomiting of pregnancy (hyperemesis gravidarum) Several well-designed studies support the use of acupuncture at the P6 wrist point for control of pregnancy-related nausea and vomiting.	B
Nausea and vomiting (postoperative in adults) Evidence supports acupuncture at the wrist P6 point for the relief of post-operative nausea and vomiting in adults, though most studies have been with women having gynecological surgeries.	B
Osteoarthritis (OA) There has been substantial research into the efficacy of acupuncture in the treatment of OA. Most studies focus on knee, cervical, and hip OA symptoms. In recent years, the evidence has improved and is now considered strong enough to recommend trying acupuncture in OA of the knee, which is one of the most common forms of this condition.	B
Pregnancy (reducing back strain) Early evidence suggests that acupuncture may substantially reduce low back pain in pregnancy. More studies are needed to confirm these results.	B
Tennis elbow Evidence suggests that there is a reduction of pain and an improvement of function in the afflicted elbow.	B
Alcohol dependence The evidence on acupuncture in alcoholism is mixed. More studies are needed to evaluate use of acupuncture in this application.	C
Angina pectoris Some research has suggested that acupuncture might help reduce distress and symptoms of angina, but this has not been consistently shown in other studies.	C
Anxiety Several studies have reported benefits but have also been small and poorly designed, leaving the evidence on this use of acupuncture inconclusive.	C
Arthritis (periarthritis of the shoulder) Early study shows promising results. Further research is needed before a recommendation can be made.	C
Asthma Some research suggests acupuncture may help prevent exercise-induced asthma and that it may reduce the perceived level of breathlessness associated with asthma or emphysema. However, reviewers agree that the available studies are small, poorly designed, and insufficient for making recommendations. A few studies have found no support for the use of acupuncture for asthma.	C
Back pain (chronic) Evidence is inconsistent regarding the effects of acupuncture in back pain. Further research is needed before a recommendation can be made.	C
Bell's palsy There is insufficient available evidence to recommend either for or against acupuncture in Bell's palsy.	C
Breast cancer (vasomotor symptoms) Electroacupuncture has been studied to treat vasomotor symptoms in breast cancer patients. More study is needed before a recommendation can be made.	C
Burn pain There is insufficient evidence to recommend for or against use of acupuncture in pain associated with burns.	C
Cancer pain There has been limited research on acupuncture for cancer pain, and the research that was done was shown to have mixed results. More studies are needed to determine potential benefits.	C
Cardiovascular conditions (low pulse pressure syndrome) Acupuncture has been found superior to medication (Shenmai Injection) for low pulse pressure syndrome. More studies are needed before a firm conclusion can be drawn.	C
Carpal tunnel syndrome Currently there is insufficient evidence available to recommend for or against the use of acupuncture in carpal tunnel syndrome.	C
Cerebral infarction Acupuncture may regulate metabolic disorder of lipids and improve main clinical symptoms in the patient of cerebral infarction with hyperlipidemia. Better-designed trials are needed to confirm these results.	C
Cerebral palsy There is insufficient evidence available from well-designed studies to recommend either for or against the use of acupuncture in cerebral palsy.	C
Cervical spondylosis Both needle-knife therapy and acupuncture have been used to treat cervical spondylosis, with one study showing needle knife therapy as a superior treatment. However, higher-quality studies with appropriate controls are needed before any recommendations can be made.	C
Chronic pain Higher-quality studies suggest potential benefit for musculoskeletal pain, but overall, studies have been poorly designed, making recommendations difficult.	C
Cognitive performance There is insufficient available evidence to recommend either for or against the use of acupuncture in neurogenic cognitive and communication disorders.	C
Colitis Preliminary study has used acupuncture for acute and chronic colitis. More study is needed before a recommendation can be made.	C
COPD (chronic obstructive pulmonary disease) Overall there is insufficient evidence on which to base recommendations for acupuncture to treat breathlessness in COPD.	C
Dementia There is insufficient evidence to recommend the use of acupuncture in the treatment of vascular dementia.	C
Depression A small number of studies have sought to compare acupuncture with antidepressant medications used in depression. More studies are needed on this use.	C
Diabetes There is a lack of well-designed studies to determine the contribution of acupuncture in this condition.	C
Drug addiction More studies are needed before a recommendation can be made for or against the use of acupuncture in cocaine/opiate addiction.	C
Dry mouth (xerostomia) There is some limited evidence suggesting that acupuncture may stimulate salivary flow in some patients with xerostomia (dry mouth). More studies of better design are needed to evaluate this use.	C
Dysmenorrhea (painful menstruation) There is currently not adequate available evidence to recommend for or against acupuncture in the treatment of dysmenorrhea.	C
Dyspepsia (functional) Currently, there is not enough data to recommend for or against the use of acupuncture in functional dyspepsia.	C
Enuresis (bed-wetting) All of the available studies do not offer evidence strong enough to validate recommendation.	C
Erectile dysfunction There is insufficient evidence to recommend for or against acupuncture in the treatment of erectile dysfunction.	C
Fasciitis (back muscles) Fasciitis is inflammation of the layer of connective tissue that covers, separates, and supports muscles. Acupuncture has been studied in fasciitis of back muscles. More studies using are needed to make any firm conclusions.	C
Headache (migraine, tension, myogenic, unspecified) Acupuncture may have promise for headaches of the various types, but higher quality studies are needed before recommendations can be made.	C
Hearing loss Early evidence suggests that deep needling may be more effective in treating sudden deafness than shallow needling. Better-designed trials are needed to reach a firm conclusion.	C
Heart disease Evidence for recommendation is inconclusive for or against the use of acupuncture in heart disease.	C
Hemiplegia Hemiplegia is a condition of full or partial paralysis of one side of the body due to disease, trauma or stroke. Various types of acupuncture, such as scalp acupuncture and traditional acupuncture have been used to treat hemiplegia. More study is needed before a recommendation can be made.	C
Hemorrhage (cerebral, vocal cords) Limited evidence indicates that acupuncture may benefit patients with cerebral hemorrhage or submucosal hemorrhage of vocal cords. Study of acupuncture's effect alone vs. in combination with other therapies, may help make a firm conclusion.	C
High blood pressure There is insufficient evidence available on which to base any recommendation for or against acupuncture in high blood pressure (hypertension).	C
Hysterectomy Hand acupuncture has been compared with moxibustion in relieving pain in women who have undergone a hysterectomy, however, it is impossible to reach a firm conclusion at this time.	C
Infertility More studies are needed to determine the benefits of acupuncture in infertility.	C
Insomnia Traditional Chinese medicine commonly uses acupuncture to treat insomnia. A review of the available studies found reports of benefit, but major weaknesses in the design of the research makes the evidence insufficient to recommend for or against acupuncture for insomnia.	C
Irritable bowel syndrome (IBS) Although limited evidence suggests benefit may be possible, more studies are needed in order to make recommendations for or against acupuncture in IBS.	C
Keratoconjunctivitis sicca (dry eyes) There is insufficient evidence on which to base recommendations for keratoconjunctivitis sicca at this time.	C
Kidney disorders There has been limited research on acupuncture for kidney disorders such as gouty renal damage. There is currently not adequate available evidence to recommend for or against acupuncture in these conditions.	C
Menopausal symptoms There has been limited research on acupuncture for menopausal symptoms such as hot flashes and menopause-related hypertension. However, there is insufficient evidence to recommend for or against acupuncture.	C
Musculoskeletal problems There is evidence from several studies suggesting that laser acupuncture therapy may be beneficial for musculoskeletal conditions. However, due to weaknesses in study methods, as well as the wide variety of conditions in this category, it is difficult to make specific recommendations.	C
Nausea and vomiting (postoperative in children) Several attempts have been made to document benefits of stimulation of the P6 wrist point to reduce post-operative nausea and vomiting. Both acupuncture and acupressure wrist bands have been tried. Study results conflict. More trials are needed to make any firm conclusion regarding the use of acupuncture in adults and children.	C
Neck pain The research on acupuncture for neck pain and cervical myofascial pain, shows mixed results. Thus it is not possible to give specific recommendations at this time.	C
Pain (craniofacial) There is insufficient evidence available on which to base recommendations for or against acupuncture in craniofacial pain.	C
Parkinson's disease There is not sufficient evidence available on which to base recommendations for or against acupuncture in Parkinson's disease.	C
Pelvic pain in pregnancy Acupuncture stimulation may lower levels of pelvic pain intensity in pregnant women, however, more controlled studies are needed to determine the magnitude of benefit, if any, over other methods.	C
Peripheral neuropathy Wrist-ankle acupuncture has been studied for the treatment of diabetic peripheral neuropathy, however, there is insufficient evidence on which to base recommendations for use of acupuncture in peripheral nerve injury.	C
Peripheral neuropathy (HIV) Further research is needed before a recommendation can be made for or against the use of acupuncture in HIV-associated peripheral neuropathy.	C
Polycystic ovary syndrome There is preliminary evidence suggesting electroacupuncture may increase ovulation in some women with polycystic ovarian syndrome (PCOS). However, the study design was inadequate to recommend for or against electroacupuncture for this indication.	C
Post-herpetic neuralgia Overall, the available evidence suggests no benefit of acupuncture over placebo in post-herpetic neuralgia. More studies are needed to draw any firm conclusion.	C
Post-operative pain Results have been mixed for the effects of both acupuncture and electroacupuncture on pain following surgery (knee arthroscopy, back, abdominal, gastroscopy, breast, pulmonary). Thus there is insufficient available evidence to recommend either for or against acupuncture for post-surgical pain.	C
Pregnancy and labor Acupuncture has been reported to encourage uterine contractions during labor and to reduce the pain of labor. However, results of formal studies are mixed, and the research designs have been weak. More studies are needed to clarify the potential of acupuncture in labor.	C
Pregnancy support Moxibustion has been used historically in acupuncture to correct cephalic version (breech presentation) by turning the fetus' head in utero. Further studies are needed to determine its role in the correction of breech presentation.	C
Prostatitis (prostate inflammation) While limited evidence suggests benefit may be possible, there is insufficient available evidence to recommend either for or against acupuncture in prostatitis.	C
Pruritus (itchy skin) While limited evidence suggests benefit may be possible, there is insufficient available evidence to recommend either for or against acupuncture in uremic cutaneous pruritus.	C
Raynaud's disease There is insufficient evidence on which to base recommendations for the use of acupuncture in Raynaud's syndrome at this time.	C
Rectal prolapse While limited evidence suggests benefit may be possible, there is insufficient available evidence to recommend either for or against acupuncture in prolapsed rectum.	C
Rheumatoid arthritis (RA) Some studies of weak design have reported that acupuncture may relieve pain associated with rheumatoid arthritis. However, a well-designed trial was unable to confirm this. More evidence is needed to clarify if or when acupuncture is beneficial in RA.	C
Rhinitis (non-allergic) There is insufficient available evidence on which to base recommendations for acupuncture in non-allergic rhinitis.	C
Shoulder pain The available research on acupuncture for shoulder pain of varying causes shows mixed results.	C
Sinusitis (chronic) More studies are needed of stronger design to determine whether or not acupuncture offers benefit in sinusitis.	C
Skin disorders There is evidence from several studies suggesting that laser acupuncture therapy may be beneficial for skin conditions. However, due to weaknesses in study methods, as well as the wide variety of conditions in this category, it is difficult to make specific recommendations.	C
Spinal cord injury Preliminary evidence suggests that acupuncture may help spinal injury patients regain some bladder control, although the severity of the injury affects outcomes. More studies are needed before definitive recommendations can be made.	C
Stroke recovery Several studies have been conducted in stroke rehabilitation. More studies are needed to determine what can be expected in the use of acupuncture with regard to this application.	C
Temporomandibular joint disorder (TMJ) The available evidence suggests acupuncture may be comparable to other forms of conservative treatments. However, the studies that have been performed have major weaknesses that call into question the meaning of the findings. More studies of better design are needed for definitive recommendations.	C
Tourette's syndrome Based on preliminary evidence, acupuncture may be an effective therapy for Tourette's syndrome. Further research is needed to confirm these results.	C
Trigeminal neuralgia (primary) Currently, there is insufficient available evidence to recommend either for or against acupuncture in primary trigeminal neuralgia.	C
Urinary tract infection Early study in women suggests a reduced recurrence over six months and reduced residual urine (urine retained in the bladder after voiding). Better-designed studies are needed to determine recommendations for this use.	C
Urticaria (rash) Acupuncture plus point-injection has been found beneficial for obstinate urticaria (rash), although more research is needed to confirm these findings.	C
Uterus inflammation Early study has suggested possible benefit in uterine inflammation. However, there is a lack of well-designed studies on which to base recommendations for or against acupuncture.	C
Vertigo (cervical) Both jinger moxibustion and acupuncture have been studied for cervical vertigo, although few conclusions can be drawn at this time.	C
Vulvodynia Subjective observations in one small study suggest a possible role of acupuncture in the treatment of vulvodynia symptoms (chronic burning or stinging sensation of the vulva in the vagina). However, there is currently insufficient evidence on which to base recommendations.	C
Weight loss Evidence is inconsistent on whether acupuncture might contribute to weight loss. Some studies show modest benefit but others show none. Currently, there is insufficient available evidence to recommend either for or against acupuncture in weight loss.	C
Smoking cessation Numerous studies of acupuncture for smoking cessation have been conducted, and the quality of studies has varied widely. Results have been inconsistent. Several critical reviews of the research have concluded that the evidence does not support acupuncture as a reliable or effective method for smoking cessation. There may, however, be some benefit in reducing side effects of withdrawal such as irritation, cigarette craving, and headache.	D
Tinnitus Small trials have been conducted and found no benefits over placebo for the treatment of chronic unilateral or bilateral tinnitus. However, non-controlled case series have found possible benefit. Larger studies are needed before a strong recommendation can be made.	D
Whiplash (adjunct) Early study does not show that laser acupuncture is any more effective than sham laser acupuncture when used in combination with drugs and other mobilization therapies. More study is needed in this area.	D

Bibliography

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

Alecrim-Andrade J, Maciel-Junior JA, Cladellas XC, et al. Acupuncture in migraine prophylaxis: a randomized sham-controlled trial. Cephalalgia. 2006 May;26(5):520-9. View Abstract

Brinkhaus B, Witt CM, Jena S, et al. Acupuncture in patients with chronic low back pain: a randomized controlled trial. Arch Intern Med. 2006 Feb 27;166(4):450-7. View Abstract

Ceccherelli F, Tortora P, Nassimbeni C, et al. The therapeutic efficacy of somatic acupuncture is not increased by auriculotherapy: a randomised, blind control study in cervical myofascial pain. Complement Ther Med. 2006 Mar;14(1):47-52. View Abstract

Diener HC, Kronfeld K, Boewing G, et al. Efficacy of acupuncture for the prophylaxis of migraine: a multicentre randomised controlled clinical trial. Lancet Neurol. 2006 Apr;5(4):310-6. View Abstract

Gates S, Smith LA, Foxcroft DR. Auricular acupuncture for cocaine dependence. Cochrane Database Syst Rev. 2006 Jan 25; (1):CD005192. View Abstract

Jiang H, Shi K, Li X, et al. Clinical study on the wrist-ankle acupuncture treatment for 30 cases of diabetic peripheral neuritis. J Tradit Chin Med. 2006 Mar;26(1):8-12. View Abstract

Kaptchuk TJ, Stason WB, Davis RB, et al. Sham device v inert pill: randomised controlled trial of two placebo treatments. BMJ. 2006 Feb 18;332(7538):391-7. View Abstract

Liu YS, Ouyang YY, Yin Y. [Clinical application of electroacupuncture plus chinese medicine in treatment of peripheral facial paralysis] Zhongguo Zhen Jiu. 2006 Apr;26(4):259-60. View Abstract

Ma S, Liu XY, Yu RL, et al. [Clinical observation on acupuncture for treatment of Tourette's syndrome]. Zhongguo Zhen Jiu. 2006 Jun;26(6):392-4. View Abstract

Schmid-Schwap M, Simma-Kletschka I, Stockner A, et al. Oral acupuncture in the therapy of craniomandibular dysfunction syndrome -- a randomized controlled trial. Wien Klin Wochenschr. 2006 Feb;118(1-2):36-42. View Abstract

Ter Riet G, Kleijnen J, Knipschild P. A meta-analysis of studies into the effect of acupuncture on addiction. Br J Gen Pract 1990;40(338):379-382. View Abstract

Tsukayama H, Yamashita H, Kimura T, et al. Factors that influence the applicability of sham needle in acupuncture trials: two randomized, single-blind, crossover trials with acupuncture-experienced subjects. Clin J Pain. 2006 May;22(4):346-9. View Abstract

Walji R, Boon H. Redefining the randomized controlled trial in the context of acupuncture research. Complement Ther Clin Pract. 2006 May;12(2):91-6. View Abstract

Westergaard LG, Mao Q, Krogslund M, et al. Acupuncture on the day of embryo transfer significantly improves the reproductive outcome in infertile women: a prospective, randomized trial. Fertil Steril. 2006 May;85(5):1341-6. View Abstract

Yu J, Zhang X, Liu C, Meng Y, et al. Effect of acupuncture treatment on vascular dementia. Neurol Res. 2006 Jan;28(1):97-103. View Abstract

Related Terms

Acupoint, auricular acupuncture, auriculotherapy, body-acupuncture, brain-resuscitation acupuncture, centro-square needling, chi, chronopuncture, classical balance method, computer-controlled electroacupuncture, De Qi, ear acupuncture, electroacupuncture, electroacupuncture according to Voll (EAV), ethnic traditional Chinese medicine, energy medicine, French acupuncture, French energetic acupuncture, hand acupuncture, Japanese acupuncture, Japanese meridian, Korean acupuncture, Korean hand acupressure, Korean hand acupuncture, laser acupuncture, laser acupuncture therapy, laser therapy, manual stimulation of needles, Matsumoto, medical acupuncture, meridian, motortherapy, moxibustion, myofascial acupuncture, neural therapy, Qi, reflexotherapy (in former USSR), Ryodoraku, shoni shin, traditional Chinese medicine, transcutaneous electrical stimulation, trigger point acupuncture, triple needling, Vietnamese acupuncture, Western acupuncture, wrist-ankle acupuncture.

Not included in this review: Acupressure, acustimulation, percutaneous electrical nerve stimulation, transcutaneous electrical nerve stimulation (TENS), shiatsu.

Natural Standard Bottom Line Monograph, Copyright © 2009 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intendedfor informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.

Natural Standard's methodology , editorial board , and grading scales.

While some complementary and alternative techniques have been studied scientifically, high-quality data regarding safety, effectiveness, and mechanism of action are limited or controversial for most therapies. Whenever possible, it is recommended that practitioners be licensed by a recognized professional organization that adheres to clearly published standards. In addition, before starting a new technique or engaging a practitioner, it is recommended that patients speak with their primary healthcare provider(s). Potential benefits, risks (including financial costs), and alternatives should be carefully considered. The below monograph is designed to provide historical background and an overview of clinically-oriented research, and neither advocates for or against the use of a particular therapy.

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Acupuncture

Background

Theory

Evidence Table (Click Here to view Natural Standard evidence-based validated grading rationale™.)

Tradition Theory

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Attribution

Bibliography

Related Terms