WHAT IS ACUPUNCTURE?
Dating back to at least 100 B.C., acupuncture was first described in writing as an organized system of diagnosis and treatment using needles. Commonly utilized in Traditional Chinese Medicine (TCM), acupuncture is linked to the belief that disease is caused by disruptions to the flow of energy, or Qi, in the body. Acupuncture stimulates points on or under the skin called acupuncture points or acupressure points, releasing this Qi. The Qi then travels through channels called meridians.
WHAT ARE THE DIFFERENT STYLES OF ACUPUNCTURE?
While it originated in China, acupuncture is used throughout the world. Different styles have developed over the centuries based on different theories. We would encourage you to speak with your practitioner about his/her style. While the basic theoretical principles of acupuncture are fairly consistent, styles of acupuncture differ greatly in terms of technique and diagnosis. There is no evidence that one particular style is more effective than another, but you should understand as much as possible about the treatment being proposed. Below is a general guide:
Traditional Chinese Acupuncture: Traditional Chinese Acupuncture, part of Traditional Chinese Medicine (TCM), is the dominant style of acupuncture studied and practiced in the U.S.
Japanese Acupuncture: “Japanese-style” acupuncture uses the same meridians and points as Chinese acupuncture but takes a more subtle route, typically using fewer and thinner needles with less stimulation.
Korean Hand Acupuncture: This technique focuses on points in the hand that correspond to areas of the body and to certain disharmonies.
Auricular Acupuncture: This system, commonly used for pain control and drug, alcohol, and nicotine addiction, focuses on points in the ear that correspond to areas of the body and to certain disharmonies.
Medical Acupuncture: When acupuncture is performed by a western Medical Doctor (MD), it is termed “Medical Acupuncture.” Acupuncture requirements for western doctors are generally more lenient than for non-MDs. If you decide to go to an MD for acupuncture, choose one who is a member of the American Academy of Medical Acupuncture, as this organization requires a minimum of 200 hours of training. Medical doctors usually use sterilized, stainless steel needles, like other acupuncturists, but also sometimes use injections.
Veterinary Acupuncture: Veterinary acupuncture is an acknowledged and respected field of medicine, requiring formal training and certification. In most states, provinces and countries, veterinary acupuncture is considered a surgical procedure that, legally, may ONLY be performed by a licensed Doctor of Veterinary Medicine.
HOW DOES ACUPUNCTURE WORK?
Acupuncture achieves the desired results by stimulating specific points near or on the surface of the skin – acupuncture points – that have the ability to alter biochemical and physiological conditions in the body. Because acupuncture points are designated areas of electrical sensitivity, inserting needles at these points stimulates sensory receptors. This in turn stimulates nerves that transmit impulses to the hypothalamic-pituitary system in the brain. The hypothalamus-pituitary glands are responsible for releasing neurotransmitters and endorphins, the body’s natural pain-killing hormones (thought to be some 200 times more potent than morphine). Endorphins play a significant role in the hormonal system, which is why acupuncture is effective in treating back pain, arthritis, PMS and infertility. The substances released as a result of acupuncture relax the body, and also regulate serotonin in the brain, which affects emotional states. Other physiological effects include increased circulation, decreased inflammation, relief of muscle spasms and increased T-cell count, which supports the immune system.
According to Dr. Ting Bao, an integrative medical oncologist at Memorial Sloan-Kettering Cancer Center in New York, “One major hypothesis is that acupuncture works through neurohormonal pathways. Basically, you put the needle through specific points in the body and stimulate the nerve. The nerve actually sends signals to the brain, and the brain releases neural hormones such as beta-Endorphins. By doing that, the patient may feel euphoric, or happy, and this increases the pain threshold and they feel less pain.”
Another hypothesis is that acupuncture works by reducing pro-inflammatory markers, or proteins, in the body. Some animal and human studies suggest that by doing acupuncture, you can significantly decrease these pro-inflammatory markers — including TNF and IL-1β — which decreases inflammation and reduces pain. One such spot is just below the knee (a point known as Stomach 36). This point is used in a wide variety of treatments that involve inflammation anywhere in the body, as well as for increasing energy and boosting the immune system, which in turn also help to decrease inflammation.
HOW DOES THIS RELATE TO WESTERN MEDICINE?
Western Science Posits that acupuncture triggers three primary mechanisms in the body:
Activation of opioid systems: Research has found that several types of pain-reducing opioids may be released into the central nervous system during acupuncture.
Changes in brain chemistry: Studies have shown that acupuncture may alter brain chemistry by altering the way in which neurotransmitters and neurohormones are released. Acupuncture has also been documented to affect sensation and involuntary body functions, such as immune reactions and processes involved in regulating blood pressure, blood flow and body temperature. Modulation of subcortical structures of the brain may be an important mechanism by which acupuncture exerts its complex multi-system effects.
Changes in blood flow: Acupuncture and Oriental medicine affects the circulation of blood to the affected area, which helps to remove pain-causing chemicals and restore normal function.
WHAT SHOULD I EXPECT AT MY FIRST VISIT?
- For your initial consultation, the acupuncturist needs to assess your general health. You will be asked about your current symptoms and any treatment you’ve received so far. It is also important to gather detailed information about your medical history and that of your family, your diet, digestive system, sleeping patterns and emotional state. The purpose is to identify what needs to be addressed in order to target your specific complaint, and to boost your overall vitality.
- Stimulation of specific areas affects the functioning of various organs. However, those areas may not be close to the part of the body where you are experiencing a problem. For example, if you suffer from headaches, needles may be inserted into your foot or hand. There are 365 specific acupuncture points on the body, and an unlimited number of non-specific points. An experienced acupuncturist will use a selection of these for each session. Often during the course of a few sessions, different points will be selected as the patient’s condition changes.
WHAT SHOULD I DO BEFORE MY FIRST VISIT?
It is recommended to wear loose, comfortable clothing to receive acupuncture treatment. You should be aware that the acupuncturist may need to access points on your torso, arms and legs. It also helps to be in a calm state. Try to arrive 5 or 10 minutes before your appointment to give yourself a chance to relax. Try to avoid the following:
- Eating a big meal within one hour of your appointment
- Fasting for more than six hours before your appointment
- Alcohol, tobacco, food or drinks that color your tongue (such as coffee) immediately prior to treatment or just following a treatment
- Vigorous exercise or sexual activity within the hour before treatment
- I also recommend that you avoid wearing any metallic jewelry, watches, or earrings. Makeup and nail polish should be minimized or eliminated. Please also avoid the use of perfumes, colognes or strongly scented cosmetics.
HOW MANY SESSIONS WILL I NEED?
- Length, number and frequency of sessions vary. For most conditions, a series of several sessions is necessary to achieve the maximum benefit. After an initial consultation, the acupuncturist should provide you with a treatment plan that includes the techniques to be used, as well as the frequency and duration of treatment.
- A typical series of sessions consists of 6 to 12 visits, once or twice a week, with sessions lasting 30 to 60 minutes each. Acute conditions, such as sprains, generally require less time and frequency, whereas more chronic or severe ailments may require several (or several dozen) sessions. Appointments are scheduled further and further apart after the optimal response has been achieved. Some people experience great benefits from weekly or monthly sessions.
WHAT CONDITIONS OR AILMENTS IS ACUPUNCTURE USED TO TREAT?
Acupuncture is recognized by the National Institutes of Health (NIH) and the World Health Organization (WHO) to be effective in the treatment of a wide variety of medical problems. The following are some of the more common conditions treatable by Chinese Medicine and Acupuncture, as outlined by the WHO.
Upper Respiratory Tract: Acute sinusitis, acute rhinitis, common cold, acute tonsillitis
Respiratory System: Acute bronchitis, bronchial asthma (most effective in children and in patients without complicating diseases)
Disorders of the Eye: Acute conjunctivitis, central retinitis, myopia (in children), cataract (without complications)
Disorders of the Mouth: Toothache, post-extraction pain, gingivitis, acute and chronic pharyngitis
Gastrointestinal Disorders: Spasms of esophagus and cardia, hiccough, gastroptosis, acute and chronic gastritis, gastric hyperacidity, chronic duodenal ulcer (pain relief), acute duodenal ulcer (without complications), acute and chronic colitis, acute bacillary dysentery, constipation, diarrhea, paralytic ileus
Neurological and Musculoskeletal Disorders: Headache and migraine, trigeminal neuralgia, facial palsy (early stage, i.e. within three to six months), pareses following a stroke, peripheral neuropathies, sequelae of poliomyelitis (early stage, i.e., within six months), Meniere’s disease, neurogenic bladder dysfunction, nocturnal enuresis, intercostal neuralgia, cervicobrachial syndrome, “frozen shoulder,” “tennis elbow,” sciatica, low back pain, osteoarthritis
IS ACUPUNCTURE USED TO TREAT ANY OTHER CONDITIONS?
The most common ailments presented to acupuncturists in the U.S. are pain-related conditions. However, as the public becomes more educated about acupuncture and Oriental medicine, people are seeking help for a number of other conditions, with good results. These include:
Eye, Ear, Nose & Throat Disorders: Sinusitis, sore throat, hay fever, earache, nerve deafness, ringing in the ears, dizziness, poor eyesight
Circulatory Disorders: High blood pressure, angina pectoris, arteriosclerosis, anemia
Gastrointestinal Disorders: Irritable bowel syndrome (IBS), spastic colon, colitis, constipation, diarrhea, food allergies, ulcers, gastritis, abdominal bloating, hemorrhoids
Gynecological and Genitourinary Disorders: Premenstrual syndrome (PMS); irregular, heavy or painful menstruation; endometriosis; menopause; fibroids; chronic bladder infection; complications in pregnancy; morning sickness; kidney stones; impotence; infertility (men and women); sexual dysfunction
Immune Disorders: Candida, chronic fatigue, HIV and AIDS, Epstein Barr virus, allergies, lupus, multiple sclerosis (MS), hepatitis
Addictions: Smoking, drugs, alcohol, food
Emotional and Psychological Disorders: Anxiety, insomnia, depression, stress
Musculoskeletal and Neurological Disorders: Arthritis, neuralgia, sciatica, back pain, bursitis, tendonitis, stiff neck, Bell’s palsy, trigeminal neuralgia, headaches and migraines, stroke, cerebral palsy, polio, sprains, muscle spasms, shingles
Respiratory Disorders: Asthma, emphysema, bronchitis, colds and flu
Miscellaneous: Chemotherapy/radiation side effects, diabetes, dermatological disorders, weight control
WHAT RESEARCH SUPPORTS THE USE OF ACUPUNCTURE FOR THESE CONDITIONS?
According to the World Health Organization (WHO), the following diseases or disorders for which acupuncture therapy has been tested in controlled clinical trials reported in the recent literature can be classified into four categories as shown below.
1. Diseases, symptoms or conditions for which acupuncture has been proved— through controlled trials—to be an effective treatment:
Adverse reactions to radiotherapy and/or chemotherapy
Allergic rhinitis (including hay fever)
Depression (including depressive neurosis and depression following stroke)
Dysentery, acute bacillary
Epigastralgia, acute (in peptic ulcer, acute and chronic gastritis, and gastrospasm)
Facial pain (including craniomandibular disorders)
Induction of labour
Low back pain
Malposition of fetus, correction of Morning sickness
Nausea and vomiting
Pain in dentistry (including dental pain and temporomandibular dysfunction)
Periarthritis of shoulder
2. Diseases, symptoms or conditions for which the therapeutic effect of acupuncture has been shown but for which further proof is needed:
Abdominal pain (in acute gastroenteritis or due to gastrointestinal spasm)
Alcohol dependence and detoxification
Cholecystitis, chronic, with acute exacerbation Cholelithiasis
Competition stress syndrome
Craniocerebral injury, closed
Diabetes mellitus, non-insulin-dependent
Epidemic haemorrhagic fever
Epistaxis, simple (without generalized or local disease)
Eye pain due to subconjunctival injection
Female urethral syndrome
Fibromyalgia and fasciitis
Hepatitis B virus carrier status
Herpes zoster (human (alpha) herpesvirus 3)
Male sexual dysfunction, non-organic
Neuralgia, post-herpetic Neurodermatitis
Opium, cocaine and heroin dependence Osteoarthritis
Pain due to endoscopic examination
Pain in thromboangiitis obliterans
Polycystic ovary syndrome (Stein–Leventhal syndrome)
Postextubation in children
Radicular and pseudoradicular pain syndrome Raynaud syndrome, primary
Recurrent lower urinary-tract infection
Reflex sympathetic dystrophy
Retention of urine, traumatic
Sore throat (including tonsillitis)
Spine pain, acute
Temporomandibular joint dysfunction
Ulcerative colitis, chronic
Whooping cough (pertussis)
3. Diseases, symptoms or conditions for which there are only individual controlled trials reporting some therapeutic effects, but for which acupuncture is worth trying because treatment by conventional and other therapies is difficult:
Choroidopathy, central serous
Irritable colon syndrome
Neuropathic bladder in spinal cord injury
Pulmonary heart disease, chronic
Small airway obstruction4. Diseases, symptoms or conditions for which acupuncture may be tried provided the practitioner has special modern medical knowledge and adequate monitoring equipment:
Breathlessness in chronic obstructive pulmonary disease Coma
Convulsions in infants
Coronary heart disease (angina pectoris)
Diarrhoea in infants and young children
Encephalitis, viral, in children, late stage
Paralysis, progressive bulbar and pseudobulbar
WHERE CAN I FIND MORE INFORMATION?
The information below comes directly from the National Center for Complementary and Integrative Health website.
More about acupuncture for these pain conditions and others:
For Low-Back Pain
- A 2012 analysis of data on participants in acupuncture studies looked at back and neck pain together and found that actual acupuncture was more helpful than either no acupuncture or simulated acupuncture.
- A 2010 review by the Agency for Healthcare Research and Quality found that acupuncture relieved low-back pain immediately after treatment but not over longer periods of time.
- A 2008 systematic review of studies on acupuncture for low-back pain found strong evidence that combining acupuncture with usual care helps more than usual care alone. The same review also found strong evidence that there is no difference between the effects of actual and simulated acupuncture in people with low-back pain.
- Clinical practice guidelines issued by the American Pain Society and the American College of Physicians in 2007 recommend acupuncture as one of several nondrug approaches physicians should consider when patients with chronic low-back pain do not respond to self-care (practices that people can do by themselves, such as remaining active, applying heat, and taking pain-relieving medications).
For Neck Pain
- A 2009 analysis found that actual acupuncture was more helpful for neck pain than simulated acupuncture, but the analysis was based on a small amount of evidence (only three studies with small study populations).
- A large German study with more than 14,000 participants evaluated adding acupuncture to usual care for neck pain. The researchers found that participants reported greater pain relief than those who didn’t receive it; the researchers didn’t test actual acupuncture against simulated acupuncture.
For Osteoarthritis/Knee Pain
- A 2014 Australian clinical study involving 282 men and women showed that needle and laser acupuncture were modestly better at relieving knee pain from osteoarthritis than no treatment, but not better than simulated (sham) laser acupuncture. Participants received 8 to 12 actual and simulated acupuncture treatments over 12 weeks. These results are generally consistent with previous studies, which showed that acupuncture is consistently better than no treatment but not necessarily better than simulated acupuncture at relieving osteoarthritis pain.
- A major 2012 analysis of data on participants in acupuncture studies found that actual acupuncture was more helpful for osteoarthritis pain than simulated acupuncture or no acupuncture.
- A 2010 systematic review of studies of acupuncture for knee or hip osteoarthritis concluded that actual acupuncture was more helpful for osteoarthritis pain than either simulated acupuncture or no acupuncture. However, the difference between actual and simulated acupuncture was very small, while the difference between acupuncture and no acupuncture was large.
- A 2012 analysis of data on individual participants in acupuncture studies looked at migraine and tension headaches. The analysis showed that actual acupuncture was more effective than either no acupuncture or simulated acupuncture in reducing headache frequency or severity.
- A 2009 systematic review of studies concluded that actual acupuncture, compared with simulated acupuncture or pain-relieving drugs, helped people with tension-type headaches. A 2008 systematic review of studies suggested that actual acupuncture has a very slight advantage over simulated acupuncture in reducing tension-type headache intensity and the number of headache days per month.
- A 2009 systematic review found that adding acupuncture to basic care for migraines helped to reduce migraine frequency. However, in studies that compared actual acupuncture with simulated acupuncture, researchers found that the differences between the two treatments may have been due to chance.
For Other Conditions
- Results of a systematic review that combined data from 11 clinical trials with more than 1,200 participants suggested that acupuncture (and acupuncture point stimulation) may help with certain symptoms associated with cancer treatments.
- There is not enough evidence to determine if acupuncture can help people with depression.
- Acupuncture has been promoted as a smoking cessation treatment since the 1970s, but research has not shown that it helps people quit the habit.
More about the challenges of studying acupuncture:
Studying acupuncture is challenging because:
- Clinical trials often differ in terms of technique, the number of acupuncture points, the number of sessions, and the duration of those sessions.
- Results of an acupuncture session may be associated with a person’s beliefs and expectations about their treatment or from their relationship with the therapist, rather than from acupuncture treatment itself.
- In some clinical trials, researchers test a product or practice against an inactive product or technique (called a placebo) to see if the response is due to the test protocol or to something else. Many acupuncture trials rely on a technique called simulated acupuncture, which may use blunt-tipped retractable needles that touch the skin but do not penetrate (in real acupuncture, needles penetrate the skin). Researchers also may simulate acupuncture in other ways. However, in some instances, researchers have observed that simulated acupuncture resulted in some degree of pain relief.
WHAT OTHER DETAILS SHOULD I KNOW ABOUT ACUPUNCTURE?
DO I HAVE TO BELIEVE IN ORDER TO OBTAIN RESULTS?
- No. As a case in point, acupuncture works very well for horses, dogs and cats, most of whom probably don’t “believe” in acupuncture. It is always beneficial to have confidence in your practitioner, but faith in a particular technique is not necessary to obtain results.
ARE THERE RISKS OR SIDE EFFECTS TO ACUPUNCTURE?
- The acupuncture needle is a fine, disposable (one-time use), sterile, FDA-approved medical device. While acupuncture is a highly safe form of physical medicine, there are a few risks. These include bruising, fainting, muscle spasms, bleeding, nerve damage (extremely rare) and punctured organs (extremely rare).
CAN I BUY AN ACUPUNCTURE MACHINE FOR SELF-TREATMENT?
- Self-treatment is not recommended, either with needles or other gadgets. Only a properly trained practitioner is qualified to objectively diagnose and administer appropriate acupuncture. Gadgets sold with manuals indicating “certain points for certain symptoms” do not use traditional acupuncture theory, and the self-treating patient can easily overlook other relevant symptoms.
HOW DEEP DO THE NEEDLES GO?
- Acupuncture points are located on or close to the skin’s surface, but needles can be inserted from 1/16 to a few inches deep. The depth of insertion depends on the nature of the location and condition being addressed, the patients’ size, age, and constitution, as well as the acupuncturist’s style and training.
DO ACUPUNCTURE NEEDLES HURT?
- There is little sensitivity to the insertion of acupuncture needles. One reason is that they are much finer than those used for injections and blood tests – 25 to 50 times thinner than hypodermic needles. Further, the actual insertion is done very quickly. While some feel nothing at all, others experience a brief moment of discomfort, sometimes followed by a mild sensation of cramping, tingling or numbness (desirable sensations known as “attaining qi”). The needles are left in place for 20 to 90 minutes. Most people find the experience relaxing, and some even fall asleep during sessions.
ARE THE NEEDLES STERILE?
- Yes. Licensed acupuncturists are required to be certified in Clean Needle Techniques and only use sterilized, individually packaged, disposable needles. However, it is a good practice to verify your acupuncturist’s clean needle technique prior to attending sessions.
CAN I GET A DISEASE LIKE HEPATITIS FROM ACUPUNCTURE?
- No. Every licensed, board certified acupuncturist is trained to prevent the transmission of diseases. Like in a hospital, acupuncturists use only disposable needles, which are used only once on patients and then discarded. While there may have been reported statistics of possible transmission of diseases over 20 years ago, current standards have virtually eliminated any risk of infection through acupuncture.
HOW LONG DO APPOINTMENTS LAST?
- The length of acupuncture sessions varies depending on your condition. Typically, your first visit will be longer than your subsequent visits. Sessions can be as short as 30 minutes to as long an hour.
HOW WILL I FEEL AFTER ACUPUNCTURE?
- Patients normally feel relaxed and calm. You may feel tired or drowsy for a few hours if the experience is particularly strong. You may also experience a short-term flair-up of symptoms in the healing process. After a session, it is a good idea to sit quietly and relax. A gentle walk or very mild exercise can also be helpful. Avoid big meals, vigorous exercise, alcohol and stressful situations.