Acupuncture is an ancient healing tradition that originated in China more than 3,000 years ago. It has evolved into many different types (e.g., traditional Chinese medicine, five elements theory, Korean hand acupuncture, scalp or ear acupuncture, Japanese acupuncture, and French energetics system) and has been practiced all over the world. Over the last few decades, acupuncture has gained increasing popularity and has come under increasing scrutiny in Europe and America, beginning in the 1970s in the United States. Since then, because of increasing support by the governments of the respective countries, substantial clinical/laboratory investigation, and strong consumer demand, there has been vast progress in the Western understanding and practice of acupuncture.

A number of specific events contributed to the current interest in and the integration of Chinese medical practice. In 1996, the U.S. Food and Drug Administration (FDA) changed the classification of acupuncture needles from experimental to medical equipment, subjecting their marketing and use to the same strict quality control standards applied to medical needles, syringes, and surgical scalpels. In 1997, the National Institutes of Health (NIH) convened a Consensus Development Conference on Acupuncture, acknowledging that acupuncture was widely practiced by thousands of physicians, dentists, acupuncturists, and other practitioners for relief from or prevention of pain and for various other health conditions. The NIH Office of Alternative Medicine (OAM) later expanded and was renamed the National Center for Complementary and Alternative Medicine (NCCAM). NCCAM currently funds research projects relating to acupuncture use for multiple medical and pain conditions.

The United States has seen an increasing demand for and acceptance of complementary therapies. It has become incumbent on health care practitioners to have knowledge of treatment alternatives to conventional medicine and to understand associated clinical implications. In a national survey published in the Journal of the American Medical Association (JAMA) in 1998, Eisenberg et al. found that the number of visits to alternative therapy centers was twice that of visits to primary care physicians and that the money spent on complementary and alternative medicine (CAM) was nearly equal to out-of-pocket expenditures for conventional care.

Most medical schools in the United States have included subjects on integrated medicine. Third-party reimbursements for alternative therapies also have increased with patient demand. With health care costs in the United States exceeding $1.7 trillion in 2003, health insurance providers have begun to emphasize preventative measures, particularly in the face of a rapidly aging population. CAM espouses a more holistic, purposeful effort toward maintaining health, contrasting with conventional medicine’s interventional approach toward management of disease. CAM will therefore likely play a vital role in minimizing costs and in improving patient health and satisfaction.

According to traditional Chinese medicine, qi (pronounced “chee”) is the life force or energy that flows through all living things and influences health on physical, mental, emotional, and spiritual levels. Any imbalance (deficiency or excess) or blockage of qi is thought to cause disease or pain. Acupuncture treats disorders by influencing the flow of qi, thereby restoring the normal balance of organ systems. In human beings, qi is thought to flow through the body along specific pathways called meridians. There are 12 major meridians named after organ systems, and eight minor meridians, which run vertically along each side of the body (bilateral pairs share the same name).

Depending on the particular school of thought on acupuncture, there are between 600 and 2,000 acupuncture points on the human body. For example, microsystem acupuncture such as auricular acupuncture or Korean hand acupuncture uses several extra points outside the traditional meridians. Points in the ear, hand, foot, or scalp correspond to organs throughout the body.

Acupuncture involves insertion of very fine needles in the skin at specific points in order to promote health and restore proper function of the body. Acupuncture points are usually chosen on the basis of the practitioner’s assessment of the particular imbalance that needs to be restored. Points can be stimulated to add or dissipate energy, or to tonify (strengthen or restore) a particular organ system. Traditional diagnostic techniques for acupuncture include methods of evaluation such as looking at the patient’s tongue for shape, color, texture, and smell, or feeling radial and ulnar pulses for information about the entire body.

Several sizes of needles are available. Needles can be manipulated in many ways—often by rotating the needle in specific directions or by applying electricity. The sensation of deqi —an
aching, warm, or tingling sensation at the insertion site noted by the patient, which usually corresponds to the practitioner feeling the needle “catching” in the muscle—is thought to be necessary for therapeutic effect.

Electroacupuncture (EA) is commonly practiced in Europe and America and uses electrical impulses conducted through needles for enhanced stimulation of acupuncture points. Different frequencies of electricity have been shown to have distinct effects and mechanisms of action. Percutaneous electrical nerve stimulation (PENS) is a modified form of acupuncture that is practiced in many pain clinics. PENS points are chosen in a dermatomal distribution associated with pain symptoms. Transcutaneous electrical nerve stimulation (TENS) is modified acupressure in the same distribution as PENS.

Related techniques include moxibustion (burning of herbs to apply heat near acupuncture points), acupressure and reflexology (stimulation of points without penetration of the skin with needles), and cupping (heat creates a partial vacuum in small jars, which are used to stimulate points with suction). Other variations employ stimulation of acupuncture points using laser and ultrasound.

In the hands of a skilled practitioner, complications associated with acupuncture are actually rare, and usually mild. The most commonly reported complication is bruising or bleeding. (Note that there are no specific guidelines on anticoagulation therapy and acupuncture.) A second, less common side effect of acupuncture and related treatments is a transient vasovagal response, which resolves quickly and completely with repositioning of the patient.

Since 1965, there has been a handful of case reports in the literature about severe complications and exceedingly rare fatal reactions associated with acupuncture, although many reported cases were not proven to be causative. When present, serious side effects have generally occurred in older, more debilitated patients, or in the hands of less skilled practitioners, and include pneumo/hemothorax, pericardial effusion, pericardial tamponade, infective endocarditis, intraabdominal and intramuscular abscess, peroneal nerve palsy, and mycobacteriosis and other infections.

Although acupuncture is clearly considered to be safe, it is important to remember that it is not always entirely benign. In Europe and America, a large segment of the patient population who may benefit from acupuncture—that is, those intolerant to medications or those who failed other therapies because of fragility, debilitation, or comorbidities—are also at highest risk for acupuncture complications.