Acupuncture

Definition

Acupuncture is one of the main forms of treatment in traditional Chinese medicine. It involves the use of sharp, thin needles that are inserted in the body at very specific points. This process is believed to adjust and alter the body's energy flow into healthier patterns, and is used to treat a wide variety of illnesses and health conditions.

Origins

The original text of Chinese medicine is the Nei Ching, The Yellow Emperor's Classic of Internal Medicine, which is estimated to be at least 2,500 years old. Thousands of books since then have been written on the subject of Chinese healing, and its basic philosophies spread long ago to other Asian civilizations. Nearly all of the forms of Oriental medicine which are used in the West today, including acupuncture, shiatsu, acupressure massage, and macrobiotics, are part of or have their roots in Chinese medicine. Legend has it that acupuncture developed when early Chinese physicians observed unpredicted effects of puncture wounds in Chinese warriors. The oldest known text on acupuncture, the Systematic Classic of Acupuncture, dates back to 282 a.d. Although acupuncture is its best known technique, Chinese medicine traditionally utilizes herbal remedies, dietary therapy, lifestyle changes and other means to treat patients.

In the early 1900s, only a few Western physicians who had visited China were fascinated by acupuncture, but outside of Asian-American communities it remained virtually unknown until the 1970s, when Richard Nixon became the first U.S. president to visit China. On Nixon's trip, journalists were amazed to observe major operations

being performed on patients without the use of anesthetics. Instead, wide-awake patients were being operated on with only acupuncture needles inserted into them to control pain . During that time, a famous columnist for the New York Times, James Reston, had to undergo surgery and elected to use acupuncture instead of pain medication, and he wrote some convincing stories on its effectiveness.

Today acupuncture is being practiced in all 50 states by more than 9,000 practitioners, with about 4,000 MDs including it in their practices. Acupuncture has shown no-table success in treating many conditions, and more than 15 million Americans have used it as a therapy. Acupuncture, however, remains largely unsupported by the medical establishment. The American Medical Association has been resistant to researching it, as it is based on concepts very different from the Western scientific model.

Several forms of acupuncture are being used today in America. Japanese acupuncture uses extremely thin needles and does not incorporate herbal medicine in its practice. Auricular acupuncture uses acupuncture points only on the ear, which are believed to stimulate and balance internal organs. In France, where acupuncture is very popular and more accepted by the medical establishment, neurologist Paul Nogier developed a system of acupuncture based on neuroendocrine theory rather than on traditional Chinese concepts, which is gaining some use in America.

Benefits

The World Health Organization (WHO) recommends acupuncture as an effective treatment for over forty medical problems, including allergies , respiratory conditions, gastrointestinal disorders, gynecological problems, nervous conditions, and disorders of the eyes, nose and throat, and childhood illnesses, among others. Acupuncture has been used in the treatment of alcoholism and substance abuse. In 2002, a center in Maine received a unique grant to study acupuncture treatment for substance abuse. Although recognizing that acupuncture had been used before for helping those with abuse, this study sought to show that ear acupuncture's effects on relaxation response helped those abusing drugs and alcohol better deal with the anxiety and life circumstances thought to lead them to substance abuse.

Acupuncture is an effective and low-cost treatment for headaches and chronic pain, associated with problems like back injuries and arthritis. It has also been used

to supplement invasive Western treatments like chemotherapy and surgery. Acupuncture is generally most effective when used as prevention or before a health condition becomes acute, but it has been used to help patients suffering from cancer and AIDS . In 2002, the National Institutes of health announced that pain from certain musculoskeletal conditions like fibromyalgia could be helped by acupuncture. Acupuncture is limited in treating conditions or traumas that require surgery or emergency care (such as for broken bones).

Description

Basic ideas of Chinese medicine

Chinese medicine views the body as a small part of the universe, and subject to universal laws and principles of harmony and balance. Chinese medicine does not draw a sharp line, as Western medicine does, between mind and body. The Chinese system believes that emotions and mental states are every bit as influential on disease as purely physical mechanisms, and considers factors like work, environment, lifestyle, and relationships as fundamental to the overall picture of a patient's health. Chinese medicine also uses very different symbols and ideas to discuss the body and health. While Western medicine typically describes health in terms of measurable physical processes made up of chemical reactions, the Chinese use ideas like yin and yang, chi, the organ system, and the five elements to describe health and the body. To understand the ideas behind acupuncture, it is worthwhile to introduce some of these basic terms.

YIN AND YANG. According to Chinese philosophy, the universe and the body can be described by two separate but complementary principles, that of yin and yang. For example, in temperature, yin is cold and yang is hot. In gender, yin is female and yang is male. In activity, yin is passive and yang is active. In light, yin is dark and yang is bright; in direction yin is inward and downward and yang is outward and up, and so on. Nothing is ever completely yin or yang, but a combination of the two. These two principles are always interacting, opposing, and influencing each other. The goal of Chinese medicine is not to eliminate either yin or yang, but to allow the two to balance each other and exist harmoniously together. For instance, if a person suffers from symptoms of high blood pressure, the Chinese system would say that the heart organ might have too much yang, and would recommend methods either to reduce the yang or to increase the yin of the heart, depending on the other symptoms and organs in the body. Thus, acupuncture therapies seek to either increase or reduce yang, or increase or reduce yin in particular regions of the body.

CHI. Another fundamental concept of Chinese medicine is that of chi (pronounced chee, also spelled qi ). Chi is the fundamental life energy of the universe. It is invisible and is found in the environment in the air, water, food and sunlight. In the body, it is the invisible vital force that creates and animates life. We are all born with inherited amounts of chi, and we also get acquired chi from the food we eat and the air we breathe. The level and quality of a person's chi also depends on the state of physical, mental and emotional balance. Chi travels through the body along channels called meridians.

THE ORGAN SYSTEM. In the Chinese system, there are twelve main organs: the lung, large intestine, stomach, spleen, heart, small intestine, urinary bladder, kidney, liver, gallbladder, pericardium, and the "triple warmer," which represents the entire torso region. Each organ has chi energy associated with it, and each organ interacts with particular emotions on the mental level. As there are twelve organs, there are twelve types of chi which can move through the body, and these move through twelve main channels or meridians. Chinese doctors connect symptoms to organs. That is, symptoms are caused by yin/yang imbalances in one or more organs, or by an unhealthy flow of chi to or from one organ to another. Each organ has a different profile of symptoms it can manifest.

THE FIVE ELEMENTS. Another basis of Chinese theory is that the world and body are made up of five main elements: wood, fire, earth, metal, and water. These elements are all interconnected, and each element either generates or controls another element. For instance, water controls fire and earth generates metal. Each organ is associated with one of the five elements. The Chinese system uses elements and organs to describe and treat conditions. For instance, the kidney is associated with water and the heart is associated with fire, and the two organs are related as water and fire are related. If the kidney is weak, then there might be a corresponding fire problem in the heart, so treatment might be made by acupuncture or herbs to cool the heart system and/or increase energy in the kidney system.

The Chinese have developed an intricate system of how organs and elements are related to physical and mental symptoms, and the above example is a very simple one. Although this system sounds suspect to Western scientists, some interesting parallels have been observed. For instance, Western medicine has observed that with severe heart problems, kidney failure often follows, but it still does not know exactly why. In Chinese medicine, this connection between the two organs has long been established.

MEDICAL PROBLEMS AND ACUPUNCTURE. In Chinese medicine, disease as seen as imbalances in the organ system or chi meridians, and the goal of any remedy or treatment is to assist the body in reestablishing its innate harmony. Disease can be caused by internal factors like emotions, external factors like the environment and weather, and other factors like injuries, trauma, diet, and germs. However, infection is seen not as primarily a problem with germs and viruses, but as a weakness in the energy of the body that is allowing a sickness to occur. In Chinese medicine, no two illnesses are ever the same, as each body has its own characteristics of symptoms and balance. Acupuncture is used to open or adjust the flow of chi throughout the organ system, which will strengthen the body and prompt it to heal itself.

A VISIT TO THE ACUPUNCTURIST. The first thing an acupuncturist will do is get a thorough idea of a patient's medical history and symptoms, both physical and emotional. This is done with a long questionnaire and interview. Then the acupuncturist will examine the patient to find further symptoms, looking closely at the tongue, the pulse at various points in the body, the complexion, general behavior, and other signs like coughs or pains. From this, the practitioner will be able to determine patterns of symptoms which indicate which organs and areas are imbalanced. Depending on the problem, the acupuncturist will insert needles to manipulate chi on one or more of the twelve organ meridians. On these twelve meridians, there are nearly 2,000 points that can be used in acupuncture, with around 200 points being most frequently used by traditional acupuncturists. During an individual treatment, one to 20 needles may be used, depending on which meridian points are chosen.

Acupuncture needles are always sterilized and acupuncture is a very safe procedure. The depth of insertion of needles varies, depending on which chi channels are being treated. Some points barely go beyond superficial layers of skin, while some acupuncture points require a depth of 1-3 in (2.5-7.5 cm) of needle. The needles generally do not cause pain. Patients sometimes report pinching sensations and often pleasant sensations, as the body experiences healing. Depending on the problem, the acupuncturist might spin or move the needles, or even pass a slight electrical current through some of them. Moxibustion may be sometimes used, in which an herbal mixture (moxa or mugwort ) is either burned like incense on the acupuncture point or on the end of the needle, which is believed to stimulate chi in a particular way. Also, acupuncturists sometimes use cupping, during which small suction cups are placed on meridian points to stimulate them.

How long the needles are inserted also varies. Some patients only require a quick in and out insertion to clear problems and provide tonification (strengthening of health), while some other conditions might require needles inserted up to an hour or more. The average visit to an acupuncturist takes about 30 minutes. The number of visits to the acupuncturist varies as well, with some conditions improved in one or two sessions and others requiring a series of six or more visits over the course of weeks or months.

Costs for acupuncture can vary, depending on whether the practitioner is an MD. Initial visits with non-MD acupuncturists can run from $50-$100, with follow-up visits usually costing less. Insurance reimbursement also varies widely, depending on the company and state. Regulations have been changing often. Some states authorize Medicaid to cover acupuncture for certain conditions, and some states have mandated that general coverage pay for acupuncture. Consumers should be aware of the provisions for acupuncture in their individual policies.

Precautions

Acupuncture is generally a very safe procedure. If a patient is in doubt about a medical condition, more than one physician should be consulted. Also, a patient should always feel comfortable and confident that their acupuncturist is knowledgable and properly trained.

Research & general acceptance

Mainstream medicine has been slow to accept acupuncture; although more MDs are using the technique, the American Medical Association does not recognize it as a specialty. The reason for this is that the mechanism of acupuncture is difficult to scientifically understand or measure, such as the invisible energy of chi in the body. Western medicine, admitting that acupuncture works in many cases, has theorized that the energy meridians are actually part of the nervous system and that acupuncture relieves pain by releasing endorphins, or natural pain killers, into the bloodstream. Despite the ambiguity in the biochemistry involved, acupuncture continues to show effectiveness in clinical tests, from reducing pain to alleviating the symptoms of chronic illnesses, and research in acupuncture is currently growing. The Office of Alternative Medicine of the National Institute of Health is currently funding research in the use of acupuncture for treating depression and attention-deficit disorder.

Training & certification

Medical acupuncture has evolved in America which uses traditional methods mainly as surgical techniques and pain management, and not as part of Chinese medicine overall. Medical acupuncture is performed by an MD or an osteopathic physician (DO). Currently 23 states allow only this type of acupuncture. Practitioners get their training as part of conventional medical school programs. As any MD can legally perform acupuncture, The American Academy of Medical Acupuncture (AAMA) was chartered in 1987 to support the education and correct practice of physician-trained acupuncturists. Its members must be either MDs or DOs who have completed proper study of acupuncture techniques. Address: 5820 Wilshire Blvd., Suite 500, Los Angeles, CA 90036, (323) 937-5514, http://medicalcupuntcture.org

For traditional acupuncturists, The National Commission for Certification of Acupuncturists (NCCA) conducts certification exams, promotes national standards, and registers members. Most states that license acupuncturists use the NCCA standards as certification. Address: 11 Canal Center Plaza, Ste. 300, Alexandra, VA 22314, (703) 548-9004, http://www.nccaim.org.

The American Association of Acupuncture and Oriental Medicine (AAAOM) is the largest organization for practitioners, with more than 1,600 members. Address: 1925 W. County Rd B2, Roseville, MN 55113, (651) 631-0204, http://www.aaaom.org.

Resources

BOOKS

Fleischman, Dr. Gary F. Acupuncture: Everything You Ever Wanted To Know. New York: Barrytown, 1998.

Kakptchuk, Ted. The Web That Has No Weaver: Understanding Chinese Medicine. New York: Congdon and Weed, 1983.

Requena, Yves, MD. Terrains and Pathology in Acupuncture. Massachusetts: Paradigm, 1986.

PERIODICALS

American Journal of Acupuncture. 1840 41st Ave., Suite 102, P.O. Box 610, Capitola, CA 95010.

Assefi, Nassim. "Acupuncture for Fibromyalgia." Alternative Medicine Alert. (February 2002): 13.

Savage, Lorraine. "Grant to Study Acupuncture"s Effectiveness on Patients Suffering from Substance Abuse." Healthcare Review. (March 19, 2002): 16.

OTHER

American Association of Oriental Medicine. http://www.aaom.org/ (December 28, 2000).

North American Society of Acupuncture and Alternative Medicine. http://www.nasa-altmed.com/ (December 28, 2000).

Douglas Dupler

Teresa G. Odle

Acupuncture

Definition

Acupuncture is one of the main forms of treatment in traditional Chinese medicine. It involves the use of sharp, thin needles that are inserted in the body at very specific points. This process is believed to adjust and alter the body's energy flow into healthier patterns, and is used to treat a wide variety of illnesses and health conditions.

Purpose

The World Health Organization (WHO) recommends acupuncture as an effective treatment for over forty medical problems, including allergies, respiratory conditions, gastrointestinal disorders, gynecological problems, nervous conditions, and disorders of the eyes, nose and throat, and childhood illnesses, among others. Acupuncture has been used in the treatment of alcoholism and substance abuse. It is an effective and low-cost treatment for headaches and chronic pain, associated with problems like back injuries and arthritis. It has also been used to supplement invasive Western treatments like chemotherapy and surgery. Acupuncture is generally most effective when used as prevention or before a health condition becomes acute, but it has been used to help patients suffering from cancer and AIDS. Acupuncture is limited in treating conditions or traumas that require surgery or emergency care (such as for broken bones).

Description

Origins

The original text of Chinese medicine is the Nei Ching, The Yellow Emperor's Classic of Internal Medicine, which is estimated to be at least 2,500 years old. Thousands of books since then have been written on the subject of Chinese healing, and its basic philosophies spread long ago to other Asian civilizations. Nearly all of the forms of Oriental medicine which are used in the West today, including acupuncture, shiatsu, acupressure massage, and macrobiotics, are part of or have their roots in Chinese medicine. Legend has it that acupuncture developed when early Chinese physicians observed unpredicted effects of puncture wounds in Chinese warriors. The oldest known text on acupuncture, the Systematic Classic of Acupuncture, dates back to 282 A.D. Although acupuncture is its best known technique, Chinese medicine traditionally utilizes herbal remedies, dietary therapy, lifestyle changes and other means to treat patients.

In the early 1900s, only a few Western physicians who had visited China were fascinated by acupuncture, but outside of Asian-American communities it remained virtually unknown until the 1970s, when Richard Nixon became the first U.S. president to visit China. On Nixon's trip, journalists were amazed to observe major operations being performed on patients without the use of anesthetics. Instead, wide-awake patients were being operated on with only acupuncture needles inserted into them to control pain. During that time, a famous columnist for the New York Times, James Reston, had to undergo surgery and elected to use acupuncture instead of pain medication, and he wrote some convincing stories on its effectiveness.

Today, acupuncture is being practiced in all 50 states by over 9,000 practitioners, with over 4,000 MDs including it in their practices. Acupuncture has shown notable success in treating many conditions, and over 15 million Americans have used it as a therapy. Acupuncture, however, remains largely unsupported by the medical establishment. The American Medical Association has been resistant to researching it, as it is based on concepts very different from the Western scientific model.

Several forms of acupuncture are being used today in America. Japanese acupuncture uses extremely thin needles and does not incorporate herbal medicine in its practice. Auricular acupuncture uses acupuncture points only on the ear, which are believed to stimulate and balance internal organs. In France, where acupuncture is very popular and more accepted by the medical establishment, neurologist Paul Nogier developed a system of acupuncture based on neuroendocrine theory rather than on traditional Chinese concepts, which is gaining some use in America.

KEY TERMS

Acupressure— Form of massage using acupuncture points.

Auricular acupuncture— Acupuncture using only points found on the ears.

Chi— Basic life energy.

Meridian— Channel through which chi travels in the body.

Moxibustion— Acupuncture technique which burns the herb moxa or mugwort.

Tonification— Acupuncture technique for strengthening the body.

Yin/Yang— Universal characteristics used to describe aspects of the natural world.

Basic ideas of Chinese medicine

Chinese medicine views the body as a small part of the universe, and subject to universal laws and principles of harmony and balance. Chinese medicine does not draw a sharp line, as Western medicine does, between mind and body. The Chinese system believes that emotions and mental states are every bit as influential on disease as purely physical mechanisms, and considers factors like work, environment, lifestyle and relationships as fundamental to the overall picture of a patient's health. Chinese medicine also uses very different symbols and ideas to discuss the body and health. While Western medicine typically describes health in terms of measurable physical processes made up of chemical reactions, the Chinese use ideas like yin and yang, chi, the organ system, and the five elements to describe health and the body. To understand the ideas behind acupuncture, it is worthwhile to introduce some of these basic terms.

YIN AND YANG. According to Chinese philosophy, the universe and the body can be described by two separate but complementary principles, that of yin and yang. For example, in temperature, yin is cold and yang is hot. In gender, yin is female and yang is male. In activity, yin is passive and yang is active. In light, yin is dark and yang is bright; in direction yin is inward and downward and yang is outward and up, and so on. Nothing is ever completely yin or yang, but a combination of the two. These two principles are always interacting, opposing, and influencing each other. The goal of Chinese medicine is not to eliminate either yin or yang, but to allow the two to balance each other and exist harmoniously together. For instance, if a person suffers from symptoms of high blood pressure, the Chinese system would say that the heart organ might have too much yang, and would recommend methods either to reduce the yang or to increase the yin of the heart, depending on the other symptoms and organs in the body. Thus, acupuncture therapies seek to either increase or reduce yang, or increase or reduce yin in particular regions of the body.

CHI. Another fundamental concept of Chinese medicine is that of chi (pronounced chee, also spelled qi ). Chi is the fundamental life energy of the universe. It is invisible and is found in the environment in the air, water, food and sunlight. In the body, it is the invisible vital force that creates and animates life. We are all born with inherited amounts of chi, and we also get acquired chi from the food we eat and the air we breathe. The level and quality of a person's chi also depends on the state of physical, mental and emotional balance. Chi travels through the body along channels called meridians.

THE ORGAN SYSTEM. In the Chinese system, there are twelve main organs: the lung, large intestine, stomach, spleen, heart, small intestine, urinary bladder, kidney, liver, gallbladder, pericardium, and the "triple warmer," which represents the entire torso region. Each organ has chi energy associated with it, and each organ interacts with particular emotions on the mental level. As there are twelve organs, there are twelve types of chi which can move through the body, and these move through twelve main channels or meridians. Chinese doctors connect symptoms to organs. That is, symptoms are caused by yin/yang imbalances in one or more organs, or by an unhealthy flow of chi to or from one organ to another. Each organ has a different profile of symptoms it can manifest.

THE FIVE ELEMENTS. Another basis of Chinese theory is that the world and body are made up of five main elements: wood, fire, earth, metal, and water. These elements are all interconnected, and each element either generates or controls another element. For instance, water controls fire and earth generates metal. Each organ is associated with one of the five elements. The Chinese system uses elements and organs to describe and treat conditions. For instance, the kidney is associated with water and the heart is associated with fire, and the two organs are related as water and fire are related. If the kidney is weak, then there might be a corresponding fire problem in the heart, so treatment might be made by acupuncture or herbs to cool the heart system and/or increase energy in the kidney system.

The Chinese have developed an intricate system of how organs and elements are related to physical and mental symptoms, and the above example is a very simple one. Although this system sounds suspect to Western scientists, some interesting parallels have been observed. For instance, Western medicine has observed that with severe heart problems, kidney failure often follows, but it still does not know exactly why. In Chinese medicine, this connection between the two organs has long been established.

MEDICAL PROBLEMS AND ACUPUNCTURE. In Chinese medicine, disease as seen as imbalances in the organ system or chi meridians, and the goal of any remedy or treatment is to assist the body in reestablishing its innate harmony. Disease can be caused by internal factors like emotions, external factors like the environment and weather, and other factors like injuries, trauma, diet, and germs. However, infection is seen not as primarily a problem with germs and viruses, but as a weakness in the energy of the body which is allowing a sickness to occur. In Chinese medicine, no two illnesses are ever the same, as each body has its own characteristics of symptoms and balance. Acupuncture is used to open or adjust the flow of chi throughout the organ system, which will strengthen the body and prompt it to heal itself.

A VISIT TO THE ACUPUNCTURIST. The first thing an acupuncturist will do is get a thorough idea of a patient's medical history and symptoms, both physical and emotional. This is done with a long questionnaire and interview. Then the acupuncturist will examine the patient to find further symptoms, looking closely at the tongue, the pulse at various points in the body, the complexion, general behavior, and other signs like coughs or pains. From this, the practitioner will be able to determine patterns of symptoms which indicate which organs and areas are imbalanced. Depending on the problem, the acupuncturist will insert needles to manipulate chi on one or more of the twelve organ meridians. On these twelve meridians, there are nearly 2,000 points which can be used in acupuncture, with around 200 points being most frequently used by traditional acupuncturists. During an individual treatment, one to twenty needles may be used, depending on which meridian points are chosen.

Acupuncture needles are always sterilized and acupuncture is a very safe procedure. The depth of insertion of needles varies, depending on which chi channels are being treated. Some points barely go beyond superficial layers of skin, while some acupuncture points require a depth of 1-3 in (2.5-7.5 cm) of needle. The needles generally do not cause pain. Patients sometimes report pinching sensations and often pleasant sensations, as the body experiences healing. Depending on the problem, the acupuncturist might spin or move the needles, or even pass a slight electrical current through some of them. Moxibustion may be sometimes used, in which an herbal mixture (moxa or mugwort) is either burned like incense on the acupuncture point or on the end of the needle, which is believed to stimulate chi in a particular way. Also, acupuncturists sometimes use cupping, during which small suction cups are placed on meridian points to stimulate them.

How long the needles are inserted also varies. Some patients only require a quick in and out insertion to clear problems and provide tonification (strengthening of health), while some other conditions might require needles inserted up to an hour or more. The average visit to an acupuncturist takes about thirty minutes. The number of visits to the acupuncturist varies as well, with some conditions improved in one or two sessions and others requiring a series of six or more visits over the course of weeks or months.

Costs for acupuncture can vary, depending on whether the practitioner is an MD. Initial visits with non-MD acupuncturists can run from $50-$100, with follow-up visits usually costing less. Insurance reimbursement also varies widely, depending on the company and state. Regulations have been changing often. Some states authorize Medicaid to cover acupuncture for certain conditions, and some states have mandated that general coverage pay for acupuncture. Consumers should be aware of the provisions for acupuncture in their individual policies.

Precautions

Acupuncture is generally a very safe procedure. If a patient is in doubt about a medical condition, more than one physician should be consulted. Also, a patient should always feel comfortable and confident that their acupuncturist is knowledgable and properly trained.

Research and general acceptance

Mainstream medicine has been slow to accept acupuncture; although more MDs are using it, the American Medical Association does not recognize it as a specialty. The reason for this is that the mechanism of acupuncture is difficult to scientifically understand or measure, such as the invisible energy of chi in the body. Western medicine, admitting that acupuncture works in many cases, has theorized that the energy meridians are actually part of the nervous system and that acupuncture relieves pain by releasing endorphins, or natural pain killers, into the bloodstream. Despite the ambiguity in the biochemistry involved, acupuncture continues to show effectiveness in clinical tests, from reducing pain to alleviating the symptoms of chronic illnesses, and research in acupuncture is currently growing. The Office of Alternative Medicine of the National Institute of Health is currently funding research in the use of acupuncture for treating depression and attention-deficit disorder.

Resources

PERIODICALS

American Journal of Acupuncture. 1840 41st Ave., Suite 102, P.O. Box 610, Capitola, CA 95010.

OTHER

American Association of Oriental Medicine. December 28, 2000. 〈http://www.aaom.org〉.

North American Society of Acupuncture and Alternative Medicine. December 28, 2000. 〈http://www.nasa-altmed.com〉.

acupuncture is perhaps most helpfully defined in general as the insertion of one or more needles into the body with therapeutic intent. The advantage of this wide definition is that it covers the many current different variants of this ancient practice, without being specifically tied to any one of them. At the broadest level, the most critical difference of approach lies between classical Oriental forms of acupuncture and those rooted more in modern Western biomedicine. Most of the main differences in practice are based on this dichotomy, although there are significant distinctions both between and within these two traditions, in terms of such issues as the model used to explain the operation of acupuncture and the scope of its practice. There are also debates in both traditions about the number and location of the acupuncture points themselves.

What is not in dispute, however, is that acupuncture has a history spanning well over 2000 years, taking its origin from ancient China. One of the oldest known books on acupuncture here is the Yellow Emperor's classic of internal medicine (the Nei Jing), which is held to date back many hundreds of years bc. From China, acupuncture spread to such local cultural areas as Korea and Japan, where it became incorporated into mainstream medicine by the seventh and eighth centuries ad. By the sixteenth and seventeenth centuries knowledge of it had reached Europe, mainly through missionaries and ships' surgeons who had witnessed its use in the East, but who had only a rudimentary understanding of its operation.

In the early nineteenth century it began to be practised by a number of doctors in Britain and the US. It went into something of a decline in most countries in the Western world thereafter — and even, briefly, in China in the modernization period under the Kuomintang in the first half of the twentieth century. However, the advent of ‘ping-pong’ diplomacy between China and the West in the first half of the 1970s, associated with dramatic television pictures of open-heart surgery being carried out by the Chinese with the use of ‘acupuncture anaesthesia’, led to spiralling public interest. This interest has continued to grow in both medical and non-medical circles up to the present day, alongside other complementary and alternative therapies—resulting in increasing numbers of acupuncturists and its widespread employment in the West in pain clinics and other settings.

In its classic application within traditional Chinese medicine, acupuncture is seen as being underpinned by the interplay of yin and yang; disease is seen as deriving from the disequilibrium of such opposing forces. In this conceptualization, drawing on Taoist philosophy, acupuncture treatment for the sick is used to correct imbalances and to maintain equilibrium in the healthy to prevent illness. This involves manipulating the patient's Qi, the life force, by stimulating needles strategically placed at selected acupuncture points which lie on the 12 main meridians that run along the body and connect with central internal organs. Typically, the needles are placed in sites at a distance from the condition itself. In this frame of reference — and as employed in China and many other Oriental societies — acupuncture is seen as something of a panacea, which can deal with a wide range of disorders spanning from asthma and ulcers to depression and angina.

Acupuncture, though, is characteristically used very differently in Western biomedicine — mainly as a more narrowly defined remedy for pain and for addictions of various kinds. The traditional Chinese philosophies about acupuncture are usually seen as problematic within this framework, not least because there is no consistent correspondence between biomedical conceptions of the physical structures of the body and the classical acupuncture points and the meridians along which they are held to run. Indeed, within more Westernized approaches, needling often occurs in situ rather than at a distance. Other explanations of its operation have also typically been sought by Western doctors, generally based on neurophysiology. Initially the ‘gate-control’ theory was widely adopted, centred on the notion that the stimulation of the larger nerve fibres can block pain. More recently, however, emphasis has shifted to the notion that endorphins — opiates of a type naturally produced by the body — are released by acupuncture, thus giving rise to its analgesic effects. However, neither theory adequately explains the long-term relief of chronic pain nor the wider therapeutic effects traditionally claimed for acupuncture.

From a conventional Western perspective, many studies of acupuncture to date have been methodologically unsound — although its proponents might point to the difficulties of evaluating its efficacy through randomized trials in view of its holistic, classical Oriental origins. Current evidence based on trials of its efficacy in treating pain is growing, though, even if rigorous trials of acupuncture for other disorders are few and far between and are not always supportive of the claimed benefits. Another important issue in the West is the regulation of acupuncture practice and whether it should be formally restricted either to doctors or to those appropriately trained in acupuncture, given that it is an invasive technique. In untutored hands, acupuncture has occasionally given rise to a number of complications, such as Hepatitis B and AIDS, and the puncturing of the heart and lungs, which carry potentially fatal consequences.

It should be stressed in conclusion that, even as discussed here, there are difficulties in clearly defining the boundaries of acupuncture. There are, for example, associated forms of treatment which do not employ needles, but which use acupuncture points. These range from the traditional application of finger pressure, through shiatsu and the burning of a herb, moxa, at such points, to the stimulation of acupuncture points using electrodes, as with techniques such as TENS (transcutaneous electrical nerve stimulation) in modern medical practice. Equally, there are surgical techniques, like suturing and the injection of medicinal substances, that are closer to the definition of acupuncture in so far as they involve needles, but are not conventionally regarded as such. Notwithstanding these definitional issues, though, acupuncture in both its traditional and modern forms looks as if it will continue to be important in the foreseeable future in both the contemporary Western and Eastern worlds, where it is being subjected to increasing use and scientific study.

Mike Saks

Bibliography

Lewith, G.,, Kenyon, J.,, and and Lewis, P. (1996). Complementary medicine: an integrated approach. Oxford University Press.
Lu Gwei-Djen and and Needham, J. (1980). Celestial lancets: a history and rationale of acupuncture and moxa. Cambridge University Press.
Mole, P. (1992). Acupuncture: energy balancing for body, mind and spirit. Element, Longmead.
Saks, M. (1995). Professions and the public interest: medical power, altruism and alternative medicine. Routledge, London.

ACUPUNCTURE

A Visit to China

In September 1971 Dr. Paul Dudley White of Massachusetts General Hospital, and Dr. E. Grey Dimond of the University of Missouri Medical School, along with their wives, were invited to the Peoples' Republic of China by the China Medical Association. When the western physicians expressed an interest in acupuncture, they were invited to witness several surgical procedures using this traditional form of Chinese medicine. Acupuncture involves the placement of needles at strategic points on the body as an anesthetic or to treat acute or chronic conditions. While acupuncture had been practiced for years among Chinese Americans, it was not until President Richard Nixon visited China in 1972 that this different means of treatment was publicized to other Americans.

How Does It Work?

Dr. John W. C. Fox, a Brooklyn anesthesiologist, hypothesized that it worked on the "gate control" technique. According to his idea, sensations passing along peripheral neural fibers must pass through a "gate" in the spinal cord before they are transmitted to the brain. Pain is transmitted along relatively thin fibers and tends to keep the gate open. Acupuncture needles placed in these fibers override the pain sensation by producing a vibratory stimulus that closes the gate and blocks the transmission of pain to the brain. The traditional Chinese explanation is that vital forces pass through meridians or pathways throughout the body. The needles, when manipulated in precise ways, cause changes to take place within the meridians, and if this procedure is done correctly, the process restores the desired balance of heat and cold, or yin and yang, and the pain is anesthetized. "The classical balance between yin and yang is very poetic," said Dr. Fox, "but acupuncture can be explained in terms the Western scientists will accept."

Curiosity and Crackdown

After U.S. scientists brought back glowing reports of acupuncture's use in mainland China, acupuncture practices in the nation's Chinatowns were swamped with non-Chinese Americans wanting treatment. It did not take long for concern to be expressed about unlicensed practitioners. In the United States Chinese acupuncturists practiced without interference for years, although they were unlicensed by state medical boards. Many held medical degrees from Chinese institutions, but bad publicity from unscrupulous practitioners threatened their livelihoods. Various states set up systems for state licensing to regulate acupuncture. The Internal Revenue Service ruled that it was a deductible medical expense for income tax purposes—a sign the practice had gained mainstream recognition.

A Medical Fad

By the end of the decade at least one-quarter of the world's population used acupuncture for analgesia and treatment. It was incorporated to some degree in medical practice and training in many other countries, and in the People's Republic of China it was a routine part of the national health-care system. Its advocates maintained it could be used as an anesthetic in such procedures as open-heart surgery; and it effectively treated conditions such as the common cold, infectious hepatitis, acute appendicitis, toothache, schizophrenia, and migraines. Acupuncture therapists claimed it could even help someone quit smoking, but by 1979 the procedure was all but ignored in the United States.

Acupuncture and American Medical Values

Most Americans dismissed acupuncture because it fit poorly into the value system of American medicine. Acupuncture is an ancient and foreign tradition, a procedure at odds with the American concept of modern, scientifically based medicine. The procedure lacks the technological mystique of the white-coated scientist using complicated instruments to effect cures. There was, moreover, no major advocate of the procedure in the United States demanding clinical trials and laboratory experiments for the practice; and the commercial potential of acupuncture seemed unattractive to the medical industry. However, acupuncture has continued to exist quietly on the medical fringe, used by a small number of adherents as an alternative to Western medicine.

Sources:

"Acupuncture Crackdown," Time (18 September 1972): 55;

"Acupuncture U.S. Style," Newsweek (12 June 1972): 74;

E. Grey Dimond, M.D., "Acupuncture Anesthesia: Western Medicine and Chinese Traditional Medicine," Saturday Evening Post (Summer 1972): 70+;

Richard A. Kurtz and H. Paul Chalfant, The Sociology of Medicine and Illness (Boston: Allyn & Bacon, 1984).

Acupuncture

Acupuncture is an ancient method for relieving pain and treating disease using very fine metal needles. While the invention date of acupuncture is not known, the theory behind it has been handed down through the centuries. According to acupuncture practitioners, certain points on the surface of the body are linked to internal organs. When a patient becomes ill, the illness often manifests itself on a surface site. Treating the external site—or a specific area of skin—creates a link to the internal imbalance.

Philosophy Explains Illness

Early Chinese medical practitioners learned that certain areas of the skin showed sensitivity during illness or organ malfunction. These points of sensitivity were discovered to be part of a pattern. Chinese doctors drew "body maps" to help keep track of the various points. The lines they used to connect the pattern points were called meridians. Each meridian was linked to certain body organs and physical conditions.

According to Chinese Taoist philosophy (a system of religion based on the teachings of philosopher Lao-tse), these points of skin sensitivity relate to the life force or energy called Qi, which circulates throughout the body. Balance within the body depends on the interplay between two forms of energy, called yin and yang. When these forces are in harmony, the body is healthy. When either force becomes dominant, disease or pain occurs. Acupuncture restores the balance between yin and yang by tapping into the body's channels, or meridians, through which these energy forms flow.

The basic reference book on acupuncture is the Nei Ching, or Yellow Emperor's Classic of Internal Medicine, said to have been written by Huang Ti (2697-2596 b.c.), also known as the Yellow Emperor. The Nei Ching, or "Canon of Internal Medicine," is divided into two parts. The first, Su Wen, explains the theoretical basis of Chinese medicine. The second, Ling Shu, tells exactly how to use acupuncture to treat and prevent every then-known disease and gives detailed needle insertion points. An edition of the original Nei Ching was compiled by Wang Ping in a.d. 762 and revised around a.d. 1200. This later edition is the basis for the modern Nei Ching, which remains the foundation of today's acupuncture.

Early Acupuncture Tools

The earliest acupuncture needles are thought to have been made of stone, fish bones, and bamboo. These materials were later replaced by metals such as copper, brass, silver, and gold. Today most acupuncture needles are made of stainless steel, gold, or silver. The needles may be several inches long and are inserted to various depths and then twirled or vibrated. A tiny electric charge may be added. Insertion is painless or, at the most, mildly uncomfortable for a moment. Acupuncture students practice needle insertion on themselves thousands of times while perfecting their technique. The Nei Ching prescribed 365 insertion points; modern acupuncturists use 650 to 800.

Westerners Experiment with Acupuncture

Knowledge of acupuncture was brought to the West by Jesuit missionaries in the 1600s, although detailed descriptions of acupuncture theory and practice were not available to Westerners until Soulie de Morant's writings in the 1940s. Western interest in acupuncture, as well as the medical philosophies that accompany its practice, has been growing steadily since then.

Today, acupuncture is still an important element of Chinese medicine. In fact, acupuncture is often used as an anesthetic when major surgery is performed in China. Western scientists acknowledge acupuncture's effectiveness, noting that the skin does in fact have different levels of electrical resistance at the ancient acupuncture points. Western researchers speculate that acupuncture may stimulate production of the body's natural pain relievers, or endorphins, or it may interrupt nervous system pain messages.

[See also Anesthesia ; Endorphin and enkephalin ; Surgical instruments ]

acupuncture , technique of traditional Chinese medicine, in which a number of very fine metal needles are inserted into the skin at specially designated points. For thousands of years acupuncture has been used, along with herbal medicine, for pain relief and treatment of various ailments. It has often been combined with moxabustion, the burning of leaves of moxa, the Chinese wormwood tree. Today it is widely used in China in the treatment of hay fever, headaches, and ulcers, and some types of blindness, arthritis, diarrhea, and hypertension. Acupuncture is also used, especially in China, as a general anesthetic during childbirth and some types of surgery. Unlike conventional anesthesia, acupuncture does not reduce blood pressure or depress breathing; in addition, the patient stays fully conscious and there is no postoperative hangover or nausea.

Generally, in the practice of acupuncture, needles varying in length from 1/2 in. (1.27 cm) to several inches are inserted in appropriate points of the body, not necessarily near the affected organ. The needles are twirled and vibrated in specific ways; the depth of insertion also affects the treatment. Modern technique sometimes adds electrical stimulation applied through the needles. The traditional acupuncture points (there are about 800) are arranged along 14 lines, or meridians, running the length of the body from head to foot.

The traditional Chinese explanation of the effectiveness of acupuncture is based on the Taoist philosophy (see Taoism ), according to which good health depends on a free circulation of chi ( qi ), or life-force energy, throughout all the organs of the body. The chi, in turn, depends upon a balance of the two opposing energies of yin (negative, dark, feminine) and yang (positive, bright, masculine). The meridians are the main channels of flow. When energy flow is impeded at any point, e.g., because of a diseased organ or stress, illness in other organs may result. Piercing the channels at the proper points is believed to correct the imbalances.

Western researchers have found that the acupuncture points correspond to points on the skin having less electrical resistance than other skin areas. It has been suggested that acupuncture works by stimulating or repressing the autonomic nervous system in various ways, and there is some evidence that stimulation of the skin can affect internal organs by means of nerve reflex pathways. One theory is that acupuncture stimulates the release of natural pain-relieving chemicals called endorphins . Another is that it stimulates the pituitary gland, which in turn stimulates the adrenal gland to release anti-inflammatory chemicals.

Since the early 1970s, acupuncture has gradually become more accepted in the United States. Many states now accredit schools of acupuncture and administer licensing examinations for nonphysicians. Some physicians are studying and using acupuncture as an adjunct treatment. In the United States acupuncture has been used most often for pain control and drug and alcohol addiction. One impediment to total acceptance is the difficulty of fitting a traditional technique from another culture into the strict methods of scientific clinical trials customary in Western medicine. Studies have shown some benefit from acupuncture, but it is difficult to control for the placebo effect; so-called sham acupuncture, involving the use of needles superficially at points not used in acupuncture, has also shown some pain-relief benefits when used as a control in studies.

Bibliography: See S. T. Chang, The Complete Book of Acupuncture (1976); G. S. De Morant, Chinese Acupuncture (2 vol., tr. 1989).

acupuncture System of medical treatment in which long needles are inserted into the body to assist healing, relieve pain, or for anaesthetic purposes. In ancient Chinese philosophy, acupuncture is proposed to restore the balance of yin and yang by freeing the flow of life-energy (chi) through pathways in the body. A possible scientific explanation is that the needles activate deep sensory nerves that stimulate the pituitary gland and hypothalamus to produce endorphins.

Acupuncture. One of the nine branches of Chinese traditional medicine. Since the body acts as a channel, especially for chʾi, the points of insertion of the needles of acupuncture do not have to be proximate to the place of pain and disorder: they stimulate and promote the body's own ability to treat itself; thus the carefully mapped points of insertion (the numbers vary from 350 to 450) are related to the body's internal system of communication and control.

acupuncture (ak-yoo-punk-cher) n. a complementary therapy, developed by Eastern physicians, in which thin metal needles are inserted into selected points beneath the skin. It is used to relieve the symptoms of a wide range of physical and psychological conditions.
www.acupuncture.org.uk Website of the British Acupuncture Council, the UK's main regulatory body for the practice of acupuncture

ac·u·punc·ture / ˈakyəˌpəngkchər/ • n. a system of complementary medicine that involves pricking the skin or tissues with needles, used to alleviate pain and to treat various conditions. DERIVATIVES: ac·u·punc·tur·ist / -ist/ n.

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