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Acupuncture is one of the oldest medical procedures in the world The earliest reference to it can be traced to a text on Chinese medicine called The Yellow Emperor s Classic of Internal Medicine (the Huang Ti Nei Ching), which dates from the second century BC Acupuncture spread through much of Asia and by the sixteenth century Jesuit missionaries had brought the practice to Europe As early as 1912, William Osler described its use in the first edition of The Principles and Practice of Medicine For lumbago, he wrote, acupuncture is, in acute cases, the most efficient treatment Research and enthusiasm in the United States grew dramatically in 1971 when James Reston wrote an article describing his experience with acupuncture for postoperative analgesia after undergoing an appendectomy while in China
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The mechanism of action of acupuncture is not well understood, but physiologic effects can be measured when acu-
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puncture points are stimulated, such as the release of endorphins and enkephalins Functional MRI studies reveal that different areas of the brain are activated and deactivated during needling
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Stux G, Berman B, Pomeranz B (editors): Basics of Acupuncture 5th ed Springer, 2003
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The current practice of acupuncture in the United States and Europe is associated with a very low incidence of adverse events (as low as 1 in 10,000 to 1 in 100,000 needle insertions) Reactions such as presyncope, syncope, and drowsiness can be easily prevented by having the patient lie flat on the table, monitoring them during their initial visit, and permitting them to remain in the office until a normal state of awareness is achieved Serious complications in the literature over the past 30 years are very rare but include spread of infection and pneumothorax from needling patients with emphysema
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Training, Licensure, & Regulation
Acupuncture educational programs are accredited by the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM) Typical acupuncture training for nonphysicians in the United States requires completion of an accredited 4-year (2500 hours) master s degree training program In order to become a licensed acupuncturist (LAc), a national and, frequently, state board examination must be passed Although many states do not require physicians to obtain additional training, most states require a minimum of 200 hours of training in an accredited program There are currently over 10,000 licensed acupuncture practitioners and 3000 physician acupuncturists in the United States In 22 of the 42 states that license, register, or certify acupuncturists, these practitioners are permitted to work independently
Clinical Uses of Acupuncture
Acupuncture has grown in popularity during the past two decades According to the 2002 National Health Interview Survey the largest and most comprehensive survey of CAM use by Americans to date an estimated 82 million US adults have used acupuncture in the past and 21 million have used it in the previous 12 months In the United States, acupuncture is frequently used to treat acute non life-threatening conditions or chronic conditions that conventional medicine is unable to treat effectively More than 65 systematic reviews of acupuncture have been published since 1989, many pointing out the challenge of designing high-quality trials with effective placebo controls Several types of placebos have been tried: needling at nonacupuncture points, using a noninsertion retractable sham needle, and needling at true acupuncture points that are inappropriate for the condition being treated Data analysis is complicated by the fact that sham treatments can have physiologic effects in and of themselves What follows is a survey of some conditions for which patients frequently seek acupuncture care
Ernst E Acupuncture a critical analysis J Intern Med 2006 Feb;259(2):125 37 [PMID: 16420542]
Clinical Practice
In the United States and Europe, Oriental medicinetrained practitioners conduct a comprehensive multisystem history, observation, and physical examination during the initial consultation Examination consists of palpation of the abdomen and selected acupuncture points; examination of the tongue to assess color, shape, and coating; and palpation of the pulse along the wrist at three locations on both arms to assess its quality, rhythm, and strength Treatment by the classic acupuncture method is based on the belief that each patient presents with a unique constellation of symptoms and signs What this means is that ten patients presenting with migraine headaches might receive ten different Chinese medical diagnoses and ten different treatments Because acupuncture is just one part of a comprehensive system, patients are also often prescribed Chinese herbal therapy, diet, and exercise Western-style practitioners will conduct a conventional examination and include variable components of the Oriental medicine approach depending on the individual s depth of training Treatment is typically based on the formula acupuncture method, which utilizes a fixed combination of acupuncture points for a given medical diagnosis, such that a cohort of migraine sufferers will be treated in a similar way Treatment involves inserting four to fifteen needles at selected acupuncture points for 10 30 minutes though certain schools leave the needles in place for only a few seconds to minutes Virtually all acupuncture is performed with thin, solid, stainless steel, sterile disposable needles that are stimulated manually or with electricity or heat Follow-up consultations last from 20 minutes to 45 minutes A usual course of treatment might consist of weekly or biweekly visits for 4 10 weeks, followed by less frequent visits as the condition improves
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