Acupuncture is thought to have originated in China and is most commonly associated with Traditional Chinese medicine (TCM). Different types of acupuncture (Japanese, Korean, and classical Chinese acupuncture) are practiced and taught throughout the world.  Acupuncture is a technique of inserting and manipulating filiform needles into "acupuncture points" on the body. According to acupuncture theory, this will restore health and well-being, and is particularly good at treating pain.

What is acupuncture?

Acupuncture is one of the oldest, most commonly used medical procedures in the world. Originating in China more than 2,000 years ago. The term acupuncture describes a family of procedures involving stimulation of anatomical points on the body by a variety of techniques.

Disease is understood as a loss of homeostasis among the several systems of function, and treatment of disease is attempted by modifying the activity of one or more systems of function through the activity of needles, pressure, heat, etc. on sensitive parts of the body of small volume traditionally called "acupuncture points" in English, or "xue" in Chinese. This is referred to as treating "patterns of disharmony".

Chinese medical theory holds that acupuncture works by normalizing the free flow of qi (a difficult-to-translate concept that pervades Chinese philosophy and is commonly translated as "vital energy") throughout the body. Pain or illnesses are treated by attempting to remedy local or systemic accumulations or deficiencies of qi. Pain is considered to indicate blockage or stagnation of the flow of qi, and an axiom of the medical literature of acupuncture is "no pain, no blockage; no blockage, no pain".

 Treatment of acupuncture points may be performed along the twelve main or eight extra meridians, located throughout the body, or on tender points, called "ashi". Of the eight extra meridians, only two have acupuncture points of their own. The other six meridians are "activated" by using a master and couple point technique which involves needling the acupuncture points located on the twelve main meridians that correspond to the particular extra meridian. Ten of the main meridians are named after organs of the body (Heart, Liver, etc.), and the other two are named after so called body functions (Heart Protector or Pericardium, and San Jiao). The meridians are capitalized to avoid confusion with a physical organ (for example, we write the "Heart meridian" as opposed to the "heart meridian"). The two most important of the eight "extra" meridians are situated on the midline of the anterior and posterior aspects of the trunk and head. The twelve primary meridians run vertically, bilaterally, and symmetrically and every channel corresponds to and connects internally with one of the twelve Zang Fu ("organs"). This means that there are six yin and six yang channels.

There are three yin and three yang channels on each arm, and three yin and three yang on each leg.

The three yin channels of the hand (Lung, Pericardium, and Heart) begin on the chest and travel along the inner surface (mostly the anterior portion) of the arm to the hand.

The three yang channels of the hand (Large intestine, San Jiao, and Small intestine) begin on the hand and travel along the outer surface (mostly the posterior portion) of the arm to the head.

The three yang channels of the foot (Stomach, Gallbladder, and Bladder) begin on the face, in the region of the eye, and travel down the body and along the outer surface (mostly the anterior and lateral portion) of the leg to the foot.

The three yin channels of the foot (Spleen, Liver, and Kidney) begin on the foot and travel along the inner surface (mostly posterior and medial portion) of the leg to the chest or flank.

The movement of qi through each of the twelve channels is comprised of an internal and an external pathway.

The external pathway is what is normally shown on an acupuncture chart and it is relatively superficial. All the acupuncture points of a channel lie on its external pathway. The internal pathways are the deep course of the channel where it enters the body cavities and related Zang-Fu organs. The superficial pathways of the twelve channels describe three complete circuits of the body.

The distribution of qi through the meridians is said to be as follows (the based on the demarcations in TCM's Chinese Clock): Lung channel of hand taiyin to Large Intestine channel of hand yangming to Stomach

channel of foot yangming to Spleen channel of foot taiyin to Heart channel of hand shaoyin to Small Intestine

channel of hand taiyang to Bladder channel of foot taiyang to Kidney channel of foot shaoyin to Pericardium

channel of hand jueyin to San Jiao channel of hand shaoyang to Gallbladder channel of foot shaoyang to Liver

channel of foot jueyin then back to the Lung channel of hand taiyin.

What does acupuncture feel like?

Acupuncture needles are metallic, solid, and hair-thin. People experience acupuncture differently, but most feel no or minimal pain as the needles are inserted. Some people are energized by treatment, while others feel relaxed. Improper needle placement, movement of the patient, or a defect in the needle can cause soreness and pain during treatment.  This is why it is important to seek treatment from a qualified acupuncture practitioner.

How might acupuncture work?

Acupuncture is one of the key components of the system of traditional Chinese medicine (TCM). In the TCM system of medicine, the body is seen as a delicate balance of two opposing and inseparable forces: yin and yang. Yin represents the cold, slow, or passive principle, while yang represents the hot, excited, or active principle. Among the major assumptions in TCM are that health is achieved by maintaining the body in a "balanced state" and that disease is due to an internal imbalance of yin and yang. This imbalance leads to blockage in the flow of qi (vital energy) along pathways known as meridians. It is believed that there are 12 main meridians and 8 secondary meridians and that there are more than 2,000 acupuncture points on the human body that connect with them.

According to the American Academy of Medical Acupuncture (2004), acupuncture may be considered as a complementary therapy for these conditions:

•           Abdominal distention/flatulence*

•           Acute and chronic pain control*

•           Allergic sinusitis *

•           Anesthesia for high-risk patients or patients with previous adverse responses to anesthetics

•           Anorexia

•           Anxiety, fright, panic*

•           Arthritis/arthrosis *

•           Atypical chest pain (negative workup)

•           Bursitis, tendonitis, carpal tunnel syndrome*

•           Certain functional gastrointestinal disorders (nausea and vomiting, esophageal spasm, hyperacidity, irritable bowel) *

•           Cervical and lumbar spine syndromes*

•           Constipation, diarrhea *

•           Cough with contraindications for narcotics

•           Drug detoxification *

•           Dysmenorrhea, pelvic pain *

•           Frozen shoulder *

•           Headache (migraine and tension-type), vertigo (Meniere disease), tinnitus *

•           Idiopathic palpitations, sinus tachycardia

•           In fractures, assisting in pain control, edema, and enhancing healing process

•           Muscle spasms, tremors, tics, contractures*

•           Neuralgias (trigeminal, herpes zoster, postherpetic pain, other)

•           Paresthesias *

•           Persistent hiccups*

•           Phantom pain

•           Plantar fasciitis*

•           Post-traumatic and post-operative ileus *

•           Selected dermatoses (urticaria, pruritus, eczema, psoriasis)

•           Sequelae of stroke syndrome (aphasia, hemiplegia) *

•           Seventh nerve palsy

•           Severe hyperthermia

•           Sprains and contusions

•           Temporo-mandibular joint derangement, bruxism *

•           Urinary incontinence, retention (neurogenic, spastic, adverse drug effect) *

*           Also included in the World Health Organization list of acupuncture indications.

Is acupuncture safe?

The U.S. Food and Drug Administration (FDA) approved acupuncture needles for use by licensed practitioners in 1996. The FDA requires that sterile, nontoxic needles be used and that they be labeled for single use by qualified practitioners only.

Note: When not delivered properly, acupuncture can cause serious adverse effects, including infections and punctured organs.

Will it be covered by my insurance?

Acupuncture is one of the CAM therapies that are more commonly covered by insurance. However, you should check with your insurer before you start treatment to see whether acupuncture will be covered for your condition and, if so, to what extent. Some insurance plans require preauthorization for acupuncture. 

Traditional Chinese medicine (TCM): A whole medical system that was documented in China by the 3rd century B.C. TCM is based on a concept of vital energy, or qi, that is believed to flow throughout the body. It is proposed to regulate a person's spiritual, emotional, mental, and physical balance and to be influenced by the opposing forces of yin (negative energy) and yang (positive energy). Disease is proposed to result from the flow of qi being disrupted and yin and yang becoming unbalanced. Among the components of TCM are herbal and nutritional therapy, restorative physical exercises, meditation, acupuncture, and remedial massage.

Safety and risks in Acupuncture

Because acupuncture needles penetrate the skin, many forms of acupuncture are invasive procedures, and therefore not without risk. Injuries are rare among patients treated by trained practitioners.

Certain forms of acupuncture such as the Japanese Tōyōhari and Shōnishin often use non-invasive techniques, in which specially-designed needles are rubbed or pressed against the skin. These methods are common in Japanese pediatric use.

Other risks of injury from the insertion of acupuncture needles include:

•  Nerve injury, resulting from the accidental puncture of any nerve.

•  Brain damage or stroke, which is possible with very deep needling at the base of the skull.

•  Pneumothorax from deep needling into the lung.

•  Kidney damage from deep needling in the low back.

•  Haemopericardium, or puncture of the protective membrane surrounding the heart, which may occur with needling over a sternal foramen (an undetectable hole in the breastbone which can occur in up to 10% of people.

•  Risk of terminating pregnancy with the use of certain acupuncture points that have been shown to stimulate the production of adrenocorticotropic hormone (ACTH) and oxytocin.

These risks are slight and can all be avoided through proper training of acupuncturists. For correct perspective, their risk should be compared to the level of side effects of common drugs and biomedical treatment - see below. Graduates of medical schools and (in the US) accreditated acupuncture schools receive thorough instruction in proper technique so as to avoid these events. 

Electroacupuncture is a form of acupuncture in which acupuncture needles are attached to a device that generates continuous electric pulses, generating a small electric current that flows between pairs of needles. Another term is Percutaneous Electrical Nerve Stimulation (PENS).

Auriculotherapy/ Auricular Therapy (Ear Acupuncture)
Auriculotherapy is the stimulation of the auricle of the external ear for the diagnosis and treatment of health conditions in other parts of the body. It is also known as ear acupuncture or auricular acupuncture when the stimulation is achieved by the insertion of acupuncture needles, whereas the term auriculotherapy often refers to electrical stimulation of the surface of ear reflex points.
Auriculotherapy is a quick, inexpensive, and non-invasive method of pain control. Ear acupuncture is also used as anesthesia during medical procedures. It is used frequently to help people overcome drug, tobacco, and alcohol addictions, and is used to treat chronic health conditions and diseases.
 

Meridian: A traditional Chinese medicine term for each of the 20 pathways throughout the body for the flow of qi, or vital energy, accessed through acupuncture points.

Qi: A Chinese term for vital energy or life force. In traditional Chinese medicine, qi (pronounced "chee") is believed to regulate a person's spiritual, emotional, mental, and physical balance, and to be influenced by the opposing forces of yin and yang.

Research:

Effects of aromatherapy acupressure on hemiplegic shoulder pain and motor power in stroke patients: a pilot study.

The effectiveness of relaxation acupoint stimulation and acupressure with aromatic lavender essential oil for non-specific low back pain in Hong Kong: a randomised controlled trial.

Treatment of low back pain by acupressure and physical therapy: randomised controlled trial.

Acupuncture as an adjunct for sedation during lithotripsy.

Effectiveness of combined acupuncture therapy and conventional treatment on shoulder range of motion and motor power in stroke patients with hemiplegic shoulder subluxation: a pilot study.