Acupuncture is one of the oldest health care systems known to humanity, it is the ancient art of inserting, manipulating and stimulating very fine needles on points along meridians of the body; to relieve pain, restore balance, and maintain the health of patients. In China the practice of acupuncture can be traced back to the Stone Age, with the Bian shi, or sharpened stones. In 1963 a bian stone was found in the Duolon County, of Inner Mongolia, China; pushing the origins of acupuncture back to the Neolithic age. Hieroglyphs and pictographs have been found dating from the Shang Dynasty (1600-1100 BCE) depicting acupuncture being practiced along with moxibustion applications. The earliest written record of acupuncture is the Chinese text Shiji in the second century BCE medical text : Yellow Emperor's Inner Canon. Approximately ninety works on acupuncture were written in China between the Han Dynasty and the Song Dynasty. The Emperor Renzong of Song, in 1023, commissioned the production of a bronze statue depicting the meridians and acupuncture points.
A 1991 discovery of the 5,000 year old mummified body of Otzi the Iceman in the European Alps, identified 15 groups of tattoos on the body, that matched contemporary acupuncture points. This evidence suggests that acupuncture has been practiced in Europe since the early Bronze Age. Portuguese missionaries in the 16th century were the first to bring reports of acupuncture to the West in the modern era. Jacob de Bondt, a Danish surgeon who travelling in Asia, described the practice of acupuncture in Japan and Java. The first European text to cite acupuncture was written by William ten Rhijne, a Dutch physician who studied acupuncture for two years while in Japan; it was an essay written in a 1683 medical text on arthritis. Europeans were also becoming interested in moxibustion, which ten Rhijne had also written about. In 1757 the Chinese physician Xu Dquan described the decline of acupuncture, saying it was becoming a lost art, with few experts left to instruct new acupuncturists; acupuncture’s decline was attributed in part to the popularity of prescriptions and medications, as well as its association with the poor. In 1822, an edict from the Chinese Emperor banned the practice and teaching of acupuncture within the Imperial Academy of Medicine.After the Chinese Civil War, Chinese Communist Party leaders ridiculed traditional Chinese medicine, including acupuncture, as superstitious, and backward. Communist Party Chairman, Mao Zedong later reversed this position, declaring "Chinese medicine and acupuncture are a great treasure house, and efforts should be made to explore and raise them to higher levels”.
Acupuncture first gained attention in the United States when President Richard Nixon visited China in 1972. New York Times reporter James Reston, who accompanied Nixon on the visit, received acupuncture in China for post-operative pain after he had undergone an emergency appendectomy under standard anesthesia. Reston was so impressed with the pain relief he experienced from the acupuncture procedure that he wrote about his experience in The New York Times after returning to America. In 1973 the American Internal Revenue Service deemed it acceptable to have acupuncture as a deductable medical expense. The World Health Organization and the United States National Institutes of Health (NIH) have stated, acupuncture can be effective in the treatment of neurological conditions and pain. Reports from the United States National Center for Complimentary and Alternative Medicine and various USA government reports have studied and commented on the efficacy of acupuncture. There is general agreement that acupuncture is safe and effective when administered by well-trained practitioners using sterile needles.
Traditional Chinese medicine (TCM) is based on several thousand years of research, trials and experience that have been handed down from one generation of practitioner to the next. In TCM, the body is treated as a whole that is composed of several systems of function known as the zang-fu (脏腑), these systems are named after specific organs. Zang systems are associated with the solid, yin organs such as the liver, while fu systems are associated with hollow yang organs such as the intestines. Health is explained as a state of balance between the yin and yang, disease is ascribed to either of these forces being unbalanced, blocked or stagnant. The yang force is the immaterial qi (chi), a concept roughly translated as “vital energy". The yin counterpart is blood, which is linked to, but not identical with the physical blood. TCM uses a variety of interventions, including pressure, heat and acupuncture applied to the body's acupuncture points (in Chinese 穴 or xue meaning "cavities") to modify the activity of the zang-fu.
Classical texts describe the majority of the main acupuncture points as existing on the twelve main and two of eight extra meridians (referred to as mai) for a total of fourteen channels through which qi and Blood flow. There are other points not on the fourteen channels that are also needled. Local pain is treated by inserting needles in the tender "ashi" points where qi or Blood is believed to have stagnated.The zang-fu of the twelve main channels are Lung, Large Intestine, Stomach, Spleen, Heart, Small Intestine, Bladder, Kidney, Pericardium, Gall Bladder, Liver and the intangible San Jiao. The eight other pathways, referred to collectively as the qi jing ba mai, include the Luo Vessels, Divergents, Sinew Channels, ren mai and du mai though only the latter two (corresponding to the anterior and posterior saggital plane of the torso respectively) have acupuncture needles applied. The remaining six qi jing ba mai are manipulated by inserting needles to the acupuncture points on the twelve main meridians.
Qi is described as flowing through each channel in a continuous circuit, each channel has a specific aspect and occupies two hours of the Chinese clock.The zang-fu are divided into yin and yang channels, with three of each type located on each limb. Qi is believed to move in a circuit through the body, travelling both superficially and deeply. External pathways correspond to acupuncture points on an acupuncture chart, while deep pathways correspond to where a channel enters the bodily cavity related to each organ. The three yin channels of the hand (Lung, Pericardium, and Heart) begin on the chest and travel along the inner surface 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 of the arm up to the head. The three yin channels of the foot (Spleen, Liver, and Kidney) begin on the foot and travel along the inner surface of the leg to the chest. The three yang channels of the foot (Stomach, Gallbladder, and Urinary Bladder) begin on the face, in the region of the eye, and travel down the body and along the outer surface of the leg to the foot. Each channel is also associated with a yin or yang aspect, either "absolute" (jue-), "lesser" (shao-), "greater" (tai-) or "brightness" (-ming). The theory of the channels is interrelated with the theory of the Organs. Traditionally, the internal Organs have never been regarded as independent anatomical entities. Rather, attention has centered upon the functional and pathological interrelationships between the channel network and the Organs. So close is this identification that each of the twelve traditional Primary channels bears the name of one or another of the vital Organs. In the clinic, the entire framework of diagnostics, therapeutics and point selection is based upon the theoretical framework of the channels. "It is because of the twelve Primary channels that people live, that disease is formed, that people are treated and disease arises." [(Spiritual Axis, chapter 12)]. The National Institutes of Health 1997 consensus development statement on acupuncture stated that acupuncture points, Qi, the meridian system and related theories play an important role in the use of acupuncture, but are difficult to relate to a contemporary understanding of the body. Chinese medicine is based on a system that relates to the world around the body rather than its internal structures.
An acupuncturist decides which points to treat by observing and questioning a patient in order to make a diagnosis according to the tradition which he or she utilizes. In TCM, there are four diagnostic methods: inspection, auscultation and olfaction, inquiring, and palpation.
• Inspection focuses on the face and particularly, the tongue, including analysis of the tongue size, shape, tension, color and coating, and the absence or presence of teeth marks around the edge.
• Auscultation and olfaction refer, respectively, to listening for particular sounds (such as wheezing) and attending to body odor.
• Inquiring focuses on the "seven inquiries", which are: chills and fever; perspiration; appetite, thirst and taste; defecation and urination; pain; sleep; and menses and leukorrhea.
• Palpation includes feeling the body for tender "ashi" points, and palpation of the left and right radial pulses at two levels of pressure (superficial and deep) and three positions Cun, Guan, Chi (immediately proximal to the wrist crease, and one and two fingers' breadth proximally, usually palpated with the index, middle and ring fingers).
Other forms of acupuncture employ additional diagnostic techniques. In many forms of classical Chinese acupuncture, as well as Japanese acupuncture, palpation of the muscles and the hara (abdomen) are central to diagnosis.
Traditional Chinese Medicine
Although TCM is based on the treatment of "patterns of disharmony" rather than biomedical diagnoses, practitioners familiar with both systems have commented on relationships between the two. A given TCM pattern of disharmony may be reflected in a certain range of biomedical diagnoses: thus, the pattern called Deficiency of Spleen Qi could manifest as chronic fatigue, diarrhea or uterine prolapse. Likewise, a population of patients with a given biomedical diagnosis may have varying TCM patterns. These observations are encapsulated in the TCM aphorism "One disease, many patterns; one pattern, many diseases". (Kaptchuk, 1982)
The meridians of acupuncture are similar to the meridians of geography. Studies using nuclear imaging have suggested that tracers may be used to follow meridians and are not related to veins or lymphatic tissues.
Most acupuncturists use disposable stainless steel needles of fine diameter (0.007 to 0.020 in (0.18 to 0.51 mm)), sterilized with ethylene oxide or by autoclave. The size and type of needle used, and the depth of insertion, depend on the acupuncture style of the practitioner. Warming an acupuncture point, typically by moxibustion (the burning of a combination of herbs, primarily (mugwort), is used as a supplemental treatment. The Chinese term zhēn jǐu (針灸), commonly used to refer to acupuncture, comes from zhen meaning "needle", and jiu meaning "moxibustion". Moxibustion is used to varying degrees among current schools of oriental medicine. For example, one well-known technique is to insert the needle at the desired acupuncture point, attach dried moxa to the external end of an acupuncture needle, and then ignite it. The moxa will then smolder for several minutes (depending on the amount adhered to the needle) and conduct heat through the needle to the tissue surrounding the needle in the patient's body. Another common technique is to hold a large glowing stick of moxa over the needles. Moxa is also sometimes burned at the skin surface, usually by applying an ointment to the skin to protect from burns, though burning of the skin is general practice in China.
In Western medicine vascular headaches (the kind that are accompanied by throbbing veins in the temples) are typically treated with analgesics such as aspirin and/or by the use of agents such as niacin that dilate the affected blood vessels in the scalp, but in acupuncture a common treatment for such headaches is to stimulate the sensitive points that are located roughly in the centers of the webs between the thumbs and the palms of the patient's hands, the hé gǔ points. These points are described by acupuncture theory as "targeting the face and head" and are considered to be the most important points when treating disorders affecting the face and head. The patient reclines, and the points on each hand are first sterilized with alcohol, and then thin, disposable needles are inserted to a depth of approximately 3–5 mm until a characteristic "twinge" is felt by the patient, often accompanied by a slight twitching of the area between the thumb and hand. In the clinical practice of acupuncturists, patients frequently report one or more of certain kinds of sensation that are associated with this treatment:
• Extreme sensitivity to pain at the points in the webs of the thumbs.
• In bad headaches, a feeling of nausea that persists for roughly the same period as the stimulation being administered to the webs of the thumbs.
• Simultaneous relief of the headache.
A review for the American Pain Society/American College of Physicians found fair evidence that acupuncture is effective for chronic low back pain. A Cochrane Review concluded that acupuncture was effective in reducing the risk of post-operative nausea and vomiting with minimal side effects. A 2006 review concluded that acupuncture appeared to be more effective than antiemetic drugs. Another Cochrane Review concluded that electroacupuncture can be helpful in the treatment of vomiting after the start of chemotherapy. Several trials have indicated that migraine patients benefit from acupuncture. Overall in these trials acupuncture was associated with better outcomes and fewer adverse effects than prophylactic drug treatment. The Osteoarthritis Research Society International released a set of consensus recommendations in 2008 that concluded acupuncture may be useful for treating the symptoms of osteoarthritis of the knee. In 1997, the United States National Institutes of Health (NIH) issued a consensus statement on acupuncture that concluded that there was sufficient evidence to encourage further study and expand the use of acupuncture. In 2003 the World Health Organization’s Department of Essential Drugs and Medicine Policy produced a report on acupuncture. The report was drafted, revised and updated by Zhu-Fan Xie, the Director for the Institute of Integrated Medicines of Beijing Medical University, and contained, based on research results available in early 1999, a list of diseases, symptoms or conditions for which it was believed acupuncture had been demonstrated as an effective treatment, as well as a second list of conditions that were possibly able to be treated with acupuncture. It is hoped that it will provide a useful resource for researchers, health care providers, national health authorities and the general public. The National Health Service of the United Kingdom states that there is "reasonably good evidence that acupuncture is an effective treatment" for nausea, vomiting, osteoarthritis of the knee and several types of pain.
Because acupuncture needles penetrate the skin, some forms of acupuncture are invasive procedures, and therefore not without risk. Injuries are rare among patients treated by trained practitioners. In most jurisdictions, needles are required by law to be sterile, disposable and used only once; in some places, needles may be reused if they are first resterilized, e.g. in an autoclave. When needles are contaminated, risk of bacterial or other blood-borne infection increases, as with re-use of any type of needle. Several styles of Japanese acupuncture use non-inserted needling, making for an entirely non-invasive procedure. In non-inserted needling the needle is brought to the skin, but never penetrates it, and various other acupuncture tools are used to tap or stroke along the meridians. Notable examples of these styles are Tōyōhari and the pediatric acupuncture style Shōnishin.
Risks of injury from the improper insertion of acupuncture needles include: Nerve injury, resulting from the accidental puncture of any nerve, Brain Danage 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 (a hole in the breastbone that occurs as the result of a congenital defect.), 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, and with unsterilized needles and lack of infection control: transmission of infectious diseases. The risk can be reduced through proper training of acupuncturists.
Compared with other treatments
Commenting on the relative safety of acupuncture compared with other treatments, the NIH consensus panel stated that "adverse side effects of acupuncture are extremely low and often lower than conventional treatments." They also stated "the incidence of adverse effects is substantially lower than that of many drugs or other accepted medical procedures used for the same condition. For example, musculoskelatol conditions, such as fibromyalgia, myofascial pain, and tennis elbow are conditions for which acupuncture may be beneficial. These painful conditions are often treated with, among other things, anti-inflamitory medications (aspirin, ibuprofen, etc.) or with steroid injections. Both medical interventions have a potential for deleterious side effects but are still widely used and are considered acceptable treatments."
Acupuncturists may practice herbal medicine and manipulative therapy (tuina), or be a physician or naturopath who incorporates acupuncture in a simplified form. In many American states, medical doctors are not required to have any formal training to perform acupuncture. Over 20 states allow chiropractors to perform acupuncture with less than 200 hours training. The typical amount of hours of training by licensed acupuncturists is over 3,000 hours. License is regulated by the state or province in many countries, and often requires passage of a board exam. In the US, acupuncture is practiced by a variety of healthcare providers. Those who specialize in Acupuncture and Oriental Medicine are usually referred to as "licensed acupuncturists", or L.Ac.'s. The abbreviation "Dipl. Ac." stands for "Diplomate of Acupuncture" and signifies that the holder is board-certified by the NCCAOM. Professional degrees are usually at the level of a Master’s Degree. A poll of American doctors in 2005 showed that 59% believe acupuncture was at least somewhat effective. In 1996, the United States Food and Drug Administration changed the status of acupuncture needles from Class III to Class II medical devices, meaning that needles are regarded as safe and effective when used appropriately by licensed practitioners. As of 2004, nearly 50% of Americans who were enrolled in employer health insurance plans were covered for acupuncture treatments.
Canadian acupuncturists have been licensed in British Columbia since 2003. Alberta Acupuncturists are licensed, as they are in Quebec and Newfoundland. In Ontario, the practice of acupuncture is now regulated by the Traditional Chinese Medicine Act, 2006, S.O. 2006, chapter 27. The Ontario government is still in the process of establishing a college whose mandate will be to oversee the implementation of policies and regulations relating to the profession.