Acupuncture: Ancient and current health care

Current acupuncture training requirements 

Today, there are 47 accredited acupuncture schools in the US, and more than 40 states issue acupuncture licenses. License requirements vary by state but most call for a master's degree from an accredited institution plus a diploma from the National Certification Commission on Acupuncture and Oriental Medicine (NCCAOM) (1). Carrying malpractice insurance is the norm.

Professional standards of the FDA and the training schools have brought acupuncture in line with modern thinking about medical hygiene. In 1996 acupuncture needles were approved by the FDA for use by licensed practitioners; needles are required by law to be labeled for single use only. In addition, all acupuncture needles are solid and sterile.

Great emphasis is placed on “universal precautions” during clinical training. Practitioners are taught to establish both clean and sterile fields for needles, and to wash hands before and after touching patients, needles, and biohazard containers. All points are swabbed with alcohol before insertion. Used needles are immediately placed in biohazard containers and are disposed of as medical sharps (ie, incinerated). Gloves are typically not worn since they interfere with the practitioner's ability to feel the patient's qi. When needles are inserted at the accurate point locations and with proper practitioner form, insertions are typically not painful.

Many additional techniques are commonly used during acupuncture treatments: electro-acupuncture (involving a battery-operated machine sending electrical impulses to the needles), cupping, bloodletting,gwa sha (a strong massage technique performed with special tools), and tui na (Chinese energetic qi and blood moving massage). Moxibustion, the burning of moxa (dried Artemesia vulgaris, or mugwort), has warming, tonifying, and moving properties and is commonly used on specific acupuncture points as well as on painful areas.

Acupuncture theory 

Acupuncture theory holds that qi travels through the body along energetic pathways called meridians, and are named for the organs they intersect and influence. Health problems occur when the body's qi is not flowing smoothly along the meridians or when a disruption occurs in the energetic function of the organs. Acupuncture works by redirecting the flow of qi along the meridians and by regulating the organs' energy. Needles inserted at points along the meridians unblock the flow of qi.

Acupuncture points on the body have both local and systemic influences. Pain, for example, is treated not only locally but distally as well, via points further along the meridian, drawing energy away from the pain. Conditions caused by organ dysfunction such as asthma or infertility are differentiated according to the specific symptoms present. Points are then selected appropriate to both the symptoms reported and the cause of that individual's problem. For example, infertility can be differentiated into nine different patterns, including such diagnoses as “Blood Deficiency,” “Cold in the Uterus,” or “Dampness in the Lower Burner,” among others. Acupuncture differentiates each medical condition according to how it presents itself in each individual—both in symptoms and causes. In this medical system, no health condition is ever unexplained.

There is not yet a complete explanation, in Western medical terms, for the physiological changes that make acupuncture effective, nor has qi ever been measured or monitored scientifically. However, in 1997 the NIH issued a consensus statement, based on a meta-analysis of the Western scientific research on acupuncture, concluding that “considerable evidence supports the claim that opioid peptides are released during acupuncture and that the analgesic effects of acupuncture are at least partially explained by their actions.” It goes on to say that acupuncture may also “stimulate the hypothalamus and the pituitary gland, resulting in a broad spectrum of systemic effects. Alterations in the secretion of neurotransmitters and neurohormones and changes in the regulation of blood flow have been documented. There is also evidence of alterations in immune functions produced by acupuncture.” (2)

This consensus statement, as well as the World Health Organization's statement (3), should allay the notion that acupuncture's effects are all attributable to the placebo effect.

The efficacy of acupuncture is difficult to study empirically because of the fundamental divergence in the two schools of thought. The gold standard in Western science is randomized, double-blind, and controlled trials, utilizing one specific protocol for each condition. However, in a medical system where each individual is treated according to specific conditions and symptoms, it would be invalid to use the same protocol for every condition. Individualized protocols are critical to the success of the acupuncture treatment. For this reason, Western scientific studies performed with acupuncture show mixed results. Only recently have studies been designed and implemented allowing for standardization, control, blinding, and a certain amount of individualization. That said, both NIH and WHO have conducted meta-analyses of scientific research and released lists of conditions for which they deem acupuncture effective (see appendix).

Despite these limitations there are some areas in which scientific studies have managed to clearly point out the effectiveness of acupuncture treatments for a variety of conditions, including infertility. Auricular acupuncture was concluded by Gerhard et al. to “offer a valuable alternative therapy for female infertility due to hormone disorders” (4). A study by Stener-Victorin et al. “on the reduction of blood flow impedance in the uterine arteries of infertile women with electro-acupuncture” concluded that the mean pulsatility index was significantly reduced with electro-acupuncture (5). Another study by Stener-Victorin et al. concluded that electro-acupuncture treatments can induce regular ovulation in women with polycystic ovary syndrome (6). A more recent study by Paulus et al. found that acupuncture treatments performed both pre- and post-IVF transfer increased the pregnancy success rates from 26.3% to 42.5% (7). Chang et al. review a number of studies concerning the role of acupuncture in infertility, discuss the physiological changes that take place in the body during acupuncture infertility treatments, and conclude that “there is sufficient evidence of acupuncture's value to expand its use into conventional medicine and treatment of female infertility” (8).

Acupuncture represents an ancient model of medicine that has evolved throughout the centuries and is increasing in popularity throughout the US today, as part of the general trend of acceptance and popularity of nonconventional medicine. Complementary medicine therapies are increasing in the US to the point where Eisenberg et al. extrapolate that “in 1990 Americans made an estimated 425 million visits to providers of unconventional therapy. This number exceeds the number of visits to all US primary care physicians (388 million). … Expenditures associated with the use of unconventional therapy in 1990 amounted to approximately $13.7 billion. This figure is comparable to the $12.8 billion spent out of pocket annually for all hospitalizations in the United States” (9). Many Americans turn to acupuncture when they have pain, when they feel they have reached the limits of conventional Western medicine, or when they are reluctant to turn to or increase medications. They will often turn to acupuncture along with conventional medical therapy to make sure they are utilizing all possible medical options.

It is important that physicians be knowledgeable about the usage and function of acupuncture so that they can best advise and inform their patients about its potential role in their care.