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This article summarizes the research base, probable mechanism of actions, and clinical applications of acupuncture. It offers the clinician a deeper understanding of appropriate conditions for which acupuncture may be useful, outlines how to integrate acupuncture into a clinical practice, and describes referral and training issues.
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Review Article
Acupuncture: A Clinical Review
Victor S. Sierpina, MD, and Moshe A. Frenkel, MD
Abstract: This article summarizes the research base, probable mech-
anism of actions, and clinical applications of acupuncture. It offers
the clinician a deeper understanding of appropriate conditions for
which acupuncture may be useful, outlines how to integrate acu-
puncture into a clinical practice, and describes referral and training
Key Words: acupuncture, alternative therapies, analgesia, traditional
Chinese medicine
Acupuncture is among the best known of complementary
and alternative therapies. Acupuncture is a treatment
method that originated more than 3,000 years ago in China
and is practiced in most of the world. The method is com-
monly practiced as a routine treatment in China, Japan, Ko-
rea, and Taiwan, and since the late 1970s has gained popu-
larity in the United States as well as other parts of the Western
Its application in humans and for a wide array of
clinical conditions requires explanation. This review will pro-
vide the busy clinician with a short summary of the history of
acupuncture, models of its imputed mechanism of action,
evidence base for effectiveness, and resources for further in-
formation about acupuncture. Primarily though, we provide a
summary of the kinds of clinical applications for which acu-
puncture can be considered and a model for how to integrate
a referral for acupuncture into the medical setting.
The practice of acupuncture consists of inserting fine,
solid needles (usually 32 to 36 gauge) into selected body
locations (acupuncture points). Classic texts describe 365
points located in systematic fashion on meridians or “chan-
nels of energy flow” that are mapped onto the surface of the
body. Key principles in traditional Chinese medicine (TCM)
are that both wellness and illness result from an imbalance of
yin and yang. Yin refers to the feminine aspect of life: nour-
ishing, lower, cool, deficient, inside, receptive, protective,
soft, yielding. Yang is the male counterpoint: hard, dominant,
energetic, upper, hot, excessive, outside, creative. The move-
ment between these opposite forces, named Qi, is considered
to be the essential element in the healing system of TCM. It
is best thought of as energy becoming manifest, a vitalistic
force that flows ceaselessly through the meridians, or energy
channels of the body.
Although a discussion of the diagnostic and pathophys-
iologic metaphors of TCM is beyond the scope of this article,
suffice it to say that it remains an internally coherent set of
correlations based on close clinical observation, which are
expressed in symbology existing for millennia. If, to our con-
temporary minds, such terms may seem quaint, dated, or even
naïve, they are highly useful in the context of TCM.
Imbalances in the flow of Qi among the meridians, or-
gans, and five elements is the cause of disease, pain, and
susceptibility to illness. Balancing such factors as heat, cold,
dampness, dryness, in both exterior and interior domains is
done by TCM practitioners as well as medical acupuncturists
using needles inserted at key points along these meridians.
Other practices included in the TCM system include dietary
approaches, herbalism, cupping, moxibustion (the heating of
an acupuncture point or needle with a smoldering herb), mas-
sage (Tui Na), Tai Chi exercise, and meditation.
2– 4
Mechanism of Action
Perhaps the most puzzling aspect of acupuncture to both
the lay person and physician with a knowledge of anatomy,
neuroanatomy, and physiology is how an unmedicated needle,
inserted at a site remote from its desired application can work,
eg, a point on the lower leg affecting gastric function, or a
point on the hand affecting headache.
Skeptics maintain that acupuncture has basically a pla-
cebo effect, since the acupuncture meridians and their “en-
From the Family Medicine Department, University of Texas Medical Branch,
Galveston, TX.
Reprint requests to Victor S. Sierpina, MD, UTMB, Family Medicine De-
partment, 301 University Boulevard, Galveston, TX 77555. Email:
Accepted June 14, 2004.
Copyright © 2005 by The Southern Medical Association
Key Points
Basic theories of acupuncture from both traditional
and scientific perspectives are reviewed.
The reader is provided with information about indi-
cations for acupuncture.
The acupuncture encounter is described.
Safety and efficacy data on acupuncture are reviewed.
An algorithm for the referral process to acupuncture is
330 © 2005 Southern Medical Association
ergy” or “chi (Qi)” as described in TCM cannot be directly
observed, dissected, or measured with standard anatomic ap-
proaches or physiologic instrumentation. The acupoints are
located at sites that have a high density of neurovascular
structures and are generally between or at the edges of muscle
These locations, curiously, are less painful than ran-
dom needle sticks into a muscle group. An interesting study
demonstrating the map of a meridian pathway involved the
injection of Technitium99, a radioactive tracer, into both true
and sham acupoints.
The scan of the injection sites showed
random diffusion of the tracer around the sham point but
rapid progression of the tracer along the meridian at a rate
that was inconsistent with either lymphatic/vascular flow or
nerve conduction. Another study demonstrated that needling
a point on the lower leg traditionally associated with the eye
activated the occipital cortex of the brain as detected by func-
tional magnetic resonance imaging.
Opium addicts who underwent acupuncture analgesia for
surgery were noted not to go through narcotic withdrawal
compared with similar patients who received conventional
anesthesia. This gave birth to the endorphin hypothesis, which
has been explored as one of the mechanisms of action of
acupuncture. Needling affects cerebrospinal fluid levels of
endorphin and enkephalin, and such effects can be blocked by
the opiate antagonist naloxone. A number of other imputed
mechanisms of action have used the model of the acupuncture
needle as an electrode, which activates changes in the ionic
milieu of the interstitial fluid, these changes being rapidly
conducted along the fascial lamellar planes by the highly
conductive electrolyte medium. Because nociceptive stimu-
lation, such as with a transcutaneous electrical nerve stimu-
lation unit, is known to block pain perception, the neurogate
theory has also been suggested as a mechanism of action for
The presence of a foreign body (the needle) may act to
stimulate vascular and immunomodulatory factors, including
locally occurring mediators of inflammation. Measurements
of adrenocorticotropic hormone (ACTH) have been demon-
strated to be elevated after acupuncture treatments, suggest-
ing that adrenal activation and release of endogenous corti-
costeroids may also result from acupuncture. Various physics
concepts such as quantum physics, electromagnetic force field
changes, and wave phenomena have been proffered to ex-
plain the nonlocal effects of acupuncture.
Explanation of the TCM system of medicine, including
the effects of acupuncture, is rich with metaphor and allego-
Such explanations refer to different kinds of Qi, the
influence and interaction of the five elements (fire, earth, metal,
water, and wood), yin and yang, and other terminology that
requires contemplation and long study of a culturally distinct
system. It is a model so different from the standard medical
model that we advise Western-trained physicians and students to
hold a temporary “suspension of disbelief” to nonjudgmentally
approach learning about it as a system of medicine, and, if in-
terested, to review the topic in more depth in some of the ref-
erences listed.
It is probably best to tell patients, students,
and colleagues, in answer to the question of how acupuncture
works, that the conclusive answer is yet to be determined, though
research has given us some windows of insight into possible
mechanisms of action.
5,8 –10,12–14
Scientific Evidence for Clinical Application
Given the popularity and wide usage of acupuncture,
patients self-refer to acupuncturists for a variety of indica-
tions. Trained physicians need to become familiar with when
and how they might refer their patients to an acupuncturist.
To inform clinicians and researchers, the National Institutes
of Health (NIH) convened a consensus panel to review the
available literature about acupuncture.
They wished to as-
sess not only clinical efficacy and effectiveness but also bi-
ological effects, implications on the healthcare system, and
the need for further research. Because much acupuncture re-
search has been done by enthusiastic practitioners rather than
trained researchers, the quality of many studies was poor.
Because of this, the NIH Consensus Panel concluded that
acupuncture was “proven” to be evidence-based for only two
indications: dental pain and nausea (postsurgical, chemother-
apy induced, or nausea related to pregnancy). Their panel
concluded that it was time to take acupuncture seriously and
that their systematic review of the literature indicated that it
might also be useful for a longer list of indications (see Table
1), but that better-designed studies were needed to confirm its
utility in these areas. These include investigations of the basic
science of acupuncture and appropriate sham needle ap-
proaches for the placebo arm.
Further acupuncture research trials have been funded by
the NIH/National Center for Complementary and Alternative
Medicine (NCCAM) and other agencies. Examples of recent
NCCAM-supported projects include:
Table 1. National Institutes of Health Consensus Panel
on Acupuncture
Well-demonstrated evidence
of effectiveness Potentially useful
Chemotherapy-induced nausea Addiction
Dental pain Asthma
Nausea of pregnancy Carpal tunnel syndrome
Postoperative nausea Epicondylitis
Low back pain
Menstrual cramps
Stroke rehabilitation
From Reference 15.
Review Article
Southern Medical Journal Volume 98, Number 3, March 2005 331
Studying the safety and effectiveness of acupuncture treat-
ment for osteoarthritis of the knee
Investigating whether electroacupuncture works for
chronic pain and inflammation
Finding out how acupuncture affects the nervous system
by using magnetic resonance imaging technology
Looking at the effectiveness of acupuncture for treating
high blood pressure
Studying the effects of acupuncture on the symptoms of
advanced colorectal cancer
Testing the safety and effectiveness
of acupuncture
Other organizations have also addressed the potential
benefits of acupuncture. Their recommendations are derived
by consensus panels as well as current standards of practice
and common clinical applications rather than through rigor-
ous, evidence-based review of the literature. The World
Health Organization has identified more than 40 medical con-
ditions effectively treated with acupuncture (Table 2).
American Academy of Medical Acupuncture has suggested a
listing for use by hospital credentialing committees in which
the matter of medical acupuncture privileges are considered
(Table 3).
Although there is some overlap in these catego-
ries, they are by no means identical. It is curious that the NIH
consensus panel findings on the efficacy of acupuncture for
nausea and vomiting do not appear explicitly in the other
lists, emphasizing the rather subjective and consensus nature
of these tables of indications.
Overall, in the United States, acute and chronic muscu-
loskeletal indications for acupuncture treatments have found
greatest acceptance. Although traditional usage and consen-
sus recommendations encompass many conditions, a number
of limitations must be noted. Limited benefit can be expected
when using acupuncture for spinal cord injuries, cerebrovas-
cular accidents, neurodegenerative diseases, thalamically me-
diated pain, severe and chronic inflammatory and immune-
mediated disorders, especially those having progressed to
requiring corticosteroid usage, or as a primary treatment for
human immunodeficiency virus infection, malignancy, or
chronic fatigue states.
It may, however, serve an important
adjunctive role in several of these conditions by improving
quality of life, reducing pain, and potentially improving im-
mune status. Acupuncture treatment may be useful in difficult
conditions such as asthenic states (“tired all the time,” “low
energy”), autonomic dysregulation disorders (anxiety, sleep
disturbance, bowel dysfunction), and immune dysregulation
disorders (recurrent infections and inflammations).
Practical Implications for Referrals and
In many contemporary acupuncture practices, the most
common indication is for chronic pain unresponsive to stan-
dard therapy. By and large, physicians will exhaust their range
of options for chronic pain management with standard treat-
Table 2. World Health Organization indications for
Respiratory tract
Acute sinusitis
Acute rhinitis
Common cold
Acute tonsillitis
Gastrointestinal disorders
Spasm of the esophagus and cardia
Acute and chronic gastritis
Gastric hyperacidity
Chronic duodenal ulcer (pain relief)
Acute and chronic colitis
Acute bacillary dysentery
Paralytic ileus
Bronchopulmonary disorders
Acute bronchitis
Bronchial asthma (most effective in children and in patients without
complicating diseases)
Neurologic disorders
Trigeminal neuralgia
Facial palsy (early stage, ie, within 3–6 mo)
Paresis after stroke
Peripheral neuropathies
Sequelae of poliomyelitis (early stage, ie, within 6 mo)
Meniere disease
Neurogenic bladder dysfunction
Nocturnal enuresis
Intercostal neuralgia
Disorders of the eye
Acute conjunctivitis
Central retinitis
Myopia (in children)
Cataract (without complications)
Musculoskeltal disorders
Cervicobrachial syndrome
Frozen shoulder
Tennis elbow
Low back pain
Disorders of the mouth
Toothache, postextraction pain
Acute and chronic pharyngitis
From Reference 18.
Sierpina and Frenkel • Acupuncture: A Clinical Review
332 © 2005 Southern Medical Association
ments including medication, surgery, nerve blocks, physical
therapy, psychologic therapy, pain clinics, or other specialty
referrals. Because evidence for the effectiveness of acupunc-
ture in pain management is inconclusive by the standards of
best evidence as adopted by the NIH Consensus Panel and
others using a purely evidence-based medicine standard, the
referring physician often sees it as the last resort for patients.
This places the acupuncturist at the unenviable end of a long
chain of evaluations, consultations, treatments, and proce-
dures before the patient is finally referred for acupuncture. It
also creates an adverse selection bias, leaving acupuncture as
an option only for those patients who fail to respond to all
other methods, and sometimes creates unrealistic expecta-
tions for patients.
A more rational approach would be to recognize the
potential role of acupuncture earlier in the treatment of po-
tentially disabling and chronic illnesses. An example would
be its use earlier in the treatment of low back pain, perhaps at
the critical juncture of between 6 and 8 weeks, when acute
back pain often starts to convert to chronic back pain. Starting
earlier in the chain of treatment may reduce the cost of ex-
pensive evaluations, can lower the burden of patient suffer-
ing, and might improve back-to-work statistics. More exten-
sive outcome studies are needed in evaluating the role of
acupuncture in low back pain before it can be recommended
as the standard of care, though certain patients may clearly
Because of the popularity of complementary and alter-
native medicine (CAM)—with estimates of popular use in the
US adult population exceeding 40%,
—physicians ought to
expect to receive questions from patients regarding the inte-
gration of acupuncture in their health care. On the other hand,
the physician can be proactive in searching for other care
options when conventional treatments are ineffective or there
is a high probability of risk or complications from conven-
tional therapies, for example, possible gastrointestinal side
effects from nonsteroidal anti-inflammatory drugs for the
chronic pain patient. Given patients’ demands and utilization
of CAM therapies, despite the lack of strong evidence, there
is an increasing need to address how CAM therapies can be
integrated into conventional medical systems.
As a first step in integrating acupuncture into medical
care and the referral process, physicians must learn the most
common indications (see Tables 1, 2, and 3) or search MED-
LINE or other online sources for information (http://cam.utmb.
In this search, the physician can look for available
studies on safety and efficacy. After assessing the risk com-
pared with the benefit, one can consider the referral. A mutual
discussion with patient and family is necessary, along with
documentation of such a conversation.
After referring the patient, one has the continuing re-
sponsibility of monitoring the patient for benefit, adverse
reactions, or failure to respond. If the patient does not respond
to treatment in 4 to 10 treatment sessions, he or she should be
advised to consider changing to another therapeutic approach
(see Figure).
Although busy physicians may not take such a system-
atic approach, the fact is that most practices have a relatively
Table 3. Conditions for which acupuncture may be indicated (American Academy of Medical Acupuncture)
Acute and chronic pain control In fractures, assisting in pain control, edema, and
enhancing healing process
Postraumatic and postoperative ileus Temporomandibular joint derangement, bruxism
Muscle spasms, tremors, tics, contractures Dysmenorrhea, pelvic pain
Paresthesias Insomnia
Anxiety, fright, panic Anorexia
Drug detoxification Atypical chest pain (negative workup)
Neuralgias (trigemnial, herpes zoster, postherpetic, other) Idiopathic palpitations, sinus tachychardia
Seventh nerve palsy sequelae of cardiovascular accident (aphasia,
Allergic sinusitis
Certain functional gastrointestinal disorders (nausea and vomiting,
esophageal spasm, hyperacidity, irritable bowel, etc)
Persistent hiccups
Headache, vertigo (Meniere), tinnitus Selected dermatoses (urticaria, pruritus, eczema, psoriasis)
Phantom pain Constipation, diarrhea
Frozen shoulder Urinary incontinence, retention (neurogenic, spastic,
adverse drug effect)
Cervical and lumbar spine syndromes Abdominal distention/flatulence
Plantar fasciitis Severe hyperthermia
Arthritis/arthrosis Cough with contraindications for narcotics
Bursitis, tendonitis, carpal tunnel syndrome Acupuncture anesthesia for high-risk patients
Sprains and contusions
From Reference 19.
Review Article
Southern Medical Journal Volume 98, Number 3, March 2005 333
narrow band of indications for acupuncture, for example,
chronic musculoskeletal pain, back pain, or headache, which
can be mastered rather quickly.
Whenever the conventional standard of care is not effec-
tive, acceptable to the patient, or has intolerable side effects,
acupuncture may be considered as one option in an integra-
tive care plan. Although not a panacea, it is often an option
physicians consider seldom or too late.
Safety and Adverse Effects
As an invasive technique, acupuncture has some risks,
which include organ puncture, for example, pneumothorax,
cardiac tamponade, damage to neural and vascular structures,
infection, metal allergy, local pain, bruising, bleeding, or he-
matoma formation.
Serious injury is extremely rare,
given the millions of acupuncture needles placed annually
A well-trained practitioner can prevent most such prob-
lems. Most of the case reports of adverse infectious effects
published in the literature were preventable by using the in-
troduction of safe needle technique with single-use, sterilized,
disposable needles, and with such techniques, the risk of
cross-transmission of HIV, hepatitis, or other infectious dis-
ease can be essentially eliminated. Perhaps the most common
potential complication is a mild but alarming syncope or
presyncope, the so-called “needle shock reaction,” in which
Flow chart: Integrating acupuncture into medical practice.
Sierpina and Frenkel • Acupuncture: A Clinical Review
334 © 2005 Southern Medical Association
the patient feels faint and diaphoretic. Removing the needles
and administering smelling salts is adequate to terminate this
reaction. It is more frequent on the first visit but can be
minimized by close observation of the patient and performing
the treatment in a recumbent rather than sitting position. Lo-
cal bruising or hematoma formation may occur, though bleed-
ing is not common with acupuncture. Delaying of conven-
tional diagnosis and treatment when using acupuncture as
part of a complete medical system (TCM) is another potential
risk, as the diagnostic and therapeutic methods of TCM have
not been validated by scientific studies.
Some patients do not tolerate acupuncture either because
of a needle phobia or the inability to remain in a comfortable
position for treatment. Septic or extremely weakened patients,
those who are uncooperative because of delusions, halluci-
nations, or paranoia, are likewise unsuitable. Local infections
such as cellulitis or loss of skin integrity from burns or ul-
cerations may preclude certain local treatments. Electroacu-
puncture should not be applied over the heart or brain or in
the region of an implanted electrical device such as a pace-
maker or medication pump. Hemophiliacs and others with
severe bleeding disorders should be excluded from acupunc-
ture treatment.
Relative Contraindications
Acupuncture during pregnancy is not contraindicated, but
an acupuncturist must be well trained and must avoid using
points that can stimulate uterine contractility. In the peripar-
tum period, acupuncture may be desirable for either pain
control or stimulation of labor. Acupuncture and acupressure
can be useful for nausea during pregnancy without involving
such “forbidden” points. Other points such as the umbilicus,
nipple, points over major vessels, or over an infant’s fonta-
nelles are likewise “forbidden” by both contemporary and
classic acupuncture texts. Acupuncture during menses is rel-
atively contraindicated, as it may not be as effective during
this period. Initiating acupuncture while a patient is taking
medication, particularly corticosteroids, benzodiazepines, and
narcotics, may reduce its effectiveness. Practically speaking,
however, many patients come to the acupuncturist while tak-
ing these medications and tapering them while acupuncture
treatments take effect is the most realistic course. Patients
with allergy to metal, patients taking anticoagulant drugs, and
those with certain bleeding disorders must be considered on
a case-by-case basis.
The Practitioner and Training
There are approximately 17,000 acupuncturists in the
United States, with most having been trained as Oriental Med-
ical Doctors, Doctors of Oriental Medicine, or Licensed Acu-
puncturists. The National Certification Commission of Acu-
puncture and Oriental Medicine (NCCAOM) maintains a
database of 13,000 practitioners distributed in every state in
the United States who have completed their certification pro-
cess (
Training here and abroad is
usually a 3- to 4-year process, including all aspects of TCM,
which includes not only acupuncture but also herbalism, mas-
sage, dietary therapy, and exercise programs such as tai chi
and qi gong. The herbalism aspect of these programs is in-
tense, since TCM formulas are often a mixture of 9 to 12
herbs and other substances meant to balance the system in a
complex way. Most schools provide 500 hours or more of
Western medical science focusing primarily on identifying
conditions, which need referral to a medical doctor, for ex-
ample, myocardial infarction, cancer, or significant weight
loss. They also teach familiarity with biomedical terminol-
ogy, the referral and consultation process, and the diagnostic
and therapeutic tools of Western physicians.
Physicians may elect a different pathway of acupuncture
training. Although weekend courses and CMEs may offer
some limited training for physicians, the most long-estab-
lished course is that offered by the University of California at
Los Angeles and the Helms Institute, which includes approx-
imately 300 hours of training in “medical acupuncture.”
Nearly 4,000 physicians in the United States have been trained
as acupuncturists, and more courses are now available. Be-
cause of their medical background, courses designed for these
MD or DO physicians are abbreviated from the lengthy TCM
training. These medical acupuncture courses do not include
learning or prescribing the extensive pharmacopoeia of Chi-
nese medicine. The training is scheduled to accommodate the
practicing physician’s needs with an initial introductory week-
end, several months of review of books and training video-
tapes, and a 10-day, intensive seminar on point location and
therapeutics. This training is typically aimed at primary care
physicians, anesthesiologists, and pain management special-
ists and is considered adequate by the majority of state med-
ical boards. Despite its shorter period of training compared
with other schools of acupuncture, medical practitioners with
this degree of training are quite competent to perform safe
and effective acupuncture for most indications. Physicians
practice acupuncture under the scope of their medical license.
They should inform their insurance carrier that they perform
acupuncture, though this does not generally involve any
change in risk and rate of insurance. The American Academy
of Medical Acupuncture (AAMA) is the professional associ-
ation that supports physicians doing medical acupuncture with
CME, research, publications, and lobbying, as some nonphy-
sician acupuncture organizations seek to limit the extent of
practice of physicians trained in acupuncture. They also pro-
vide a list of physician acupuncturists by region, which is
available at (,
along with per-
tinent rules and regulations and training information. This
organization also sponsors a national certifying board exam-
ination for physician acupuncturists.
Review Article
Southern Medical Journal Volume 98, Number 3, March 2005 335
What the Patient Can Expect
An initial consultation with the medical acupuncture
practitioner might not include needle treatment. Depending
on the complexity of the problem, this initial consultation
may be devoted to history and physical examination and re-
view of the medical records. Additional diagnostic studies
such as laboratory or radiologic examinations may be re-
quested. This evaluation is necessary in the Western model to
determine the full spectrum of the patient’s treatment options,
to confirm preceding diagnostic impressions, and to decide if
acupuncture is likely to be helpful in this case. In the case of
the Oriental Medical Doctor or Licensed Acupuncturist, the
history will include a detailed inquiry into diet and lifestyle
and familial and personal factors such as taste, color, and
seasonal preferences, not usually included in the routine med-
ical history. The tongue, pulses, and ear will be closely ex-
amined in addition to standard physical examination. Chinese
herbal mixtures may be offered as part of the treatment plan,
and although these are a significant part of classic TCM prac-
tice, patients must be aware that contaminants, pharmaceuti-
cals, heavy metals, and other impurities have been reported in
Chinese herbs and that standardization and dosage is impre-
cise and unregulated.
Patients should inquire into the practitioner’s training,
certification by the NCCAOM, state licensure, whether ster-
ile, single-use needles are to be used, and the expected num-
ber and cost of treatments. Although some patients are intol-
erant of needles, most feel little if any discomfort besides a
slight aching sensation at the site of insertion. Despite usual
apprehension about pain, needle treatments are comfortable
and relaxing for most patients. The patient typically lies on an
examination or massage-type table while as few as one needle
but occasionally up to 30 needles are commonly inserted on
the extremities, trunk, ear, or other selected points. These
needles are then either manually manipulated, heated with an
herb called moxa (Artemisia vulgaris), or stimulated with an
electrical device powered bya9Vbattery, similar to a typical
transcutaneous electrical nerve stimulation unit. A typical
treatment session is 20 to 40 minutes. Some styles of treat-
ment use fewer needles for shorter periods and do not use the
electrical stimulation. Imbedded tacks are sometimes left in
place for a few days, particularly in the ear. Visits typically
start at weekly intervals or more often and as improvement
occurs are spaced further apart.
Patients may experience a mild euphoria or drowsiness,
especially after the first treatment, and should be advised not
to drive or operate machinery immediately after the treat-
ment. Bleeding or bruising, pain on needling, and aggravation
of symptoms occur in 1 to 3% of patients. Patients are also
advised to avoid strenuous physical activity, heavy meals,
alcohol intake, or sexual activity for up to 8 hours after a
treatment. This is thought to improve the “take” or effective-
ness of the treatment.
Acupuncture costs $50 to 100 per treatment, plus the
additional cost of the initial evaluation. For physician acu-
puncturists, the initial evaluation, not including the acupunc-
ture treatment, can generally be billed as a consultation visit
or standardE&Mcode. Inpatient acupuncture can also be
provided as a consultation service.
A series of 4 to 10
sessions is generally considered an adequate initial trial of
therapy. Nonresponders can be referred for other treatment
modalities. In the United States, some health maintenance
organizations and major insurance plans including Worker’s
Compensation do cover acupuncture, but this remains a mi-
nority. Medicare and Medicaid do not currently cover acu-
The ancient method of acupuncture has gained signifi-
cant popularity in our era, particularly among non-Asian pop-
ulations. Because of its long history of use, safety, and reports
of efficacy, more patients select acupuncture as part of their
therapeutic plan. Although thorough clinical trials of the re-
ported benefits of acupuncture as well as understanding of its
mechanism of action lag behind its widespread use, physi-
cians ought to become familiar with its potential applications
for their patients. Some physicians may wish to expand the
scope of his or her practice by taking additional training to
administer acupuncture. However, even if one does not add
this training, knowing how to refer to credible, well-trained
acupuncturists and for what indications is increasingly im-
portant in the evolving model of integrative medicine, com-
bining the best of both scientific medicine and traditional
systems of care.
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A pint of sweat, saves a gallon of blood.
––General George S. Patton
Review Article
Southern Medical Journal Volume 98, Number 3, March 2005 337
... In some case reports, it has been reported that high-dose prokinetic agents or vinegar can relieve refractory hiccups [5][6] . However, during chemotherapy, refractory hiccup is often induced by chemotherapeutic agents [7] or by simultaneously administered glucocorticoids [8] . Therefore, it is unclear regarding which drug contributes to causing hiccups during chemotherapy, and the selection of optimal treatment is also a great challenge [5] . ...
... Acupuncture has been clinically applied for more than 3000 years in China for pain control and management of body functions [8] . Acupuncture and moxibustion is one of the primary therapeutic methods in TCM. ...
The aim of the study was to present two cases that illustrate the beneficial effects of acupuncture on chemotherapy-induced refractory hiccup in cancer patients. This report described two patients with diffuse large B cell lymphoma (DLBCL) and right upper pulmonary lobe moderate-differentiation adenocarcinoma (pT1N0M0) who experienced chemotherapy-induced refractory hiccup. Alternative treatment was administered to relieve the symptoms of refractory hiccup. The patients were treated with acupuncture 30 min prior to chemotherapy. The selected acupoints included Zusanli (ST36), Taichong (LR3), Zhongwan (CV12), Jiuwei (RN15), and Neiguan (PC6). The symptoms related to chemotherapy-induced refractory hiccup were completely relieved after treatment with 2 to 3 cycles of acupuncture. Based on our experience, we conclude that these two cancer patients benefited from acupuncture treatment, suggesting that acupuncture not only plays a role in pain control, but is also effective in relieving chemotherapy-induced refractory hiccup in cancer patients. The beneficial outcomes need large-scale studies to examine the effectiveness of acupuncture treatment for relieving chemotherapy-induced refractory hiccup in cancer patients.
... Disease, pain, and susceptibility to sickness are caused by disturbances in the movement of Qi among the meridians, organs, and five elements. TCM practitioners and medical acupuncturists use needles put at important locations along these meridians to balance elements like as heat, cold, wetness, and dryness in both the outer and inner domains [37]. ...
... It is more common on the first visit, although it may be reduced by keeping a careful eye on the sufferer and delivering the therapy in a recumbent rather than sitting posture. Hematoma development is possible, although bleeding is uncommon with acupuncture [37]. ...
Full-text available
Abstract Irritable bowel syndrome, also known as IBS, is a chronic and severe functional gastrointestinal disease that is characterized by a variety of symptoms that have a major negative impact on patients' quality of life. It affects nine percent to twenty-three percent of the total population of the world. At this time, there is no medication that is capable of addressing all symptoms associated with IBS in an effective manner (antispasmodics, antidiarrheals, tranquilizers, sedatives). More than half of patients may seek treatment for their gastrointestinal problems via the use of complementary and alternative medicine (CAM), which includes treatments like herbal medicine, acupuncture, and acupuncture. The objective of this chapter is to evaluate the effectiveness and safety of a herbal preparation, acupuncture, and acupressure treatment in patients diagnosed with irritable bowel syndrome. Several sources were used to acquire the material, including review articles published in various publications that had keywords such as herbal drugs, acupuncture, acupressure, irritable bowel syndrome and so on. The information was also gathered from the Internet. Herbal therapy and plant products are widely utilized to treat IBS. Acupuncture and acupres-sure have long been used successfully by patients to treat functional gastrointestinal problems. Multiple clinical studies have shown that their effectiveness and safety are superior to those of placebo and conventional medications. Herbal medications, acupressure, or acupuncture show clinically and statistically significant alleviation of IBS symptoms.
... Acupuncture is not recommended for patients who have haemophilia, bleeding disorders, and septicaemia, or those with cellulitis, local skin infections, or loss of skin integrity from burns or ulcerations in the case of needling. Extra care should be taken for individuals who are pregnant, have metal allergies, or are taking anticoagulant drugs (Sierpina and Frenkel, 2005). ...
Background: Many pharmacological and nonpharmacologic therapies are available for the treatment of the low back pain (LBP). Despite medications are the most frequently prescribed therapy for LBP, the use of various complementary medicine techniques is increasing. The paper summarizes the latest evidence on the treatment of musculoskeletal conditions (with special focus on chronic LBP) by using acupuncture and bee venom therapy (BVT). Methodology: The overview is based on English-language studies and articles found by searches of Medline over more than last 10 years. All the paper found that refer to LBP and at least one of the analyzed therapies have been taken into account. Results: The mechanism of action, efficiency, harms, toxicity and contraindications are highlighted for the two therapies. The literature on these topics is extensive and controversial. There are trials in favour of using the two complementary therapies for rheumatic diseases, as well trials arguing that the observed analgesic effects are related to a strong placebo response. Conclusions: The choice of using acupuncture and BVT for chronic LBP depends on various factors related to patient features and preferences, but nowadays an increased attention and support has to be noted.
... La acupuntura es una técnica que se realiza a través de la colocación de agujas, en determinados puntos anatómicos, que según la medicina tradicional China, corresponden a meridianos energéticos (7) . Entre las patologías que se presentan en la consulta médica diaria podemos mencionar dolor cervical, dolor lumbar, dolor miofascial, epicondilitis y diversas condiciones musculoesqueléticas, que podrían beneficiarse con la utilización de la acupuntura por su efecto analgésico (8) . ...
Full-text available
Objetivo. Hacer una revisión sobre la eficacia de la acupuntura en patologías que cursan con dolor crónico. Materiales y métodos. Se realizó una búsqueda en la base de datos de Pubmed y Lilacs, de los últimos 5 años (2014-2019), respondiendo a la pregunta: ¿en adultos con dolor crónico, la acupuntura es eficaz para controlar este síntoma y mejorar su calidad de vida? Existieron restricciones con respecto al idioma. Se incluyeron sólo revisiones sistemáticas y metaanálisis. No hubieron limitaciones en la frecuencia, intensidad y duración del tratamiento. La calidad global de la recomendación de la evidencia se realizó mediante GRADE. Resultados. Doce revisiones sistemáticas y metaanálisis se incluyeron en la revisión. Se encontró en las revisiones sistemáticas incluidas, evidencia que sustenta, la posible indicación de acupuntura en el tratamiento del dolor lumbar, prostatitis crónica / síndrome de dolor pélvico crónico, dolor crónico relacionado con insomnio, fibromialgia, cervicalgia, neuralgia del trigémino, dolor crónico de rodilla, dolor en pacientes con cáncer, dolor musculoesquelético crónico y neuropatía periférica inducida por quimioterapia en adultos con cáncer. Sin embargo, aún se necesitan estudios que sigan las recomendaciones STRICTA para mejorar el nivel de evidencia de las investigaciones en acupuntura. Conclusiones. Existe evidencia actual sobre el uso de la acupuntura en el manejo del dolor crónico. No se presentó información sobre la presentación de reacciones adversas serias.
... Em outras situações a acupuntura pode ser útil: adição a drogas, fibromialgia, tensão pré-menstrual, síndrome do túnel do carpo, epicondilite, lombalgia, asma, reabilitação pós-acidente vascular cerebral. Algumas outras doenças como cefaléia crônica, cervicalgia crônica e algumas osteoartroses têm sido estudadas com ensaios clínicos randomizados e duplo-cegos, mostrando a eficácia da acupuntura, levando a Associação Médica Britânica a aceitar acupuntura como alternativa validada para tratar essas condições 5,6,7 . ...
Uma das mais antigas modalidades de terapêutica, acupuntura faz parte da MedicinaTradicional Chinesa. Baseada principalmente em um antigo pensamento filosófico chinês e na observação da ocorrência de fenômenos da natureza. Medicina Tradicional Chinesa possui uma fisiopatologia peculiar, um sistema de diagnóstico complicado baseado em exame de língua e pulso e na observação de comportamento e atitudes de pacientes. Durante décadas,a acupuntura foi considerada uma alternativa exótica à Medicina Ocidental Ortodoxa, entretanto, estudos recentes e estudos de painel do NIH norte americano em 1988 elegeram a acupuntura como uma terapia validada para uma extensa lista de afecções, transformando a em uma modalidade terapêutica séria. Necessitamos de mais estudos e discussões para aumentar as indicações baseadas em evidência para outras afecções, além de ajudar a implementar a educação médica em acupuntura.
Conference Paper
Full-text available
The results of this study have suggested that real acupuncture may have beneficial effects on allergic rhinitis, such as reducing the symptoms, improving the quality of life, and enhancing the tolerance to allergens. The action of real acupuncture is dual decreasing the symptomology of allergic rhinitis and increasing the intervals between attacks
Previous meta-analyses have shown a superiority of acupuncture over artificial tear for treating typical dry eye syndrome (DES). However, given that the acupuncture protocols were quite diverse in the randomized controlled trials (RCTs) included in the meta-analyses, it is necessary to establish the acupuncture guidelines. Thus, the optimal acupuncture protocol involved in improvements of tear-film breakup time (BUT) or Schirmer tear test (STT) was examined by meta-analyses for RCTs in patients with typical DES. Eight databases until Jun 2018 were searched for 21 RCTs (n = 1542 eyes) comparing effectiveness of acupuncture versus artificial tear control. Indirect comparison of Bucher analysis was used to find specific acupoints (SAPs) improving BUT or STT by comparing the outcomes between subgroups of the RCTs including and excluding certain SAPs. Meta-analysis was examined for the outcomes in subgroups of the RCTs based on the number of SAPs, and network meta-analysis was for multiple pairwise comparisons across the protocols using the SAPs to yield relative effects. The Bucher analyses identified nine SAPs with positive effects on BUT or STT, and the positive relations of two SAPs involved in improvements of both BUT and STT suggested potential combinations of three (‘KI3–LI4–SP6’ or ‘KI3–GB14–ST2’) or four SAPs (‘KI3–BL1–EX-HN7–SP6’). Subgroup meta-analyses showed the SAP-depending improvements of BUT or STT in the subgroups including more than three SAPs, compared with the artificial tear control. Meta-regression and network meta-analyses revealed significant correlations between the number of SAPs and the improvements of BUT and STT, and demonstrated that acupuncture using four SAPs for 21–30 days, particularly at two–three times per week, can be optimal for improving the symptoms of typical DES. These results provide useful information for guiding acupuncture in clinical trials for DES.
The word "elective" refers to medications and procedures undertaken by choice or with a lower grade of prioritization. Patients usually use elective medications or undergo elective procedures to treat pathologic conditions or for cosmetic enhancement, impacting their lifestyle positively and, thus, improving their quality of life. However, those interventions can affect the homeostasis of the tear film and ocular surface. Consequently, they generate signs and symptoms that could impair the patient's quality of life. This report describes the impact of elective topical and systemic medications and procedures on the ocular surface and the underlying mechanisms. Moreover, elective procedures performed for ocular diseases, cosmetic enhancement, and non-ophthalmic interventions, such as radiotherapy and bariatric surgery, are discussed. The report also evaluates significant anatomical and biological consequences of non-urgent interventions to the ocular surface, such as neuropathic and neurotrophic keratopathies. Besides that, it provides an overview of the prophylaxis and management of pathological conditions resulting from the studied interventions and suggests areas for future research. The report also contains a systematic review investigating the quality of life among people who have undergone small incision lenticule extraction (SMILE). Overall, SMILE seems to cause more vision disturbances than LASIK in the first month post-surgery, but less dry eye symptoms in long-term follow up.
PurposeLaser acupuncture, a non-invasive variant of acupuncture, has been proven effective in the medical and dental fields. Hence, the present study aims to determine the effect of low-level laser therapy on the LI4 point, using a laser acupuncture pen, in reducing children’s pain during local anesthetic (LA) administration.Methods Children in the age range of 8–12 years, in need of LA administration, were randomly assigned to two groups: Group I: laser acupuncture, Group II: control. For all the children, baseline simplified Modified Child Dental Anxiety Scale-Faces version (MCDAS(f)) was recorded, followed by laser acupuncture or standard care. Following the conventional protocol, LA was administered. The procedural pain was assessed using the Faces, Legs, Activity, Cry and Consolability scale (FLACC) and Faces Pain Scale-Revised (FPS-R). All the variations in pulse rate were recorded from baseline to the completion of LA administration. After the procedure, simplified MCDAS(f) was recorded one more time. The data were tabulated and analyzed statistically.ResultsA significant reduction in anxiety after LA administration, as observed in MCDAS(f) score, was noticed only in the laser acupuncture group. The pain scores, as reported in FPS-R, were low in children randomized to the laser group compared to the control. The FLACC pain scores also showed low values in the experimental group.Conclusion Based on the study findings, within the limitations, low-level laser therapy using a laser acupuncture pen can reduce the pain perception of children undergoing LA administration and alleviate dental anxiety.
Musculoskeletal and joint pain are common in women, especially in perimenopausal and aging women. In women diagnosed with breast cancer, cancer treatment can be associated with musculoskeletal symptoms, particularly arthralgia, or non-inflammatory joint pain. Evaluation of new-onset arthralgia should include the history, physical examination, and laboratory evaluation for common non-inflammatory and inflammatory causes of joint pain. After chemotherapy, the self-limited syndrome of post-chemotherapy rheumatism may develop within 3–4 months of treatment and can last several months before it subsides. This syndrome may overlap with the start of adjuvant endocrine therapy, which may also be associated with arthralgia, particularly endocrine therapy with aromatase inhibitors. Aromatase inhibitor-associated arthralgia (AIAA) is common and difficult to treat. Regular exercise and adequate vitamin D levels can alleviate arthralgia and are also associated with improved well-being and better breast cancer and overall outcomes. Other approaches to relieve AIAA include switching to another endocrine therapy, use of a complementary intervention (like acupuncture or a supplement), and duloxetine. In cases where inflammatory arthritis is suspected or arthralgia is more persistent or severe than is typical for AIAA, referral to a rheumatologist is warranted.
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A prior national survey documented the high prevalence and costs of alternative medicine use in the United States in 1990. To document trends in alternative medicine use in the United States between 1990 and 1997. Nationally representative random household telephone surveys using comparable key questions were conducted in 1991 and 1997 measuring utilization in 1990 and 1997, respectively. A total of 1539 adults in 1991 and 2055 in 1997. Prevalence, estimated costs, and disclosure of alternative therapies to physicians. Use of at least 1 of 16 alternative therapies during the previous year increased from 33.8% in 1990 to 42.1% in 1997 (P < or = .001). The therapies increasing the most included herbal medicine, massage, megavitamins, self-help groups, folk remedies, energy healing, and homeopathy. The probability of users visiting an alternative medicine practitioner increased from 36.3% to 46.3% (P = .002). In both surveys alternative therapies were used most frequently for chronic conditions, including back problems, anxiety, depression, and headaches. There was no significant change in disclosure rates between the 2 survey years; 39.8% of alternative therapies were disclosed to physicians in 1990 vs 38.5% in 1997. The percentage of users paying entirely out-of-pocket for services provided by alternative medicine practitioners did not change significantly between 1990 (64.0%) and 1997 (58.3%) (P=.36). Extrapolations to the US population suggest a 47.3% increase in total visits to alternative medicine practitioners, from 427 million in 1990 to 629 million in 1997, thereby exceeding total visits to all US primary care physicians. An estimated 15 million adults in 1997 took prescription medications concurrently with herbal remedies and/or high-dose vitamins (18.4% of all prescription users). Estimated expenditures for alternative medicine professional services increased 45.2% between 1990 and 1997 and were conservatively estimated at $21.2 billion in 1997, with at least $12.2 billion paid out-of-pocket. This exceeds the 1997 out-of-pocket expenditures for all US hospitalizations. Total 1997 out-of-pocket expenditures relating to alternative therapies were conservatively estimated at $27.0 billion, which is comparable with the projected 1997 out-of-pocket expenditures for all US physician services. Alternative medicine use and expenditures increased substantially between 1990 and 1997, attributable primarily to an increase in the proportion of the population seeking alternative therapies, rather than increased visits per patient.
In the fall and winter of 1979-1980, David Eisenberg and I were fellow inmates at a medium-security institution on the outskirts of Peking—the language school, which served as a halfway house for foreign students awaiting release into Chinese academia at large. Among those privileged "prisoners of peace" in that initial cautious period, we were the first admitted from the United States to study medicine in China. Eisenberg was at that time between the third and fourth years of medical school. In the spring semester, he moved to the Beijing Institute of Traditional Chinese Medicine.His book explores traditional Chinese medicine in much the way he did, through a succession of enthralling encounters with tutors explaining yin and yang, diagnosticians examining tongues and pulses, practitioners prescribing herbs and acupuncture, and, eventually, masters of qi gong performing feats of parapsychological derringdo.Anecdotes from events in and out of the classroom portray the
The aim of this study is to investigate the pathways of acupuncture meridians in the human body through the injection of radioactive tracers at acupuncture points. Technetium 99m (99mTc) as sodium pertechnetate, the most common radioactive tracer in nuclear medicine, has been used. The migration patterns were recorded with a scintillation camera associated with computer imaging capabilities. Our findings show that the preferential pathways taken by the radiotracer coincide with acupuncture meridians as described in Chinese traditional medicine. More, it has been established that these pathways are distinguishable from either lymphatic or vascular routes.
Robert W. Daly is Professor of Psychiatry and Medical Humanities at the SUNY Health Science Center at Syracuse and a contributing editor to Literature and Medicine. He is currently completing a book on the conceptual foundations of psychiatry.