Acupuncture

The National Institutes of Health (NIH) Consensus Development Program was established in 1977 and is designed to assess health technology. The program organizes major conferences that produce consensus statements and technology assessment statements on controversial issues in medicine important to health care providers, patients, and the general public. The following statement is from the NIH Consensus Development Statement on Acupuncture on November 3-5, 1997.
Acupuncture as a therapeutic intervention is widely practiced in the United States. There have been many studies of its potential usefulness. However, many of these studies provide equivocal results because of design, sample size, and other factors. The issue is further complicated by inherent difficulties in the use of appropriate controls, such as placebo and sham acupuncture groups.
However, promising results have emerged, for example, efficacy of acupuncture in adult post-operative and chemotherap nausea and vomiting and in post-operative dental pain. There are other situations such as addiction, strok rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthriti, low back pain, carpal tunnel syndrome, and asthma where acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program.
Findings from basic research have begun to elucidate the mechanisms of action of acupuncture, including the release of opioids and other peptides in the central nervous system and the periphery and changes in neuroendocrine function. Although much needs to be accomplished, the emergence of plausible mechanisms for the therapeutic effects of acupuncture is encouraging.
The introduction of acupuncture into the choice of treatment modalities that are readily available to the public is in its early stages. Issues of training, licensure, and reimbursement remain to be clarified. There is sufficient evidence, however, of acupuncture's value to expand its use into conventional medicine and to encourage further studies of its physiology and clinical value. This statement is representative of the opinions of current standard medical practice.

acupuncture

Description:

Pediatric Acupuncture. Kym Kleiman performs a

child's balancing treatment at Liferoot Acupuncture

Clinic in Tucson, AZ.

Description:

Kym Kleiman performing prenatal Acupuncture at the Liferoot Acupuncture Clinic in Tucson, AZ.

Acupuncture

After reviewing the existing body of knowledge, the U.S. Food and Drug Administration (FDA) removed acupuncture needles from the category of "experimental medical devices."

The FDA now regulates acupuncture needles, just as it does other devices such as surgical scalpels and hypodermic syringes, under good manufacturing practices and single-use standards of sterility.
                                             The program organizes major conferences that produce consensus statements and technology assessment statements on controversial issues in medicine important to health care providers, patients, and the general public. The following statement is from the NIH Consensus Development Statement on Acupuncture on November 3-5, 1997.

Acupuncture as a therapeutic intervention is widely practiced in the United States. There have been many studies of its potential usefulness.

However, many of these studies provide equivocal results because of design, sample size, and other factors.

The issue is further complicated by inherent difficulties in the use of appropriate controls, such as placebo and sham acupuncture groups.

Acupuncture

One of the major challenges in acupuncture research is in the design of an appropriate placebo control group

In trials of new drugs, double blinding is the accepted standard, but since acupuncture is a procedure rather than a pill, it is difficult to design studies in which both the acupuncturist and patient are blinded as to the treatment being given. The same problem arises in double-blinding procedures used in biomedicine, including virtually all surgical procedures, dentistry, physical therapy, etc.

Blinding of the practitioner in acupuncture remains challenging. One proposed solution to blinding patients has been the development of "sham acupuncture", i.e., needling performed superficially or at non-acupuncture sites. Controversy remains over whether, and under what conditions, sham acupuncture may function as a true placebo, particularly in studies on pain, in which insertion of needles anywhere near painful regions may elicit a beneficial response.

A review in 2007 noted several issues confounding sham acupuncture

Acupuncture therapy

Acupuncture has been used to treat a variety of illnesses for more than 2,000 years. Acupuncture is a component of the traditional Chinese medicine (TCM) system of medicine. As such, a diagnosis based on TCM is generally made prior to the administration of acupuncture needles. This TCM diagnosis, which is much different than diagnosis in Western medicine, is based on a practitioner's observation (of the pulse and tongue) and a thorough patient interview. The patient interview is useful for assessing the body's balance of yin and yang (hot or cold properties), for evaluating deficiency or excess patterns of disease, and for determining the state of the body's internal organs and channels. Once an assessment is made, a series of acupuncture points is selected to improve the balance of yin and yang, to harmonize a deficient or excess condition, and to nourish the organ or channel involved in the disease process. Stimulation of the selected acupoints (situated along 'meridians' in the body) by inserting needles is believed to promote the flow of energy through the system, and thereby restore the body's balance.

Acupuncture Therapy

The traditional acupuncture points are no more real than the black spots a drunkard sees in front of his eyes."
The meridians of acupuncture are no more real than the meridians of geography. If someone were to get a spade and tried to dig up the Greenwich meridian, he might end up in a lunatic asylum. Perhaps the same fate should await those doctors who believe in [acupuncture] meridians."
Felix Mann tried to join up his medical knowledge with that of Chinese theory.
In spite of his protestations about the theory, he was fascinated by it and trained many people in the west with the parts of it he borrowed. He also wrote many books on this subject. His legacy is that there is now a college in London and a system of needling that is known as "Medical Acupuncture". Today this college trains Doctors and western medical professionals only.
Medical acupuncture has caused much controversy amongst traditional practitioners; the British Acupuncture Council wished for it to be called 'treatment using needles', and removing from it the title 'Acupuncture', as it is so different to traditional methods but have had to retract this after pressure from the medical profession. Mann proposed that the acupuncture points related to the nerve endings and he reassigned the points different uses. He altered the theory so that the treatments given are no longer individual to each client, a central premise of traditional theory. Traditionally the needle combinations differ according to the age of the client, the length of time they had the condition, the type of pain they experience and their health history. In medical acupuncture none of this is addressed and the presenting symptom is treated using a set group of points.
A few Chinese scientists we met maintained that although Qi is merely a metaphor, it is still a useful physiological abstraction (e.g., that the related concepts of Yin and Yang parallel modern scientific notions of endocrinologic [sic] and metabolic feedback mechanisms).
They see this as a useful way to unite Eastern and Western medicine. Their more hard-nosed colleagues quietly dismissed Qi as only a philosophy, bearing no tangible relationship to modern physiology and medicine.
George A. Ulett, MD, PhD, Clinical Professor of Psychiatry, University of Missouri School of Medicine states:
"Devoid of metaphysical thinking, acupuncture becomes a rather simple technique that can be useful as a nondrug method of pain control. He believes that the traditional Chinese variety is primarily a placebo treatment, but electrical stimulation of about 80 acupuncture points has been proven useful for pain control.
Ted J. Kaptchuk, author of The Web That Has No Weaver, refers to acupuncture as "prescientific." Regarding TCM theory, Kaptchuk states:
"These ideas are cultural and speculative constructs that provide orientation and direction for the practical patient situation. There are few secrets of Oriental wisdom buried here. When presented outside the context of Chinese civilization, or of practical diagnosis and therapeutics, these ideas are fragmented and without great significance. The "truth" of these ideas lies in the way the physician can use them to treat real people with real complaints.
According to the 1997 NIH consensus statement on acupuncture:
"Despite considerable efforts to understand the anatomy and physiology of the "acupuncture points", the definition and characterization of these points remains controversial. Even more elusive is the basis of some of the key traditional Eastern medical concepts such as the circulation of Qi, the meridian system, and the five phases theory, which are difficult to reconcile with contemporary biomedical information but continue to play an important role in the evaluation of patients and the formulation of treatment in acupuncture.
At least one study found that acupuncture "seems to alleviate pain just barely better than sticking needles into nonspecified parts of the body and concluded that some of acupuncture's effects may be due to the placebo effect.
According to The Straight Dope, a popular question-and-answer newspaper column published in the Chicago Reader:
Traditional acupuncture theory is a quaint patchwork of folklore with about as much relevance to current medical practice as medieval European notions about the four bodily humors. While it may be useful as a guide to future research, no scientist would regard it as satisfactory as it stands.

Acupuncture Therapy

The acupuncturist decides which points to treat by observing and questioning the 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 on 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.

Acupuncture therapy

Classical texts describe most discuss of the main acupuncture points as existing on the twelve main and two of eight extra meridians (also referred to as mai) for a total of fourteen "channels" through which qi and Blood flow. Other points not on the fourteen channels are also needled. Local pain is treated by needling 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 SanJiao.
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 sagittal plane of the torso respectively) are needled. The remaining six qi jing ba mai are manipulated by needling points on the twelve main meridians.
Normally qi is described as flowing through each channel in a continuous circuit. In addition, each channel has a specific aspect and occupies two hours of the "Chinese clock".
Flow of qi through the meridians

Flow of qi through the meridians
Zang-fu	Aspect	Hours
Lung	taiyin	0300-0500
Large Intestine	yangming	0500-0700
Stomach	yangming	0700-0900
Spleen	taiyin	0900-1100
Heart	shaoyin	1100-1300
Small Intestine	taiyang	1300-1500
Bladder	taiyang	1500-1700
Kidney	aoyin	1700-1900
Pericardium	jueyin	1900-2100
San Jiao	shaoyang	2100-2300
Gallbladder	shaoyang	2300-0100
Liver	jueyin	0100-0300
Lung (repeats cycle)

Acupuncture Theory

                                                 

TCM is based on a pre-scientific paradigm of medicine that developed over several thousand years and involves concepts that have no counterpart within contemporary medicine.
In TCM, the body is treated as a whole that is composed of several "systems of function" known as the zang-fu.These systems are named after specific organs, though the systems and organs are not directly associated.
The zang systems are associated with the solid, yin organs such as the liver while the fu systems are associated with the hollow yang organ such as the intestines .
Health is explained as a state of balance between the yin and yang with disease ascribed to either of these forces being unbalanced, blocked or stagnant.
The yang force is the immaterial qi a concept that is roughly translated as vital energy.

The yin counterpart is Blood, which is linked to but not identical with physical blood and capitalized to distinguish the two. TCM uses a variety of interventions, including pressure, heat and acupuncture applied to the body's acupuncture points (in Chinese xue meaning "cavities") to modify the activity of the zang-fu.

Acupuncture

TCM is based on a pre-scientific paradigm of medicine that developed over several thousand years and involves concepts that have no counterpart within contemporary medicine.

In TCM, the body is treated as a whole that is composed of several "systems of function" known as the zang-fu

These systems are named after specific organs, though the systems and organs are not directly associated.

The zang systems are associated with the solid, yin organs such as the liver while the fu systems are associated with the hollow yang organs such as the intestines.

Health is explained as a state of balance between the yin and yang with disease ascribed to either of these forces being unbalanced, blocked or stagnant.

The yang force is the immaterial qi a concept that is roughly translated as "vital energy.

The yin counterpart is Blood, which is linked to but not identical with physical blood and capitalized to distinguish the two. TCM uses a variety of interventions, including pressure, heat and acupuncture applied to the body's acupuncture points (in Chinese meaning "cavities") to modify the activity of the zang-fu.