What’s the Bottom Line?

How much do we know about acupuncture?
There have been extensive studies conducted on acupuncture, especially for back and neck pain, osteoarthritis/knee pain, and headache. However, researchers are only beginning to understand whether acupuncture can be helpful for various health conditions.

What do we know about the effectiveness of acupuncture?
Research suggests that acupuncture can help manage certain pain conditions, but evidence about its value for other health issues is uncertain.

What do we know about the safety of acupuncture?
Acupuncture is generally considered safe when performed by an experienced, well-trained practitioner using sterile needles. Improperly performed acupuncture can cause serious side effects.
What Is Acupuncture?
Acupuncture is a technique in which practitioners stimulate specific points on the body—most often by inserting thin needles through the skin. It is one of the practices used in traditional Chinese medicine.

See the National Center for Complementary and Alternative Medicine (NCCAM) Web site for more information on traditional Chinese medicine.

What the Science Says About the Effectiveness of Acupuncture
Results from a number of studies suggest that acupuncture may help ease types of pain that are often chronic such as low-back pain, neck pain, and osteoarthritis/knee pain. It also may help reduce the frequency of tension headaches and prevent migraine headaches. Therefore, acupuncture appears to be a reasonable option for people with chronic pain to consider. However, clinical practice guidelines are inconsistent in recommendations about acupuncture.

The effects of acupuncture on the brain and body and how best to measure them are only beginning to be understood. Current evidence suggests that many factors—like expectation and belief—that are unrelated to acupuncture needling may play important roles in the beneficial effects of acupuncture on pain.

Read more about acupuncture for these pain conditions and others:
For Low-Back Pain
For Neck Pain
For Osteoarthritis/Knee Pain
For Headache
For Other Conditions
Read more about the challenges of studying acupuncture:
What Is Simulated Acupuncture?
What the Science Says About Safety and Side Effects of Acupuncture
Relatively few complications from using acupuncture have been reported. Still, complications have resulted from use of nonsterile needles and improper delivery of treatments.
When not delivered properly, acupuncture can cause serious adverse effects, including infections, punctured organs, collapsed lungs, and injury to the central nervous system.
NCCAM-Funded Research
NCCAM funds research to evaluate acupuncture’s effectiveness for various kinds of pain and other conditions, and to further understand how the body responds to acupuncture and how acupuncture might work. Some recent NCCAM-supported studies are looking at:

If acupuncture can reduce the frequency of hot flashes associated with menopause
Whether acupuncture can reduce pain and discomfort that may accompany chemotherapy
Objectively determining if actual acupuncture is more effective than simulated acupuncture or usual care for pain relief, and (if so) by how much.
More to Consider
Don’t use acupuncture to postpone seeing a health care provider about a health problem.
If you decide to visit an acupuncturist, check his or her credentials. Most states require a license, certification, or registration to practice acupuncture; however, education and training standards and requirements for obtaining these vary from state to state. Although a license does not ensure quality of care, it does indicate that the practitioner meets certain standards regarding the knowledge and use of acupuncture. Most states require a diploma from the National Certification Commission for Acupuncture and Oriental Medicine for licensing.
Some conventional medical practitioners—including physicians and dentists—practice acupuncture. In addition, national acupuncture organizations (which can be found through libraries or by searching the Internet) may provide referrals to acupuncturists. When considering practitioners, ask about their training and experience.
Ask the practitioner about the estimated number of treatments needed and how much each treatment will cost. Some insurance companies may cover the costs of acupuncture, while others may not. For more information, see NCCAM’s fact sheet Paying for Complementary Health Approaches.
Help your health care providers give you better coordinated and safe care by telling them about all the health approaches you use. Give them a full picture of what you do to manage your health. For tips about talking with your health care providers about complementary health approaches, see NCCAM’s Time to Talk campaign.

complementary or alternative medicine

Acupuncture is a form of ancient Chinese medicine in which fine needles are inserted into the skin at certain points on the body.It is a complementary or alternative medicine (CAM). This means that acupuncture is different in important ways from treatments that are part of conventional western medicine. Unlike conventional treatments, the use of acupuncture is not always based on scientific evidence.
Theory

Acupuncture is based on the belief that an energy, or 'life force', flows through the body in channels called meridians. This life force is known as Qi (pronounced 'chee').
Practitioners who adhere to traditional beliefs about acupuncture believe that when Qi cannot flow freely through the body, this can cause illness. They also believe that acupuncture can restore the flow of Qi, and so restore health.
Some scientists and acupuncturists believe that acupuncture may stimulate nerves and muscle tissue, and that this may be responsible for any beneficial effects.
Uses

Practitioners – called acupuncturists – use acupuncture to treat a wide range of health conditions. It is often used to treat pain conditions such as headache, lower back pain and dental pain, but is also commonly used against conditions ranging from infertility to anxiety and asthma. To learn more, see common uses of acupuncture.
The availability of acupuncture on the NHS is limited (see box, left). Most acupuncture patients pay for private treatment.
Does it work?

Currently, the National Institute for Health and Clinical Excellence (NICE) recommends acupuncture as a treatment option only for lower back pain. NICE makes this recommendation on the basis of scientific evidence. Read the NICE 2009 guidelines on low back pain (PDF, 980kb).
There is some evidence that acupuncture works for a small number of other conditions, including migraine and post-operative nausea. However, there is little or no scientific evidence that acupuncture works for many of the conditions for which it is often used. More scientific research is needed to establish whether acupuncture is effective against these and other conditions.
There is no scientific evidence for the existence of Qi or meridians. More research is needed before acupuncture’s method of action is fully understood.

Chronic Fatigue is psychological or merely

Chronic fatigue is one of the most common complaints heard in the clinic. Many different illnesses and prescription drugs are capable of causing fatigue, and it is important that a medical history be taken to determine which of these, if any, may be causing the problem.

Unfortunately, many people who suffer from chronic fatigue have submitted themselves to the usual tests and have obtained no clear diagnosis. It is then frustrating for them to hear that their problem, which is often debilitating, is "psychological" or merely "psychosomatic." Of course, in some cases, the etiology is psychological. But even though fatigue is an important somatic symptom of depression, conversely, it is natural for a psychologically healthy person who feels extremely fatigued to become depressed about being in such a condition.

In such cases where there is no clear organic, psychological or pharmaceutical cause, chronic fatigue is commonly related to immune deficiency and is clinically associated with a lingering viral infection, most notably the Epstein-Barr virus. Besides exhaustion, other symptoms of Chronic Epstein Barr Virus (CEBV) infection occur. The most notable are a lack of ability to concentrate or recall simple things (called "brain fog" by some), recurrent sore throats, swollen lymph nodes in the neck, muscle pain or weakness, and intermittent depression. In this case, though, the depression is not necessarily a cause of fatigue, but rather an effect of the infection.

The Epstein Barr virus also causes mononucleosis, the so-called "kissing disease." Most people have been exposed to the virus, evidenced by the fact that about 80% of the population has antibodies against it. The symptoms of mononucleosis resemble those of chronic fatigue, but the disease runs its course in 4 to 6 weeks, whereas in the case of chronic fatigue, the immune system is too weak to fight off the virus, which remains in the body creating problems.

There are many reasons why some people have weak immune systems. Frequent use of antibiotics and birth control pills, improper diet and exercise, stress, and an overly competitive attitude have been blamed by some. The important thing is acupuncture and herbs can strengthen a weakened immune system.

At the core of the disease is a pattern in Chinese medicine that is called "deficiency of qi." "Qi" is the vital energy of the body and mind. Herbs and acupuncture points that strengthen the qi are employed, along with other points and herbs to customize the treatment. Most of the herbs are taken from a category of botanical remedies called "adaptogens." The term adaptogen was coined by Soviet scientists who studied the physiological effects of tonic herbs that have been used by the Chinese for centuries to enhance resistance to disease, improve physiological and mental functioning, and increase longevity. Research has proved that these herbs have a non-specific strengthening effect on the immune system, as well as other systems of the body, such as the cardiovascular, digestive and respiratory systems.

Another class of herbs is used as well. Traditionally found in the clear heat, clean toxin category, these herbs have an anti-viral effect, though the exact mechanism of their action is not completely understood. Traditionally, they have been used for inflammatory conditions such as sore throat, swollen lymph glands and fevers.

In Oriental medicine, it is important to treat the person rather than the disease. Often, other patterns are involved in CEBV, so acupuncture and herbal treatments must be adjusted accordingly. Chinese herbal medicine and acupuncture have a long tradition of use in the treatment and prevention of immune-related disorders. They have been shown to be effective in the treatment of CEBV as well, and a patient will usually experience results in 3 to 6 months

Chinese Herbal and Medicine

Chinese herbs in their raw form. It is more common to find them in tablet form in the modern acupuncture clinic.

Why use Chinese herbs?
Chinese Herbal Medicine is a gentle and effective alternative to Western drugs—one relatively free of side effects. Chinese medicine is holistic, which means that herbal formulas are designed to treat the whole person, both mind and body. Hence, the patient will often notice improvement in overall health along with amelioration of specific symptoms or complaints.

In combination with acupuncture, Chinese herbal prescriptions play an important and effective role in the treatment of many conditions. The Chinese herbal tradition has evolved over thousands of years of clinical experience, during which time it has been constantly tested and refined. Through the ages, many classical formulas have been developed to treat specific disorders. This process of evolution continues even today, as new herbal formulas are developed to treat diseases which predominate in modern industrialized countries.

What are the substances used in herbal formulas?
Chinese medical texts contain references to many diverse items, including animal products and minerals, but most of the commonly used herbs come from plants.

Why are combinations of herbs superior to individual herbs?
Combinations of herbs are considered to be more effective than individual herbs because they have a more balancing effect on the body. A single herb might address only one aspect of a person's imbalance, but a formula can be tailored to address the full range of the imbalance on a constitutional level. A formula commonly contains from 4 to 16 ingredients chosen for their synergistic effect. A classical formula is usually used as a base, and herbs are added or subtracted to prepare a custom-made combination that addresses a patient's unique physiological imbalance.

At this time, herbal combinations are available in four different forms:

Loose herbs, which are used to brew teas
Pills
Tinctures, which are alcohol-based
Powders
Your acupuncturist will determine which form is suitable in each individual case.

Tonic Herbs: the Treasure of Chinese Medicine
Many Chinese herbal formulas contain special tonic herbs that can be taken daily to increase resistance to disease, enhance energy and prolong life. Ginseng and astragalus are perhaps the most widely known in this group. Others less commonly known include ligustrum, schizandra, he shou wu and ganoderma. These herbs are called "adaptogens" because they strengthen the body, enhancing its ability to adapt to stress. They have a particularly positive effect on the immune system and are being used successfully in the treatment of immune-related disorders such as chronic fatigue syndrome (Epstein-Barr) and systemic candida, as well as in the management of ARC and AIDS.

Why is it important to obtain a proper diagnosis before taking Chinese herbs?
Many people take Chinese herbs, particularly the tonic ones, without properly understanding whether they are suitable for their condition or constitution. Most herbs have a gentle effect on the body, but their indiscriminate use over a long period of time, or even a short period in certain cases, may cause side effects. Such side effects rarely occur if the proper diagnosis has been obtained. It is also common for the diagnosis to change as the physiology moves toward a state of greater balance. The herbal prescription is then adjusted accordingly.

Your acupuncturist is highly trained in the art of diagnosis and herbal prescription and will recommend a formula that is appropriate for your constitution and disorder.

Backache Acupuncture

Among afflictions that plague modern man, backaches rank third, following heart disease and cancer. Statistics indicate that 50% of people forced to abandon work do so because of problems involving the back. Such problems are often very painful. Acupuncture is a very effective method for treating back pain.

What is Acupuncture?
Acupuncture is a complete and natural system of medicine based on principles that have been used in the Orient for the last four thousand years. It works with the natural energies inherent within all living things. When this energy is balanced through acupuncture therapy, the body's vitality is restored and the body begins to heal itself.

How does Acupuncture Help Back Pain?
In four ways. First, it stimulates the production of endorphins, the body's natural pain killers. Second, it blocks the transmission of pain signals to the brain. Third, it increases circulation in the problem area and promotes tissue regeneration. Fourth, it effectively deactivates trigger points, which are overly sensitive spots beneath the skin that sometimes "trigger" pain or other symptoms into a "reference" zone, an area in a different part of the body, either close or far away. Trigger points are often involved in cases of chronic low back pain.

Why Should I Choose Acupuncture as a Form of Treatment?
For one thing, there are no side effects. Conventional methods of treating back pain involve surgery or pain-relieving medication, which often cause unwanted side effects. Acupuncture relieves pain in a natural way without side effects, and it is very cost-effective. For another thing, acupuncture does not just treat the symptoms of backache. It is a holistic system of medicine, which means it treats the whole person. Some degenerative changes that occur in the back are the result of imbalances involving the whole body. By balancing the energy of the body, systemic changes often occur, and the patient will notice an overall improvement in health.

How Many Treatments Are Necessary?
Each person is unique. Some people will respond to acupuncture more quickly than others. It is not uncommon for patients to experience significant relief after one or two treatments. Six to ten treatments within a three to five week period is a normal course of treatment, and then the case is re-evaluated. Sometimes periodic maintenance treatments are recommended.

Are Other Methods of Treatment Used along with Acupuncture?
At the Natural Medicine Clinic, we combine herbal medicine and therapeutic massage to get the best possible results. Herbal medicine strengthens the body and enhances the functioning of the immune system. Massage increases circulation in affected areas and helps to deactivate painful trigger points. We also give nutritional guidance when appropriate. The old adage "you are what you eat" has proved itself to be true time and time again.

Can Other Conditions Be Treated by Acupuncture?
Absolutely! The World Health Organization lists over forty diseases that respond to acupuncture therapy, including hypertension, digestive disorders, tinnitus, chronic fatigue, pre-menstrual syndrome, stress disorders and depression.

Allergic Rhinitis and Acupuncture and Asthma

We all recognize the symptoms of asthma—wheezing, phlegmy rattling—because we all know someone who suffers from it. It occurs as recurrent attacks ranging from mild to life-threatening, and unfortunately, certain forms of it get worse during the seasons many of us enjoy most—spring and summer. Fortunately, relief can be obtained with acupuncture and Chinese herbs.

There are typically two types of asthma—extrinsic and intrinsic—and both will respond to acupuncture. Intrinsic asthma is caused by factors such as chemicals, cold air, exercise, infection and emotional upset. Extrinsic asthma is allergy-related and is triggered by pollens, dust, molds and animal dander.

During an asthma attack, the walls in the bronchioles of the lungs become swollen, or edematous. The smooth muscles of the walls constrict, narrowing breathing passages, and the bronchioles secrete excess mucus, creating obstructive plugs. During an allergy-related asthma attack, there is an increase of histamine and other inflammatory chemicals in the blood. In intrinsic asthma, there appears to be a hyper excitation of the parasympathetic nervous system. The result in both cases is swelling or edema of the mucosal walls of the bronchioles, increased bronchial smooth muscle contraction, and hyper secretion of bronchial mucus with obstructive mucus plugs.

Studies in China involving acupuncture have shown that needling the acupuncture point St 36 (Zusanli)

on a healthy subject increased ventilation capacity by 6.6%. The maximal breathing capacity increased 20%, with a 22% increase in the volume of expiration. Acupuncture appears to act on the nervous system by relieving excitation of the parasympathetic nerves while raising the level of excitation of sympathetic nerves. This causes the bronchioles to expand and mucus membranes to contract, leading to improved breathing. Acupuncture also appears to reduce the level of inflammatory chemicals in the blood, thereby reducing allergic responses.

The effects of acupuncture are cumulative. After a series of treatments, one often notices a reduction in the frequency and severity of attacks. Acupuncture has the effect of strengthening a person's constitution and overall health so that their allergic response is reduced.

Chinese herbal formulas serve as a useful adjunct to acupuncture in relieving asthma. In fact, when I received advanced herbal training in China, half of the patients I saw were suffering from asthma or bronchitis. Many asthma formulas contain herba ephedra (Ma Huang), which has the effect of expanding constricted bronchioles. Other herbs are used to reduce phlegm production, combat infection, moisten the lungs and astringe coughing. There are many different types of asthma in Chinese medicine, and different herbal formulas are appropriate. It is best to consult a trained practitioner before selecting a formula.

Allergic Rhinitis & Acupuncture

"Hegu" (L.I.4),. The most important distal point for clearing the lower sinuses

Interestingly, the point on the right hand treats the left lower sinus and vice versa. Ask your acupuncturist why this is the case.Spring and summer are wonderful seasons to many. In spring, nature stirs after the sleep of winter, and people awaken to the joy of being alive. Summer brings this process to fruition, for those who don't mind the heat. But to those who suffer from hay fever, spring and summer can be the worst seasons of the year, especially here in Sacramento, which is known as the allergy capital of California.

Hay fever is recognized by the annoying symptoms of watery nasal discharge, sneezing, and itchy eyes and nose. Hay fever is actually a popular name for allergic rhinitis, a disease provoked by airborne pollens and other substances. Everybody recognizes the symptoms of allergic rhinitis because we all know someone who suffers from it. It is estimated that 15 to 20% of Americans have recurrent or chronic nasal problems, and these are often caused by allergies, though there are other etiologies as well.

Allergic rhinitis is usually a seasonal phenomenon. People who are allergic to tree pollens will develop symptoms in mid-March or early April. If they are allergic to grasses, the symptoms will appear in mid-May or June. Ragweed and other summer weeds provoke symptoms in late August. And then there are those who have multiple allergies and are miserable for several months every year. If a person suffers from allergic rhinitis year-round, the problem is being caused by dust, molds, animal dander, or some kind of chemical.

In Western medicine, allergic rhinitis is caused by a release of histamine from mast cells in the nasal mucosa. This release is mediated by IgE and other substances. The reaction occurs in response to inhalation of an antigen, the substance one is allergic to. It is generally treated with antihistamines, decongestants, intranasal topical corticosteroids, or cromolyn sodium. With the exception of cromolyn sodium, none of these drugs are without side-effects. Most antihistamines cause unwanted drowsiness, and those that don't are very expensive. Nasal decongestants can actually result in a worsening of symptoms due to reflex vasodilation, and they are, in a sense, addicting because they must be used more and more frequently to achieve the original effect. Use of topical corticosteroids is relatively safe, but excessive dosages may lead to adrenal suppression. Colonization of the nose by candida and nose bleeding have also been reported, though not frequently. Another form of therapy involves reducing sensitivity to allergens by injecting incremental doses of them over a period of time in order to build up antibodies, but the response to this mode of therapy is not dramatic, and medication must usually be taken as well.

Acupuncture offers a natural and effective treatment of allergic rhinitis, one which is free of unwanted side-effects. Oriental medicine sees the body, and indeed the whole universe, as an energy system, a concept not at all foreign to modern physics. Material objects, including the biochemicals responsible for physiological processes, are manifestations of energy. This energy is called qi in the Chinese language. According to the Oriental diagnostic system, chronic allergic rhinitis often results from an underlying deficiency of the qi, or life-energy, of the Lung and can be treated in part by stimulating points on the lung meridian, most of which are found near the wrist. The symptoms of hay fever involve the nose, but in Chinese medicine, the nose is regarded as an extension of the lung, which in fact it is. When the lung functions normally, respiration is normal, the nose is unobstructed, and the sense of smell is acute. Points on other meridians are used as well. The most commonly used point, Large Intestine 4 (He Gu), is found on the web between the thumb and index finger. Other points are located over the sinuses and have the effect of reducing nasal secretion. When the energy of the lung is strengthened, the sensitivity to airborne allergens decreases, and the patient can experience substantial relief. Since acupuncture is a holistic system of medicine, the whole person is treated, both mind and body. Patients with a lung qi deficiency often have systemic symptoms that include general lassitude and fatigue, lack of spirit and apathy, spontaneous sweating, and a propensity for catching cold. Often, other organ systems and meridians are involved as well. By supplementing the qi where it is deficient, draining it where it is excess, and balancing its flow and distribution, overall improvements in health can result.

Laboratory studies corroborate the traditional Chinese account of how allergic responses can be reduced or eliminated. They have shown that after acupuncture, the IgE level decreases, resulting in a decrease in histamine production. Acupuncture also seems to desensitize the nerves that would normally react adversely to the IgE-antigen complex.

Herbal medicine is a very useful adjunct to acupuncture treatment because there are a number of Chinese herbs which reduce the inflammatory response as well as sinus congestion. In Oriental medicine, herbs are rarely given singly, but are combined with other herbs in formulas that have a balancing effect on the body. Each individual is different, and formulas are adjusted accordingly.

Acupuncture treats other conditions as well. The World Health Organization lists over 40 disorders that respond favorably to acupuncture. [View the World Health Organization Acupuncture chart]. Among these are chronic pain, injuries, back and neck pain, chronic fatigue, headaches, depression (mild), stress disorders, hypertension, insomnia, digestive disorders, PMS and other women's problems, constipation, the common cold, and addictions.