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More Patients Pick Acupuncture


In 2004, 370 of 1,394 reporting hospitals offered some complementary alternative medicine (CAM) services in the U.S. Of the 370 hospitals reporting CAM services, 11.5% (42 hospitals) reported inpatient acupuncture services.1

This threefold increase since 1998 demonstrates the growing use of and demand for acupuncture services in hospitals. This trend is driven by patient demand and clinical effectiveness. Acupuncture is a safe treatment modality hospital physicians should be familiar because it can benefit patients in the inpatient setting.

Table 1. Efficacy of Acupuncture click for large version

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Origins of Acupuncture

The first use of acupuncture is not known. The earliest medical textbook on acupuncture was The Medical Classic of the Yellow Emperor, written about 100 B.C. The first translation of this text into English was in 1949.2

The book outlined the theory of a system of six sets of symmetrical channels on the body’s surface, which it called meridians; along these, it posited an intricate network of points.3 Needling the points was supposed to manipulate or release the flow of energy or life force—Qi—to the internal organs, thereby alleviating symptoms. Heating acupuncture points with burning herbs—moxibustion—was also purported to relieve pain.

Licensing requirements vary by state. As acupuncture has gained popularity and respect, and as its benefit for various medical conditions has been proved in high-quality studies, many well-established medical institutions and universities have begun to integrate it with more traditional Western medical treatments.

Acupuncture in the U.S.

The first documented use of acupuncture in the United States occurred in the 19th century. In 1826, Bache used it to treat lumbago.4 During that same era, William Mosley used acupuncture to treat patients with lumbago and sciatica.5

In 1971, a first-person account of the use of acupuncture by New York Times reporter James Reston excited great interest in the technique. Reston was introduced to the procedure to relieve pain after an emergency appendectomy during a trip to China with Henry A. Kissinger.6

Since then, there has been a steady increase in the use of acupuncture by physicians. The American Academy of Medical Acupuncture, the only physician-based acupuncture society in North America, was formed in 1987; in 1992, the Office of Alternative Medicine was created within the NIH. In November 1997, the Food and Drug Administration (FDA) removed the experimental designation for acupuncture needles and approved their use by licensed practitioners. By 1993, the FDA had a record of more than 9,000 licensed acupuncturists, estimated to be providing more than 10 million treatments annually at a cost in excess of $500 million.7

Acupuncture is part of the quasi-medical area of complementary and alternative medicine, whose practitioners field more visits annually than all primary-care physicians in this country combined.8 Most acupuncturists practice the Chinese technique.9

Licensing requirements vary by state.10 As acupuncture has gained popularity and respect, and as its benefit for various medical conditions has been proved in high-quality studies, many well-established medical institutions and universities have begun to integrate it with more traditional Western medical treatments.

Overall, acupuncture is a safe treatment method. Many large studies have confirmed that most types of acupuncture have a low rate of complications and that most of these complications are transient and minor in nature. They are incident-reporting studies, however, and have the limitations inherent in these studies. Nausea, dizziness, bruising, and needle pain are commonly reported.

Acupuncture Theories

The early Chinese theories about how best to perform acupuncture were varied and sometimes conflicting.11 Early treatments using heat, bloodletting, and crude stone implementation evolved over centuries into the intricate practice known today.

Western scientists first became seriously interested in researching the effects of acupuncture in the 1970s. Many of the early studies were poorly designed, and the results were often not reproducible. They were not sufficiently randomized or blinded, and placebo controls were unreliable or nonexistent. To date, no single theory has been put forth that can explain all the phenomena associated with acupuncture treatment.

In 1991, the World Health Organization proposed a standard nomenclature for the 400 acupuncture points and the 20 meridians connecting those points.12 The precise anatomical locations of these areas have not yet been identified definitively. They have a low electrical resistance compared with surrounding tissue. Theories attempting to correlate the acupuncture points with neurovascular bundles have been postulated but remain unproved. The existence of acupuncture points has been verified with galvanometer scanning. These devices measure electrical conductance and emit an audio signal when an area of low resistance is encountered. New points have been added and the location of some of the original ones redefined by this technique.

In some of the earliest research conducted, French acupuncturists Niboyet and Grall mapped many of the points.13,14 Darras attempted to prove the existence of the meridians by tracing the flow of the radionuclide technetium TC 99m sulfur colloid after it was injected into them.15 No published reports in the English-language medical literature have reliably confirmed scientific studies documenting either the existence or location of the meridians.16

The neurohumoral theory postulates that the analgesic effects of acupuncture are related to the release of neurotransmitters such as endogenous opioids. In addition, acupuncture appears to inhibit the transmission of C-fiber pain at the level of the spinal cord.17,18 Other physiological phenomena have also been observed with acupuncture by needling. They include vasodilation, increased serum cortisol, variations in serum glucose and cholesterol levels, increased white blood cell counts, and acid suppression.5 Their significance continues to be questioned.

More info

  • National Center for Complementary and Alternative Medicine Web site:
  • Accreditation Commission of Acupuncture and Oriental Medicine Web site:
  • National Certification Commission for Acupuncture and Oriental Medicine Web site:
  • Helms Medical Institute Web site:

Evidence-Based Approach

Many studies of acupuncture have methodological flaws. The biggest problem as yet unresolved is an appropriate placebo control.19 Sham acupuncture, which involves needling non-acupuncture points, is frequently the control of choice but has serious limitations.

In 1997, the landmark NIH consensus statement was probably the most important presentation of evidence supporting the efficacy of acupuncture.20 Conclusions made about the effectiveness of acupuncture were based on evidence from reliable studies. Many promising results emerged. Specific indications for use of acupuncture were identified on the basis of published reports of its effectiveness. Efficacy in treating dental pain and post-operative and chemotherapy-induced nausea were demonstrated. Research suggested its usefulness as an adjunct or alternative treatment for lower-back pain, osteoarthritis, addiction, and stroke rehabilitation. The panel also concluded that further research would likely uncover additional uses for acupuncture.

From the standpoint of acupuncture’s effectiveness, it can clearly benefit specific patient groups. It is most commonly used as a treatment for back pain.21 Since the NIH conference, further research has confirmed its effectiveness in treating a variety of medical conditions. (See Table 1, above)

Much of the ongoing research on acupuncture has focused on the use of functional magnetic resonance imaging of the brain, specifically on the areas that light up, or show brain activity, during activities or a state of pain.22-24 Acupuncture has been found to reduce the intensity of signals in such areas. The mechanism for the analgesic effects of acupuncture may be the result of reduced blood flow to the brain.24 Several studies have identified specific areas of the brain affected by pressure on various acupuncture points.25

Practical Aspects

Acupuncture treatments are extremely time efficient and require minimal equipment. They can be administered with the patient in the recumbent position or sitting upright. For initial sessions, I prefer the former, especially for younger males, who are more prone to vasovagal reactions. Any of several different methods of acupuncture can be used to stimulate points. In addition to needling, acupuncture can be conducted by electro-acupuncture, moxibustion, cupping, scraping, tapping, acupressure, or laser.

Most inpatient referrals are for pain management. Other common indications include post-operative or chemotherapy-induced nausea (emesis), anxiety, and prevention of withdrawal symptoms from narcotics.

Acupuncture Safety

Overall, acupuncture is a safe treatment method. Many large studies have confirmed that most types of acupuncture have a low rate of complications and that most of these complications are transient and minor in nature.28,29 They are incident-reporting studies, however, and have the limitations inherent in these studies. Nausea, dizziness, bruising, and needle pain are some of the most commonly reported. The rare but serious adverse events, such as pneumothorax, usually occur as a result of the practitioner’s poor training or technique.30

Future of Acupuncture

Public acceptance of, and demand for, acupuncture for pain relief is increasing. Additional clinical studies are needed, however, to expand the types of conditions for which acupuncture may be useful. It is essential to maintain a constant focus on safe practice, which would be aided by the establishment of a standardized accreditation and training system. Hospitals need to establish uniform credentialing guidelines similar to those for other procedures that require evidence of medical competence and safety.31

In February 2005, the Federal Acupuncture Coverage Act was introduced to Congress. If enacted, the measure would allow acupuncture to be covered under Part B for Medicare recipients.

The trend toward an integrated approach to patient therapy in large academic medical institutions is encouraging. The incorporation of the teaching of acupuncture within the current medical school curricula would no doubt complement this approach. TH



Stainless steel, disposable needles are most commonly used. They vary in length from a few millimeters to needle ear points to as long as 6 inches and are used to treat deeper tissue points on the back. The depth of insertion is variable, and they are typically inserted for five to 25 minutes.

Electro-acupuncture involves connecting the needles to a battery-powered device that passes a low current into them. This provides a more powerful analgesic effect.26 Insertion is effected by a swift downward stroke followed by gradual advancement until the patient experiences “de Qi.” This term describes a variety of sensations experienced at the needle tip, such as tingling or mild aching. Absolute contraindications to electro-acupuncture include fever and hypotension. Relative contraindications include the use of a pacemaker, the presence of epilepsy or pregnancy, and uncontrolled anticoagulation therapy.


This procedure utilizes a flexible hammer that has tiny dermal needles at one end. The acupuncture points are tapped repetitively for several minutes. There are no reliable studies comparing the efficacy of this method with needling.


This method involves applying a vacuum suction to cups that have been placed over acupuncture points. There are no randomized trials to support the efficacy of this treatment.


This is a popular and simple treatment employing the application of pressure to acupuncture points with the thumbs. Studies on its efficacy have been less than convincing.32

Gua Sha

A traditional practice employed less commonly in the U.S., but popular in the Far East. Ceramic or metal spoons are used to abrade the skin overlying the acupuncture points; this results in a hyperemia that warms them. Bleeding over a wide area can occur and may cause infection.


This practice uses an herb, Artemia vulgaris, that burns at a low temperature and delivers heat to the points. Traditionally, it was wrapped around the needle head after insertion to enhance the analgesic effects of acupuncture. More modern methods employ a “cigar” held above them. Its use is limited by its unpleasant odor and the risk of skin burns, in addition to the lack of reliable data supporting its efficacy.


This practice is gaining in popularity because it is easy and painless to apply. Optical stimulation of acupuncture points using handheld devices has a theoretical basis, but is not, at this time, backed by any large, reliable clinical trials. A large meta-analysis of the use of low-intensity laser for musculoskeletal pain did not show this method to be efficacious.27 More research is needed about laser acupuncture.

Joseph C. Charles, MD, FACP, is an assistant professor of medicine and division education coordinator for the Department of Hospital Internal Medicine at the Mayo Clinic Hospital Arizona.


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