Acupuncture As Energy Medicine

COURSE DESCRIPTION

The ancient Chinese healing practice of acupuncture has been used for thousands of years to treat many ailments, especially pain. Today, this therapy that addresses disharmony in the body, mind, and spirit is widely practiced throughout China and is used by millions of individuals in the United States and many other countries. This course explores the history of acupuncture, the theories involved in its practice (including yin and yang, qi, the meridian system, and causes of disharmony), the types and benefits of acupuncture, as well as possible complications and contraindications of the therapy and training issues.

The goal/outcome of this course is to provide learners with an overview of the practice, theories, and clinical efficacy of acupuncture.

COURSE OBJECTIVES

Upon completion of this course, you will be able to do the following:

1. Describe the key historical developments related to acupuncture. 2. Explain yin and yang theory. 3. Discuss the energetic concept of qi. 4. Describe the meridian system. 5. Discuss causes of disharmony. 6. Describe types of acupuncture. 7. Identify the health benefits of acupuncture. 8. List possible complications and contraindications of acupuncture. 9. Identify training issues related to acupuncturists.

INTRODUCTION

Acupuncture is one of the principle components (along with herbalism, massage, and other therapies) of an ancient system of medicine known as traditional Chinese medicine (TCM) (Mole, 2014). Acupuncture is a technique in which the practitioner stimulates specific points on the body, usually by inserting thin needles through the skin either manually or by electrical stimulation (Chiu, 2014; National Center for Complementary and Alternative Medicine [NCCAM], 2014). Acupuncture may be combined with moxibustion for the treatment of many diseases. Moxibustion is a technique in which heat is applied to the acupoints through the burning of compressed, powdered herbal materials (Chiu, 2014).

The History of Acupuncture

Acupuncture is among the oldest healing practices in the world (NCCAM, 2013a). The term acupuncture, or needle puncture, is actually a European word invented by Willem Ten Rhyne, a Dutch physician who visited Nagasaki in Japan in the early part of the 17th century and saw the technique. The Chinese use the character “Chen” to describe acupuncture. The Chinese character literally means to “prick with a needle” (Lewis, 1982).

Traditional Chinese medicine practitioners have used acupuncture to influence health and healing for over 2,500 years. It has formed the theoretical basis of the medical systems developed in China and its neighboring countries of Japan, Korea, Taiwan, and Vietnam (Chiu, 2014; Mole, 2014). While Western medicine can be traced back to Hippocrates, Chinese acupuncture theory was fully developed by the end of the second century B.C. and undocumented evidence of tattoo marks on Tyrolean Iceman (dating back to 3300 BCE) coincide with acupuncture points used today (Chiu, 2014). The Chinese believe the practice of acupuncture began during the Stone Age when stone knives or sharp edged tools were used to puncture and drain abscesses. The Chinese character “Bian” means the use of sharp edged stones to treat disease. The Chinese character “Bi” is believed to be derivation of “Bian” and represents a disease of pain (Lewis, 1982).

Tortoise shells with inscriptions dating to the Shang dynasty (about 1500 B.C) are believed to describe the origins of Chinese medicine since they were probably used for divination in the art of healing. The first known acupuncture

© ALLEGRA Learning Solutions, LLC All Rights Reserved. text is the Nei Ching Su Wen and there is much controversy about the exact origins and authorship of the text. It is believed to date from 475-221 B.C. This text is also known by alternative titles such as the Yellow Emperor’s Classic of Internal Medicine, or the Canon of Medicine and describes the Chinese view of medicine, including the concepts of Yin and Yang (Lewis, 1982).

The practice of acupuncture declined in China during the Ching dynasty (A.D. 1644-1911) due to the political chaos in the country at that time and the perspective that acupuncture was a barrier to progress. In 1822, acupuncture was abolished from the curriculum of the Imperial Medical College. In addition, the Confucian ethic did not support the growth of medical knowledge (especially the concept of surgery) because the Chinese feared that if they died during surgery, they would go to their ancestors with body parts missing. From the late 1800s through the early 1920s, medical missionaries began to expose the Chinese to western medical therapies. There was much resistance to these therapies, but Chinese therapies (including acupuncture) were in decline and few healing options were readily available to most Chinese citizens. By the late 1920s, the Communist party of China was formed under the leadership of Chairman Mao. During Mao’s regime, the Communists realized there were little or no medical services in many areas of the country and so they encouraged the use of traditional Chinese remedies, including acupuncture, to keep their troops healthy. The use of acupuncture gained momentum as a result, and by the 1950s, Chinese hospitals opened clinics to provide, teach, and investigate acupuncture methods. This created an acupuncture “renaissance” and the development of many new methods of acupuncture (Lewis, 1982).

In 1972, interest in this therapy was renewed when silk scrolls were found in the Ma Wang Dui tomb (sealed in 198 BCE). The scrolls referred to moxibustion as well as meridians but did not refer to acupuncture or acupoints. This suggested to scholars that both the origins of moxibustion and meridians predate the origins of acupuncture and acupoints (Chiu, 2014). Moxibustion is still used with acupuncture today.

President Nixon and the First Lady at the Great Wall of China

In the United States, interest in acupuncture was barely evident until Richard Nixon visited China in 1972. During that visit to China, Richard Nixon had an emergency appendectomy and his post-operative pain was treated with acupuncture. A New York Times journalist (James Reston) had accompanied President Nixon on his trip to China and was so impressed with the pain relief experienced by the President that he decided to write about it. Until President Nixon’s visit to China in 1972, the practice of acupuncture to treat pathophysiological conditions in the United States was rare. After his visit and the article in the New York Times, a national discussion began. Today, the use of acupuncture continues to grow in the United States and other countries due to consumer demand for alternative and complementary forms of healing, recognition by the National Institutes of Health and The Joint Commission regarding the efficacy of the therapy, and the increasingly standardized training and licensing of acupuncturists (Nielsen & Hammerschlag, 2004).

Currently, more than three million Americans use acupuncture (Zhang, Lao, Chen, & Ceballos, 2012). More than 3,000 U. S. physicians integrate acupuncture into their clinical practice (McMillen & Martin, 2011). Millions of individuals in China and throughout Europe also use the therapy. Acupuncture is generally considered to be a safe intervention when practiced by qualified professionals (Xue, Zhang, Greenwood, Lin, & Story, 2010).

In the United States, the primary reasons for using acupuncture include the following (Zhang, Lao, Chen, & Ceballos, 2012):  To treat a specific health problem

 Current medical treatment did not resolve or help with a health problem  Recommendation by family and friends  Recommendation by health care provider  To maintain general wellness  To enhance energy levels  To improve immune function

A HOLISTIC THERAPY

The philosophy of Chinese medicine never considers the mind separate from the body or the spirit, as Western medicine does. This means that TCM is fundamentally different from Western medicine in its approach to health and healing. Western medicine believes that the human body is basically a sophisticated machine made of up distinct parts (the reductionist theory of illness) and this has led to many extraordinary advances in technology, science, and treatment. However, it has also caused much dissatisfaction among patients because this approach to health and healing fails to understand the extremely powerful interactions between the body, mind, and spirit and the concept that human beings are more than the sum of their parts (Mole, 2014).

The general theory of acupuncture is grounded in the philosophy of Chinese medicine and purports that health is impacted by yin and yang forces, and that disease is caused by disruptions and imbalances in the flow of qi (vital life energy) through the body. Acupuncture attempts to unblock congested energy pathways (meridians), thus allowing a freely flowing energy current (qi) throughout the body (Seaward, 2013). Acupuncturists search for patterns of disharmony that cause the symptoms the person is presently experiencing (Mole, 2014).

YIN AND YANG THEORY

Part of the Chinese worldview since ancient times, the concepts of yin and yang are fundamental to TCM and to the practice of acupuncture (Bright, 2002). These concepts are derived from observing the physical world and from the Taoist philosophy that nature and wholeness are comprised of the union of mutually dependent opposite pairs (Fontaine, 2000). Yin and yang are general terms used to describe interdependent aspects of objects or natural phenomena such as heaven and earth, day and night, and water and fire (Bing & Hongcai, 2010).

Yin and yang theory classifies the health care practitioner’s examination findings and guides the client’s treatment because the goal is to foster a balance and harmony between yin and yang.

The natures of yin and yang are relative. They always exist together as variable proportions of each other, just as the concept of hot has no meaning without cold and day has no meaning without night. In addition, the concepts of yin and yang support the emphasis of acupuncture on disease and healing processes rather than physiological structures.

Thus, yin and yang describe a dynamic interaction between all aspects of nature and the universe. Yin and yang are always waxing and waning, and they express the idea of opposing but complementary phenomena that exist in a state of dynamic equilibrium (Ergil, 2010; Trivieri & Anderson, 2002; Williams, 2003).

 Yin translates as “shady side of the mountain” and represents substance more than energy. It is associated with cold, earth, moon, night, autumn, winter, female, rest, downwardness, and passivity (Bing & Hongcai, 2010; Bright, 2002; Ergil, 2010; Fontaine, 2000).

 Yang translates as “sunny side of the mountain” and represents warmth, light, heaven, sun, summer, male, fast, excitement, upwardness, and vigor (Bing & Hongcai, 2010; Bright, 2002; Ergil, 2010; Fontaine, 2000).

In theory, all yin and yang can be subdivided into aspects that are themselves yin and yang. For example, the front of the body is considered yin in relation to the back (which is yang), but the upper front of the body (the chest) is considered to be yang in relation to the lower front (the abdomen).

An important concept is the dynamic interaction between yin and yang. Change is at the root of all of nature. As an example, Williams (2003) notes that the concepts of yin and yang can be compared to the growth of a seed—the seed (yin) grows into the plant (yang), and the plant dies and dissolves into the earth (yin). This process takes place within the seasons—winter (yin) evolves into spring, which evolves into summer (yang), which in turn evolves through the fall into winter again.

Disharmony and illness result when this dynamic change (transformation) is prevented from occurring. Conversely, a healthy body is characterized by a dynamic balance between the aspects of yin and yang. Everything in the universe can be categorized into yin and yang (Bing & Hongcai, 2010).

ENERGETIC CONCEPT OF QI

Qi (pronounced chee) is a fundamental concept in traditional Chinese medicine and lies at the heart of the practice of acupuncture. There is no comparable concept in Western medicine for this element. Western medicine tends to view the human being as a group of specialized organs and functions, while TCM is more concerned with the dynamics of interrelationships, especially the patterns of vital energy in the individual person (Dale, 1994). Qi is known as ki (in Japan), prana (in India), and rlun (in Tibet) and, for people who have grown up in the Far East, the concept forms an integral part of an individual’s view of themselves as human beings (Mole, 2014).

Qi is the basic vital substance that makes up the human body and an essential material that circulates constantly with strong energy. It has been called “life force,” “vital force,” “matter-energy,” and “breath” as well as many other translations. It is present in all living matter and throughout the universe (Mole, 2014

Qi maintains life activities (Dale, 1994; Yanchi & Lianrong, 1998). Qi is simply that element which gives human beings life (Mole, 2014). TCM and acupuncture study and observe the flow, rhythm, cycles, changes, movement, and balance of qi. Qi is inherited from our parents and forms the basis of an individual’s unique constitution (Mole, 2014).

From the Western point of view, energy is measurable and synonymous with vigorous action. However, qi means more than that in TCM. Consider the following explanations from the Chinese medicine perspective (Bright, 2002; Williams, 2003; Yanchi & Lianrong, 1998):

 Everything in the universe has qi, but qi is not considered a particle or substance. Qi varies with its distribution, origin, and function.

 Qi begins with original or primary qi (yuan qi), also called prenatal or before-heaven qi. This qi is inherited from our parents at conception and nourished by food after birth. If original or primary qi is congenitally deficient or depleted because of chronic illness, pathological changes can occur in the body.

 Pectoral qi is composed mainly of clear qi and is inhaled by the lung.

 Essential qi is transformed by the stomach and spleen from the essence of food and drink.

 Two sources of postnatal qi are food or substance (gu qi) and inhaled air or clean qi (kong qi). These two mix to form gathering or aggregative qi (zong qi), which nourishes the heart and lungs and thus promotes respiration and blood circulation.

 Nutritive qi (ying qi) evolves from gathering qi. It originates from the essential elements of food transformed by the spleen and stomach. It is secreted by the body fluids, circulates inside the blood vessels, and nourishes all tissues in the body, including the extremities.

 Defensive qi (wei qi), which circulates outside the body, warms and nourishes tissues and organs, adjusts the opening and closing of body pores, and protects the body from factors that can cause disharmony, such as exogenous pathogenic factors.

Qi has five main functions (Dale, 1994; Williams, 2003):

 It is impulsive, and is thus a source of all body activity, growth, and movement.

 It warms the body and maintains normal body temperature.

 It protects (or defends) the body from harmful external environmental factors.

 It transforms food and air into other vital substances (such as qi itself, blood, and body fluids).

 It controls the body by holding organs, vessels, and body tissues in their correct place so they function properly.

Illness (or disease) is caused by a disturbance (or dis-ease) of the qi within the body (Bing, 2010; Ergil, 2010).

The Meridian (Channel) System

The Chinese theory of medicine is derived from ancient texts and teachings and it regards the human being as a small universe comprised of atoms, molecules, and multi-levels of matter as well as invisible conduits of energy, or qi (Lo, 2004). In Western medicine, it is common knowledge that the human body contains a nervous system and a circulatory system. In Chinese medicine, there is also a meridian system, which is considered more basic to human health than either the nervous or circulatory system. While it is easy to see the nervous and circulatory system in human anatomy, meridians are not visible. Meridians are pathways through which qi and blood circulate (Dale, 1994; Lo, 2004).

The meridian system consists of 12 bilateral main channels (six Yin and six Yang channels) as well as two midline channels (one in front and the other in the back of the body (Han, 2011). Physiologically, these channels and collaterals are thought of as a series of connecting passages through which qi and blood circulate throughout the organs and viscera of the body (Bing & Hongcai, 2010; Williams, 2003; Yanchi, 1995; Yanchi & Lianrong, 1998). Each channel has its own characteristic (such as Liver Qi, Spleen Qi, etc.) (Dale, 1994).

Since acupuncture operates at a very subtle energy level, the meridians are not the same as arteries, veins, and capillaries, and they do not correspond to any anatomical map in Western medicine. Instead, the meridian system is an energy distribution network that is, itself, also energetic (Moyers, 1993; Williams, 2003). A common analogy is that qi is like a river flowing toward its ultimate source, the ocean. During its course, it is

Meridians represent areas of high qi concentration where the energy is dynamic. Any block to that energy flow results in an imbalance that manifests itself in illness or disease. Along the channels or meridians, access points (or energy vortices) allow qi to be removed from the body. These vortices are the acupuncture points that can be used to directly cause changes in the human body’s energy system resulting in physical effects (Williams, 2003).

The channel system performs three functions in the body (Williams, 2003; Yanchi, 1995):

 It provides a way for the body to communicate among related parts.  It helps regulate the activities of the zang-fu organs (the solid organs of the body such as the liver, heart, spleen, lungs, kidneys, gall bladder, stomach, intestines, and bladder).  It helps distribute qi.

At times qi and blood flow are at their maximum in each given channel, and the practitioner uses this information when diagnosing illness and developing treatment strategies.

CAUSES OF DISHARMONY

The concept of disharmony, which has evolved over the centuries, refers to a state or condition of being out of balance or not in harmony. Acupuncture practitioners are trained to view the body, mind, and spirit as one system so a disturbance in the body’s qi is connected to a body, mind, or spirit disturbance and must be released or readjusted for healing to occur (Alternative Medicine Foundation, 2010). For example, if a patient complains to his or her health care provider about a lack of energy, the provider may first complete a physical exam to determine if there is a pathological reason for the lethargy (such as a infection, anemia, etc.). Often there is no discernable cause and the individual may be sent away with no specific treatment or possibly diagnosed with depression. The acupuncturist, however, believes this person is suffering from dysfunctional qi and prescribes specific treatments to enhance the person’s energy (Mole, 2014).

There are four types of qi disharmony (Williams, 2003):

 Deficient qi results in a body’s inability to effectively carry out necessary functions. For example, an aging person may have a qi deficiency that results in a chronic cold.

 Sinking qi results when a deficiency is so tremendous that the organ no longer functions. An organ prolapse is an example of sinking qi.

 Stagnant qi results when the qi flow to an organ is impaired, sluggish, or blocked. For example, an injury to the arm may result in swelling and pain.

 Rebellious qi occurs when qi flows in the wrong direction. For example, a rebellious stomach qi results in hiccups, nausea, or vomiting.

By following various established diagnostic procedures, acupuncturists can construct a detailed assessment of the status of all the internal organs without the aid of laboratory tests or other modern technology. Then acupuncture is used to treat the disharmony and restore balance to the body. Disharmony can result from internal, external, or miscellaneous causes (Bing & Hongcai, 2010; Williams, 2003).

The therapeutic goal of acupuncture is to restore harmony by improving and regulating qi through strategically placed needles along the meridians. These needles help tone, disperse, sedate, warm, cool, guide, or drain qi between body surfaces and deep internal organs, restoring balance to the body, mind, and spirit in the process (Ergil, 2010; Leddy, 2006).

ACUPUNCTURE NEEDLES

Acupuncture is based on a significant amount of scientific evidence derived from the systematic observation of the effects of needles placed on specific ashi points on the body. Initially, the needles were made from locally available materials and were specifically connected to various cultures. Materials initially used for needles included sharpened stones, animal bones, or bamboo. Later, bronze, iron, and gold needles were used (Chiu, 2014).

Today, acupuncture practitioners use rigorous standards of sterilization for their equipment. In fact, many practitioners use disposable needles packed in foil packs with guide tubes. The needles are usually made from stainless steel and can range in thickness and in length, depending on the style of acupuncture used (Williams, 2003).

In acupuncture, the practitioner’s skill and intent are crucial. Before the session, the experienced practitioner conducts a diagnostic interview and makes a complete assessment of the patient’s health condition (Williams, 2003). The practitioner’s intent must be positive, and his or her concentration must be focused while performing the procedure. The needle must be correctly located and manipulated to elicit the desired therapeutic effect. Needles can be rotated, flicked, or stroked. The technique chosen depends on the practitioner’s personal preference and experience. Practitioners also use various methods to select the specific acupuncture points for treating a client. When the qi is accessed via the needles, both the client and the practitioner may be able to detect the sensation. While the sensation is difficult to describe, some individuals who have undergone Chinese styles of acupuncture have said it feels like a small pinch followed by a sensation of itching, tingling, numbness, ache, traveling warmth, or heaviness (Ergil, 2010; Williams, 2003).

The client can use his or her recall of the sensation to advise the practitioner as to when the needle has reached the correct point. The practitioner can use the needle to reinforce a deficiency of qi, reduce an excess of qi, or smooth out qi that is not overly excessive or deficient (Williams, 2003). The practitioner may also use pressure, friction, suction, heat, or electromagnetic energy to stimulate specific anatomic points (Fontaine, 2000).

ELECTROACUPUNCTURE

A relatively new acupuncture technique has come into use by acupuncturists all over the globe. Electroacupuncture (EA) is believed, by some, to have first been used by physicians in France and Italy as far back as the 1800s. Others attribute it to Japanese scientists in the 1940s who were seeking ways to make bone fractures heal more quickly. Still others state that electroacupuncture was developed around 1958 by Chinese acupuncturists who were experimenting to see if it helped relieve pain. (Acupuncture Today, 2014). Whatever its origins, electroacupuncture remains an increasingly popular form of treatment and is used by acupuncturists for many types of conditions.

Electroacupuncture is a technique in which two needles are inserted as electrodes to help conduct an electric current. At least one of the needles is in an acupoint (Napadow, et. al., 2005). Electroacupuncture is similar to traditional acupuncture in many ways. The same points are stimulated during treatment as with traditional treatment and needles are inserted along specific meridian points in the body. In EA, however, the needles are attached to a device that generates continuous electrical pulses using small clips attached to the needles. The pulses can be adjusted in frequency and intensity by the practitioner, depending on the specific health condition being treated. Usually, two needles are used at the same time so impulses can travel from one needle to the next. Several pairs of needles can be used simultaneously as well. Treatments usually last about 30 minutes (Acupuncture Today, 2014).

Advantages of electroacupuncture over traditional acupuncture include the following (Acupuncture Today, 2014):

 The practitioner does not have to be as precise with needle insertion because the current delivered through the needles is larger than the needles themselves and so treats a wider area.

 The technique can be employed without using needles (similar to transcutaneous electrical nerve stimulation, or TENS, where electrodes are taped to the skin surface instead of needles being inserted into the skin). This technique is useful for individuals with a fear of needles or a condition that prohibits them from being needled.

SIMULATED ACUPUNCTURE

Used in clinical trials to test a product or practice against a placebo (an inactive product or technique used to see if a response is due to the test protocol or to something else), simulated acupuncture may use blunt-tipped retractable needles that touch the skin but do not penetrate the skin. In some cases, simulated acupuncture resulted in some degree of pain relief (NCCAM, 2014).

ACUPUNCTURE AND HEALTH

The number of randomized, clinical trials conducted on acupuncture has increased significantly in recent years (Xue, Zhang, Greenwood, Lin, & Story, 2010). In addition, many studies on humans and animals have shown that acupuncture can cause multiple types of biological responses, either locally (at the site of the needle application) or at a distance (mediated by sensory neurons within the central nervous system) (Lee & Hsu, 2014; Rouhbakhsh, 2014).

One of the effects of acupuncture is that it decreases the signals to the brain, specifically the limbic system (amygdala, anterior hippocampus, and prefrontal cortex), and increases signals to the anterior insula (the part of the brain responsible for emotion and homeostasis). The limbic system is central to the effects of acupuncture. This system plays a crucial role in affect (especially fear and defensive behavior) and is also important in processing pain. The hippocampus, for example, links affective states with memory and can link pain experiences with memories of that pain, which can contribute to its perpetuation. Acupuncture’s effect on the limbic system of the brain plays an important role in the reduction of pain sensations after acupuncture treatments (Chiu, 2014; Kong, Schnyer, Johnson, & Mackey, 2013; Rouhbakhsh, 2014; Napadow, et al., 2005).

Recent studies have examined the relationship between acupuncture and the release of opioid peptides (responsible for analgesic effects of the therapy through the desensitization of peripheral nociceptors and the reduction of proinflammatory cytokines peripherally and in the spinal cord). These “endogenous opiates” included Met-enkephalin, Leu- enkephalin, dynorphin, beta-endorphin, and endomorphin (Chiu, 2014). Acupuncture and electroacupuncture are also involved in altering the metabolism of substances involved in both the ascending facilitative pain pathways (such as N- methyl-D-aspartate receptors, substance P, and interleukin-1) and descending inhibitory pain pathways (such as endogenous opioids, serotonin, and norepinephrine) (Kong, Schnyer, Johnson, & Mackey, 2013; Zhang, Lao, Ren, & Berman, 2014).

While acupuncture is most commonly known for its ability to treat pain, it is effective in treating many conditions (Benor, 2004; Bing & Hongcai, 2010; Chou, et al., 2007; Fontaine, 2000; He, Chen, Pan, & Ying, 2014; Kong, Schnyer,

Johnson, & Mackey, 2013; Lo, 2004; Lu, 2005; Sierpina, 2001; NCCAM, 2014; Pfab, et al., 2011; Tsai, et al., 2014; Vickers & Linde, 2014; Yin & Chen, 2010).

While most of these conditions are associated with pain, there are others (such as allergies) for which acupuncture may be successfully used. Studies in the use of acupuncture for conditions other than pain are fewer than those for its use in the relief of pain but they are increasing.

 Low back pain o Acupuncture has been found to be more helpful for back and neck pain together than either no acupuncture or simulated acupuncture. Clinical practice guidelines issued by the American Pain Society and the American College of Physicians recommends acupuncture as one of the several nondrug approaches that physicians and other health care professionals should consider when treating patients with chronic low-back pain that do not respond to self-care techniques (such as remaining active, applying heat, and taking pain-relieving medications).

 Neck pain o Acupuncture has been shown to be more helpful for neck pain than simulated acupuncture.

 Osteoarthritis/knee pain o Acupuncture has been shown to be more helpful for osteoarthritic pain than simulated acupuncture or no acupuncture. The difference between actual and simulated acupuncture was very small, but the difference in pain relief between acupuncture and no acupuncture was large.

 Headaches o In research examining migraine and tension headaches, acupuncture was effective for patients in reducing the frequency and severity of headaches. o Acupuncture is more effective than simulated acupuncture or pain- relieving drugs in individuals with tension-type headaches.

 Other conditions o Results from multiple studies show that acupuncture (and acupuncture point stimulation) are helpful with certain symptoms associated with cancer treatments (such as nausea and vomiting that result from chemotherapy). It is also useful as an adjunct treatment or acceptable alternative for the following conditions. It is important to note that with some of the conditions listed below, studies have been small but research is ongoing.

 Motion disabilities, stroke rehabilitation, myofascial pain, osteoarthritis, low-back pain, carpal tunnel syndrome, and tennis elbow

 Respiratory and cardiovascular conditions, including asthma, chronic obstructive pulmonary disease (COPD), palpitations, and hypertension

 Eye, ear, nose, and throat disorders (conjunctivitis, tinnitus, Meinier’s disease, rhinitis, sore throat)

 Gastrointestinal disorders (gastritis, ulcers, colitis, constipation, irritable bowel syndrome)

 Urogenital conditions (premenstrual syndrome, endometriosis, menopausal symptoms, prostatitis, incontinence, erectile problems)

 Skin disorders (eczema, shingles, urticaria)

 Addictive disorders, generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), and withdrawal syndromes

Acupuncture has not been shown to be effective in individuals with depression or smoking cessation (NCCAM, 2014).

COMPLICATIONS

There have been relatively few reported complications from the use of acupuncture. Those reported have been the result of the use of nonsterile needles and the improper delivery of treatments. When not delivered appropriately, acupuncture can have serious adverse effects including the following (NCCAM, 2014; Zhang, et al., 2014; Zhang, Shang, Geo, & Ernst, 2010):

 Slight bleeding  Tissue or nerve injury  Spinal cord injury  Viral hepatitis  Hematoma  Infections  Pneumothorax  Cardiac tamponade  Syncope  Allergy

 Aphonia (inability to speak)  Cough or thirst  Somnolence  Broken needles

Studies of complications in China, where acupuncture is the most widely used, show a range of transient adverse effects ranging from 6.7% to 15 percent (Zhang, Shang, Geo, & Ernst, 2010). Reports of adverse effects are declining, especially in China, with the advent of recent practices such as clean needle techniques and rigorous acupuncturist training requirements (Mayo Clinic, 2014).

CONTRAINDICATIONS

Acupuncture should never be used in place of, or to postpone, a visit to a health care provider about a health issue (NCCAM, 2014). In addition, traditional acupuncture is contraindicated in those clients with hemophilia, pregnancy, severe psychotic conditions, and acute cardiovascular disorders or in those who have recently taken drugs or alcohol (Fontaine, 2000; Williams, 2003).

Electroacupuncture should not be used in those individuals with a history of seizures, epilepsy, heart diseases or stroke, or on patients with pacemakers. It also should not be applied on a patient’s ear or throat, or directly over the heart. In addition, when the needles are being connected to an electrical current, the current should not travel across the midline of the body (the imaginary line running from the bridge of the nose to the naval) (Acupuncture Today, 2014).

In order to ensure that acupuncture is not provided to an individual with a contraindicated condition, it is vital that clients are open and honest with their acupuncture provider by telling them about their health history and all the health approaches they use (NCCAM, 2014).

TRAINING

Anyone considering the use of acupuncture should check the registry of their state or country’s professional licensing body to ensure that the practitioner is registered and in good standing and to determine whether any complaints have been filed against that practitioner. The training, accreditation, and registration of acupuncture practitioners vary from country to country and, in the United States, from state to state. Most states require a diploma from the National Certification

Commission for Acupuncture and Oriental Medicine (NCCAOM) for licensing (NCCAM, 2014).

Fully registered practitioners have, however, undertaken specific training in the practice of TCM and acupuncture and have met curricula standards for Western anatomy, physiology, and pathology. These practitioners can perform acupuncture and massage, prescribe Chinese herbs, teach Qigong, and provide dietary and lifestyle advice. They adhere to a rigorous standard of ethical conduct, and most carry comprehensive professional indemnity insurance.

When considering the use of acupuncture for wellness or a health condition, it is important to ask the practitioner about the estimated number of treatments needed and how much each treatment will cost. Some insurance companies cover the costs of acupuncture, while others do not. In addition, some coverage varies from state to state so even an insurance company that pays for coverage in one state many not pay for that exact coverage in another state (NCCAM, 2013b).

SUMMARY

Acupuncture is an ancient Chinese medicine technique in which the practitioner stimulates specific points on the body by inserting thin needles through the skin either manually or by electrical stimulation with the goal of simulating the qi of the body and restoring balance and harmony to the individual. Practiced for thousands of years, this therapy is increasingly being used to maintain health as well as treat a variety of medical conditions. Selecting an effective acupuncturist means understanding the training standards necessary to develop competence and ensuring the practitioner chosen meets those standards.

REFERENCES

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Bing, Z. & Hongcai, W. (2010). Basic theories of traditional Chinese medicine. London, UK: Peoples Military Medical Press.

Bright, M. A. (2002). Holistic health and healing. Philadelphia, PA: F. A. Davis.

Chiu, J. (2014). History of acupuncture. In Lin, Y., & Shen, E. S. (Eds.), Acupuncture for Pain Management (pp. 3-12), New York, NY: Springer Science + Business Media.

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