CHAPTER 218 Acupuncture

The insertion of fine needles into the body at specific points, or “channels of energy flow,” called meridians has been used in the treatment of human and animal disease for thousands of years. The oldest reference to this traditional East Asian medical procedure dates to 2600 BC, when fine, sharpened stone or bamboo needles were reported to be used in the treatment and prevention of illness.

Contemporary use of acupuncture has become increasingly popular. It is offered not only by traditionally trained doctors of Oriental medicine, but by allopathic and osteopathic physicians and clinicians. Patient interest and acceptance of acupuncture in the United States have resulted in its investigation and recognition by such bodies as the National Institutes of Health’s (NIH) Office of Alternative Medicine. Their advisory panel recently released a consensus statement supporting the efficacy of acupuncture and acknowledging the potential benefit of acupuncture in a number of acute and chronic conditions (NIH, 2005). Furthermore, they recommended that the insurance industry consider wider coverage for this safe and effective technique. These statements have begun changing the perceptions of this ancient medical art from that of a curiosity or an “experimental treatment” to that of an acceptable procedure within medical science.

Although the exact mechanism of its action is not known, acupuncture is the most widely studied alternative therapy, and a wide variety of theories attempt to explain its effects. After use for many centuries, the traditional concept used by the Chinese and others to explain acupuncture is that it is a method of balancing qi (or chi), an invisible yet essential, ceaselessly flowing life energy that circulates silently and invisibly in the body. Because no scientist has ever measured or seen qi, only its effects can be observed. These effects are best demonstrated when the body is performing normally, an amalgamation of all the physiologic, immunologic, and homeostatic functions of a living organism. The blockage of the flow of qi, an inadequate or waning supply of it, or an excess amount of qi can all lead to conditions of pain, disease, and loss of homeostasis.

This quasi-mystical explanation is not always satisfying to the medical scientist’s theorizing mind. Thus, attempts have been made over the years to derive a more robust explanation, one that is understandable in terms of Western scientific tradition and terminology. The work of Pomeranz and others showed that some of the effects of acupuncture are achieved by activating the endorphin neuropeptide system and can be blocked by the opiate receptor antagonist naloxone. Others have looked into the quantum physics realm and found parallels there in nonlocal effects, standing wave theory, and other quantum principles now used by physicists. Certain hybrid models apply Western medical and physiologic terminology to explain the effect of needling. These models discuss the ionic and electrical milieu of cells and tissues as well as the foreign body effect and the pattern of injury currents induced by needling. Additional theories explain acupuncture results as being due to a “neurogate blocking phenomenon,” various neural or endocrinologic events, effects on cytokine and prostaglandin inflammatory pathways, or electromagnetic field realignment. Given the sheer range and diversity of these explanations, it is likely that acupuncture works through a number of mechanisms and perhaps is not yet fully explicable with our current science. However, its effects on humans and animals, its longevity as a healing art, and its resurgence in the Western medical community are all inductive evidence of the value of acupuncture, whatever its mechanism of action.

Although there is considerable variability among training approaches for physicians, the annual 300-hour course called Medical Acupuncture for Physicians offered by the Helms Medical Institute (1-510-649-8488; www.hmieducation.com) and Stanford University (http://cme.stanford.edu/courses) is widely acknowledged as a benchmark minimum for those wanting to practice acupuncture. Classes are offered over several months, including distance learning by DVD and video, and are designed to give practical knowledge without requiring too much time away from a medical practice. The longer, 3- to 4-year courses offered at Asian medical colleges are not usually required by states for licensure for physicians and are often impractical for the practicing clinician to complete.

Laws governing physician acupuncture are listed on the American Academy of Medical Acupuncture’s website, www.medicalacupuncture.org.

Blending this ancient medical art into a medical practice can be a source of satisfaction to both professionals and their patients. It can serve as a practice builder and provide new opportunities to attract patients. With the NIH consensus panel’s opinion on record, health care professionals have reason to anticipate better insurance coverage for acupuncture and a resulting increase in demand. In fact, some HMOs already reimburse for alternative therapies, including acupuncture.

Equipment

A variety of needles are available, ranging from very fine, 34- or 36-gauge needles, to 18-gauge needles used for veterinary acupuncture. The most commonly used needles are those from 0.5 to 3 inches in length and in the 30- to 34-gauge size. Acupuncture needles usually have solid stainless steel shafts and a copper, silver, or wound-steel-wire handle. The longer needles are used in thicker muscle groups, such as the back, buttocks, and legs, whereas the shorter, more delicate needles are used in the hands, face, and ears.

In addition to the needles, acupuncturists both in the United States and abroad, including China, now commonly use electrostimulation units (Fig. 218-1). These are small, hand-held, battery-operated units, similar in design to transcutaneous electrical stimulation (TENS) units used for pain control. Instead of the electrode pad that is used with the TENS unit, a small alligator clip is placed on the shaft of an acupuncture needle to deliver the electrical current.