World Health Organization (WHO) and National Institutes of Health (NIH) Consensus on Acupuncture

It is important to understand what is meant by the word ‘health’. The World Health Organization defines health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”

NIH Consensus of Acupuncture reported in 1997 that “studies have demonstrated that acupuncture can cause multiple biological responses, mediated mainly by sensory neurons to many structures within the central nervous system. This can lead to activation of pathways affecting various physiological systems in the brain as well as in the periphery. Acupuncture may also activate the hypothalamus and the pituitary gland, resulting in a broad spectrum of systemic effects. Alteration in the secretion of neurotransmitters and neurohormones and changes in the regulation of blood flow, both centrally and peripherally have been documented. There is also evidence of alterations in immune functions produced by acupuncture.”

Acupuncture is recognized by the National Institutes of Health (NIH) and World Health Organization (WHO) to be effective in the treatment of:

 

  • Addiction-alcohol, drug, smoking
  • Anxiety
  • Arthritis
  • Asthma
  • Bronchitis
  • Carpal tunnel syndrome
  • Chronic fatigue
  • Colitis
  • Common cold
  • Constipation
  • Dental pain
  • Depression
  • Diarrhea
  • Digestive trouble
  • Dizziness
  • Dysentery
  • Emotional problems
  • Eye problems
  • Facial palsy/tics
  • Fatigue
  • Fibromyalgia
  • Gingivitis
  • Headache
  • Hiccough
  • Incontinence
  • Indigestion
  • Infertility
  • Irritable bowel syndrome
  • Low back pain
  • Menopause
  • Menstrual irregularities
  • Migraine
  • Morning sickness
  • Nausea
  • Osteoarthritis
  • Pain
  • PMS
  • Pneumonia

  • Reproductive problems
  • Rhinitis
  • Sciatica
  • Seasonal affective disord
  • er (SAD)
  • Shoulder pain
  • Sinusitis
  • Sleep disturbances
  • Smoking cessation
  • Sore throat
  • Stress
  • Tennis elbow
  • Tonsillitis
  • Tooth pain
  • Trigeminal neuralgia
  • Urinary tract infection
  • Vomiting
  • Wrist pain

 

Safety

One of the benefits of acupuncture is the extremely low risk to adverse effects. The following studies demonstrate no adverse effects occur 99.8% of the time. Acupuncture is even safe during pregnancy.

  1. Frequency and Types of Adverse Events in 55,291 Acupuncture Treatments (Rosted, 1996 & Yamashita, 1998): 64 minor adverse events. 99.8% of these acupuncture treatments were performed without even  minor  adverse events; “The most frequent adverse event was failure to remove needles after treatment; no sequelae occurred after removal of the needles. The second most common adverse event was dizziness, discomfort, or perspiration probably due to transient hypotension associated with the acupuncture treatment.”

    The most serious adverse events during acupuncture are pneumothorax and septicemia. “Instruction is given by both lectures and practical training and includes information about anatomically risky depth of insertion and use of aseptic procedure for puncturing… Most important, no serious events such as pneumothorax, spinal lesion, or infection were reported… We may, therefore, reasonably conclude that serious adverse events in acupuncture treatment are uncommon in the practice of adequately trained acupuncturists.”

  2. Acupuncture Safety (White, 2001 & MacPherson, 2001): 2 September 2001 Studies of safety of acupuncture in the British Medical Journal; Details of 43 minor adverse events associated with 34,407 acupuncture treatments; 91 minor events in 31,822 acupuncture treatments; if combined with the other study above, minor adverse event incidence is 0.16%, no pneumothorax noted.

  3. Pregnancy and Acupuncture (Smith, 2002): In treatment for nausea and vomiting, “our findings suggest that no serious adverse effects arise from acupuncture administered in early pregnancy.” 593 subjects.

Disease Based Studies

  1. Chronic Low Back Pain (Witt, 2006): Largest study to date demonstrates acupunctures effectiveness and cost-effectiveness in the treatment of chronic low back pain based on functionality, pain and quality of life assessed directly after, 3 months after, and 6 months after treatment. 11,630 patients.

  2. Acute Cerebral Infarction (Pei, 2001): “Early acupuncture treatment for acute stroke patients may improve motor functions, and consequently the activities of daily living.” 86 patients.

  3. Acute Spinal Cord Injury (Wong, 2003): “The use of concomitant auricular and electrical acupuncture therapies, when implemented early in acute spinal cord injury, can contribute to significant neurologic and functional recoveries.” 100 subjects.

  4. Breech birth (Cardini, 1998): “Cardini and Weixin found that moxibustion (stimulation of an acupuncture point by heat generated from burning a specific herb) is helpful for correction of breech presentation in late pregnancy. 260 subjects.

  5. Cocaine Dependence (Avants, 2000): “Findings from the current study suggest that acupuncture shows promise for the treatment of cocaine dependence. Further investigation of this treatment modality appears to be warranted.” 82 subjects.

  6. Dysmenorrhea, Primary (Pouresmail, 2002): “the therapeutic efficacies of acupressure and Ibuprofen were similar with no significant difference, and were significantly better than the placebo. Thus acupressure, with no complications, is recommended as an alternative and also a better choice in the decrease of the severity of PD [than Ibuprofen].” 216 subjects.

  7. In Vitro Fertilization (Dieterle, 2006): “The clinical pregnancy rate and ongoing pregnancy rate (33.6% and 28.4%, respectively) were significantly higher than in group II (15.6% and 13.8%). Luteal-phase acupuncture has a positive effect on the outcome of IVF/ICSI.” 225 patients

  8. Labor pain (Skilnand E, 2002 & Ramnero, 2002): “The results indicate that acupuncture reduces the experience of pain in labor. A secondary outcome of acupuncture was a shorter delivery time, which mainly, if not exclusively, can be explained by the reduced need for epidural analgesia.” 210 subjects.

  9. Migraine without Aura (Allais, 2002): “Acupuncture proved to be adequate for migraine prophylaxis. Relative to flunarizine, acupuncture treatment exhibited greater effectiveness in the first months of therapy and superior tolerability.” Comparison without placebo groups. 160 subjects.

  10. Nausea and Vomiting after Abdominal Hysterectomy (Kim, 2002): 1 group each for 2 points, and one placebo group. “Capsicum plaster at either the Korean hand acupuncture point K-D2 or the Pericardium 6 acupoint reduces postoperative nausea and vomiting in patients undergoing abdominal hysterectomy.” 160 subjects.

  11. Nausea and Vomiting; Comparing and Combining Acupressure and Zofran (White, 2002): “The ReliefBand compared favorably to ondansetron (4 mg intravenously) when used for prophylaxis against postoperative nausea and vomiting. Furthermore, the acustimulation device enhanced the antiemetic efficacy of ondansetron after plastic surgery.” 120 subjects.

  12. Nausea and Vomiting in Children (Wang SM, 2002): “In children, P6 acupoint injections are as effective as droperidol in controlling early postoperative nausea and vomiting.” 4 groups of 43-50 children.

  13. Osteoarthritis of Knee (Berman, 2004): “”Overall, those who received acupuncture had a 40 percent decrease in pain and a nearly 40 percent improvement in function compared to baseline assessments. This trial, which builds upon our previous NCCAM-funded research, establishes that acupuncture is an effective complement to conventional arthritis treatment and can be successfully employed as part of a multidisciplinary approach to treating the symptoms of osteoarthritis.” 570 subjects.

  14. Smoking Cessation (Bier, 2002): Quasi-factorial design, sham-controlled. “Acupuncture and education, alone and in combination, significantly reduce smoking; however, combined they show a significantly greater effect, as seen in subjects with a greater pack-year history.” 141 subjects.

Physiological Mechanisms of Acupuncture

(NIH, 1997): “Many studies in animals and humans have demonstrated that acupuncture can cause multiple biological responses. These responses can occur locally, i.e., at or close to the site of application, or at a distance, mediated mainly by sensory neurons to many structures within the central nervous system. This can lead to activation of pathways affecting various physiological systems in the brain as well as in the periphery.” A focus of attention has been the role of endogenous opioids in acupuncture analgesia. Considerable evidence supports the claim that opioid peptides are released during acupuncture and that the analgesic effects of acupuncture are at least partially explained by their actions. That opioid antagonists such as naloxone reverse the analgesic effects of acupuncture further strengthens this hypothesis. Other physiological responses to acupuncture include

  1. Group III & Group IV afferent neurons (via substance P)
  2. CNS activation via HPA axis, homeostatic effect
  3. studied immune effects include stimulation of mast cell, bradykinin, cytokines
  4. needle insertion at specific segmental level (and via dermatomal distribution) stimulating CNS descending control mediates some of the immune response to acupuncture
  5. activate the hypothalamus and the pituitary gland, resulting in a broad spectrum of systemic effects,
  6. alter the secretion of neurotransmitters/neurohormones, regulate circulation & blood rheology, both centrally and peripherally,
  7. PET-Scans of the brain during acupuncture (Dold, 1998): University of California Irvine professor and physicist Zang-Hee Cho, a member of the National Academy of Science, inventor of an early version of the PET scanner and a pioneer of the MRI scanner, found that stimulation of the vision-related acupoint showed the same reaction in the brain as stimulation of the eye. As the acupuncture signal passes to the brain via nervous system, it possibly stimulates the hypothalamus, responsible for the production and release of hundreds of neurochemicals.
  8. Acupuncture: pain management coupled to immune stimulation (Gollub, 1999): “The phenomenon of acupuncture is both complex and dynamic. Recent information demonstrates that acupuncture may exert its actions on pain and immune processes. The coupling of these two systems occurs via common signaling molecules, i.e., opioid peptides. In this regard, we surmise that

    • opioid activation leads to the processing of opioid peptides from their precursor, proenkephalin
    • the simultaneous release of antibacterial peptides contained within the precursor as well.
    • central nervous system pain circuits may be coupled to immune enhancement.
    • Furthermore, acupuncture needle manipulation elicited signal increases bilaterally in the region of the primary and secondary somatosensory corticies in human brain as determined by magnetic resonance imaging.
    • The maps reveal marked signal decreases bilaterally in multiple limbic and deep gray structures including the nucleus accumbens, amygdala, hypothalamus, hippocampus, and ventral tegmental area.

Taken together, we surmise a major central nervous system pathway as well as local pain and immune modulation during acupuncture.”

  1. (Fu, 2000): “In recent years, more and more laboratory proof has accumulated that acupuncture can
    • change the charge and potential of neurons,
    • the concentrations of K(+), Na(+), Ca(++) and
    • the content of neuro-transmitters such as aspartate, and taurine and
    • the quantities of neuro-peptides such as beta-endorphin and leu-enkephalin.
    • All these phenomena are directly related to nerve cells.”

  2. Immune System effects of Acupuncture (Joos, 2002): “The following changes were found in the TCM group: within the lymphocyte subpopulations the CD3+ cells (p = 0.005) and CD4+ cells (p = 0.014) increased significantly. There were also significant changes in cytokine concentrations: interleukin (IL)-6 (p = 0.026) and IL-10 (p = 0.001) decreased whereas IL-8 (p = 0.050) rose significantly. Additionally, the in vitro lymphocyte proliferation rate increased significantly (p = 0.035) while the number of eosinophils decreased from 4.4% to 3.3% after acupuncture (p > 0.05). The control group, however, showed no significant changes apart from an increase in the CD4+ cells (p = 0.012).”

  3. Difference between Manual and Electro Acupuncture (Kong, 2002): “Results showed that electroacupuncture mainly produced fMRI signal increases in precentral gyrus, postcentral gyrus/inferior parietal lobule, and putamen/insula; in contrast, manual needle manipulation produced prominent decreases of fMRI signals in posterior cingulate, superior temporal gyrus, putamen/insula. These results indicate that different brain networks are involved during manual and electroacupuncture stimulation. It suggests that different brain mechanisms may be recruited during manual and electroacupuncture.”

  4. In Parkinson’s Disease (Wang L., 2002): “Under the auditory evoked brain stem potential (ABP) examination, the latent period of V wave and the intermittent periods of III-V peak and I-V peak were significantly shortened in Parkinson’s disease patients of the treatment group (N = 29) after acupuncture treatment. The difference of cumulative scores in Webster’s scale was also decreased in correlation analysis.”

References

  1. Allais G, De Lorenzo C, Quirico PE, Airola G, Tolardo G, Mana O, Benedetto C. Acupuncture in the prophylactic treatment of migraine without aura: a comparison with flunarizine. Headache. 2002 Oct;42(9):855-61.

  2. Avants SK, Margolin A, Holford TR, Kosten TR. A randomized controlled trial of auricular acupuncture for cocaine dependence.
    Arch Intern Med 2000 Aug 14-28;160(15):2305-12.

  3. Bannerman R H 1979 Acupuncture: the WHO View. World Health, December, p27-28.

  4. Bensoussan A, Talley NJ, Hing M, Menzies R, Guo A, Ngu M. Treatment of irritable bowel syndrome with Chinese herbal medicine: a randomized controlled trial. JAMA. 1998 Nov 11;280(18):1585-9.

  5. Berman BM, Lao L, Langenberg P, Lee WL, Gilpin AMK, Hochberg MC. Effectiveness of Acupuncture as Adjunctive Therapy in Osteoarthritis of the Knee: A Randomized, Controlled Trial. Annals of Internal Medicine. 2004; 141(12):901-910.

  6. Bier ID, Wilson J, Studt P, Shakleton M. Auricular acupuncture, education, and smoking cessation: a randomized, sham-controlled trial. Am J Public Health. 2002 Oct;92(10):1642-7.

  7. Bullock ML, Kiresuk TJ, Sherman RE, Lenz SK, Culliton PD, Boucher TA, Nolan CJ. A large randomized placebo controlled study of auricular acupuncture for alcohol dependence. J Subst Abuse Treat. 2002 Mar;22(2):71-7.

  8. Cardini F, Weixin H. Moxibustion for correction of breech presentation: a randomized controlled trial. JAMA. 1998;280:1580-1584.

  9. Carlsson CP, Axemo P, Bodin A, Carstensen H, Ehrenroth B, Madegard-Lind I, Navander C. Manual acupuncture reduces hyperemesis gravidarum: a placebo-controlled, randomized, single-blind, crossover study. J Pain Symptom Manage 2000 Oct;20(4):273-9.

  10. David J, Townsend S, Sathanathan R, Kriss S, Dore CJ. The effect of acupuncture on patients with rheumatoid arthritis: a randomized, placebo-controlled cross-over study. Rheumatology (Oxford). 1999 Sep;38(9):864-9.

  11. Dold C. Needles & Nerves. Discover. September, 1998.

  12. Fu H. What is the material base of acupuncture? The nerves! Med Hypotheses 2000 Mar;54(3):358-9

  13. Gollub RL, Hui KK, Stefano GB. Acupuncture: pain management coupled to immune stimulation. Zhongguo Yao Li Xue Bao 1999 Sep;20(9):769-77.

  14. Gordon. MRI Evidence of Acupuncture. The Orange County Register. December 25, 1998. http://www.acupuncturedoc.com/scientif.htm

  15. Henderson H. Acupuncture: evidence for its use in chronic low back pain. Br J Nurs 2002 Nov 28-Dec 11;11(21):1395-403. Review.
  16. Jan, S. Acupuncture treatment of grade III and IV canine thoracolumbar disc disease ( hind limb paralysis). Am J Acupunct
    1998 26/3-Feb:179-187 (Not avail on MedLine).
    www.medicalacupuncture.org/wkstone/ webkeystone.py?Profile=RefLibrary/viewCitation.prof&RefID=10106&User
    ID=biz_aama

  17. Joos S, Schott C, Zou H, Daniel V, Martin E. J Altern Complement Med 2000 Dec;6(6):519-25. Immunomodulatory effects of acupuncture in the treatment of allergic asthma: a randomized controlled study.

  18. Kim KS, Koo MS, Jeon JW, Park HS, Seung IS. Capsicum plaster at the korean hand acupuncture point reduces postoperative nausea and vomiting after abdominal hysterectomy. Anesth Analg. 2002 Oct;95(4):1103-7.

  19. Kong J, Ma L, Gollub RL, Wei J, Yang X, Li D, Weng X, Jia F, Wang C, Li F, Li R, Zhuang D. A pilot study of functional magnetic resonance imaging of the brain during manual and electroacupuncture stimulation of acupuncture point (LI-4 Hegu) in normal subjects reveals differential brain activation between methods. J Altern Complement Med. 2002 Aug;8(4):411-9.

  20. MacPherson, Thomas, Walters, Fitter. The York acupuncture safety study: prospective survey of 34 000 treatments by traditional acupuncturists. BMJ 2001; 323: 486-487.

  21. Margolin A, Kleber HD, Avants SK, Konefal J, Gawin F, Stark E, Sorensen J, Midkiff E, Wells E, Jackson TR, Bullock M, Culliton PD, Boles S, Vaughan R. Acupuncture for the treatment of cocaine addiction: a randomized controlled trial. JAMA. 2002 Jan 2;287(1):55-63.

  22. NCCAM, National Institutes of Health. Acupuncture Clinical Trials (as of 1/27/03). http://nccam.nih.gov/clinicaltrials/acupuncture.htm

  23. NIH. NIH Consensus Conference on Acupuncture, Programs and abstracts (Bethesda, MD, Nov. 3-5, 1997). Office of Alternative Medicine and Office of Medical Applications of Research. Bethesda

  24. Pei J, Sun L, Chen R, Zhu T, Qian Y, Yuan D. The effect of electro-acupuncture on motor function recovery in patients with acute cerebral infarction: a randomly controlled trial. J Tradit Chin Med. 2001 Dec;21(4):270-2.

  25. Phil B. Fontanarosa, MD; George D. Lundberg, MD. Alternative Medicine Meets Science. JAMA. 1998;280.

  26. Pouresmail Z, Ibrahimzadeh R. Effects of acupressure and ibuprofen on the severity of primary dysmenorrhea. J Tradit Chin Med. 2002 Sep;22(3):205-10.

  27. Ramnero A, Hanson U, Kihlgren M. Acupuncture treatment during labour–a randomised controlled trial. BJOG. 2002 Jun;109(6):637-44.

  28. Rosted P. Literature survey of reported adverse effects associated with acupuncture treatment. Am J Acupunct. 1996;24:27-34.

  29. Skilnand E, Fossen D, Heiberg E. Acupuncture in the management of pain in labor. Acta Obstet Gynecol Scand. 2002 Oct;81(10):943-8.

  30. Smith C, Crowther C, Beilby J. Pregnancy outcome following women’s participation in a randomised controlled trial of acupuncture to treat nausea and vomiting in early pregnancy. Complement Ther Med. 2002 Jun;10(2):78-83.

  31. Studdert DM, Eisenberg DM, Miller FH, et al. Medical malpractice implications of alternative medicine. JAMA. 1998;280:1610-1615.

  32. Sumano H, Bermudez E, Obregon K. Treatment of wobbler syndrome in dogs with electroacupuncture. Dtsch Tierarztl Wochenschr. 2000 Jun;107(6):231-5.

  33. Taguchi A, Sharma N, Ali SZ, Dave B, Sessler DI, Kurz A. The effect of auricular acupuncture on anaesthesia with desflurane. Anaesthesia. 2002 Dec;57(12):1159-63.

  34. Wang L, He C, Liu Y, Zhu L. Effect of acupuncture on the auditory evoked brain stem potential in Parkinson’s disease. J Tradit Chin Med. 2002 Mar;22(1):15-7.

  35. Wang SM, Kain ZN. P6 acupoint injections are as effective as droperidol in controlling early postoperative nausea and vomiting in children. Anesthesiology. 2002 Aug;97(2):359-66.

  36. White PF, Issioui T, Hu J, Jones SB, Coleman JE, Waddle JP, Markowitz SD, Coloma M, Macaluso AR, Ing CH. Comparative efficacy of acustimulation (ReliefBand) versus ondansetron (Zofran) in combination with droperidol for preventing nausea and vomiting. Anesthesiology. 2002 Nov;97(5):1075-81.

  37. White, Hayhoe, Hart, Ernst. Adverse events following acupuncture: prospective survey of 32 000 consultations with doctors and physiotherapists. BMJ 2001; 323: 485-486.

  38. Witt CM, Jena S, Selim D, Brinkhaus B, Reinhold T, Wruck K, Liecker B, Linde K, Wegscheider K, Willich SN. Pragmatic randomized trial evaluating the clinical and economic effectiveness of acupuncture for chronic low back pain. Am J Epidemiol. 2006 Sep 1;164(5):487-96. Epub 2006 Jun 23.

  39. Wong AM, Leong CP, Su TY, Yu SW, Tsai WC, Chen CP. Clinical trial of acupuncture for patients with spinal cord injuries. Am J Phys Med Rehabil. 2003 Jan;82(1):21-7.

  40. Yamashita, Tsukayama, Tanno, Nishijo. Adverse Events Related to Acupuncture. JAMA 1998; 280 (18)