Debate continues over efficacy and safety of acupuncture

An acupuncturist shows how to use a needle. (Photo by Rick Yi/Taiwan News)

A long, metallic needle seems to have magical powers in East Asian cultures as a way to ease pain and cure some diseases.

One of the world’s oldest healing procedures, acupuncture has been practiced in Taiwan, China, Japan, South Korea, Vietnam and other Asian countries for thousands of years. It also plays a key role in traditional Chinese medicine (TCM) while the US and Europe view it as part of complementary and alternative medicines (CAM).

Acupuncture attracted wide attention in the US when New York Times correspondent James Reston wrote a story on July 26, 1971, about how doctors in China used needles to relieve his pain following a July 17 surgery on his acute appendicitis.

Since then a veritable acupuncture frenzy has spread rapidly in the US and in Italy, Germany and France. Doctors and their apprentices have begun establishing acupuncture schools and promoting acupuncture studies.

This traditional medical practice was once dismissed by many as unscientific, but now a growing number of scientifically trained doctors are starting to embrace it. In January 2011 it was even listed in the 2010 Intangible Cultural Heritage of Humanity by the UN Educational Scientific and Cultural Organization (UNESCO).

Acupuncture is widely believed to have originated in China more than 3,000 years ago.

According to TCM, disease is caused by an internal imbalance between two opposing and inseparable forces - the yin (cold, slow or passive power) and the yang (hot, excited or active strength).

This imbalance leads to blockage in the flow of qi (invisible vital energy) in channels that range throughout the body, also known as meridians. But this stagnant condition can be relieved through acupuncture at certain points on the human body that is lined by the 12 meridians and punctuated by 361 acupuncture points (acupoints) officially recognized by the World Health Organization (WHO).

Chang Chia-pei, a physician for the Department of Traditional Chinese Medicine at Taipei Medical University Hospital, says that acupuncture needles stimulate the immune system, help enhance the circulation of qi and make the functions of the meridians return to normal.

Unlike modern medical practices which are based on Western scientific methodology and evidence, traditional Chinese medicine has been passed down from veteran practitioners to their apprentices for countless generations.

An apprentice used to learn his craft from a veteran acupuncturist at a hospital, watching how the needles are inserted into a patient’s body manipulated. But now those who hope to become licensed acupuncturists must get training from medical institutions and pass national exams.

To receive a license to practice acupuncture in Taiwan, a physician or dentist must have completed 132 hours of course work and done 60 hours of clinical training. Alternatively, they may apply to an international master’s program in acupuncture with 14 mandatory credits, at least 10 optional credits and 480 hours of clinical internship which is provided by China Medical University in Taichung, Taiwan. Once students have completed those requirements, they must pass a national certification examination in acupuncture.

In New York State those planning to practice acupuncture must have finished 4,050 hours of course work, done 650 hours of clinical training and treated 250 patients before passing a national certification exam and getting a license.

Few Asians doubt the existence of meridians and acupuncture points because they believe the efficacy of acupuncture, but Westerners tend to question its effectiveness, Chang said.

As the knowledge and practice of acupuncture migrated to other countries, subtle differences in teaching methods, principles and educational programs have caused small variations in the locations of some acupuncture points. These changes may inlfuence the effectiveness of acupuncture treatments and the overall perception of acupuncture as a legitimate form of healing.

According to the 1997 National Institutes of Health (NIH) consensus on acupuncture, despite considerable efforts to understand the anatomy and physiology of the acupoints, the name, definition and characterization of these points still remain controversial.

In a move designed to standardize acupoint locations, the WHO’s Regional Office for the Western Pacific (WPRO) invited a group of leading acupuncturists and scientists from Japan, China and South Korea in October 2003 to work together and establish an international standard for acupuncture points. As a result, the WPRO announced in 2008 that 86 of the 92 controversial points among the total of 361 acupoints had been standardized.

This standardization will lead to a better understanding of acupuncture mechanisms and can be used as a common language to discuss the clinical efficacy of acupuncture around the world.

Lin Jaung-geng, Distinguished Professor of the Graduate Institute of Acupuncture Science at China Medical University in Taichung has practiced acupuncture for over three decades and promotes a safer depth of points to further the spread of acupuncture as a health care system around the world.

After graduating from college in 1979, Lin worked as resident physician at Taipei Veterans General Hospital. At that time many cases of collapsed lung resulting from acupuncture misuse were reported. Such problems prompted him to devote himself to the integration of Western and traditional Chinese medicines.

As the first Taiwanese doctor to get a Ph.D. in Acupuncture, Lin used autopsy and computer tomography (CT) to determine the safe depth of needles at certain acupoints in the chest and back. His 12 years of research have enhanced the safety of acupuncture and earned him international recognition.

Lin, then 33, served as a medical advisor to the King of Saudi Arabia in 1980. In that Islamic country, he combined acupuncture with surgery to cure a chronic disease of one of the King’s family members.

In 2009 this veteran acupuncturist teamed up with a group of Taiwanese scholars and practitioners in traditional Chinese medicine to compile and publish a book titled “Acupuncture.” The work has become a textbook for those who hope to become qualified acupuncturists at home and abroad.

"If a doctor follows the guidelines in ancient books, he will put his needles into his patient’s body at a depth of about 4 centimeters (1.57 inches),” Lin said. “But my CT findings showed that the safe depth should stand at 3.66 centimeters (1.44 inches). Even such a small difference may allow a needle to penetrate the patient’s organs accidentally and threaten his life.”

Acupuncture has become a global therapeutic method in recent decades. In a 2007 survey conducted by the US government’s National Center for Complementary and Alternative Medicine, a unit of the NIH, an estimated 3.1 million American adults and 150,000 children reported that they had used acupuncture in the previous year, up from 2.1 million in a 2002 survey.

While opponents think of acupuncture treatments as placebo effects, proponents say that acupuncture can help relieve neck pain, shoulder pain, low back pain, chronic headaches and osteoarthritis; keep one healthy; help one lose weight or quit smoking; and treat infertility.

A poll in 2005 found that 59 percent of US doctors believe acupuncture has the efficacy of pain control.

In 2008 the Osteoarthritis Research Society International made the recommendation that acupuncture may help treat degenerative joint disease.

A team of neuroscientists at the University of Rochester Medical Center in New York reported in May 2010 that acupuncture eases pain in the limbs because it releases a natural molecule called adenosine, which acts as a natural painkiller.

To do the experiment, the team performed 30-minute acupuncture treatments on lab mice that had discomfort in one paw. The researchers inserted very fine needles below the midline of the mice’s knee, at a well-known acupuncture location called the Zusanli point. They rotated the needle gently every five minutes, mimicking a standard acupuncture treatment with people.

As a result, levels of adenosine in the tissues surrounding the needle surged by 24 times, nearly tripling the duration of acupuncture’s effectiveness, which thereby reduced the mice’s pain by two-thirds, they found.

One recent study, conducted by a group of Taiwanese doctors and published in the March 2011 edition of Microvascular Research found that acupuncture may improve the blood circulation of patients who have suffered strokes.

But acupuncture is no panacea for all diseases, Lin cautions, adding that it can ease pain caused by cancers instead of killing tumor cells.

A growing number of people are turning to acupuncture for help with conditions including weight loss. Fu Pei-mei, a famed Taiwan’s cooking teacher, then 71, got thinner through a combination of walking, acupuncture and liposuction in 2002.

Acupuncture can, however, help control a person’s appetite and help him or her lose weight quickly, Lin says, adding that you may get fatter again if you stop the acupuncture sessions.

"Patients should have patience, because acupuncture often has cumulative effects, not instant effects.”

For most people, safety is another consideration.

When delivered improperly, acupuncture may cause serious side effects including infection, punctured organs, paralysis and death.

But acupuncture is safe when administered by a well-trained, licensed practitioner using sterile needles, and relatively few complications have been reported from the use of acupuncture.

In 1996 the US Food and Drug Administration (FDA) required that acupuncture needles not only be sterile and disposable, but also be applied by licensed practitioners only.

Furthermore, those who stay up late, get drunk or feel weak or indisposed should not undergo acupuncture treatments.