Acupuncture is a traditional Chinese medical technique which consists of inserting needles through particular points on the body. The needles may be twirled or heated, and today are sometimes even stimulated with weak electrical current, ultrasound or certain wavelengths of light. Acupuncture has been used in China for over 4,000 years to alleviate pain and to cure disease. Estimates vary, but apparently somewhere between 10 and 15 million Americans spend approximately $500 million a year on acupuncture for everything from relieving pain, to treating drug addiction or fighting AIDS, to treating depression, allergies, asthma, arthritis, bladder and kidney problems, constipation, diarrhea, colds, flu, bronchitis, dizziness, smoking, fatigue, gynecologic disorders, headaches, migraines, paralysis, high blood pressure, PMS, sciatica, sexual dysfunction, stress, stroke, tendinitis and vision problems. Does it work? Most of the evidence for the effectiveness of acupuncutre is identical to the majority of evidence we have for any alternative medical practice: it is mainly anecdotal. All we know for sure right now is that sticking needles in people at various traditional acupuncture points is often effective in alleviating pain. As for the rest of it, well, studies are underway.
However, because of the nature of acupuncture, what will be tested in America and other western countries, will not be acupuncture, but something much more narrow. We will be testing the effectiveness of sticking needles into muscles. If doing this lowers blood pressure, for example, it will not be a validation of acupuncture because traditional Chinese acupuncture is not a scientific theory, but a metaphysical one. And metaphysical theories can't be empirically tested.
According to traditional Chinese medicine, acupuncture is a technique for manipulating chi (ch'i or qi) in order to balance yin and yang, two opposite forces in the body. Chi is believed to flow through the body along 14 main pathways called meridians. Disease or injury is the consequence of an obstruction along one of the meridians. Acupuncture removes the obstruction, affects the distribution of yin and yang, thereby restoring normal energy flow. When yin and yang are in harmony, chi flows freely and in harmony with the physical body and a person is healthy. When it doesn't, a person is sick. How a physical needle affects a metaphysical entity is not addressed. In any case, this theory cannot be empirically tested, since its major components are unobservable. Of course, the positive side of this is that traditional acupuncture can't be disproved, either. There is a perfect harmony here between proof and disproof: each being impossible. The thought of it sends shivvvers up my spine.
If modern medicine is to test the effectiveness of anything, it will be of the physical effects of sticking needles into the body. There is some research which indicates that sticking needles into certain points affects the nervous system and stimulates the body's production of such natural pain-killing chemical substances as endorphins and enkephalins, and triggers the release of certain neural hormones including serotonin. Studies have shown, that many acupuncture points are more richly supplied with nerve endings than are the surrounding skin areas. Another theory suggests that acupuncture blocks the transmission of pain impulses from parts of the body to the central nervous system. These theories are empirically testable. They are couched in terms of the western and scientific view of the body's anatomical and neurological system. However, some of the studies of acupuncture try to mimic traditional control group studies. Some have been tried where patients were randomized to treatment either with acupuncture or "sham acupuncture." The latter treatment consisted of acupuncture needles being inserted at the "wrong" points (i.e., not one of the 500 traditional points). The false point stickings were considered analogous to a placebo treatment, but are they? If better results are achieved by sticking the traditional points, does that confirm traditional acupuncture? Of course not. If these are the kinds of studies that are going to be done, then I think our tax dollars are being wasted. And, while it might be cruel to refuse treatment for pain to a group of people just to compare them to others with similar symptoms who are treated with acupuncture or given drugs or treated with surgery, it seems very unwise to compare people stuck with a needle in a "right" point versus a "wrong" point, unless you already know that sticking people can help and you are just trying to find the right place to stick them.
Undoubtedly, however, if sticking needles into people really does help drug addicts or cure AIDS, acupuncturists will claim vindication. They will no doubt say that chi flows along the same paths as the blood and nerve impulses, that there is a parallel universe to the physical one, a sort of Leibnitzian pre-established harmony between chi/yin/yang and the physical body. So, whatever is demonstrated regarding the stimulation of endorphins, for example,is also due to chi. But what happens if it turns out that sticking needles into people doesn't lower high blood pressure or cure bronchitis? Will that be taken as proof that chi is a chimera? I doubt it.
I have no reason to oppose doing research into the effectiveness of sticking needles into body points. In March, 1996, the FDA classified acupuncture needles as medical devices for general use by trained professionals. Until then, acupuncture needles had been classified as Class III medical devices, meaning their safety and usefulness was so uncertain that they could only be used in approved research projects. Because of that "experimental" status, many insurance companies, as well as Medicare and Medicaid, have refused to cover acupuncture.This new designation may mean that more research will be done using needles, but it also means that insurance companies may not be able to avoid covering useless or highly questionable acupuncture treatments for a variety of ailments. Wayne B. Jonas, director of the Office of Alternative Medicine at the National Institutes of Health in Bethesda, Md, said that "It's a very wise and logical decision."
Whether the decision was either remains to be seen. Will researchers couch their studies in terms of chi, yin and yang? If so, it is not likely anything wise will result. If the decision just encourages more practitioners of traditional Chinese medicine to feel validated as they continue putting salt in a patient's naval and burning mugwort on the belly (along with needles in the tongue) to treat parasites, then the wisdom of the decision seems suspect.
On the other hand, is any harm being done to people who are undergoing acupuncture? Well, besides those who are not being treated for diseases or injuries which modern medicine could treat effectively, there are some other risks. There have been some reports of lung and bladder punctures, some broken needles, and some allergic reactions to needles containing substances other than surgical steel. Acupuncture may be harmful to the fetus in early pregnancy since it may stimulate the production of adrenocorticotropic hormone (ACTH) and oxytocin which affect labor. Then of course, there is always the possibility of infection from unsterilized needles. But mostly it is probably just useless. For every anecdote of someone whose pain was relieved by acupuncture there is another anecdote of someone whose pain was not relieved by acupuncture. For some, the relief is real but shortlived.The treatment is akin to anesthesia. The patient has to be assisted with walking afterwards, driven home, feels good for awhile, and then the pain returns within a day or two.
See related entry on alternative health practicesand chi.
further reading
Butler, Kurt. A consumer's guide to "alternative medicine" : a close look at homeopathy, acupuncture, faith-healing, and other unconventional treatments; edited by Stephen Barrett (Buffalo, N.Y. : Prometheus Books, 1992).
note: This was the only book of 71 in our local University of California library which is skeptical of acupuncture.