On Pins and Needles

Although Acupunture has been an established medical treatment in China for several thousand years, it has only been utilized as therapy in the United States in the last two centuries. We know that Bache (an American physician) used acupuncture in his practice in the 1820s. Subsequently, in 1913, Sir William Osler prescribed acupuncture as a treatment for lumbago in his Principles and Practice of Medicine. However, for a variety of reasons, Chinese medical practices essentially disappeared (or retreated into Chinatowns nationwide) from the early 1900s until James Reston had a highly publicized appendectomy during his visit to China in 1971. Acupuncture was used as a component of his surgical anesthesia and to help control his postoperative pain. Today, over 30 states (including the District of Columbia) license, certify, or register the practice of acupuncture. In fact in 1998, the National Institutes of Health concluded that “acupuncture may be useful as an adjunct treatment or an acceptable alternative” for a variety of conditions. Americans made over 5 million visits to acupuncturists during 1997 alone (Eisenberg, JAMA 1998). Clearly acupuncture has pricked the interest of the U.S. patient population.

The underlying principle in acupuncture is the flow of vital energy (or Qi) along defined paths in the body known as meridians. In essence, Chinese medicine sees the body as a series of energy conduits. Disruption of the flow of energy is responsible for pain and/or illness. Consequently, the purpose of acupuncture is to rebalance the flow of Qi, thereby restoring health and well-being. In Western contemporary medicine, we look for physical and chemical abnormalities when a person is ill. However, Chinese medical doctors search for hidden forces out of balance in the body; their goal is not to treat illness but rather to restore harmony in the body’s energy forces. When Qi flows unimpeded through the body, a person is in a state of health–truly a foreign concept to most of us reared in a Western culture that values evidence-based medicine as the core of conventional medical treatment.

Since your curiosity should be sharpened by now, it’s time for a few pointed comments about mechanics. A typical acupuncture needle has a body or shaft that is approximately one inch long and a handle of the same length. The needles are solid and gently tapered with a distinctive tip which is rounded and moderately sharp–much like the tip of a pine needle. The typical diameter is 0.25mm. Acupuncturists aim to obtain Qi at the needling sites (or acupuncture points) and may manipulate the needles to achieve desired therapeutic effects. Patients generally describe sensations of correctly placed needles as itching, numbness, a swollen feeling, or a distinct electrical sensation. I have had several acupuncture treatments myself, and I am not needling you when I say that there was no pain during the therapy and no bleeding when the needles were removed.

The Workshop on Acupuncture sponsored by the Office of Alternative Medicine presented results that support acupuncture as therapy for pain management (including severe menstrual cramping and migraines), substance abuse treatment (including alcohol and cocaine), and antiemesis treatment (including hyperemesis of pregnancy, and management of postoperative and chemotherapy-induced nausea and vomiting). Other uses of acupuncture include adjunctive treatment for stroke rehabilitation, depression, asthma, osteoarthritis, chronic low back pain, and a variety of joint, muscle, and ligamentous disorders( including fibromyalgia). Many patients try acupuncture when they have not been helped by conventional Western medicine, cannot tolerate side effects of medication, or prefer a nonpharmacologic approach.

As with any treatment, acupuncture may not work for every patient or every problem, and there are relative contraindications to its use in select patients. Research on the efficacy of acupuncture is ongoing in the United States, China, and other countries. Many Western trained medical scientists continue to find the argument to legitimize acupuncture to be full of holes. Although study design issues and the quality of research methods and publications have been problematic, the National Institutes of Health has renewed efforts to produce clear scientific validation of acupuncture as an effective treatment modality. In the meantime, some health maintenance organizations are beginning to cover acupuncture, and this year, The American College of Rheumatology mentioned acupuncture in its medical management of osteoarthritis of the knee. Moreover, utilization of Alternative Therapies (including chiropractic, Chinese medicine, homeopathy, naturopathy, and massage therapy) by Americans is growing steadily; in 1998 alone, U.S. patients spent $27.2 billion for these treatments. Many researchers, including Dr. D.M. Eisenberg at Harvard , say that alternative therapies will not be truly accepted as mainstream until scientists can prove not only that they work but how they work. However, there is a Chinese Proverb “Real gold does not fear the heat of even the hottest fire.” While research continues, millions of Americans will be on pins and needles . . . and receiving relief from a variety of ailments in the process.

Stephen L. Hines, M.D.
March 2000