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Chinese medicine theory describes a vital energy called chi (pronounced “chee”) that circulates in the body through 12 pathways called meridians. Disease occurs when the flow of chi in the body is disturbed or unbalanced. Acupuncture uses needles to stimulate anatomic points along the meridians to promote the proper flow of chi and thus treat illness and promote health. Many styles of acupuncture exist and are practiced as part of the thousands of years old medical traditions of China, Japan, Korea, and other countries. In addition to describing the structure and function of the organ itself, the naming of each meridian also reflects a broader energetic function in Chinese medicine. It is critical to note that the practice of Chinese medicine includes much more than acupuncture (eg, herbs, cupping, dietary advice, a form of massage called “tui na,” etc). However, most published studies investigate acupuncture only.

MECHANISM OF ACTION

The mechanism of action of acupuncture is not well understood, but physiologic effects can be measured when acupuncture points are stimulated, such as the release of endorphins and enkephalins. Functional MRI studies reveal that different areas of the brain are activated and deactivated during needling. In addition, there are increasing number of studies that are examining the role that acupuncture plays in modulating the biological planes that persist across fascia and connective tissue. There have been molecular and cellular targets identified for acupuncture analgesia and antidepressive effects as well as inflammatory modulation and characterization of specific body locations for needle stimulation for specific conditions. In addition, studies are looking at how the connective tissue system and nervous system may be differentially involved in acupuncture efficacy.

TRAINING, LICENSURE, & REGULATION

Typical acupuncture training for nonphysicians in the United States involves completion of a 4-year (2500-hour) master's degree training program accredited by the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM). To become a licensed acupuncturist (LAc), a national and, frequently, state board examination must be passed. Although many states do not require physicians to obtain additional training, many encourage a minimum of 200 hours of training in an accredited program. There are approximately 38,000 licensed acupuncture practitioners and more than 10,000 physician acupuncturists in the United States, with only three states without acupuncture practice laws. In most states that license, register, or certify acupuncturists, these practitioners are permitted to work independently.

CLINICAL PRACTICE

In the United States and Europe, acupuncturists typically conduct a comprehensive multisystem history, observation, and physical examination during the initial consultation. Examination primarily consists of inspection of the tongue to assess color, shape, and coating; and palpation of the pulse to assess its quality, rhythm, and strength. In classic acupuncture, each patient is viewed as having a unique constellation of symptoms and signs. What this means is that 10 patients presenting with migraine headaches might receive 10 unique Chinese medical diagnoses and ...

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