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Acupuncture originated in China more than 2,000 years ago. It's one of the key components of Traditional Chinese Medicine, or TCM. From the TCM perspective, the body comprises a delicate balance between two energy forces—the yin and the yang. Yin represents the cold, slow, passive aspect, while yang represents the hot, excited or active aspect.

Practitioners of TCM believe that the body is healthy when the yin/yang energy is in balance, and that if there's an imbalance, a blockage of energy is the result. The belief is that the blockage can cause illness. Balance, on the other hand, fosters not only physical health, but mental and spiritual well-being.

This energy, which in TCM is called qi (pronounced "chee"), needs to flow through the body well to remain balanced. Qi flows in the body through pathways called meridians. Acupuncturists place needles in the body's meridians to improve the flow of qi.

A primary belief in Chinese medicine is that the different parts of the body form a connected whole. Consequently, illness is not a single, separate event, but a mere part of an entire, interconnected system. In this way, an acupuncturist may use a needle to stimulate a meridian that's related to the gall bladder, for example, but the acupuncture point itself may be nowhere near the actual gall bladder. This way of looking at illness can seem a little strange to people who are used to the more Western approach.

TCM also believes that there's a deep connection between the environment and the body. One type of acupuncture, Five Element Acupuncture, believes that the body is influenced by the five elements of wood, water, fire, earth and metal. Each element has specific characteristics that correspond to traits and symptoms in the physical body. The Five Element acupuncturist takes the time to evaluate which elements are strongest and which are weakest in a patient, and then works to create a balance among all the elements in the body.

What does acupuncture feel like?

Acupuncture needles are metallic, solid and extremely thin. Placement of the needles rarely results in any pain. You feel the prick of the needle, but it's not a feeling that most people would describe as painful. Practitioners use a new set of sterilized needles, from a sealed package, for each patient.

Are there different kinds of acupuncture?

There are different schools of thought among acupuncturists and among acupuncture schools. Some practitioners use just their hands to insert the needles into acupuncture points. Some have an electrical current pulse through the needles, believing that the current provides needed extra stimulation to help treat pain, to accelerate the healing of tissue and to reduce swelling and inflammation. Some acupuncturists believe that auricular acupuncture—ear acupuncture—is an effective modality. They believe that the different points in the ear correspond to specific areas of the body. Auricular acupuncture is most often used to treat pain and addictions to nicotine, alcohol and other drugs.

When you talk to an acupuncturist, be sure to ask about the kind of acupuncture you'll be receiving and why the practitioner uses that particular style. It's important for you to understand what your treatments will be like, why you're being treated in the way that you are and why your practitioner has chosen these specific methods.

What conditions can acupuncture help?

There have been small acupuncture studies over the years that have had mixed results. But few of these studies have been large, double blind ones, in which there's a large group of people receiving the actual studied treatment and a large group of people who are not, and nobody knows who his getting which.

There was a landmark study in 2004, however, that showed that acupuncture provides pain relief and improves function for people with osteoarthritis of the knee. This is the largest Phase III clinical trial ever conducted of acupuncture for this kind of pain.

The study was funded by the National Center for Complementary and Alternative Medicine and by the National Institute of Arthritis and Musculoskeletal and Skin Disease, which are both a part of the National Institutes of Health. The study involved 570 patients age 50 and older. All had osteoarthritis of the knee. Participants had significant pain in their knee in the month before the study, but they had never experienced acupuncture before, had not had knee surgery in the previous six months and had not used steroid injections. For the study, participants continued to receive standard care from their primary physicians, including common medications for arthritis pain.

Participants were randomly assigned to one of three groups: acupuncture alone, sham acupuncture (in which needles were placed at areas in the body that were not true acupuncture points) or a control group that followed the Arthritis Foundation's self-help course for managing their condition.

By week eight of the study, patients receiving acupuncture were showing a significant increase in function, and by week 14, they were showing a significant decrease in pain. The study lasted for 26 weeks, and the improved function and pain lasted for the duration of the study. Overall, participants receiving acupuncture achieved a 40 percent decrease in pain and a 40 percent increase in function.

Smaller studies have shown that acupuncture may be effective, either on its own or in conjunction with other treatments, for conditions that include

  • Post-operative and chemotherapy nausea
  • Post-operative dental pain
  • Addiction
  • Digestive disorders
  • Stroke rehabilitation
  • Headache
  • Menstrual cramps
  • Tennis elbow
  • Fibromyalgia
  • Osteoarthritis
  • Low-back pain
  • Carpal tunnel syndrome
  • Asthma

What should you expect from a visit to an acupuncturist?

During your first visit to an acupuncturist, before inserting any needles, the practitioner is likely to spend a lot of time asking you about your health condition, your lifestyle and relevant behavior. Be sure to tell the practitioner about any medications or other types of treatment you're taking and all the medical conditions you have.

What should you look for in an acupuncturist?

It's important to have an acupuncturist who has licensure in your state and who has graduated from an accredited acupuncture school. To find an acupuncturist, you might first want to ask if your doctor can refer you to someone. Another way is to visit the Web site of the National Certification Commission for Acupuncture and Oriental Medicine, which has an online directory you can use to find an acupuncturist near you. (

Annals of Internal Medicine, 21 December 2004; National Center for Complementary and Alternative Medicine
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