Acupuncture is one of several treatment approaches widely used in traditional Chinese medicine (TCM). Like much of TCM, it is based on the idea that a vital energy, or life force, ﬂows throughout the body along channels called meridians. Illness, both physical and psychological, is attributed to imbalances or disturbances in the ﬂow of this energy, often referred to as chi or qi. Treatment, therefore, consists of adjusting the balance and ﬂow of qi through such practices as qigong (similar to the discredited American practice of therapeutic touch) and acupuncture.
In acupuncture, ﬂow of qi is adjusted via the insertion of very thin stainless-steel needles into various “acupuncture points” along meridians throughout the body. In modern practice, weak electrical currents are sometimes applied to the needles to enhance the effect (this is known as electro acupuncture). Over the course of the approximately 2,000 years of Chinese acupuncture practice, the number of these identiﬁed points has increased from the original 365 (one point to correspond to each day of the year) to about 2,000. Unfortunately, practice is not especially standardized—some practitioners place needles near the location of the injury or illness, others choose locations based on the ancient belief of symptoms corresponding with particular meridians, and many engage in some combination of these two methods.
Acupuncture advocates claim that it is helpful in treating a wide range of physical and psychological ailments, including but not limited to stress and anxiety, depression, smoking, overeating, drug addiction and alcoholism, gastrointestinal complaints, hypertension, chronic pain, migraines, impotence, and deafness. These are remarkably broad claims, based on remarkably narrow evidence. Most advocates cite only their own observations and poorly controlled studies as evidence of the treatment’s effectiveness. Large-scale examinations of acupuncture’s effectiveness (see Ter Reit et al., 1990) tend to conclude that acupuncture is neither more nor less effective than a placebo, suggesting the palliative properties may be due to nonspeciﬁc effects rather than acupuncture. Double-blind placebo-controlled research on acupuncture is rare in any case, due to the very real difﬁculties of designing a realistic placebo condition that will not be distinguishable from real acupuncture by the research participants.
Probably the most-researched effect of acupuncture is its alleged utility in the treatment of pain, both in cases of chronic pain and as an anesthetic measure. How such pain relief might actually occur is unclear. Advocates mostly adhere to either the gate-control hypothesis or the endorphin hypothesis. According to the gate-control advocates, acupuncture somehow diverts pain impulses in such a way that they do not reach the spinal cord or the brain, in effect shutting the “gate” to those areas. The other major theory is that acupuncture somehow stimulates the release of endorphins, opiate-like neurotransmitters that reduce pain in exactly the same way as prescription painkillers.
Within the medical world, opinion has been strongly divided as to whether or not these effects exist, as well as regarding whether the effects are unique to acupuncture, even if it can be shown to work. A 1981 American Medical Association report, for example, concluded that pain relief does not occur consistently or reproducibly in most patients, or at all in some of them. In 1991 the National Council Against Health Fraud went further, publishing a paper that concluded that acupuncture is an unproven treatment based on concepts of health and disease that bear no relationship to present scientiﬁc knowledge, and that recent research has failed to show the effectiveness of acupuncture against any disease. Despite this, a National Institutes of Health panel convened in 1997 concluded that the government and insurers should expand coverage of acupuncture to increase the number of people with access to its beneﬁts. This panel and its conclusions have lent acupuncture a new aura of scientiﬁc respectability in the popular media, but they have been roundly disparaged by the scientiﬁc community as the result of loading the committee with acupuncture proponents rather than with more objective scientiﬁc minds (Sampson, 1998).
The inconsistency of research results, even when reported by advocates, is not surprising given the physiological improbability of the alleged mechanism involved in acupuncture. The meridians do not correspond with any known structures in the body (they do not, for example, correspond to the nervous or circulatory systems), and so it is unclear exactly how the qi ﬂows along them. The vital force itself has also proven remarkably elusive when attempts have been made to measure it. Acupuncture is therefore a mechanism by which a healer attempts to affect the ﬂow of a force that cannot be measured along pathways that don’t exist.
- Barrett, S. Acupuncture, Qigong, and “Chinese Medicine.” www. quackwatch.org, 2002;
- Beyerstein, B. L., and Sampson W. “Traditional Medicine and Pseudoscience in China: A Report of the Second CSICOP Delegation (Part 1).” Skeptical Inquirer, 20(4) (1996): 18–26;
- Melzack, R., and Katz, J. “Auriculotherapy Fails to Relieve Chronic Pain: A Controlled Crossover Study.” Journal of the American Medical Association, 251 (1984): 1041–1043;
- Sampson, W. “Acupuncture: The Position Paper of the National Council Against Health Fraud.” Clinical Journal of Pain, 7 (1991): 162–166;
- Sampson, W. “On the National Institute of Drug Abuse Consensus Conference on Acupuncture.” Scientiﬁc Review of Alternative Medicine, 2(1) (1998): 54–55;
- Skrabanek, P. “Acupuncture: Past, Present, and Future.” In D. Stalker and C. Glymour, eds. Examining Holistic Medicine. Amherst, NY: Prometheus, 1985;
- Ter Reit, G., Kleijnen, J., and Knipschild, P. “Acupuncture and Chronic Pain: A Criteria-Based Meta-Analysis.” Clinical Epidemiology, 43 (1990): 1191–1199;
- Ter Reit, G., Kleijnen, J., and Knipschild, P. “A Meta-Analysis of Studies into the Effect of Acupuncture on Addiction.” British Journal of General Practice, 40 (1990): 379–382.