VICUS.COM (26 July 2000) -- Most Americans first became exposed to acupuncture when President Nixon visited China in 1972. Accompanying the president was James Reston, the New York Times columnist who underwent an emergency appendectomy during the trip.

After the operation, Reston was impressed by the use of a few well-placed needles to provide pain relief. He wrote about his experience, and Western physicians began to travel to China to observe the procedure firsthand. 

Since then, there has been an explosion of interest in the West over this alternative method of treatment, which has been a part of the health-care system in China for thousands of years.

Today, there are more than 10,000 acupuncturists in the United States, who administer between 9 million and 12 million acupuncture treatments each year. Many states require licensing. There is a certifying board, and several national organizations maintain directories of acupuncturists. There is also a directory of acupuncturists at Vicus.com.

Compared to Western medicine, acupuncture has its own unique terminology and approach to diagnosis. As in Western medicine, an accurate diagnosis is the basis of clinical success in Chinese medicine. In most cases, this consists of identifying an underlying "pattern" of disharmony in the patient. 

The term "disease" in a Chinese context applies more to disease symptoms (e.g., headache, dizziness, wheezing, breathlessness, epigastric pain, abdominal pain, etc.) than to "disease states" (e.g., coronary artery disease, diabetes, leukemia, etc.) as understood by Western physicians. 

Based on this approach, it is not surprising that the greatest success using acupuncture is in the management of symptoms, particularly pain, that accompany disease. Acupuncturists treat patients as individuals, and successful treatment is judged on the ability to control clinical manifestations of disease and improve mental outlook.

What is acupuncture? Acupuncture is a method of encouraging the body to promote natural healing and improve health. It is done by inserting thin needles at precise acupuncture points on the body to stimulate the flow of  gi (pronounced chi), or natural healing energy. 

What is qi? Qi is the vital life energy present in all living organisms. Acupuncture is based on the belief that health is determined by a balanced flow of qi.

Where is qi located in the body? Qi circulates in the body along energy pathways called meridians. Each meridian is linked to specific internal organs and organ systems. Stimulation of acupoints (acupuncture points) within the meridian system enhances the flow of qi. When acupuncture needles are inserted into these acupoints, they help correct and rebalance the flow of energy, which leads to pain relief and restored health.

Where are meridians located? There are 20 meridians that run roughly parallel along the surface of the body and connect some of the acupuncture points. In the 1960s, Professor Kim Bong Han, working in Korea, found evidence using microdissection techniques of an independent series of fine duct-like tubes corresponding to the paths of traditional acupuncture meridians. The fluid in this system sometimes traveled in the same direction as blood and lymph and at other times in the opposite direction. Kim concluded that the meridians might exist within these duct-like tubes. The French researcher Pierre de Vernejoul corroborated these findings in 1985, by injecting radioactive isotopes into the acupoints in humans and tracking their movement. He found that the movement of the isotopes corresponded to the acupuncture meridians.

What is the role of the acupoints? There appears to be a relationship among the 400 acupoints, meridians and electrical currents of the body. In the 1970s, Robert Becker, M.D., and Maria Reichmanis, a biophysicist, proved that electrical currents follow along the meridians. They reported that 25% of acupuncture points exist along those scientifically measurable lines and act as amplifiers to boost the minute electrical signals as they travel along the body.

What about the other acupuncture points? The function of the other acupuncture points, those that do not exist along meridians, is unclear. They may be weaker amplifiers, or spurious points, or they may have a role that has yet to be defined.

How do the acupuncture needles create an electrical current? Studies show that calcium ion concentration in meridians and acupuncture points is higher than in nonmeridian and nonacupuncture points. Stimulating the acupuncture points with a needle creates an electrochemical gradient (or flow) that contributes to the electrical potential across the cell and along the meridian. Calcium appears to play an important role in this reaction, because if calcium is bound (or chelated), the therapeutic response to acupuncture is blocked. 

How does acupuncture actually work? From the perspective of Western medicine, acupuncture works by needling (the term used to describe manipulation of the needles after insertion) the acupuncture points. This stimulates the nervous system to release chemicals in the muscles, spinal cord and brain, which either changes the experience of pain, or triggers the release of chemicals and hormones that influence the body's own internal regulating system. Acupuncture is associated with increased levels of prostaglandins, white blood cells and gamma globulins, as well as the production and distribution of enkephalins, serotonin, noradrenaline and other neurotransmitters and neuromodulators. >From the perspective of Chinese medicine, acupuncture is used to maintain a balance between the yin (negative) and yang (positive).

Is acupuncture effective? Acupuncture as a therapeutic intervention is widely practiced in the United States, as well as in Asia. It is considered effective in the management of adult postoperative and chemotherapy-related nausea and vomiting and in postoperative dental pain. However, proving that acupuncture works from the perspective of the Western scientific method has been difficult for several reasons. Many studies provide equivocal results because of problems in study design, sample size and other factors. For example, when designing an acupuncture study, there are inherent difficulties in the use of appropriate controls, such as placebos and sham acupuncture groups. 

Can I become infected from the needles? It is possible, but unlikely. Many acupuncturists use pre-sterilized, disposable needles. For those who don't, strict procedures for needle sterilization have been developed by state and federal agencies. Knowledge and proper utilization of these procedures are part of licensing examinations for acupuncturists. 

Are there other conditions in which acupuncture is used effectively? Yes, there is evidence that acupuncture may be useful alone or as part of a comprehensive program for the treatment of addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofacial pain, osteoarthritis, low back pain, carpal tunnel syndrome and asthma, among others. The World Health Organization compiled a list of more than 100 conditions that can be treated using acupuncture. A partial list is shown in the table.

Table. Conditions that can be treated using acupuncture 

Source: World Health Organization, 1997

John Russo Jr., Pharm.D, is senior vice president of medical communications at Vicus.com. He is a pharmacist and medical writer with more than 20 years of experience in medical education.

This story was updated on July 26, 2000.