Acupuncture may seem mainstream when compared to many other forms of alternative medicine. But I just checked a local bookstore and yes indeedy, acupuncture is still in the "Alternative Medicine" section, right next to homeopathy and herbal healing.

It has been said that there's really no such thing as "alternative medicine." There are alternatives in medicine--such as different types of medication one might choose to treat a particular ailment--but all of these alternatives are still found in the literature of scientifically accepted medicine.

I'll save the description of just what alternative medicine is for another article, but for now, we should narrow our view and take a quick look at acupuncture. There sure are a lot of people who practice acupuncture, and a ton more who receive such treatments regularly. But just what is acupuncture, really? And more importantly, does it work?

Acupuncture is an ancient Chinese form of medicine. It is described in the oldest surviving medical text, called: "Huangdi Neijing." Roughly translated, that's the "Yellow Emperor's Inner Canon."

This document says that the body has a series of interconnected meridians through which qi or chi is said to flow. This chi is described as the vital energy. These meridians are said to approach the surface of the skin at certain points. Acupuncture is supposed to correct the chi flow (and thus, cause healing) by inserting needles or pins at these particular points.

That's the original Chinese version. The version being practiced in the Western world hasn't changed much, but the explanations have certainly changed quite a bit. Indeed, there has been some research that seems to show there might be something to this (but as I said, it's still in the alternative medicine section).

Before we move on to discuss our Western acupuncture, let's briefly clarify a few things about the ancient Chinese version.

1) There is no form of energy in science known as chi. This word could possibly be used to describe something quite different that is explained in science. Remember that when acupunture was invented, science was far from as advanced as it is today. Many perfectly natural things we now understand perfectly could have been misunderstood by the ancient Chinese and described as this mystical chi.

2) Just like there's no such thing as chi, there are no meridians through which such chi could flow. It could be said that these meridians are actually blood vessels. This would seem to make some sense. Blood vessels are pathways through which blood flows, naturally, and blood could possibly have been thought of by ancient man as a mystical "vital energy."

However, this idea falls apart when you realize that you're not going to get any medican benefits from inserting acupuncture needles into blood vessels. The only result you're going to get from that is a stinging sensation and (possibly) some minor bleeding.

Another possible explanation is that these meridians are actually nerves. The nervous system is indeed very much like a system of pathways through which impulses travel. This brings us a step closer to the modern versions of acupuncture, so we'll come back to it in a moment. For now, let's turn to the Western acupuncturists.

According to the Mayo Clinic, there are about 3,000 Medical Doctors in the United States who practice acupuncture in addition to standard medicine. They generally receive 200 to 300 hours of acupuncture training in addition to their standard medical training. There are also around 11,000 certified acupuncturists in the U.S. who are not medical doctors. They recieve certification from the National Certification Commission for Acupuncture and Oriental Medicine and generally have 2,000 to 3,000 hours of training.

It's certainly a popular form of alternative medicine. Let's see what's the same and what's different from the ancient Chinese acupunture.

The actual treatment is essentially the same, although the tools used have advanced to some degree. The needles used are sterile, individually wrapped stainless steel needles which are used once and they disposed of. In this regard, it's perfectly safe. You're not going to get any disease from tainted acupuncture needles.

Treatments are generally given weekly or biweekly. The extent of the treatment is usually 12 visits, each of which usually lasts from half an hour to an hour.

Needles are inserted into the skin, just deep enough to stick, but not deep enough to cause any serious physical damage or pain. The literature on acupunture says that many patients feel a brief stinging sensation as the needle is inserted, but no lingering pain. I asked my mother, who has received such treatments in the past, and she confirmed that the pain is minimal (and sometimes, she didn't even feel it at all).

In some cases, one the needles are placed, they may be gently moved or stimulated with electricity or heat, but this is by no means a universal practice.

All in all, the basic principles of the treatment have remained the same since it was first introduced in ancient China (with some minor differences, mainly keeping up with changes in technology and standards in hygeine and sanitation).

Since the ancient Chinese explanation of acupuncture simply doesn't hold up to scientific scrutiny, there are two possible explanations for why the treatment has remained so much the same.

1) The ancient Chinese discovered a real and effective means of treating some conditions, but lacked the medical knowledge to properly explain how it worked.

2) The modern doctors who practice it are still working under the same principles, but giving it a makeover to make it seem more scientific.

But which is true?

Well, we know that acupuncture does work for pain relief in some cases. We don't know exactly why it works. Skeptics generally say that this is just a placebo effect. Psychologically, the patient expects to receive healing, and thus the brain makes it so, even though no true medical benefit is to be found. This is the same result that would be expected if the patient were given a sugar pill and told it was real medicine.

Researchers have been looking into several ideas to explain how it works.

1) A release of endorphins during acupuncture causes the pain relief (reducing pain similarly to taking a pain medication).

2) Nerve manipulation. Acupunture may manipulate the nerves in the spinal cord in such a way as to cause pain relief. This is also called the "gate theory."

3) Attention may be distracted from a symptom by irritating another part of the body.

Let's examine these briefly.

1) According to the National Council Against Health Fraud's position paper on acupuncture, "Naloxone, which reverses the effects of administered opiates, has been reported to reduce the analgesia produced by acupuncture. However, some studies show no reversal. Even if endorphin release were a real mechanism for acupuncture action, there are simpler and non invasive ways to cause endorphin release."

2) There is no scientific basis for this explanation. We have a very complete knowledge of anatomy and we know what connects to what, and to accept this explanation of acupunture would be to throw away much of our accepted scientific knowledge of anatomy.

3) Hitting your thumb with a hammer works much better.

I also hate to point out that few studies on acupunture have met basic scientific standards for testing of medical claims.

The NCAHF also points out possible hazards related to acupuncture: "The frequency of complications of acupuncture needling is not known, since no survey has been done. Nevertheless, serious complications occur even in experienced hands and are reported in medical journals. These include fainting, local hematoma (bleeding from punctured blood vessel), pneumothorax (punctured lung), convulsions, local infections, hepatitis B (from unsterile needles), bacterial endocarditis, contact dermatitis, and nerve damage. The herbs used by acupuncture practitioners are not regulated for safety, potency or effectiveness. There is also the risk that a lay acupuncturist will fail to diagnose a dangerous condition."

Conclusion: Acupuncture is just another form of alternative medicine that actually has no basis beyond a placebo effect.

See also:
NCAHF Position Paper on Acupuncture

Mayo Clinic article on acupuncture