use in medicine, surgery,
gynecology, pediatrics, ophthalmology, and skin diseases.
Also Included:
534 clinical research studies
using acupuncture are described in great depth. Videos include an acupuncture
demonstration and a comprehensive lecture by Wei Liu, Doctor of Chinese
Medicine. Also included are body charts, a glossary of acupuncture points, over
60 diagrams, tables relating to the study of acupuncture, full-text search,
annotations, bookmarking, and more.
There is scientific agreement that an
evidence-based medicine (EBM) framework should be used to
assess health outcomes and that systematic reviews with strict
protocols are essential. Organisations such as the
Cochrane Collaboration and
Bandolier publish such reviews.
For the following conditions, the
Cochrane Collaboration concluded there is insufficient
evidence that acupuncture is beneficial, often because of the
paucity and poor quality of the research and that further
research would be needed to support claims for efficacy:
For
headache, Cochrane concluded that "(o)verall, the existing
evidence supports the value of acupuncture for the treatment of
idiopathic headaches. However, the quality and amount of
evidence are not fully convincing. There is an urgent need for
well-planned, large-scale studies to assess the effectiveness
and cost-effectiveness of acupuncture under real-life
conditions.". Bandolier states: "There is no evidence from high
quality trials that acupuncture is effective for the treatment
of migraine and other forms of headache. The trials showing a
significant benefit of acupuncture were of dubious
methodological quality. Overall, the trials were of poor
methodological quality."
For
nausea and
vomiting: The Cochrane review on the use of the P6 acupoint
for the reduction of post-operative nausea and vomiting
concluded that "compared with anti emetic prophylaxis, P6
acupoint stimulation seems to reduce the risk of nausea but not
vomiting" . Bandolier said “P6 acupressure in two studies showed
52% of patients with control having a success, compared with 75%
with P6 acupressure."and
that one in five adults, but not children showed reduction in
early postoperative nausea.
A review published by the Scientific Review of Alternative
Medicine, however, disagreed.
According to Cochrane: "Electroacupuncture is effective for
first day vomiting after chemotherapy, but trials considering
modern antivomiting drugs are needed.".
Bandolier also stated:
"There were no high quality trials of acupuncture for
stroke that showed that it was beneficial."
In practice, EBM does not demand that doctors ignore research
outside its "top-tier" criteria.
NIH consensus statement
In
1997, the
National Institutes of Health (NIH) issued a
consensus statement on acupuncture that concluded that
there is sufficient evidence of acupuncture's value
to expand its use into conventional medicine and to
encourage further studies of its physiology and clinical
value.
The statement was not a policy statement of the NIH but rather the assessment of a panel whose impartiality
has been questioned by members of the The National Council
Against Health Fraud (NCAHF).
The NIH consensus statement said that
the data in support of acupuncture are as strong as
those for many accepted Western medical therapies
and added that
there is clear evidence that needle acupuncture is
efficacious for adult postoperative and
chemotherapy nausea and vomiting and probably for the
nausea of pregnancy... There is reasonable evidence of
efficacy for postoperative dental pain... reasonable studies
(although sometimes only single studies) showing relief of
pain with acupuncture on diverse pain conditions such as
menstrual cramps, tennis elbow, and fibromyalgia...
The NIH consensus statement summarized and made a prediction:
Acupuncture as a therapeutic intervention is widely
practiced in the United States. While there have been many
studies of its potential usefulness, many of these studies
provide equivocal results because of design, sample size,
and other factors. The issue is further complicated by
inherent difficulties in the use of appropriate controls,
such as placebos and sham acupuncture groups. However,
promising results have emerged, for example, showing
efficacy of acupuncture in adult postoperative and
chemotherapy nausea and vomiting and in postoperative dental
pain. There are other situations such as addiction, stroke
rehabilitation, headache, menstrual cramps, tennis elbow,
fibromyalgia, myofascial pain, osteoarthritis, low back
pain, carpal tunnel syndrome, and asthma, in which
acupuncture may be useful as an adjunct treatment or an
acceptable alternative or be included in a comprehensive
management program. Further research is likely to uncover
additional areas where acupuncture interventions will be
useful.
The NIH's
National Center For Complementary And Alternative Medicine
continues to abide by the recommendations of the NIH Consensus
Statement.
American Medical Association statement
In 1997, the following statement was adopted as policy of the
American Medical Association (AMA) after a report on a
number of alternative therapies including acupuncture:
"There is little evidence to confirm the safety or
efficacy of most alternative therapies. Much of the
information currently known about these therapies makes it
clear that many have not been shown to be efficacious.
Well-designed, stringently controlled research should be
done to evaluate the efficacy of alternative therapies."
A note on scientific methodology and acupuncture
One of the major criticisms of studies which purport to find
that acupuncture is anything more than a placebo is that most
such studies are not (in the view of critics) properly
conducted. Many are not double blinded and are not randomised.
However, double-blinding is not a trivial issue in acupuncture:
since acupuncture is a procedure and not a pill, it is difficult
to design studies in which the person providing treatment is
blinded as to the treatment being given. The same problem arises
in double-blinding procedures used in biomedicine, including
virtually all surgical procedures, dentistry, physical therapy,
etc.; the
NIH Consensus Statement notes such issues with regard to
sham acupuncture, a technique often used in studies
purporting to be double-blinded. See also
Criticism of evidence-based medicine. Tonelli, a prominent
critic of EBM, argues that
complementary and alternative medicine (CAM) cannot be
EBM-based unless the definition of evidence is changed. Tonelli
also says "the methods of developing knowledge within CAM
currently have limitations and are subject to bias and varied
interpretation. CAM must develop and defend a rational and
coherent method for assessing causality and efficacy, though not
necessarily one based on the results of controlled clinical
trials.".
Safety and risks
Because acupuncture needles penetrate the skin, many forms of
acupuncture are
invasive procedures, and therefore not without risk.
However, injuries are rare among patients treated by trained
practitioners. Forms of acupuncture such as the Japanese
Tōyōhari and Shōnishin often use
non-invasive techniques, in which specially-designed needles
are rubbed or pressed against the skin. These methods are common
in Japanese pediatric use.
Hematoma may result from accidental puncture of any
circulatory structure.
Nerve
injury can result from the accidental puncture of any nerve.
Brain damage or
stroke is possible with very deep needling at the base of
the skull. Also rare but possible is
pneumothorax from deep needling into the
lung,
and
kidney damage from deep needling in the low back. Needling
over an occult sternal foramen (an undetectable hole in the
breastbone which can occur in up to 10% of people) may result in
a potentially fatal haemopericardium.
Certain acupuncture points have been shown to stimulate the
production of adrenocorticotropic hormone (ACTH)
and
oxytocin; these points are contraindicated for use on
pregnant women to avoid inducing abortion or harming the fetus.
The Parliamentary Committee on the Health Care Complaints
Commission in the Australian state of New South Wales
commissioned a report investigating Traditional Chinese medicine
practice.
They recommended the introduction of a government
appointed registration board that would regulate the profession
by restricting use of the titles "acupuncturist", "Chinese
herbal medicine practitioner" and "Chinese medicine
practitioner". The aim of registration is to protect the public
from the risks of acupuncture by ensuring a high baseline level
of competency and education of registered acupuncturists,
enforcing guidelines regarding continuing professional education
and investigating complaints of practitioner conduct. The
registration board will hold more power than local councils in
respect to enforcing compliance with legal requirements and
investigating and punishing misconduct. Victoria is the only
state of Australia with an operational registration board. Currently acupuncturists in NSW are bound by the
guidelines in the Public Health (Skin Penetration) Regulation
2000
which is enforced at local council level. Other states
of Australia have their own skin penetration acts. The act
describes explicitly that single-use disposable needles should
be used wherever possible, and that a needle labelled as
"single-use" should be disposed of in a sharps container and
never reused. Any other type of needle that penetrates the skin
should be appropriately sterilised (by
autoclave) before reuse.
The report noted that:
Environmental Health Team leaders classified
acupuncture as a high-risk area. Procedures like
bloodletting were being performed in one council area using
un-sterilised needles. Other breaches of a serious nature
include the re-use of single use needles. and - - :The
evidence provided by City of Sydney Council concerning their
results of their regular hygiene inspections convinced the
Committee that the public would best be protected by leaving
acupuncturists under local council jurisdiction until the
profession as a whole has been upgraded to higher clinical
and professional standards.
Dr Stephen Li, Senior Vice President of the Australian
Chinese Medical Association, in supporting the recommendations
of the report, said:
we often have to deal with patients who develop very
serious adverse side effects because of TCM or other herbal
medicine … most of the complaints that we receive from the
Chinese Australian community are that they have been
victimised, they have been ripped off by people who claim to
be TCM practitioners … Some of these patients have terminal
illnesses and they rip them off before they die.
The NIH consensus panel said:
"Adverse side effects of acupuncture are extremely low
and often lower than conventional treatments
and "the incidence of adverse effects is substantially lower
than that of many
drugs or other accepted medical procedures used for the
same condition. For example,
musculoskeletal conditions, such as
fibromyalgia,
myofascial pain, and
tennis elbow... are conditions for which acupuncture may
be beneficial. These painful conditions are often treated
with, among other things,
anti-inflammatory medications (aspirin, ibuprofen, etc.)
or with
steroid injections. Both medical interventions have a
potential for deleterious side effects but are still widely
used and are considered acceptable treatments."
Needles that are not properly sterilized can transfer
diseases such as
HIV
and
hepatitis. Most acupuncturists in the USA use sterile
one-time-use needles (rather than resterilizing needles after
use). In 1996, the FDA
changed the status of acupuncture needles from Class III to
Class II medical devices, meaning that needles are regarded as
safe and effective when used appropriately by licensed
practitioners.
