chapter 130
Acupuncture
M. Kay Garcia and Joseph S. Chiang
Public interest in complementary and alternative therapies,
both for the maintenance of wellness and the treatment of
disease, has grown rapidly in the United States in recent
years.1-5 Integrating complementary and alternative treatment
approaches shown to be effective into the current mainstream
healthcare system in a well-regulated environment is an
important step toward achieving goals set forth by the U.S.
Department of Health and Human Services in Healthy People
2010.6 Unfortunately, putative mechanisms of many such
therapies remain unclear, and the need for quality research
evaluating integrative clinical practice remains. In this chapter
we discuss complementary and integrative medicine with a
focus on traditional Chinese medicine (TCM) and, more
specifically, acupuncture for pain control.
■ HISTORICAL CONSIDERATIONS
With the arrival of the 21st century, a multibillion dollar
industry in complementary and alternative medicine (CAM)
has emerged.7 Overall estimates of CAM use in the United
States range from 28.9% to 42%.1-5 To maximize the benefit
to public health and ensure quality of care, in 1998, the U.S.
Congress established the National Center for Complementary
and Alternative Medicine (NCCAM) at the National Institutes
of Health (NIH). The purpose of the NCCAM is to stimulate,
develop, and support CAM-related research.8 Furthermore, in
response to public demand for more information and guid-
ance, the White House Commission on Complementary and
Alternative Medicine Policy was created in March, 2000.
Among the recommendations made by the commission were
(1) federal agencies should receive increased funding for clin-
ical, basic science, and health services research of CAM ther-
apies; (2) the federal government should consider enacting
legislative and administrative incentives to stimulate private
sector investment in CAM research of products that may not
be patentable; (3) federal, private, and nonprofit sectors
should support research of CAM modalities and approaches
designed to improve self-care and promote wellness; and (4)
these sectors should support innovative CAM research of core
questions posed by new areas of scientific study that might
expand our understanding of health and disease.9
Additionally, the World Health Organization (WHO)
established specific objectives regarding CAM use that
address policy; safety, efficacy and quality; access; and
rational use.10 The challenges of meeting these objectives are
many, but considering the global economic and public health
impact of CAM, they are challenges that must be addressed.
Efforts by the WHO and the US government to establish
meaningful healthcare policies regarding CAM are extremely
important for ensuring the safe and appropriate use of these
therapies.
History of Acupuncture
TCM is a complete system of healthcare that has been prac-
ticed in China for thousands of years. According to the WHO,
TCM is used to treat at least 200 million people annually and
accounts for nearly 40% of all healthcare provided in China.
The primary disciplines within TCM include acupuncture,
herbs, and food therapy; Tui na, or Chinese bodywork; Tai
chi (therapeutic exercise); and Qi gong (meditative/energy
therapy). Acupuncture is among the most popular of these
therapies and is used in at least 78 countries worldwide.10
In the West, acupuncture therapy has grown substantially
more common over the past few decades. In 1971, James
Reston, a journalist for the New York Times, wrote a front-
page article describing how his postoperative pain from an
emergency appendectomy was relieved by acupuncture while
traveling in Beijing.11 Three months later, a group of US
physicians visiting hospitals in China observed acupuncture
for surgical analgesia and reported their observations in the
Journal of the American Medical Association.12 Growing
public interest ensued, and in 1972, President Richard Nixon,
accompanied by his personal physician, witnessed several
surgeries using acupuncture-assisted anesthesia.13 The NIH
subsequently sponsored a team of physicians to study the
healthcare system in China; as a result, several studies
attempting to elucidate the underlying mechanisms of action
for acupuncture were initiated, textbooks of TCM were trans-
lated into English, and training programs were established.14
Before President Nixon’s visit to China, little information
about acupuncture was available in the United States. There
is documented evidence, however, of acupuncture being used
in clinical practice as early as 1826, when Franklin Bache, a
Philadelphia physician and grandson to Benjamin Franklin,
concluded in a published report that he had found acupunc-
ture to be an effective treatment for pain due to rheumatism
and neuralgia among prisoners at the Pennsylvania state pen-
itentiary.15 Sir William Osler also endorsed acupuncture as an
effective treatment for lumbago and sciatica in The Principles
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