Acupuncture: A Clinical Review

Victor S. Sierpina, MD; Moshe A. Frenkel, MD

Family Medicine Department, University of Texas Medical Branch, Galveston, TX
Abstract

This article summarizes the research base, probable mechanism of actions, and clinical
applications of acupuncture. It offers the clinician a deeper understanding of appropriate
conditions for which acupuncture may be useful, outlines how to integrate acupuncture into a
clinical practice, and describes referral and training issues.
Introduction

Acupuncture is among the best known of complementary and alternative therapies.
Acupuncture is a treatment method that originated more than 3,000 years ago in China and
is practiced in most of the world. The method is commonly practiced as a routine treatment in
China, Japan, Korea, and Taiwan, and since the late 1970s has gained popularity in the
United States as well as other parts of the Western world.[1] Its application in humans and for
a wide array of clinical conditions requires explanation. This review will provide the busy
clinician with a short summary of the history of acupuncture, models of its imputed
mechanism of action, evidence base for effectiveness, and resources for further information
about acupuncture. Primarily though, we provide a summary of the kinds of clinical
applications for which acupuncture can be considered and a model for how to integrate a
referral for acupuncture into the medical setting.

The practice of acupuncture consists of inserting fine, solid needles (usually 32 to 36 gauge)
into selected body locations (acupuncture points). Classic texts describe 365 points located
in systematic fashion on meridians or channels of energy flow that are mapped onto the
surface of the body. Key principles in traditional Chinese medicine (TCM) are that both
wellness and illness result from an imbalance of yin and yang. Yin refers to the feminine
aspect of life: nourishing, lower, cool, deficient, inside, receptive, protective, soft, yielding.
Yang is the male counterpoint: hard, dominant, energetic, upper, hot, excessive, outside,
creative. The movement between these opposite forces, named Qi, is considered to be the
essential element in the healing system of TCM. It is best thought of as energy becoming
manifest, a vitalistic force that flows ceaselessly through the meridians, or energy channels
of the body.

Although a discussion of the diagnostic and pathophysiologic metaphors of TCM is beyond
the scope of this article, suffice it to say that it remains an internally coherent set of
correlations based on close clinical observation, which are expressed in symbology existing
for millennia. If, to our contemporary minds, such terms may seem quaint, dated, or even
naíve, they are highly useful in the context of TCM.

Imbalances in the flow of Qi among the meridians, organs, and five elements is the cause of
disease, pain, and susceptibility to illness. Balancing such factors as heat, cold, dampness,
dryness, in both exterior and interior domains is done by TCM practitioners as well as
medical acupuncturists using needles inserted at key points along these meridians. Other
practices included in the TCM system include dietary approaches, herbalism, cupping,
moxibustion (the heating of an acupuncture point or needle with a smoldering herb),
massage (Tui Na), Tai Chi exercise, and meditation.