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chapter 130
Acupuncture
M. Kay Garcia and Joseph S. Chiang
Public interest in complementary and alternative therapies, many, but considering the global economic and public health
both for the maintenance of wellness and the treatment of impact of CAM, they are challenges that must be addressed.
disease, has grown rapidly in the United States in recent Efforts by the WHO and the US government to establish
years.1-5 Integrating complementary and alternative treatment meaningful healthcare policies regarding CAM are extremely
approaches shown to be effective into the current mainstream important for ensuring the safe and appropriate use of these
healthcare system in a well-regulated environment is an therapies.
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 History of Acupuncture
therapies remain unclear, and the need for quality research
evaluating integrative clinical practice remains. In this chapter TCM is a complete system of healthcare that has been prac-
we discuss complementary and integrative medicine with a ticed in China for thousands of years. According to the WHO,
focus on traditional Chinese medicine (TCM) and, more TCM is used to treat at least 200 million people annually and
specifically, acupuncture for pain control. 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
■ HISTORICAL CONSIDERATIONS chi (therapeutic exercise); and Qi gong (meditative/energy
therapy). Acupuncture is among the most popular of these
With the arrival of the 21st century, a multibillion dollar therapies and is used in at least 78 countries worldwide.10
industry in complementary and alternative medicine (CAM) In the West, acupuncture therapy has grown substantially
has emerged.7 Overall estimates of CAM use in the United more common over the past few decades. In 1971, James
States range from 28.9% to 42%.1-5 To maximize the benefit Reston, a journalist for the New York Times, wrote a front-
to public health and ensure quality of care, in 1998, the U.S. page article describing how his postoperative pain from an
Congress established the National Center for Complementary emergency appendectomy was relieved by acupuncture while
and Alternative Medicine (NCCAM) at the National Institutes traveling in Beijing.11 Three months later, a group of US
of Health (NIH). The purpose of the NCCAM is to stimulate, physicians visiting hospitals in China observed acupuncture
develop, and support CAM-related research.8 Furthermore, in for surgical analgesia and reported their observations in the
response to public demand for more information and guid- Journal of the American Medical Association.12 Growing
ance, the White House Commission on Complementary and public interest ensued, and in 1972, President Richard Nixon,
Alternative Medicine Policy was created in March, 2000. accompanied by his personal physician, witnessed several
Among the recommendations made by the commission were surgeries using acupuncture-assisted anesthesia.13 The NIH
(1) federal agencies should receive increased funding for clin- subsequently sponsored a team of physicians to study the
ical, basic science, and health services research of CAM ther- healthcare system in China; as a result, several studies
apies; (2) the federal government should consider enacting attempting to elucidate the underlying mechanisms of action
legislative and administrative incentives to stimulate private for acupuncture were initiated, textbooks of TCM were trans-
sector investment in CAM research of products that may not lated into English, and training programs were established.14
be patentable; (3) federal, private, and nonprofit sectors Before President Nixon’s visit to China, little information
should support research of CAM modalities and approaches about acupuncture was available in the United States. There
designed to improve self-care and promote wellness; and (4) is documented evidence, however, of acupuncture being used
these sectors should support innovative CAM research of core in clinical practice as early as 1826, when Franklin Bache, a
questions posed by new areas of scientific study that might Philadelphia physician and grandson to Benjamin Franklin,
expand our understanding of health and disease.9 concluded in a published report that he had found acupunc-
Additionally, the World Health Organization (WHO) ture to be an effective treatment for pain due to rheumatism
established specific objectives regarding CAM use that and neuralgia among prisoners at the Pennsylvania state pen-
address policy; safety, efficacy and quality; access; and itentiary.15 Sir William Osler also endorsed acupuncture as an
rational use.10 The challenges of meeting these objectives are effective treatment for lumbago and sciatica in The Principles
1093

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