Saturday, April 9, 2011

Basic Training of Acupuncture

Acupuncture is an important element of traditional Chinese medicine. It began to
be used more than 2500 years ago, and its theory was already well developed at a
very early time, as is shown in many of the Chinese classics. It was introduced to
neighboring countries in Asia in the 6th Century, being readily accepted, and by
the early 16th Century it had reached Europe. Over the past two decades
acupuncture has spread worldwide, which has encouraged the further
development of this therapy, particularly through studies from modern medical
perspectives and research methodologies.
Many elements of traditional medicine are beneficial, and WHO encourages and
supports countries to identify safe and effective remedies and practices for use in
public and private health services. It has paid particular attention to supporting
research in and the proper application of acupuncture and, in 1991, the Fortyfourth
World Health Assembly urged Member States to introduce measures for
its regulation and control (Resolution WHA44.34).
With the increasing use of acupuncture, the need for a common language to
facilitate communication in teaching, research, clinical practice and exchange of
information had become pressing and, in 1989, WHO convened a Scientific
Group which approved a Standard International Acupuncture Nomenclature
which is being widely disseminated and applied.
The Scientific Group also recommended that the Organization develop a series of
statements and guidelines on acupuncture relating to basic training, safety in
clinical practice, indications and contraindications, and clinical research.
Guidelines for clinical research on acupuncture were issued by the WHO
Regional Office for the Western Pacific in 1995.
The present document consists of guidelines on basic training and safety in
acupuncture. More than 50 international experts shared their knowledge and
experience in their preparation.
Basic training in acupuncture
The guidelines cover basic requirements for training non-physician
acupuncturists and physicians wishing to use acupuncture in their clinical work,
and include a core syllabus. They are intended to assist national health
authorities in setting standards and establishing official examinations, and also
medical schools and institutions wishing to arrange training programs.
Guidelines on basic training and safety in acupuncture 
Safety in acupuncture
These guidelines are meant for hospitals, clinics and practitioners, and provide
standards for safety in the clinical practice of acupuncture. Their purpose is to
minimize the risk of infection and accidents, to alert acupuncturists to
contraindications, and to advise on the management of complications occurring
during treatment.

Section I: Basic training in acupuncture
The increasing popularity in recent years of acupuncture as a form of therapy
and the interest of some countries in introducing it into primary health care mean
that national health authorities must ensure safety and competence in its use.
In countries with a formal system of education in traditional medicine, and
where acupuncture is firmly established as a normal component of health care,
training may extend over several years at college level, and suitable mechanisms
for supervision of its practitioners have been created.
However, for other countries, where "modern Western medicine" forms the only
basis of the national health system, the position is different and there may be no
educational, professional or legislative framework to govern the practice of
Making use of acupuncture in modern medical care means taking it out of its
traditional context and applying it as a therapeutic technique for a limited
number of conditions for which it has been shown to be effective, without having
to reconcile the underlying theories of modern and traditional medicine.
In this type of situation, lengthy periods of instruction in traditional medicine as
a background to acupuncture are neither feasible nor necessary, and shorter
training must suffice.
Furthermore, in many countries, acupuncture is not yet officially recognized and
regulations and registration requirements, where they exist, vary considerably. In
some, only qualified physicians may practice acupuncture, while in others,
practitioners trained in traditional medicine may also do so.
It seems useful, therefore, to provide guidelines for relatively short periods of
theoretical and practical training in acupuncture which, with well designed
curricula and skilled instructors, would be sufficient to ensure the safety and
competence of those so trained.
In recent decades, the theoretical and practical aspects of acupuncture have been
developed in various countries, particularly in those where modern Western
medical perspectives and research methodologies have been applied to studies of
this traditional therapy. The achievements of these studies should be included in
the training. However, since a new theoretical system has not yet been
established, traditional Chinese medical theory is still taken as the basis of the
Core Syllabus.

1. Purpose of the guidelines
These guidelines will, it is hoped, assist national health authorities in countries
where modern Western medicine forms the basis of health care to establish
regulations concerning:
·  general requirements for basic training in and the practice of acupuncture;
·  the knowledge and experience of modern Western medicine required of
acupuncture practitioners employed as such in the national health care
system; and the knowledge and experience of acupuncture required of
physicians and other health staff wishing to include acupuncture in their
professional work in modern Western medicine.
2. Use of acupuncture in national health
A decision by the Ministry of Health to incorporate acupuncture in primary
health care (or at any other level of government health services) in a system
based on modern Western medicine raises a number of important issues which
would need to be taken into account.
2.1 Administrative and academic considerations
The training of health personnel in acupuncture involves certain administrative
and academic considerations, for example:
·  Which types of personnel should be trained?
·  What would be their functions and responsibilities?
·  What would be the content of training, in each case?
·  Where would such training be given and by whom?
·  Are suitably qualified instructors available or would they also have to be
·  What would be the mechanisms for official recognition of training courses,
instructors and institutions?
2.2 Examinations and licensing
A system of examination and licensing would be needed to ensure the
competence of those trained, and to prevent unauthorized practice of

This would bring under control the situation, current in certain industrialized
and developing countries, where commercial exploitation of acupuncture
training and practice is not uncommon, with all the harmful consequences that
may ensue.
2.3 Supervision, monitoring and evaluation
The introduction of one or more new categories of personnel in the health system
would probably make it necessary to provide for:
·  a period of supervised practice after training;
·  monitoring of performance of the trainees individually and as a group; and
·  evaluation of the benefits (or otherwise) of including acupuncture in primary
health care (and at other levels) where it was not previously available, and of
its cost-effectiveness compared with other forms of treatment for common
2.4 Further education and career possibilities
Possibilities to be envisaged, and perhaps encouraged, are that some
acupuncture practitioners may wish to increase their knowledge of modern
Western medicine, while other health personnel who have not received the basic
training may wish to acquire a knowledge of acupuncture and later apply it.
Ultimately, a blending of the two disciplines must, to some extent, take place.
3. Levels of training
The guidelines address four levels of training in acupuncture, namely:
·  full training for those with little or no prior medical education or experience,
who wish to qualify as recognized acupuncture practitioners licensed to
practice independently, subject to the limitations imposed by the Ministry of
·  full training of qualified physicians (modern Western medicine) in
·  training of qualified physicians (and certain other medical graduates) from
schools of modern Western medicine, who wish to include acupuncture as a
technique in their clinical work; and
·  limited training of other health personnel (modern Western medicine)
working in the primary health care system of their country.
4. Training programs
The basic training of the four groups is different. For traditional acupuncture
practitioners, a complete course extending over two years is recommended. For
physicians and medically trained non-physicians, training would be adapted to
their specific requirements and confined to the clinical applications of
acupuncture. An indication of the period of training to be desired in each case is
given in Table 1 below.
Table 1
Basic training in acupuncture

5. Training of acupuncture practitioners
5.1 Acupuncture practitioners
This training program is designed for personnel of suitable educational level,
but with little or no formal training or experience in modern Western health care.
5.2 Entrance requirements
Completed secondary schooling, university entrance or equivalent, and
appropriate training in the basic bio sciences.
5.3 Duration of training
Two years full time (2500 hours), or the part-time equivalent, with not less than
1000 hours of practical and clinical work.
5.4 Objective
The aim of training at this level is to prepare acupuncture practitioners who
would subsequently be employed by national health services. Training would
equip them to give safe and effective acupuncture treatment to selected patients
in hospitals, or as part of the primary health care team at health centers or
community level. They would initially work under the general supervision of the
medical officer in charge.
5.5 Core syllabus in acupuncture
1. Brief history of acupuncture
2. Basic theory
·  Philosophy of traditional Chinese medicine, including but not limited
to concepts of yin-yang and the five phases.
·  Functions of qi, blood, mind, essence and body fluids, as well as their
relationship to one another.
·  Physiological and pathological manifestations of zang-fu (visceral
organs) and their relationship to one another.
·  Meridians and collateral, their distribution and functions.
·  Causes and mechanisms of illness.
3. Knowledge of acupuncture points
·  Location of the 361 classical points on the 14 meridians and the 48
extraordinary points. Location and anatomical description of the
Commonly Used Points selected for Basic Training.
·  Alphanumeric codes and names, classifications of points, direction
and depth of insertion of needles, actions and indications of the
commonly used points listed in the Appendix.
4. Diagnosis
·  Methods of diagnosis, history taking, inspection and tongue
diagnosis, palpation and pulse taking, auscultation and olfaction.
·  Differentiation of syndromes according to the eight principles, the
theory of visceral manifestations (zang-fu), the theory of qi and blood,
and the theory of meridians and collateral vessels.
5. Treatment (as permitted by national laws and health service
Principles of treatment
·  Practical application of theory and diagnosis to treatment in each
individual case.
·  Appropriateness of acupuncture treatment for the patient.
·  Planning of the acupuncture treatment to be given.
·  Appropriate selection of points and methods of needle manipulation.
·  Limitations of acupuncture, and need for referral to other health
professionals or specialists.
Guidelines on safety in acupuncture
Treatment techniques
·  Needling: sterile and safe needling technique, selection of needles,
proper insertion, depth, duration, manipulation (various measures of
reinforcement, reduction, uniform reinforcement-reduction) and
withdrawal, and contraindications of needling.
·  Micro systems acupuncture used in the country concerned: theory,
location of points and applications.
·  Electrical stimulation and laser therapy: theory and applications.
·  Moxibustion: direct and indirect methods, appropriate use and
·  Cupping methods: appropriate use and contraindications.
Treatment of the diseases, illnesses, and conditions for which patients
commonly seek acupuncture treatment
Acupuncture treatment of emergencies
Prevention in traditional medicine
5.6 Core syllabus in modern Western medicine
1. Approach to training
By the end of the course the student should have:
·  a sound understanding of the essentials of anatomy (including the
anatomical location of acupuncture points), physiology, and the basic
mechanisms of disease;
·  an understanding of the principles of hygiene, the common forms of
disease and ill-health in the community, and their causative factors;
·  proficiency in making a simple but competent examination of a
patient, and in arriving at a tentative diagnosis and a reasonable
assessment of the gravity of symptoms and signs;
·  the ability to decide whether a patient may safely and suitably be
treated by acupuncture, or should be referred to a health professional
or facility; and
·  training in first aid, cardiopulmonary resuscitation, and the action to
take in emergencies.
2. Scope and depth of training
These must be defined by the national health authorities, according to the
duties and responsibilities the acupuncture practitioners will have in the
national health system; including whether these will also involve the use
of modern Western medicine (alone or in combination with acupuncture),
and the degree of supervision under which the practitioner will work.
5.7 Other related fields of health care
As future personnel in the national health system, student non-physician
acupuncturists should also have adequate knowledge of the organization of
health services in the country, relevant regulations and procedures, the
disposition of health staff and facilities, ethical considerations, and insurance
5.8 Examination
On completion of the full period of training, the student's theoretical knowledge
of and proficiency in acupuncture, and knowledge of modern Western medicine
(at the appropriate level), should be evaluated by an official examination,
recognized by national health authorities as evidence of the suitability of the
trainee to be licensed to practice.
6. Full training in acupuncture for
qualified physicians
This training program is designed for qualified physicians (modern Western
medicine) who wish to practice acupuncture independently, treating the various
conditions for which patients are commonly treated by acupuncture
Qualified physicians who already have adequate knowledge and skills in
modern Western medicine, would only need to follow the Core Syllabus for
acupuncture. The theoretical course could be shortened, as qualified physicians
can learn traditional medicine more easily than those with no prior medical
education. The course should comprise at least 1500 hours of formal training,
including 1000 hours of practical and clinical work.
On completion of the course and after passing an official examination,
participants should be entitled to practice acupuncture in various fields of
medicine where it is indicated.
7. Limited training in acupuncture for
qualified physicians
7.1 Basic training
Shorter training courses would be suitable for qualified physicians (and certain
other graduates) who wish to become competent in acupuncture as a form of
therapy in modern Western clinical practice (or as a subject for scientific
For them, a brief introduction to traditional acupuncture (derived from the Core
Syllabus) would probably suffice, and the training would then be largely
orientated to the use of acupuncture in modern Western medicine.
The course should comprise at least 200 hours of formal training, and should
include the following components:
1. Introduction to traditional Chinese acupuncture
2. Acupuncture points
·  Location of the 361 classical points on the 14 meridians and the 48
extraordinary points.
·  Alphanumeric codes and names, classifications of points, direction
and depth of insertion of needles, actions and indications of the
Commonly Used Points selected for Basic Training.
3. Applications of acupuncture in modern Western medicine
·  Principal clinical conditions in which acupuncture has been shown to
be beneficial.
·  Selection of patients and evaluation of progress/benefit.
·  Planning of treatment, selection of points and methods of needle
manipulation, and use of medication or other forms of therapy
concurrently with acupuncture.
4. Guidelines on safety in acupuncture
5. Treatment techniques
·  General principles.
·  Specific clinical conditions.
On completion of the course and after passing an official examination,
participants should be able to integrate acupuncture into their clinical
work or specialty.
7.2 Special courses
Some physicians or dental surgeons might wish to acquire proficiency in certain
specific applications of acupuncture (for example, pain relief, or dental or
obstetric analgesia) and for them flexibility would be needed in designing special
courses adapted to their particular areas of interest.
7.3 Advanced training
Physicians or other health personnel who have satisfactorily completed a "short"
course of basic training might wish to pursue their training at an advanced level,
in which case suitable courses would have to be "tailor-made" to meet their
8. Limited training in acupuncture for
primary health care personnel
The introduction of "acupuncture" into primary health care at community level
would require the training of a considerable number of personnel over a short
period, if it is to have a demonstrable effect. This would probably strain the
teaching and supervision resources of the country concerned.
It would seem wiser, in such cases, to train such personnel in acupressure (zhi-ya)
rather than in acupuncture itself. Training in acupressure would make no great
demands, could be incorporated into the general training of primary health care
personnel, and would carry no risk to the patient. The use of acupressure in
primary health care would have to be evaluated after a suitable trial period.
Some personnel who show particular aptitude might be chosen for basic training
in acupuncture, a training program being arranged according to the
applications envisaged.
9. Selected acupuncture points for basic
Participants at the WHO Consultation on Acupuncture at Cervia, Italy in 1996
drew up a list of Commonly Used Points suitable for inclusion in basic training
courses. These were selected from the document A Proposed Standard International
Acupuncture Nomenclature: Report of a WHO Scientific Group (WHO, Geneva, 1991).
As may be seen from the table below, the selection includes 187 of the 361
classical points, and 14 of the 48 extra points. Thus, the basic training courses for
the categories of personnel described lay emphasis on the use of only 201 of a
total of 409 points.
The guidelines on safety, which follow, mention certain points as being
potentially dangerous and requiring special skill and experience in their use.
Some of these are included in the selection of Commonly Used Points, and
attention is drawn to this fact.
10. Selected points for basic training in acupuncture

Section II: Safety in acupuncture
In competent hands, acupuncture is generally a safe procedure with few
contraindications or complications. Its most commonly used form involves
needle penetration of the skin and may be compared to a subcutaneous or
intramuscular injection. Nevertheless, there is always a potential risk, however
slight, of transmitting infection from one patient to another (e.g. HIV or hepatitis)
or of introducing pathogenic organisms. Safety in acupuncture therefore requires
constant vigilance in maintaining high standards of cleanliness, sterilization and
aseptic technique.
There are, in addition, other risks which may not be foreseen or prevented but for
which the acupuncturist must be prepared. These include: broken needles,
untoward reactions, pain or discomfort, inadvertent injury to important organs
and, of course, certain risks associated with the other forms of therapy5 classified
under the heading of "acupuncture".
Finally, there are the risks due to inadequate training of the acupuncturist. These
include inappropriate selection of patients, errors of technique, and failure to
recognize contraindications and complications, or to deal with emergencies when
they arise.
1. Prevention of infection
As with any subcutaneous or intramuscular injection, avoidance of infection in
acupuncture requires:
·  a clean working environment;
·  clean hands of the practitioner;
·  preparation of the needling sites;
·  sterile needles and equipment, and their proper storage;
·  aseptic technique; and
·  careful management and disposal of used needles and swabs.
1.1 Clean working environment
The treatment room should be free from dirt and dust, and should have a special
working area, such as a table covered with a sterile towel, on which sterile
equipment should be placed. This equipment (including trays of needles, cotton
wool balls and sticks, and 70% alcohol) should be covered with a sterile towel
until needed for use. Adequate light and ventilation should be provided
throughout the treatment rooms.
1.2 Clean hands
Practitioners should always wash their hands before treating a patient. Washing
the hands again immediately before the acupuncture procedure is particularly
important in preventing infection, and should include thorough lathering with
soap, scrubbing the hands and fingernails, rinsing under running water for 15
seconds, and careful drying on a clean paper towel.
Many acupuncturists palpate the acupuncture point after the needling site has
been prepared. In such cases, their fingertips should again be cleaned with an
alcohol swab. The use of sterile surgical gloves, or individual finger stalls, is
recommended for the protection of the patient and the practitioner, especially if
the latter has cuts or abrasions. Those with infected lesions on the hands should
not practice until they are healed.
1.3 Preparation of the needling sites
The needling sites should be clean, free from cuts, wounds or infections. The
point to be needled should be swabbed with 70% ethyl or isopropyl alcohol, from
the center to the surrounding area using a rotary scrubbing motion, and the
alcohol allowed to dry.
1.4 Sterilization and storage of needles and equipment
Sterilization is required for all needles (filiform, plum-blossom, seven-star,
subcutaneous, round-head subcutaneous), cups and other equipment used
(storage trays, forceps, guide tubes for needles, cotton wool balls and sticks, etc.).
Disposable sterile acupuncture needles and guide tubes are strongly
recommended in all instances. However, the use of disposable needles should
not slacken the practitioner's vigilance in adopting aseptic techniques in other
aspects of clinical practice. All disposable needles should be discarded
immediately after use and placed in a special container.
Each sterile filiform needle should be used for puncturing once, and once only.
Plum-blossom or seven-star needles may be used repeatedly on one and the
same patient, but must be sterilized before being used for another patient, or else
disposable plum-blossom heads should be used.
Sterilization procedures should conform to those described in the Appendix. The
therapist is responsible for ensuring that these standards are maintained.
Immediately after use, reusable needles and other contaminated equipment
should be immersed in an effective chemical disinfectant, then soaked in water,
with or without detergent and, after careful cleaning, thoroughly rinsed in water
before being packaged for re sterilization.
The sterilized package should be stored in a safe and clean area, well ventilated
and free from excessive humidity, to preclude any possibility of condensation
and mold growth. The maximum safe storage time varies with the type of
packaging. Needles should be placed in a test tube which should then be plugged
with cotton wool, and clearly labelled with an expiry date not more than seven
days after the date of sterilization. Improper storage conditions may, however,
cause equipment to lose sterility long before the expiry date. The integrity of the
package should be inspected before use. Sterile needles stored in needle trays
should be re sterilized at the end of the day because the trays may become
contaminated during use in treatment.
1.5 Aseptic technique
The needle shaft must be maintained in a sterile state prior to insertion. Needles
should be manipulated in such a way that the practitioner's fingers do not touch
the shaft. If there is difficulty in inserting a long needle, such as that used in
puncturing GB 30 huantiao or BL 54 zhibian by just grasping its handle, the shaft
should be held in place with a sterile cotton wool ball or swab. The use of
disposable sterile surgical gloves or finger stalls makes it easy to manipulate
needles without contamination.
On withdrawing a needle, a sterile cotton wool ball should be used to press the
skin at the insertion site, thus protecting the patient's broken skin surface from
contact with potential pathogens, and the practitioner from exposure to the used
needle shaft and the patient's body fluid. All compresses or cotton wool balls
contaminated by blood or body fluids must be discarded in a special container
for infectious waste.
2. Contraindications
In view of the "regulatory action" of acupuncture, it is difficult to stipulate
absolute contraindications for this form of therapy. However, for reasons of
safety, it should be avoided in the following conditions.
2.1 Pregnancy
Acupuncture may induce labor and, therefore, should not be performed in
pregnancy, unless needed for other therapeutic purposes and then only with
great caution.
Just the act of needling with a certain mode of manipulation at certain
acupuncture points may cause strong uterine contractions and induce abortion.
However, this may have a use in pregnancy for the purpose of inducing labour
or shortening its duration.
Traditionally, acupuncture, and moxibustion are contraindicated for puncture
points on the lower abdomen and lumbosacral region during the first trimester.
After the third month, points on the upper abdomen and lumbosacral region,
and points which cause strong sensations should be avoided, together with ear
acupuncture points that may also induce labor.
2.2 Medical emergencies and surgical conditions
Acupuncture is contraindicated in emergencies. In such cases, first aid should be
applied and transport to a medical emergency center arranged.
Acupuncture should not be used to replace a necessary surgical intervention.
2.3 Malignant tumours
Acupuncture should not be used for the treatment of malignant tumours. In
particular, needling at the tumour site should be prohibited. However,
acupuncture may be used as a complementary measure, in combination with
other treatments, for the relief of pain or other symptoms, to alleviate side-effects
of chemotherapy and radiotherapy, and thus to improve the quality of life.
2.4 Bleeding disorders
Needling should be avoided in patients with bleeding and clotting disorders, or
who are on anticoagulant therapy or taking drugs with an anticoagulant effect.
3. Accidents and untoward reactions
3.1 Needle quality
Stainless steel is the material of choice for acupuncture needles. Each should be
carefully checked before use. If it is bent, the shaft eroded, or the tip hooked or
blunt, the needle is defective and should be discarded.
It is recommended that the quality of manufacture of acupuncture needles be
controlled by the national health authority.
3.2 Position of patient
The patient should assume a comfortable posture before needling and be
requested to remain still and not to change position abruptly during treatment.
3.3 Fainting
During acupuncture treatment, the patient may feel faint. The needling
procedure and the sensations it may cause should therefore be carefully
explained before starting. For those about to receive acupuncture for the first
time, treatment in a lying position with gentle manipulation is preferred. The
complexion should be closely watched and the pulse frequently checked to detect
any untoward reactions as early as possible. Particular care should be taken
when needling points that may cause hypotension, e.g. LR 3 taichong.
Symptoms of impending faintness include feeling unwell, a sensation of
giddiness, movement or swaying of surrounding objects, and weakness. An
oppressive feeling in the chest, palpitations, nausea and sometimes vomiting
may ensue. The complexion usually turns pale and the pulse is weak. In severe
cases, there may be coldness of the extremities, cold sweats, a fall in blood
pressure, and loss of consciousness. Such reactions are often due to nervousness,
hunger, fatigue, extreme weakness of the patient, an unsuitable position, or too
forceful manipulation.
If warning symptoms appear, remove the needles immediately and make the
patient lie flat with the head down and the legs raised, as the symptoms are
probably due to a transient, insufficient blood supply to the brain. Offer warm
sweet drinks. The symptoms usually disappear after a short rest. In severe cases,
first aid should be given and, when the patient is medically stable, the most
appropriate of the following treatments may be applied:
·  press GV 26 shuigou with the fingernail or puncture GV 26 shuigou, PC 9
zhongchong, GV 25 suliao, PC 6 neiguan and ST 36 zusanli; or
·  apply moxibustion to GV 20 baihui, CV 6 qihai and CV 4 guanyuan.
The patient will usually respond rapidly to these measures, but if the symptoms
persist, emergency medical assistance will be necessary.
3.4 Convulsions
All patients about to receive acupuncture should be asked if they have a history
of convulsions. Patients who do have such a history should be carefully observed
during treatment. If convulsions do occur, the practitioner should remove all
needles and render first aid. If the condition does not stabilize rapidly or if
convulsions continue, the patient should be transferred to a medical emergency
3.5 Pain
During needle insertion
Pain during insertion is usually due to clumsy technique, or to blunt, hooked or
thick needles. It may also occur in highly sensitive patients. In most patients,
skilful and rapid penetration of the needle through the skin is painless. The
correct technique and optimum degree of force to use must be learned through
practice. A few devices may facilitate smooth and fast penetration, such as the
use of needle guide tubes (which hold the needle steady over the point while it is
tapped into place), and the "flicking-in" technique (a method of inserting the
needle by flicking the upper end of its handle with the middle or index finger of
one hand while the handle of the needle is loosely held by the index and middle
fingers of the other hand, with the tip of the needle lightly touching the
acupuncture point). The "acupuncture sensation" of soreness, tingling and
heaviness indicating the arrival of qi (deqi) at the point should be distinguished
from painful reactions.
After insertion
Pain occurring when the needle is inserted deep into the tissues may be due to
hitting pain receptor nerve fibres, in which case, the needle should be lifted until
it is just beneath skin and carefully inserted again in another direction.
Pain occurring when the needle is rotated with too wide an amplitude, or is lifted
and thrust, is often due to it becoming entwined with fibrous tissue. To relieve
the pain, gently rotate the needle back and forth until the fibre is released.
Pain occurring while the needle is in place is usually caused by it curving when
the patient moves, and is relieved by resuming the original position.
After withdrawal
This is usually due to unskilled manipulation or excessive stimulation. For mild
cases, press the affected area; for severe cases, moxibustion may be applied in
addition to pressure.
3.6 Stuck needle
After insertion, one may find it difficult or impossible to rotate, lift and thrust, or
even to withdraw the needle. This is due to muscle spasm, rotation of the needle
with too wide an amplitude, rotation in only one direction causing muscle fibers
to tangle around the shaft, or to movement by the patient.
The patient should be asked to relax. If the cause is excessive rotation in one
direction, the condition will be relieved when the needle is rotated in the
opposite direction. If the stuck needle is due to muscle spasm, it should be left in
place for a while, then withdrawn by rotating, or massaging around the point, or
another needle inserted nearby to divert the patient's attention. If the stuck
needle is caused by the patient having changed position, the original posture
should be resumed and the needle withdrawn.
3.7 Broken needle
Breaks may arise from poor quality manufacture, erosion between the shaft and
the handle, strong muscle spasm or sudden movement of the patient, incorrect
withdrawal of a stuck or bent needle, or prolonged use of galvanic current.
If, during insertion, a needle becomes bent, it should be withdrawn and replaced
by another. Too much force should not be used when manipulating needles,
particularly during lifting and thrusting. The junction between the handle and
the shaft is the part that is apt to break. Therefore, in inserting the needle, onequarter
to one-third of the shaft should always be kept above the skin.
If a needle breaks, the patient should be told to keep calm and not to move, so as
to prevent the broken part of the needle from going deeper into the tissues. If a
part of the broken needle is still above the skin, remove it with forceps. If it is at
the same level as the skin, press around the site gently until the broken end is
exposed, and then remove it with forceps. If it is completely under the skin, ask
the patient to resume his/her previous position and the end of the needle shaft
will often be exposed. If this is unsuccessful, surgical intervention will be needed.
3.8 Local infection
Negligence in using strict aseptic techniques may cause local infection, especially
in ear acupuncture therapy. When such infection is found, appropriate measures
must be taken immediately, or the patient referred for medical treatment.
Needling should be avoided in treating areas of lymphoedema.
3.9 Burning during moxibustion
Burning of the skin should be prevented in indirect moxibustion. Although
scarring moxibustion is performed by means of burning the skin so as to result in
non-bacterial suppuration, this technique should only be used with the full
knowledge and prior consent of the patient. It is a special therapeutic technique
only performed at specific points.
Direct moxibustion should not be applied to points on the face, or at sites where
tendons or large blood vessels are located. Moxibustion with non-bacterial
suppuration near a joint is also inappropriate because the joint movement may
make healing difficult. Special care should be taken in patients with reduced
levels of consciousness, sensory disturbance, psychotic disorders, purulent
dermatitis, or in areas of impaired circulation.
4. Electrical stimulation and laser
Electrical stimulation is potentially harmful. It is contraindicated: in pregnancy; if
the patient has a pace-maker; if there is lack of skin sensation; and in cases of
impaired circulation, severe arterial disease, undiagnosed fever or severe skin
Careful monitoring of the electrical stimulation is recommended to prevent
neural injury. Galvanic current should be used for only a very short period of
Low energy laser therapy may harm the eyes and both patient and operator
should wear protective glasses.
5. Injury to important organs
If administered correctly, acupuncture should not injure any organ. However, if
injury does occur, it may be serious.
There are a great many acupuncture points, some which carry little or no risk
and others where the potential of serious injury always exists, particularly in
unskilled or inexperienced hands.
As training programs in acupuncture are intended for different levels of
personnel, it follows that they should be adapted to the knowledge, abilities and
experience of those concerned. At elementary levels, the selection of acupuncture
points should be limited. At professional levels, the range can be expanded but,
even so, the use of certain points and manipulations should still be restricted to
those with great experience.
The following passages present examples of points which carry particular
potential risk. As in all forms of treatment, it is important to measure risk against
expected benefit.
5.1 Areas not to be punctured
Certain areas should not be punctured, for example: the fontanelle in babies, the
external genitalia, nipples, the umbilicus and the eyeball.
5.2 Precautions to be taken
Special care should be taken in needling points in proximity to vital organs or
sensitive areas. Because of the characteristics of the needles used, the particular
sites for needling, the depth of needle insertion, the manipulation techniques
used, and the stimulation given, accidents may occur during treatment. In most
instances they can be avoided if adequate precautions are taken. If they do occur,
the acupuncturist should know how to manage them effectively and avoid any
additional harm. Accidental injury to an important organ requires urgent
medical or surgical help.
Chest, back and abdomen
Points on the chest, back and abdomen should be needled cautiously, preferably
obliquely or horizontally, so as to avoid injury to vital organs. Attention should
be paid to the direction and depth of insertion of needles.
Lung and pleura
Injury to the lung and pleura caused by too deep insertion of a needle into points
on the chest, back or supraclavicular fossa may cause traumatic pneumothorax.
Cough, chest pain and dyspnoea are the usual symptoms and occur abruptly
during the manipulation, especially if there is severe laceration of the lung by the
needle. Alternatively, symptoms may develop gradually over several hours after
the acupuncture treatment.
Liver, spleen and kidney
Puncture of the liver or spleen may cause a tear with bleeding, local pain and
tenderness, and rigidity of the abdominal muscles. Puncturing the kidney may
cause pain in the lumbar region and haematuria. If the damage is minor the
bleeding will stop spontaneously but, if the bleeding is serious, shock may follow
with a drop of blood pressure.
Central nervous system
Inappropriate manipulation at points between or beside the upper cervical
vertebrae, such as GV 15 yamen and GV 16 fengfu may puncture the medulla
oblongata, causing headache, nausea, vomiting, sudden slowing of respiration
and disorientation, followed by convulsions, paralysis or coma. Between other
vertebrae above the first lumbar, too deep needling may puncture the spinal
cord, causing lightning pain felt in the extremities or on the trunk below the level
of puncture.
Other points
Other points which are potentially dangerous and which therefore require
special skill and experience in their use include:
·  BL 1 jingming and ST 1 chengqi, located close to the eyeball;
·  CV 22 tiantu, in front of the trachea;
·  ST 9 renying, near the carotid artery;
·  SP 11 jimen and SP 12 chongmen, near the femoral artery; and
·  LU 9 taiyuan on the radial artery.
Circulatory system
Care should be taken in needling areas of poor circulation (e.g. varicose veins)
where there is a risk of infection, and to avoid accidental puncture of arteries
(sometimes aberrant) which may cause bleeding, haematoma, arterial spasm or
more serious complications when pathological change is present (e.g. aneurysm,
atherosclerosis). Generally, bleeding due to puncture of a superficial blood vessel
may be stopped by direct pressure.
6. Patient records
Patient records should contain full details of the medical history, clinical
findings, diagnostic data, treatment plan and the response to treatment. They
should be regarded as confidential.

Conditions for which Medical Acupuncture May Be Indicated in a Hospital Setting

This information is for use by Hospital Credentialling where the matter of Medical Acupuncture privileges are considered.
Because pain of musculo-skeletal origin can respond to acupuncture treatment so dramatically, this modality is best known for its pain relief benefits than for any other indications. Pain is also relatively easy to quantify, and progress can be measured fairly simply. For these reasons, physicians trained in Medical Acupuncture treat musculo-skeletal pain conditions as one of their early applications of their newly developed skills.
However, in the hands of a more experienced physician who is well trained in Chinese medicine, pain control may be a common but by far not the only symptom treatable with Medical Acupuncture. Acupuncture is incorporated as another modality in the repertoire of useful medical interventions.
For example, moderate allergic sinusitis may be treated well with antihistamines and decongestants. If the condition is annoying to the patient, recurs often, or is poorly controlled with common medications it may require steroids and frequent antibiotics. In these cases, acupuncture may be an excellent complement to routine care, often minimizing or altogether eliminating the need for medications, releasing the patient from continuous exacerbation-remission cycles.
Another example would be a paralytic ileus, as a postoperative condition or perhaps due to a pelvic fracture. One could keep the patient NPO and on suction through a naso-gastric tube for as long as the ileus lasts. Or, acupuncture can be used concomitantly with the above measures to help the patient regain bowel motility sooner, allowing for a more speedy and more comfortable recovery.
Asthma and chronic bronchospasm are other examples where the use of Medical Acupuncture reduces the required doses of bronchodilators, thus reducing unpleasant side effects. and preventing a steroid dependent state.
Diagnosis of underlying medical conditions should be established within the context of the state-of-the-art of medical care. Once diagnosis has been made and routine treatment measures are in progress. Medical Acupuncture, if appropriate, can be used as a complementary modality within the working allopathic framework.
The list below includes a number of medical conditions that have been found to respond effectively to Medical Acupuncture. This list is by no means exhaustive, and should serve as informational material and for guidelines purposes only.
It should be called to your attention that certain drugs such as steroids (an equivalent to 20mg or more of prednisone), and some tranquilizers and antidepressants, longer-standing and more complex illnesses may require more sessions (an average of 6 to 8), depending on the patient's general condition and type of problem.
The Academy is available for any further information your Committee may require in regards to Medical Acupuncture and its use in a hospital setting.
  • Acute and chronic pain control
  • Postraumatic and postoperative ileus
  • Muscle spasms, tremors, tics, contractures
  • Paresthesiae
  • Anxiety, fright, panic
  • Drug detoxification
  • Neuralgias (trigemnial , Herpes Zoster, postherpetic, other)
  • Seventh nerve palsy Sequelae of CVA's (aphasia, hemiplegia)
  • Certain functional gastro-intestinal disorders (nausea and vomiting, esophageal spasm, hyperacidity, irritable bowel, etc.)
  • Headache, vertigo (Meniere's), tinnitus
  • Phantom pain
  • Frozen shoulder
  • Cervical and lumbar spine syndromes
  • Plantar fasciitis
  • Arthritis/arthrosis
  • Bursitis, tendonitis, carpal tunnel syndrome
  • Sprains and contusions
  • In fractures, assisting in pain-control, edema, and enhancing healing process Temporo-mandibular joint derangement, bruxism
  • Dysmenorrhea, pelvic pain
  • Insomnia
  • Anorexia
  • Atypical chest pain (negative work-up)
  • Idiopathic palpitations, sinus tachychardia
  • Allergic sinusitis
  • Persistent hiccups
  • Selected dermatoses (urticaria, pruritus, eczema, psoriasis)
  • Constipation, diarrhea
  • Urinary incontinence. retention (neurogenic. spastic, adverse drug effect)
  • Abdominal distention/flatulence
  • Severe hyperthermia
  • Cough with contraindications for narcotics
  • Acupuncture anesthesia for high risk patients, or patients with previous adverse responses to anesthetics

Frequently Asked Questions About Acupuncture

Doctor, can acupuncture help my condition?The best answer will come from an experienced practitioner. The practitioner, based on your medical history, condition, and what other treatments you have been or are receiving, can best help you decide whether acupuncture is suitable by itself or as adjunctive therapy. I generally tell patients that if their treatment, according to a Western diagnosis with options, isnt resolving the problem,is quite expensive, or has significant side effects/hassles associated with it, then clearly acupuncture is worth a try. I include the Western diagnosis criteria because I think, as just an example, it is ridiculous to treat someones dizziness with acupuncture if what they need is to have excessive wax cleaned out from their ear canals. On the other hand, if one is having difficulty controlling or improving ones asthma with Western treatments, a trial of acupuncture makes utmost sense.

How does the acupuncturist manage infection control?Non-physician acupuncturists are required by law in most states to use disposable one-time-use sterilized needles. Physicians because of their experience and background in infection control have the perogative of using re-usable sterilized needles. These needles would need to be sterilized in the same way as any surgical instrument.
Because blood loss and bleeding are minimal with acupuncture, I am not aware of any attempt to require acupuncturists to wear gloves.
My review of the literature on the risk of infection associated with acupuncture assures me that if one receives acupuncture from a licensed practitioner in North America the risk of a serious infection is drastically less than the risk of a serious accident while traveling to the acupuncturist's office. The exception to this might be acupuncture being delivered in a hospital setting

What training is required to practice acupuncture? Do you have recommendations in this regard?Requirements can vary significantly worldwide. In most of Europe a person to legally practice acupuncture must first be a medical doctor. In this country there are non-physicians who are licensed to practice. Again there can be significant variations in requirements depending upon local laws.
You can review our requirements for membership in the AAMA as a guideline for recommendations for physicians wanting special training. We, as an organization, leave issues of credentialing of non-physicians as acupuncturists in the hands of non-physicians and politicians.

Acupuncture in Cancer Treatment
by Eugene Mak, MD
Board Certified Oncologist and MARF Board Member
A frequently asked question by patients undergoing cancer treatment is, "Can acupuncture help me?"
The issue then becomes: is there a place for acupuncture in the vast field of cancer with its diverse treatment modalities?
"Vast" since cancer is not one disease but over 300 different malignancies, each with its own unique histology, patho-physiology, and clinical behavior. 'Diverse" because of the different chemotherapeutic classes of agents, hormonal agents, types of High-energy particle beam generators, and various delivery systems for radiation treatment. "Diverse" also because it encompasses various types of surgical procedures, nutritional support, and the body-mind holistic approach.
Timely diagnosis and early surgery offer the most favorable possibility of a cure for solid tumors. The germinal cancers and Hodgkin's lymphoma, along with some hematologic malignancies such as childhood leukemia, are the few exceptions. These are treated with chemotherapy, radiation therapy, bone marrow or stem cell transplantation singly or in combination. Some of the latter are the most predictably curable malignancies with or without surgery.
If the diagnosis is late, surgery unsuccessful, or should the tumor recur after surgery, then the chance of a cure, with rare exceptions, is considered lost This class of patients, along with those not amenable to surgical approaches, are treated palliatively. Palliative therapies also consist of chemotherapy, hormonal therapy, and radiation therapy and/or palliative surgery.
The role of acupuncture in the curative group is in its adjunctive use in anesthesia, in post-operative pain control, and in aiding and hastening recovery from the side effects of the various therapies. Acupuncture is effective for control of pain, of local swelling post-operatively, for shortening the resolution of hematoma and tissue swelling and for minimizing use of medications and their attendant side effects. Energetic acupuncture, an approach consisting of the use of needles with electricity and moxibustion (a form of local heating with herbs imparts a sense of well being and accelerates patients' recovery. In conjunction with nutritional support, its use is routinely employed in some cancer institutions.
The dreaded nausea and vomiting which commonly occurs in some patients undergoing chemotherapy and inevitably, with the use of certain classes of agents, can often be worse than the disease itself. Most oncologists have experienced the patients who start vomiting at the thought of their next clinic visit. At the University of Los Angeles (UCLA) School of Medicine, a well-controlled study completed over two Years ago, the authors of the published paper reported significant reduction of nausea and vomiting when pre-treated with. It is now routinely administered before, after and in between chemotherapy treatment sessions for control or nausea and emesis. Such treatments are relatively simple and easily executed in an outpatient setting. Its effectiveness helps in minimizing the use of standard, expensive multi-drug anti-nausea regimens with their attendant side effects, given along with the chemotherapeutic agents.
That acupuncture is a powerful tool for general pain control is widely known. . Less known is its success use in some cancer-related pain and in reducing narcotic use and thereby minimizing the side effects confusion, disturbed mentation, behavioral changes, nausea and severe constipation.
Needling a variety of trigger and painful points, percutaneous electrical nerve stimulation, and osteo-puncture, along with whole body energetic acupuncture support, .are approaches available to the acupuncturists. In the acupuncture paradigm, any chronic disease process depletes the energy level in the organism. Such depletion can be ameliorated, at least temporarily, by tonification, a process of imparting energy into the system. This is deemed necessary for more durable, successful pain control. It can also add to the patients' sense of well being and decrease the malaise associated with any chronic disease, especially cancer.
Nutritional support as an aid in boosting immune response in cancer patients, along with minimizing the immune and white blood cell suppression that occurs with most chemotherapeutic agents, has been receiving greater attention and funding for research.. Kenneth Conklin, M.D., Ph.D., an anesthesiologist at UCLA working with the Oncology Department, reports gratifying results utilizing nutrition and supplements combined with energetic acupuncture.
Energetic acupuncture repletes energy level to the organism as a whole, reestablishes homeostasis by re-balancing energy distribution and un-blocking energy flow. This systems approach to deal with system wide patho-physiology can be complemented by distinct meridian acupuncture, which directs healing energy to specific organ pathology and is a routine approach in treating diseased organs such as liver, pancreas kidney, including those ravaged by cancers.
While the degree of beneficial results from acupuncture treatment is dependent on various clinical factors such as presenting symptoms, clinical staging, timing of the encounter in the course of the illness, areas of involvement, the answer to the opening question "can acupuncture help me?" is, in all probability, that it can help in the care of the cancer patient.

Conditions Recommended for Acupuncture by the World Health Organization (W.H.O.)

  • Acute sinusitis
  • Acute rhinitis
  • Common cold
  • Acute tonsillitis
Bronchopulmonary Diseases
  • Acute bronchitis
  • Bronchial asthma
Eye Disorders
  • Acute conjuctivitis
  • Cataract (without complications)
  • Myopia
  • Central retinitis
Disorders of the Mouth Cavity
  • Toothache
  • Pain after tooth extraction
  • Gingivitis
  • Pharyngitis
Orthopedic Disorders
  • Periarthritis humeroscapularis
  • Tennis elbow
  • Sciatica
  • Low back pain
  • Rheumatoid arthritis
Gastrointestinal Disorders
  • Spasm of the esophagus and cardia
  • Hiccups
  • Gastroptosis
  • Acute and chronic gastritis
  • Gastric hyperacidity
  • Chronic duodenal ulcer
  • Acute and chronic colitis
  • Acute bacterial dysentery
  • Constipation
  • Diarrhea
  • Paralytic ileus
Neurologic Disorders
  • Headache
  • Migraine
  • Trigeminal neuralgia
  • Facial paralysis
  • Paralysis after apoplectic fit
  • Peripheral neuropathy
  • Paralysis caused by poliomyelitis
  • Meniere's syndrome
  • Neurogenic bladder dysfunction
  • Nocturnal enuresis
  • Intercostal neuralgia

About Acupuncture

Acupuncture is a method of encouraging the body to promote natural healing and to improve functioning. This is done by inserting needles and applying heat or electrical stimulation at very precise acupuncture points.

The classical Chinese explanation is that channels of energy run in regular patterns through the body and over its surface. These energy channels, called meridians, are like rivers flowing through the body to irrigate and nourish the tissues. An obstruction in the movement of these energy rivers is like a dam that backs up in others.
The meridians can be influenced by needling the acupuncture points; the acupuncture needles unblock the obstructions at the dams, and reestablish the regular flow through the meridians. Acupuncture treatments can therefore help the body's internal organs to correct imbalances in their digestion, absorption, and energy production activities, and in the circulation of their energy through the meridians.
The modern scientific explanation is that needling the acupuncture points stimulates the nervous system to release chemicals in the muscles, spinal cord, and brain. These chemicals will either change the experience of pain, or they will trigger the release of other chemicals and hormones which influence the body's own internal regulating system.
The improved energy and biochemical balance produced by acupuncture results in stimulating the body's natural healing abilities, and in promoting physical and emotional well-being.

Acupuncture is a very old medical art, and there are many approaches to learning and practicing it. Medical acupuncture is the term used to describe acupuncture performed by a doctor trained and licensed in Western medicine who has also had thorough training in acupuncture as a specialty practice. Such a doctor can use one or the other approach, or a combination of both as the need arises, to treat an illness.

Medical acupuncture is a system which can influence three areas of health care:
  • promotion of health and well-being,
  • prevention of illness,
  • treatment of various medical conditions.
While acupuncture is often associated with pain control, in the hands of a well-trained practitioner it has much broader applications. Acupuncture can be effective as the only treatment used, or as the support or adjunct to other medial treatment forms in many medical and surgical disorders.The World Health Organization recognizes the use of acupuncture in the treatment of a wide range of medical problems, including:
  • Digestive disorders: gastritis and hyperacidity, spastic colon, constipation, diarrhea.
  • Respiratory disorders: sinusitis, sore throat, bronchitis, asthma, recurrent chest infections.
  • Neurological and muscular disorders: headaches, facial tics, neck pain, rib neuritis, frozen shoulder, tennis elbow, various forms of tendinitis, low back pain, sciatica, osteoarthritis.
  • Urinary, menstrual, and reproductive problems.
Acupuncture is particularly useful in resolving physical problems related to tension and stress and emotional conditions

The number of treatments needed differs from person to person. For complex or long-standing conditions, one or two treatments a week for several months may be recommended. For acute problems, usually fewer visits are required, and for health
Usually not. As energy is redirected in the body, internal chemicals and hormones are stimulated and healing begins to take place. Occasionally the original symptoms worsen for a few days, or other general changes in appetite, sleep, bowel or urination patterns, or emotional state may be triggered. These should not cause concern, as they are simply indications that the acupuncture is starting to work. It is quite common with the first one or two treatments to have a sensation of deep relaxation or even mild disorientation immediately following the treatment. These pass within a short time, and never require anything more than a bit of rest to overcome.


People experience acupuncture needling differently. Most patients feel only minimal pain as the needles are inserted; some feel no pain at all. Once the needles are in place, there is no pain felt. Acupuncture needles are very thin and solid and are made from stainless steel. The point is smooth (not hollow with cuttingedges like a hypodermic needle) and insertion through the skin is not as painful as injections or blood sampling. The risk of bruising and skin irritation is less than when using a hollow needle.
Because your doctor carefully sterilizes the needles using the same techniques as for surgical instruments, or uses disposable needles, there is no risk of infection from the treatments.

Yes. In the past 2,000 years, more people have been successfully treated with acupuncture than with all other health modalities combined. Today acupuncture is practiced widely in Asia, the Soviet Union, and in Europe. It is now being used more and more in America by patients and physicians. Acupuncture treatments can be given at the same time other techniques are being used, such as conventional Western medicine,osteopathic or chiropractic adjustments, and homeopathic ornaturopathic prescriptions. It is important that your physician-acupuncturist know everything that you are doing, so he or she can help you get the most benefit from all your treatments.

No. Acupuncture is used successfully on cats, dogs, horses and other animals. These animal patients do not understand or believein the process that helps them get better. A positive attitude toward wellness may reinforce the effects of the treatment received, just as a negative attitude may hinder the effects of acupuncture or any other treatment. A neutral attitude ("I don't know if I really believe in this.") will not block the treatment results.

Yes. To enhance the value of a treatment, the following guidelines are important:
  • Do not eat an unusually large meal immediately before or after your treatment.
  • Do not over-exercise, engage in sexual activity, or consume alcoholic beverages within 6 hours before or after the treatment.
  • Plan your activities so that after the treatment you can get some rest, or at least not have to be working at top performance. This is especially important for the first few visits.
  • Continue to take any prescription medicines as directed by your regular doctor. Substance abuse (drugs and alcohol) especially in the week prior to treatment, will seriously interfere with the effectiveness of acupuncture reatments.
  • Remember to keep good mental or written notes of what your response is to the treatment. This is important for your doctor to know so that the follow-up treatments can be designed to best help you and your problem

Some insurance companies currently cover acupuncture costs, other companies do not yet recognize the value of acupuncture. Each health policy must be reviewed to determine acupuncture benefits. More and more insurance companies are recognizing the value of providing coverage for medical acupuncture services. You can help by insisting that your insurance company offer you reimbursement for medically indicated acupuncture treatments before you accept their policy.


Dear friends myself Dr. Ibn Sina I am the founder of acupuncture for all blog and I am working as an acupuncturist in Meridian Acupuncture Health Care Center. As a practitioner of acupuncture, TCM, tuina, qi gong and the martial arts, I am most interested in exploring the theories behind the effectiveness of these treatment styles and techniques. I also consider it a responsibility to help educate people about complementary and alternative medicine and raise the general awareness of the treatment options available for people looking to heal disease and improve their vitality." Through this blog site I'm going to discuss about Acupuncture therapy. The purpose of this blog site is to create the awareness of Acupuncture system as well Other Alternative Medicine.