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Acupuncture, Qigong, and "Chinese Medicine"
Stephen Barrett, M.D.
"Chinese medicine," often called "Oriental medicine"
or "traditional Chinese medicine (TCM)," encompasses
a vast array of folk medical practices based on mysticism. It
holds that the body's vital energy (chi or qi) circulates
through channels, called meridians, that have branches
connected to bodily organs and functions. Illness is attributed
to imbalance or interruption of chi.. Ancient practices
such as acupuncture, Qigong, and the use of various herbs are
claimed to restore balance.
Traditional acupuncture, as now practiced, involves the insertion
of stainless steel needles into various body areas. A low-frequency
current may be applied to the needles to produce greater stimulation.
Other procedures used separately or together with acupuncture
include: moxibustion (burning of floss or herbs applied to the
skin); injection of sterile water, procaine, morphine, vitamins,
or homeopathic solutions through the inserted needles; applications
of laser beams (laserpuncture); placement of needles in the external
ear (auriculotherapy); and acupressure (use of manual pressure).
Treatment is applied to "acupuncture points," which
are said to be located throughout the body. Originally there were
365 such points, corresponding to the days of the year, but the
number identified by proponents during the past 2,000 years has
increased gradually to about 2,000 . Some practitioners place
needles at or near the site of disease, whereas others select
points on the basis of symptoms. In traditional acupuncture, a
combination of points is usually used.
Qigong is also claimed to influence the flow of "vital
energy." Internal Qigong involves deep breathing, concentration,
and relaxation techniques used by individuals for themselves.
External Qigong is performed by "Qigong masters" who
claim to cure a wide variety of diseases with energy released
from their fingertips. However, scientific investigators of Qigong
masters in China have found no evidence of paranormal powers and
some evidence of deception. They found, for example, that a patient
lying on a table about eight feet from a Qigong master moved rhythmically
or thrashed about as the master moved his hands. But when she
was placed so that she could no longer see him, her movements
were unrelated to his . Falun
gong, which China
recently banned, is a Qigong varient claimed to be "a
powerful mechanism for healing, stress relief and health improvements."
Most acupuncturists espouse the traditional Chinese view of
health and disease and consider acupuncture, herbal medicine,
and related practices to be valid approaches to the full gamut
of disease. Others reject the traditional approach and merely
claim that acupuncture offers a simple way to achieve pain relief.
The diagnostic process used by TCM practitioners may include questioning
(medical history, lifestyle), observations (skin, tongue, color),
listening (breathing sounds), and pulse-taking. Six pulse aspects
said to correlate with body organs or functions are checked on
each wrist to determine which meridians are "deficient"
in chi. (Medical science recognizes only one pulse, corresponding
to the heartbeat, which can be felt in the wrist, neck, feet,
and various other places.) Some acupuncturists state that the
electrical properties of the body may become imbalanced weeks
or even months before symptoms occur. These practitioners claim
that acupuncture can be used to treat conditions when the patient
just "doesn't feel right," even though no disease is
TCM (as well as the folk medical practices of various other
Asian countries) is a threat to certain animal species. For example,
black bears -- valued for their gall bladders -- have been hunted
nearly to extinction in Asia, and poaching of black bears is a
growing problem in North America.
The conditions claimed to respond to acupuncture include chronic
pain (neck and back pain, migraine headaches), acute injury-related
pain (strains, muscle and ligament tears), gastrointestinal problems
(indigestion, ulcers, constipation, diarrhea), cardiovascular
conditions (high and low blood pressure), genitourinary problems
(menstrual irregularity, frigidity, impotence), muscle and nerve
conditions (paralysis, deafness), and behavioral problems (overeating,
drug dependence, smoking). However, the evidence supporting these
claims consists mostly of practitioners' observations and poorly
designed studies. A controlled study found that electroacupuncture
of the ear was no more effective than placebo stimulation (light
touching) against chronic pain . In 1990, three Dutch epidemiologists
analyzed 51 controlled studies of acupuncture for chronic pain
and concluded that "the quality of even the better studies
proved to be mediocre. . . . The efficacy of acupuncture in the
treatment of chronic pain remains doubtful."  They also
examined reports of acupuncture used to treat addictions to cigarettes,
heroin, and alcohol, and concluded that claims that acupuncture
is effective as a therapy for these conditions are not supported
by sound clinical research .
Acupuncture anesthesia is not used for surgery in the Orient
to the extent that its proponents suggest. In China physicians
screen out patients who appear to be unsuitable. Acupuncture is
not used for emergency surgery and often is accompanied by local
anesthesia or narcotic medication .
How acupuncture may relieve pain is unclear. One theory suggests
that pain impulses are blocked from reaching the spinal cord or
brain at various "gates" to these areas. Another theory
suggests that acupuncture stimulates the body to produce narcotic-like
substances called endorphins, which reduce pain. Other
theories suggest that the placebo effect, external suggestion
(hypnosis), and cultural conditioning are important factors. Melzack
and Wall note that pain relief produced by acupuncture can also
be produced by many other types of sensory hyperstimulation, such
as electricity and heat at acupuncture points and elsewhere in
the body. They conclude that "the effectiveness of all of
these forms of stimulation indicates that acupuncture is not a
magical procedure but only one of many ways to produce analgesia
[pain relief] by an intense sensory input." In 1981, the
American Medical Association Council on Scientific Affairs noted
that pain relief does not occur consistently or reproducibly in
most people and does not operate at all in some people .
In 1995, George A. Ulett, M.D., Ph.D., Clinical Professor of
Psychiatry, University of Missouri School of Medicine, stated
that "devoid of metaphysical thinking, acupuncture becomes
a rather simple technique that can be useful as a nondrug method
of pain control." He believes that the traditional Chinese
variety is primarily a placebo treatment, but electrical stimulation
of about 80 acupuncture points has been proven useful for pain
The quality of TCM research in China has been extremely poor.
A recent analysis of 2,938 reports of clinical trials reported
in Chinese medical journals concluded that that no conclusions
could be drawn from the vast majority of them. The researchers
In most of the trials, disease was defined and diagnosed according
to conventional medicine; trial outcomes were assessed with objective
or subjective (or both) methods of conventional medicine, often
complemented by traditional Chinese methods. Over 90% of the
trials in non-specialist journals evaluated herbal treatments
that were mostly proprietary Chinese medicines. . . .
Although methodological quality has been improving over the
years, many problems remain. The method of randomisation was
often inappropriately described. Blinding was used in only 15%
of trials. Only a few studies had sample sizes of 300 subjects
or more. Many trials used as a control another Chinese medicine
treatment whose effectiveness had often not been evaluated by
randomised controlled trials. Most trials focused on short term
or intermediate rather than long term outcomes. Most trials did
not report data on compliance and completeness of follow up.
Effectiveness was rarely quantitatively expressed and reported.
Intention to treat analysis was never mentioned. Over half did
not report data on baseline characteristics or on side effects.
Many trials were published as short reports. Most trials claimed
that the tested treatments were effective, indicating that publication
bias may be common; a funnel plot of the 49 trials of acupuncture
in the treatment of stroke confirmed selective publication of
positive trials in the area, suggesting that acupuncture may
not be more effective than the control treatments. 
Two scientists at the University of Heidelberg have developed
a "fake needle" that may enable acupuncture researchers
to perform better-designed controlled studies. The device is a
needle with a blunt tip that moves freely within a copper handle.
When the tip touches the skin, the patient feels a sensation similar
to that of an acupuncture needle. At the same time, the visible
part of the needle moves inside the handle so it appears to shorten
as though penetrating the skin. When the device was tested on
volunteers, none suspected that it had not penetrated the skin
In 2004, a University of Heidelberg team proved the worth of
their "sham acupuncture" technique in a study of postoperative
nausea and vomiting (PONV) in women who underwent breast or gynecologic
surgery. The study involved 220 women who received either acupuncture
or the sham procedure at the acupuncture point "Pericardium
6" on the inside of the forearm. No significant difference
in PONV or antivomiting medication use was found between the two
groups or between the people who received treatment before anesthesia
was induced and those who received it while anesthetized .
A subgroup analysis found that vomiting was "significantly
reduced" among the acupuncture patients, but the authors
correctly noted that this finding might be due to studying multiple
outcomes. (As the number of different outcome measures increases,
so do the odds that a "statistically significant" finding
will be spurious.) This study is important because PONV reduction
is one of the few alleged benefits of acupuncture supported by
reports in scientific journals. However, the other PONV studies
claiming to show positive results have not been as tightly controlled..
Improperly performed acupuncture can cause fainting, local
hematoma (due to bleeding from a punctured blood vessel), pneumothorax
(punctured lung), convulsions, local infections, hepatitis B (from
unsterile needles), bacterial endocarditis, contact dermatitis,
and nerve damage. The herbs used by acupuncture practitioners
are not regulated for safety, potency, or effectiveness. There
is also risk that an acupuncturist whose approach to diagnosis
is not based on scientific concepts will fail to diagnose a dangerous
The adverse effects of acupuncture are probably related to
the nature of the practitioner's training. A survey of 1,135 Norwegian
physicians revealed 66 cases of infection, 25 cases of punctured
lung, 31 cases of increased pain, and 80 other cases with complications.
A parallel survey of 197 acupuncturists, who are more apt to see
immediate complications, yielded 132 cases of fainting, 26 cases
of increased pain, 8 cases of pneumothorax, and 45 other adverse
results . However, a 5-year study involving 76 acupuncturists
at a Japanese medical facility tabulated only 64 adverse event
reports (including 16 forgotten needles and 13 cases of transient
low blood pressure) associated with 55,591 acupuncture treatments.
No serious complications were reported. The researchers concluded
that serious adverse reactions are uncommon among acupuncturists
who are medically trained .
Moe recently, members of the British Acupuncture Council who
participated in two prospective studies have reported low complication
rates and no serious complications among patients who underwent
a total of more than 66,000 treatments 14,15]. An accompany editorial
suggests that in competent hands, the likelihood of complcations
is small . Since outcome data are not available, the studies
cannot compare the balance of risks vs benefit. Nor do the studies
take into account the likelihood of misdiagnosis (and failure
to seek appropriate medical care) by practitioners who use traditional
In 1971, an acupuncture boom occurred in the United States
because of stories about visits to China by various American dignitaries.
Entrepreneurs, both medical and nonmedical, began using flamboyant
advertising techniques to promote clinics, seminars, demonstrations,
books, correspondence courses, and do-it-yourself kits. Today
some states restrict the practice of acupuncture to physicians
or others operating under their direct supervision. In about 20
states, people who lack medical training can perform acupuncture
without medical supervision. The FDA now classifies acupuncture
needles as Class II medical devices and requires labeling for
one-time use by practitioners who are legally authorized to use
them . Acupuncture is not covered under Medicare. The March
1998 issue of the Journal of the American Chiropractic Association
carried a five-part cover story encouraging chiropractors to get
acupuncture training, which, according to one contributor, would
enable them to broaden the scope of their practice .
The National Certification
Commission for Acupuncture and Oriental Medicine (NCCAOM)
has set voluntary certification
standards and certified several thousand practitioners. By
November 1998, 32
states had licensing laws, with 29 of them using NCCAOM examination
as all or part of their educational, training, or examination
requirement, and three with addditional eligibility criteria.
The credentials used by acupuncturists include C.A. (certified
acupuncturist), Lic. Ac. (licensed acupuncturist), M.A. (master
acupuncturist), Dip. Ac. (diplomate of acupuncture), and O.M.D.
(doctor of Oriental medicine). Some of these have legal significance,
but they do not signify that the holder is competent to make adequate
diagnoses or render appropriate treatment.
In 1990, the U.S. Secretary of Education recognized what is
now called the Accreditation Commission
for Acupuncture and Oriental Medicine (ACAOM) as an accrediting
agency. However, such recognition is not based on the scientific
validity of what is taught but upon other criteria . Ulett
Certification of acupuncturists is a sham. While a few of
those so accredited are naive physicians, most are nonmedical
persons who only play at being doctor and use this certification
as an umbrella for a host of unproven New Age hokum treatments.
Unfortunately, a few HMOs, hospitals, and even medical schools
are succumbing to the bait and exposing patients to such bogus
treatments when they need real medical care.
The National Council
Against Health Fraud has concluded:
- Acupuncture is an unproven modality of treatment.
- Its theory and practice are based on primitive and fanciful
concepts of health and disease that bear no relationship to present
- Research during the past 20 years has not demonstrated that
acupuncture is effective against any disease.
- Perceived effects of acupuncture are probably due to a combination
of expectation, suggestion, counter-irritation, conditioning,
and other psychologic mechanisms.
- The use of acupuncture should be restricted to appropriate
- Insurance companies should not be required by law to cover
- Licensure of lay acupuncturists should be phased out.
- Consumers who wish to try acupuncture should discuss their
situation with a knowledgeable physician who has no commercial
The NIH Debacle
In 1997, a Consensus Development Conference sponsored by the
National Institutes of Health and several other agencies 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 panelists also suggested that the federal government and insurance
companies expand coverage of acupuncture so more people can have
access to it. These conclusions were not based on research done
after NCAHF's position paper was published. Rather, they reflected
the bias of the panelists who were selected by a planning committee
dominated by acupuncture proponents . NCAHF board chairman
Wallace Sampson, M.D., has described the conference "a consensus
of proponents, not a consensus of valid scientific opinion."
Although the report described some serious problems, it failed
to place them into proper perspective. The panel acknowledged
that "the vast majority of papers studying acupuncture consist
of case reports, case series, or intervention studies with designs
inadequate to assess efficacy" and that "relatively
few" high-quality controlled trials have been published about
acupuncture's effects. But it reported that "the World Health
Organization has listed more than 40 [conditions] for which [acupuncture]
may be indicated." This sentence should have been followed
by a statement that the list was not valid.
Far more serious, although the consensus report touched on
Chinese acupuncture theory, it failed to point out the danger
and economic waste involved in going to practitioners who can't
make appropriate diagnoses. The report noted:
- The general theory of acupuncture is based on the premise
that there are patterns of energy flow (Qi) through the body
that are essential for health. Disruptions of this flow are believed
to be responsible for disease. The acupuncturist can correct
imbalances of flow at identifiable points close to the skin.
- Acupuncture focuses on a holistic, energy-based approach
to the patient rather than a disease-oriented diagnostic and
- Despite considerable efforts to understand the anatomy and
physiology of the "acupuncture points," the definition
and characterization of these points remains controversial. Even
more elusive is the scientific basis of some of the key traditional
Eastern medical concepts such as the circulation of Qi, the meridian
system, and the five phases theory, which are difficult to reconcile
with contemporary biomedical information but continue to play
an important role in the evaluation of patients and the formulation
of treatment in acupuncture.
Simply stated, this means that if you go to a practitioner
who practices traditional Chinese medicine, you are unlikely to
be properly diagnosed.
In 1998, following his lecture at a local college, an experienced
TCM practitioner diagnosed me by taking my pulse and looking at
my tongue. He stated that my pulse showed signs of "stress"
and that my tongue indicated I was suffering from "congestion
of the blood." A few minutes later, he examined a woman and
told her that her pulse showed premature ventricular contractions
(a disturbance of the heart's rhythm that could be harmless or
significant, depending on whether the individual has underlying
heart disease). He suggested that both of us undergo treatment
with acupuncture and herbs -- which would have cost about $90
per visit. I took the woman's pulse and found that it was completely
normal. I believe that the majority of nonmedical acupuncturists
rely on improper diagnostic procedures. The NIH consensus panel
should have emphasized the seriousness of this problem.
A study published in 2001 illustrates the absurdity of TCM
practices. A 40-year-old woman with chronic back pain who visited
seven acupuncturists during a two-week period was diagnosed with
"Qi stagnation" by 6 of them, "blood stagnation"
by 5 , "kidney Qi deficiency" by 2, "yin deficiency"
by 1, and "liver Qi deficiency" by 1. The proposed treatments
varied even more. Among the six who recorded their recommendations,
the practitioners planned to use between 7 and 26 needles inserted
into 4 to 16 specific "acupuncture points" in the back,
leg, hand, and foot. Of 28 acupuncture points selected, only 4
(14%) were prescribed by two or more acupuncturists.  The
study appears to have been designed to make the results as consistent
as possible. All of the acupuncturists had been trained at a school
of traditional Chinese medicine (TCM). Six other volunteers were
excluded because they "used highly atypical practices,"
and three were excluded because they had been in practice for
less than three years. Whereas science-based methods are thoroughly
studied to ensure that they are reliable, this appears to be the
first published study that examines the consistency of TCM diagnosis
or treatment. I would expect larger studies to show that TCM diagnoses
are meaningless and have little or nothing to do with the patient's
health status. The study's authors state that the diagnostic findings
showed "considerable consistency" because nearly all
of the practitioners found Qi or blood stagnation. However, the
most likely explanation is that these are diagnosed in nearly
everyone. It would be fascinating to see what would happen if
a healthy person was examined by multiple acupuncturists.
For Additional Information
This article was revised on January
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