- Acupuncture.

*Acupuncture is an alternative medicine methodology originating in ancient China that treats patients by manipulating thin, solid needles which have been inserted into acupuncture points in the skin.

*Theory

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. Acupuncture may correct imbalances of flow at identifiable points close to the skin. (1)


The most common mechanism of stimulation of acupuncture points employs penetration of the skin by thin metal needles, which are manipulated manually or by electrical stimulation.(1)

The acupuncturist decides which points to treat by observing and questioning the patient in order to make a diagnosis.

Tongue and pulse

• Examination of the tongue and the pulse are among the principal diagnostic methods in traditional Chinese medicine (TCM). The surface of the tongue is believed to contain a map of the entire body, and is used to determine acupuncture points to manipulate.(2)
• TCM diagnosis also involves measuring for three superficial and three deep pulses at different locations on the radial artery of each arm, for a total of twelve pulses that are thought to correspond to twelve internal organs. The pulse is examined for several characteristics including rhythm, strength and volume, and described with terms like "floating, slippery, bolstering-like, feeble, thready and quick", which are used to ascribe a specific imbalance in the body. Learning TCM pulse diagnosis can take several years.(3)

Needles

• Acupuncture needles are typically made of stainless steel wire.
• Needles vary in length between 13 to 130 millimetres, with shorter needles used near the face and eyes, and longer needles in more fleshy areas
• needle diameters vary from 0.16 mm to 0.46 mm(4)
• The tip of the needle should not be made too sharp to prevent breakage, although blunt needles cause more pain.(5)

Needling technique

Insertion

Since most pain is felt in the superficial layers of the skin, a quick insertion of the needle is recommended. If skilled enough, a practitioner purportedly can insert the needles without causing any pain. (4)


De-qi sensation
De-qi refers to a sensation of numbness, distension, or electrical tingling at the needling site which might radiate along the corresponding meridian. If it can not be generated, inaccurate location of the acupoint, improper depth of needle insertion, inadequate manipulation, or a very weak constitution of the patient have to be considered, all of which decrease the likelihood of successful treatment. If de-qi sensation doesn't immediately occur upon needle insertion, various manipulation techniques can be applied to promote it (such as "plucking", "shaking" or "trembling").(4)

In most cases, a number of needles are inserted and left for up to 20min.(6)

Indications of acupuncture according to WHO:-

In an official report (7), the WHO has listed the following Diseases, symptoms or conditions for which acupuncture has been proved-through controlled trials-to be an effective treatment:

• Adverse reactions to radiotherapy and/or chemotherapy
• Allergic rhinitis (including hay fever)
• Biliary colic
• Depression (including depressive neurosis and depression following stroke)
• Dysentery, acute bacillary
• Dysmenorrhoea, primary
• Epigastralgia, acute (in peptic ulcer, acute and chronic gastritis, and gastrospasm)
• Facial pain (including craniomandibular disorders)
• Headache
• Hypertension, essential
• Hypotension, primary
• Induction of labour
• Knee pain
• Leukopenia
• Low back pain
• Malposition of fetus, correction of
• Morning sickness
• Nausea and vomiting
• Neck pain
• Pain in dentistry (including dental pain and temporomandibular dysfunction)
• Periarthritis of shoulder
• Postoperative pain
• Renal colic
• Rheumatoid arthritis
• Sciatica
• Sprain
• Stroke
• Tennis elbow

Contraindications(6)

• refused by patient
• pregnancy (especially 1st trimester)
• bleeding disorders and anticoagulant use (relative contraindication)
• skin infections or diseased skin
• disorders of the immune system
• valvular heart disease (only if indwelling needles are used).

Adverse effects: 

Adverse events are rare (1:1000 treatments) and are usually associated with poorly trained unlicensed acupuncturists including:-

• Infection (ONLY go to practitioners using disposable needles)
• Bruising/haemorrhage
• Anatomical damage (pneumothorax most common)
• Needle fracture or needles left in situ
• Fainting
• Sweating
• Convulsions
• Miscarriage (anecdotal)

*References:-

1.  NIH Consensus Development Program (November 3–5, 1997). ""Acupuncture --Consensus Development Conference Statement"". National Institutes of Health. Retrieved 2007-07-17.
2. Maciocia, G (1995). Tongue Diagnosis in Chinese Medicine. Eastland Press.
3. Wright, Thomas; Eisenberg, David (1995). Encounters with Qi: exploring Chinese medicine. New York: Norton. pp.53–4
4. Aung and Chen, 2007, "p.116","pp.113"
5. Ellis, A; Wiseman N; Boss K (1991). Fundamentals of Chinese Acupuncture. Paradigm Publications. "pp.2–3.". ISBN 091211133X.
6.  Oxford Handbook of General Practice, 2nd Editionp144
7.  "Acupuncture: Review and Analysis of Reports on Controlled Clinical Trials"