What is it?
Because of the wide variety of theories, approaches, and specific practices acupuncturists use, it is difficult to find agreement as to what exactly acupuncture is. At its core, acupuncture is the practice of inserting needles into the body in an attempt to relieve suffering, treat disease, or improve the quality of a patient’s life.
Though needling and other interventions at points on the body have been practiced in various cultures around the world, acupuncture today is usually associated with needling practices that originated in China. Some acupuncturists claim that they base their treatments on the Chinese concept of Ch’i, which is usually described as a vital force which flows through channels in the body (often called meridians). These practitioners may also claim that imbalances or blockages of Ch’i can cause disease, which can then be treated by inserting needles into meridians at specific points. Ch’i is not detectable by any known means, and neither acupuncture points nor meridians can be identified as physical structures in the body or through any kind of medical imaging.
Other acupuncturists disavow mystical concepts such as Ch’i and claim their treatments work by stimulating release of natural pain control chemicals, such as endorphins, or by affecting blood flow, the function of nerves, and other scientific physiological means. However, none of these proposed mechanisms are supported by any consistent research evidence.
Still other schools of acupuncture claim that the entire body can be mapped onto one part, such as the hand (e.g. Korean Hand Acupuncture) or the ear (a system developed in France in the 1950s), and that needling or other manipulations of points in this location can affect distant organs. Again, no identifiable connections between these proposed local maps and distant organs have been found.
The number and location of acupuncture points has changed often through history, and today there is great variety among acupuncturists as to the sites used. In fact, some proponents of acupuncture, including Felix Mann, past president of the British Acupuncture Society, deny that specifically identifiable point for applying acupuncture exist at all.
In addition to needle insertion, some acupuncturists burn herbs at acupuncture points, pass electric current through the needles or pads placed on the skin, massage or inject vitamins at acupuncture points, or use laser light or other methods to treat patients. Thus, there is no agreement among proponents of acupuncture about the underlying basis for the practice, the specific points to be used, or how these points are to be stimulated.
The popularity of acupuncture has risen and fallen many times in China and the West. After being largely replaced in China by Western medical practices in the 19th and early 20th centuries, the practice underwent a resurgence in the 1950s and 1960s, as an effort by the Communist Party to provide cheap health care in places without modern facilities or trained doctors. It has since become a relatively minor element of medical care in China among those with access to more popular, Western scientific medical. The current interest in acupuncture in Europe and the United States began in the 1970s, following the reopening of China to outsiders.
Historically, acupuncture as understood today was never applied to animals in China. Other interventions, such as bleeding or burning herbs at points on the skin were practiced on animals, but animals were considered fundamentally different from humans in ways that made the methods which have since been developed into modern acupuncture inappropriate for veterinary patients.
Nevertheless, with the rise in interest in acupuncture in the West during the 1970s, the acupuncture points in use for animals today were invented by Western practitioners extrapolating from charts made for humans. The logic of this is sometimes questionable, as for example in the use of a “gallbladder meridian” for acupuncture treatment in horses despite the absence of a gallbladder in this species. As with humans, there is no consistency among acupuncturists as to the rationale for therapy or the specific points or methods to be used.
Does It Work?
There is an enormous amount of scientific research devoted to acupuncture in humans. As always, some studies support its use and others find no evidence of benefit. It can be difficult to sort out the real answer from this confusion.
Studies performed by proponents of acupuncture or published in journals devoted to the practice are almost always positive. Studies performed by critics or neutral researchers are generally negative or inconclusive. Furthermore, as with any medical therapies, negative studies on acupuncture are less likely to be published since they are disappointing to the researchers and not attractive to journals, so there is some inherent bias in the literature for positive results. This is especially true in China, where many of the studies of acupuncture have been published and where 98% of all medical studies published (and 100% of studies in alternative methods such as acupuncture) report positive results.
The best quality scientific studies require blinding, where the patients and researchers not know whether each subject is getting the real acupuncture treatment or a fake (placebo) treatment. Unfortunately, it can be very difficult to fool a person about whether or not they are receiving real or fake acupuncture, and it is impossible to fool the acupuncturist doing the treatment.
Many other factors complicate interpretation of human clinical trials. Confidence in the results can only come from consistent, repeatable outcomes of many well-designed trials conducted by different investigators. However, despite decades of studies in acupuncture, there is still no such body of evidence that shows acupuncture to be consistently effective for any condition.
When the best quality studies, with reasonable numbers of subjects and good controls for bias, are reviewed they find no benefit from acupuncture for most conditions. The evidence is mixed or shows some benefit for some types of chronic pain, and for nausea following chemotherapy or surgery. The largest, best designed, and most recent studies have found that sham or fake acupuncture (using random locations or not actually puncturing the skin with the needles) seems to have about the same benefit as real acupuncture treatment. And patients who believe they are getting real acupuncture even when they aren’t get more relief than those who actually get acupuncture but think they are getting the placebo treatment. The degree of benefit, when any is seen, is generally very small and considerably less than most conventional therapies when these are used for comparison.
So the evidence for humans indicates that acupuncture may make people with chronic pain or nausea feel more comfortable, though this is probably due to altering their perception or awareness of the discomfort rather than actually treating the source of the discomfort in the body. This may have some benefit as an adjunct to traditional scientific medical treatment.
Does it work for animals? This would seem to be easier to determine than it is for humans because no effect from the patients’ attitudes or beliefs would be expected in animals. However, it is currently impossible to determine if there is any benefit of acupuncture for veterinary patients because of the lack of well-conducted research studies. The quality of the acupuncture studies that have been done in veterinary medicine is generally very low. A recent systematic review in the Journal of Veterinary Internal Medicine found so few controlled trials of such poor quality that despite reports of benefit from acupuncture in some studies and no benefit in most, the authors concluded that “there is no compelling evidence to recommend or reject acupuncture for any condition in domestic animals.”
For now, we can only say that it appears somewhat helpful for subjective discomfort, such as pain or nausea, in humans, especially if the patient believes it will be helpful. The evidence is not available to say with certainty whether it is helpful to veterinary patients, but the apparent importance of patient attitudes or beliefs for benefit in humans make it doubtful that animals will experience the same benefits, since their experience is unlikely to be affected by such factors. However, the caretakers of veterinary patients, who evaluate the effectiveness of therapy and make medical decisions for the patients, can be influenced by their own experiences and beliefs, which makes objective assessment of the effect of acupuncture in the clinical setting very difficult.
Is it Safe?
The incidence of complications from acupuncture in humans is low. It has been reported to cause minor local pain and bleeding fairly commonly. More serious side effects, including fainting, vomiting, hepatitis, permanent nerve damage, and death from collapsed lungs have been reported, but these appear to be extremely rare. Adverse effects of acupuncture in animals have not been reported in the sparse literature that exists on the subject.
- There is no evidence for the reality of the more mystical principles underlying some acupuncture practices, such as Ch’i, yin/yang, specific acupuncture points, or meridians. There is also no verifiable way to locate or identify specific locations for applying acupuncture.
- More scientific concepts, such as endorphins and neuronal gating, are at least potentially testable, but as yet the evidence does not show that these explanations justify the clinical use of acupuncture.
- In humans, acupuncture may have some benefits for reducing the perception of chronic pain and nausea, but it is doubtful that our animal patients will experience this same benefit since it seems to be highly dependant on what the subject believes about their condition and treatment. There is no consistent evidence for a benefit in the outcome of any disease in humans treated with acupuncture.
- In animals, there is no reliable, high-quality research evidence for the benefits of acupuncture. The studies that have been done have found both positive and negative results, but the poor quality and lack of replication make the existing evidence insufficient to recommend acupuncture therapy.
- Acupuncture is unlikely to be harmful to most patients.
- With very little risk of harm, and no convincing evidence of benefit, the use of acupuncture in animals should be seen as an experimental adjunct to conventional therapy, not a replacement for proven medical treatments.
References and More Information
Barker Bausell, R., Snake Oil Science: The Truth About Complementary and Alternative Medicine, Oxford University Press, 2007
Ernst, E., White, A.R., Prospective studies of the safety of acupuncture: a systematic review. Am J Med Apr 2001;110(6):481-5
Habacher, G., Pittler, M.H., Ernst, E., Effectiveness of acupuncture in veterinary medicine: systematic review. J Vet Int Med May-Jun 2006;20(3):480-8.
Mann, Felix. Reinventing Acupuncture, Butterworth Heinemann, 1992
Ramey, D., Rollin, B., Complementary and Alternative Veterinary Medicine Considered, Iowa State Press, 2004
Sing, S., Ernst, E., Trick or Treatment: The Undeniable Facts About Alternative Medicine, W.W. Norton & Company, 2008
The Cochrane Collaboration, The Cochrane Reviews, a searchable database of systematic reviews of the human medical literature at http://www.cochrane.org/reviews/