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Andrew C Ahn, MD, MPH
Section Editor
Mark D Aronson, MD
Deputy Editor
H Nancy Sokol, MD


The word "acupuncture" is derived from the Latin words "acus" (needle) and "punctura" (penetration). Acupuncture originated in China approximately 2000 years ago and is one of the oldest medical procedures in the world.

Over its long history and dissemination, acupuncture has diversified and encompasses a large array of styles and techniques. Common styles include Traditional Chinese, Japanese, Korean, Vietnamese, and French acupuncture, as well as specialized forms such as hand, auricular, and scalp acupuncture.

Acupuncture also refers to a family of procedures used to stimulate anatomical points. Aside from needles, acupuncturists can incorporate manual pressure, electrical stimulation, magnets, low-power lasers, heat, and ultrasound.

Despite this diversity, the techniques most frequently used and studied are manual manipulation and/or electrical stimulation of thin, solid, metallic needles inserted into skin. Except where specifically stated, "acupuncture" in this topic refers to these two most common procedures.

A general discussion of acupuncture is presented here. Additional discussions of acupuncture for rheumatic conditions and for cancer are presented separately. (See "Complementary and alternative therapies for cancer", section on 'Acupuncture and related therapies'.)


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Literature review current through: Sep 2016. | This topic last updated: Feb 1, 2016.
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  1. Unschuld P. Medicine in China: A History of Ideas, University of California Press, Berkeley 1985.
  2. Lu H. The Yellow Emperor's Book of Acupuncture, Academy of Oriental Heritage, Vancouver 1973.
  3. Kaptchuk T. The Web That Has No Weaver: Understanding Chinese Medicine, ed, McGraw-Hill, Lincolnwood, IL 2000.
  4. Helms J. Acupuncture Energetics: A Clinical Approach for clinicians, Medical Acupuncture Publishers, Berkeley 1995.
  5. Sivin N. Traditional Medicine in Contemporary China, The University of Michigan Press, Ann Arbor 1987.
  6. White A, Ernst E. A brief history of acupuncture. Rheumatology (Oxford) 2004; 43:662.
  7. Osler, W. The Principles and Practices of Medicine. Appleton, New York 1892.
  8. Reston, J. Now About My Operation in Peking. New York Times 1971; 1:6.
  9. Barnes PM, Powell-Griner E, McFann K, Nahin RL. Complementary and alternative medicine use among adults: United States, 2002. Adv Data 2004; :1.
  10. Astin JA, Marie A, Pelletier KR, et al. A review of the incorporation of complementary and alternative medicine by mainstream physicians. Arch Intern Med 1998; 158:2303.
  11. Ahn AC, Ngo-Metzger Q, Legedza AT, et al. Complementary and alternative medical therapy use among Chinese and Vietnamese Americans: prevalence, associated factors, and effects of patient-clinician communication. Am J Public Health 2006; 96:647.
  12. Kaptchuk TJ. Acupuncture: theory, efficacy, and practice. Ann Intern Med 2002; 136:374.
  13. Capra, F. The Tao of Physics, 4th ed, Shambhala, Boston 2000.
  14. Birch, S, Felt, R. Understanding Acupuncture. Churchill Livingstone, London 1999.
  15. Maciocia, G. The Foundations of Chinese Medicine. Churchill Livingstone, London 1989.
  16. Huai, L, Broffman, M, Pei, S. A Comprehensive Textbook. China Acupuncture and Moxibustion Supplies, Taiwan 1976.
  17. Abad-Alegría F, Pomarón C. About the neurobiological foundations of the De-Qi--stimulus-response relation. Am J Chin Med 2004; 32:807.
  18. Cheng, X. Chinese Acupuncture and Moxibustion. Foreign Language Press, Beijing, China 1987.
  19. Shanghai College of Traditional Medicine. Acupuncture. A Comprehensive Text. Eastland, Seattle, WA 1987.
  20. Beijing Shanghai aNCoTCM. Essentials of Chinese Acupuncture. Foreign Language Press, Beijing, China 1980.
  21. Lee, BY, LaRiccia, PJ, Newberg, AB. Acupuncture in theory and practice part 2: Theoretical basis and physiologic effects. Hospital Physician 2004; :11.
  22. Paterson C, Britten N. Acupuncture as a complex intervention: a holistic model. J Altern Complement Med 2004; 10:791.
  23. Pomeranz B, Cheng R, Law P. Acupuncture reduces electrophysiological and behavioral responses to noxious stimuli: pituitary is implicated. Exp Neurol 1977; 54:172.
  24. Pomeranz B. Do endorphins mediate acupuncture analgesia? Adv Biochem Psychopharmacol 1978; 18:351.
  25. Pomeranz B, Paley D. Electroacupuncture hypalgesia is mediated by afferent nerve impulses: an electrophysiological study in mice. Exp Neurol 1979; 66:398.
  26. Pomeranz B, Bibic L. Electroacupuncture suppresses a nociceptive reflex: naltrexone prevents but does not reverse this effect. Brain Res 1988; 452:227.
  27. Pomeranz B, Warma N. Electroacupuncture suppression of a nociceptive reflex is potentiated by two repeated electroacupuncture treatments: the first opioid effect potentiates a second non-opioid effect. Brain Res 1988; 452:232.
  28. Pomeranz B. Scientific research into acupuncture for the relief of pain. J Altern Complement Med 1996; 2:53.
  29. Pomeranz B, Cheng R. Suppression of noxious responses in single neurons of cat spinal cord by electroacupuncture and its reversal by the opiate antagonist naloxone. Exp Neurol 1979; 64:327.
  30. Han JS. Acupuncture analgesia. Pain 1985; 21:307.
  31. Han JS, Xie GX, Zhou ZF, et al. Acupuncture mechanisms in rabbits studied with microinjection of antibodies against beta-endorphin, enkephalin and substance P. Neuropharmacology 1984; 23:1.
  32. Han JS, Tang J, Ren MF, et al. Central neurotransmitters and acupuncture analgesia. Am J Chin Med 1980; 8:331.
  33. Han JS, Xie GX. Dynorphin: important mediator for electroacupuncture analgesia in the spinal cord of the rabbit. Pain 1984; 18:367.
  34. Han JS, Xie GX, Zhou ZF, et al. Enkephalin and beta-endorphin as mediators of electro-acupuncture analgesia in rabbits: an antiserum microinjection study. Adv Biochem Psychopharmacol 1982; 33:369.
  35. Han JS, Fei H, Zhou ZF. Met-enkephalin-Arg6-Phe7-like immunoreactive substances mediate electroacupuncture analgesia in the periaqueductal gray of the rabbit. Brain Res 1984; 322:289.
  36. Han JS, Li SJ, Tang J. Tolerance to electroacupuncture and its cross tolerance to morphine. Neuropharmacology 1981; 20:593.
  37. Cheng RS, Pomeranz B. Electroacupuncture analgesia could be mediated by at least two pain-relieving mechanisms; endorphin and non-endorphin systems. Life Sci 1979; 25:1957.
  38. Cheng RS, Pomeranz BH. Electroacupuncture analgesia is mediated by stereospecific opiate receptors and is reversed by antagonists of type I receptors. Life Sci 1980; 26:631.
  39. Cheng R, McKibbin L, Roy B, Pomeranz B. Electroacupuncture elevates blood cortisol levels in naive horses; sham treatment has no effect. Int J Neurosci 1980; 10:95.
  40. Cheng RS, Pomeranz B, Yu G. Electroacupuncture treatment of morphine-dependent mice reduces signs of withdrawal, without showing cross-tolerance. Eur J Pharmacol 1980; 68:477.
  41. Cheng RS, Pomeranz B. Monoaminergic mechanism of electroacupuncture analgesia. Brain Res 1981; 215:77.
  42. Han JS, Terenius L. Neurochemical basis of acupuncture analgesia. Annu Rev Pharmacol Toxicol 1982; 22:193.
  43. Andersson S, Lundeberg T. Acupuncture--from empiricism to science: functional background to acupuncture effects in pain and disease. Med Hypotheses 1995; 45:271.
  44. Ulett GA, Han S, Han JS. Electroacupuncture: mechanisms and clinical application. Biol Psychiatry 1998; 44:129.
  45. Carlsson C. Acupuncture mechanisms for clinically relevant long-term effects--reconsideration and a hypothesis. Acupunct Med 2002; 20:82.
  46. Vickers AJ, Rees RW, Zollman CE, et al. Acupuncture for chronic headache in primary care: large, pragmatic, randomised trial. BMJ 2004; 328:744.
  47. Guerra de Hoyos JA, Andrés Martín Mdel C, Bassas y Baena de Leon E, et al. Randomised trial of long term effect of acupuncture for shoulder pain. Pain 2004; 112:289.
  48. Change in the medical science of acupuncture. World Federation of Acupuncture and Moxibustion Societies, Kyoto 1993.
  49. Cho ZH, Chung SC, Jones JP, et al. New findings of the correlation between acupoints and corresponding brain cortices using functional MRI. Proc Natl Acad Sci U S A 1998; 95:2670.
  50. Fang JL, Krings T, Weidemann J, et al. Functional MRI in healthy subjects during acupuncture: different effects of needle rotation in real and false acupoints. Neuroradiology 2004; 46:359.
  51. Wu MT, Sheen JM, Chuang KH, et al. Neuronal specificity of acupuncture response: a fMRI study with electroacupuncture. Neuroimage 2002; 16:1028.
  52. Yan B, Li K, Xu J, et al. Acupoint-specific fMRI patterns in human brain. Neurosci Lett 2005; 383:236.
  53. Yoo SS, Teh EK, Blinder RA, Jolesz FA. Modulation of cerebellar activities by acupuncture stimulation: evidence from fMRI study. Neuroimage 2004; 22:932.
  54. Langevin HM, Yandow JA. Relationship of acupuncture points and meridians to connective tissue planes. Anat Rec 2002; 269:257.
  55. Langevin HM, Churchill DL, Wu J, et al. Evidence of connective tissue involvement in acupuncture. FASEB J 2002; 16:872.
  56. Langevin HM, Churchill DL, Cipolla MJ. Mechanical signaling through connective tissue: a mechanism for the therapeutic effect of acupuncture. FASEB J 2001; 15:2275.
  57. Manheimer E, White A, Berman B, et al. Meta-analysis: acupuncture for low back pain. Ann Intern Med 2005; 142:651.
  58. Furlan AD, van Tulder M, Cherkin D, et al. Acupuncture and dry-needling for low back pain: an updated systematic review within the framework of the cochrane collaboration. Spine (Phila Pa 1976) 2005; 30:944.
  59. Scharf HP, Mansmann U, Streitberger K, et al. Acupuncture and knee osteoarthritis: a three-armed randomized trial. Ann Intern Med 2006; 145:12.
  60. Brinkhaus B, Witt CM, Jena S, et al. Acupuncture in patients with chronic low back pain: a randomized controlled trial. Arch Intern Med 2006; 166:450.
  61. White P, Lewith G, Prescott P, Conway J. Acupuncture versus placebo for the treatment of chronic mechanical neck pain: a randomized, controlled trial. Ann Intern Med 2004; 141:911.
  62. Streitberger K, Diefenbacher M, Bauer A, et al. Acupuncture compared to placebo-acupuncture for postoperative nausea and vomiting prophylaxis: a randomised placebo-controlled patient and observer blind trial. Anaesthesia 2004; 59:142.
  63. Ezzo J, Vickers A, Richardson MA, et al. Acupuncture-point stimulation for chemotherapy-induced nausea and vomiting. J Clin Oncol 2005; 23:7188.
  64. Ezzo JM, Richardson MA, Vickers A, et al. Acupuncture-point stimulation for chemotherapy-induced nausea or vomiting. Cochrane Database Syst Rev 2006; :CD002285.
  65. Smith CA, Collins CT, Cyna AM, Crowther CA. Complementary and alternative therapies for pain management in labour. Cochrane Database Syst Rev 2006; :CD003521.
  66. Rosted P. The use of acupuncture in dentistry: a review of the scientific validity of published papers. Oral Dis 1998; 4:100.
  67. Ernst E, Pittler MH. The effectiveness of acupuncture in treating acute dental pain: a systematic review. Br Dent J 1998; 184:443.
  68. Ahn AC, Kaptchuk TJ. Advancing acupuncture research. Altern Ther Health Med 2005; 11:40.
  69. Linde K, Streng A, Jürgens S, et al. Acupuncture for patients with migraine: a randomized controlled trial. JAMA 2005; 293:2118.
  70. Flachskampf FA, Gallasch J, Gefeller O, et al. Randomized trial of acupuncture to lower blood pressure. Circulation 2007; 115:3121.
  71. Suzuki M, Muro S, Ando Y, et al. A randomized, placebo-controlled trial of acupuncture in patients with chronic obstructive pulmonary disease (COPD): the COPD-acupuncture trial (CAT). Arch Intern Med 2012; 172:878.
  72. Brinkhaus B, Ortiz M, Witt CM, et al. Acupuncture in patients with seasonal allergic rhinitis: a randomized trial. Ann Intern Med 2013; 158:225.
  73. Dodin S, Blanchet C, Marc I, et al. Acupuncture for menopausal hot flushes. Cochrane Database Syst Rev 2013; :CD007410.
  74. Zhang SH, Liu M, Asplund K, Li L. Acupuncture for acute stroke. Cochrane Database Syst Rev 2005; :CD003317.
  75. Wu HM, Tang JL, Lin XP, et al. Acupuncture for stroke rehabilitation. Cochrane Database Syst Rev 2006; :CD004131.
  76. Smith CA, Hay PP, Macpherson H. Acupuncture for depression. Cochrane Database Syst Rev 2010; :CD004046.
  77. Mayhew E, Ernst E. Acupuncture for fibromyalgia--a systematic review of randomized clinical trials. Rheumatology (Oxford) 2007; 46:801.
  78. Lan L, Zeng F, Liu GJ, et al. Acupuncture for functional dyspepsia. Cochrane Database Syst Rev 2014; :CD008487.
  79. Shen X, Xia J, Adams CE. Acupuncture for schizophrenia. Cochrane Database Syst Rev 2014; :CD005475.
  80. White AR, Rampes H, Liu JP, et al. Acupuncture and related interventions for smoking cessation. Cochrane Database Syst Rev 2011; :CD000009.
  81. Tahiri M, Mottillo S, Joseph L, et al. Alternative smoking cessation aids: a meta-analysis of randomized controlled trials. Am J Med 2012; 125:576.
  82. Lao L, Hamilton GR, Fu J, Berman BM. Is acupuncture safe? A systematic review of case reports. Altern Ther Health Med 2003; 9:72.
  83. Ernst E, White AR. Prospective studies of the safety of acupuncture: a systematic review. Am J Med 2001; 110:481.
  84. Vucicevic Z, Sharma M, Miklic S, Ferencic Z. Multiloculated pleural empyema following acupuncture. Infection 2005; 33:297.
  85. Park JH, Shin HJ, Choo SJ, et al. Successful removal of migrated acupuncture needles in a patient with cardiac tamponade by means of intraoperative transesophageal echocardiographic assistance. J Thorac Cardiovasc Surg 2005; 130:210.
  86. Saifeldeen K, Evans M. Acupuncture associated pneumothorax. Emerg Med J 2004; 21:398.
  87. Studd RC, Stewart PJ. Images in clinical medicine. Intraabdominal abscess after acupuncture. N Engl J Med 2004; 350:1763.
  88. Cheng TO. Cardiac tamponade following acupuncture. Chest 2000; 118:1836.
  89. Woo PC, Li JH, Tang W, Yuen K. Acupuncture mycobacteriosis. N Engl J Med 2001; 345:842.
  90. Vickers A, Wilson P, Kleijnen J. Acupuncture. Qual Saf Health Care 2002; 11:92.
  91. Yamashita H, Tsukayama H, Tanno Y, Nishijo K. Adverse events in acupuncture and moxibustion treatment: a six-year survey at a national clinic in Japan. J Altern Complement Med 1999; 5:229.
  92. Melchart D, Weidenhammer W, Streng A, et al. Prospective investigation of adverse effects of acupuncture in 97 733 patients. Arch Intern Med 2004; 164:104.
  93. White A, Hayhoe S, Hart A, Ernst E. Adverse events following acupuncture: prospective survey of 32 000 consultations with doctors and physiotherapists. BMJ 2001; 323:485.
  94. MacPherson H, Thomas K, Walters S, Fitter M. The York acupuncture safety study: prospective survey of 34 000 treatments by traditional acupuncturists. BMJ 2001; 323:486.
  95. World Health Organization. Guidelines on Basic Training and Safety in Acupuncture. Geneva,1999. p. 1-31.
  96. Lau EW, Birnie DH, Lemery R, et al. Acupuncture triggering inappropriate ICD shocks. Europace 2005; 7:85.
  97. Filshie J. Safety aspects of acupuncture in palliative care. Acupunct Med 2001; 19:117.
  98. Stones RW, Vits K. Pelvic girdle pain in pregnancy. BMJ 2005; 331:249.
  99. Cardini F, Lombardo P, Regalia AL, et al. A randomised controlled trial of moxibustion for breech presentation. BJOG 2005; 112:743.
  100. Elden H, Ladfors L, Olsen MF, et al. Effects of acupuncture and stabilising exercises as adjunct to standard treatment in pregnant women with pelvic girdle pain: randomised single blind controlled trial. BMJ 2005; 330:761.
  101. Lee H, Ernst E. Acupuncture for labor pain management: A systematic review. Am J Obstet Gynecol 2004; 191:1573.
  102. Neri I, Airola G, Contu G, et al. Acupuncture plus moxibustion to resolve breech presentation: a randomized controlled study. J Matern Fetal Neonatal Med 2004; 15:247.
  103. Jewell D, Young G. Interventions for nausea and vomiting in early pregnancy. Cochrane Database Syst Rev 2003; :CD000145.
  104. Maciocia, G. Obstetrics & Gynecology in Chinese Medicine. Churchill Livingstone, London 1998.
  105. Smith CA, Crowther CA. Acupuncture for induction of labour. Cochrane Database Syst Rev 2004; :CD002962.
  106. Sciammarella, J. Acupuncture in patients anticoagulated with warfarin. Medical Acupuncture 2002; 13:.
  107. Studdert DM, Eisenberg DM, Miller FH, et al. Medical malpractice implications of alternative medicine. JAMA 1998; 280:1610.
  108. Lee, BY, LaRiccia, PJ, Newberg, AB. Acupuncture in Theory and Practice part 2: Clinical indications, efficacy, and safety. Hospital Physician 2004; :33.
  109. The Kaiser Family Foundation, Health Research and Educational Trust. Employer Health Benefits 2004 Annual Survey. Kaiser Family Foundation, Menlo Park 2004.
  110. Devitt, M. Report: Insurance coverage for acupuncture on the rise. Acupuncture Today 2005; 6.
  111. Schnyer RN, Allen JJ. Bridging the gap in complementary and alternative medicine research: manualization as a means of promoting standardization and flexibility of treatment in clinical trials of acupuncture. J Altern Complement Med 2002; 8:623.
  112. Kaptchuk, TJ. Web that has no weaver. 2nd ed. Contemporary (McGraw Hill), Chicago 2000.
  113. Seem, M. American acupuncture comes of age: Perspectives from the front line. Medical Acupuncture 1992; 4:16.
  114. Rubinstein SM, van Middelkoop M, Kuijpers T, et al. A systematic review on the effectiveness of complementary and alternative medicine for chronic non-specific low-back pain. Eur Spine J 2010; 19:1213.
  115. Cherkin DC, Sherman KJ, Avins AL, et al. A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain. Arch Intern Med 2009; 169:858.
  116. Berman BM, Lao L, Langenberg P, et al. Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized, controlled trial. Ann Intern Med 2004; 141:901.
  117. Witt C, Brinkhaus B, Jena S, et al. Acupuncture in patients with osteoarthritis of the knee: a randomised trial. Lancet 2005; 366:136.
  118. Manheimer E, Linde K, Lao L, et al. Meta-analysis: acupuncture for osteoarthritis of the knee. Ann Intern Med 2007; 146:868.
  119. Foster NE, Thomas E, Barlas P, et al. Acupuncture as an adjunct to exercise based physiotherapy for osteoarthritis of the knee: randomised controlled trial. BMJ 2007; 335:436.
  120. Hinman RS, McCrory P, Pirotta M, et al. Acupuncture for chronic knee pain: a randomized clinical trial. JAMA 2014; 312:1313.
  121. Linde K, Witt CM, Streng A, et al. The impact of patient expectations on outcomes in four randomized controlled trials of acupuncture in patients with chronic pain. Pain 2007; 128:264.
  122. Acupuncture for Treatment of Menopausal Hot Flashes. Ann Intern Med 2016; 164:I.
  123. Madsen MV, Gøtzsche PC, Hróbjartsson A. Acupuncture treatment for pain: systematic review of randomised clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups. BMJ 2009; 338:a3115.
  124. Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for chronic pain: individual patient data meta-analysis. Arch Intern Med 2012; 172:1444.