Acupuncture's cultural and historical roots go back to the emergence of Chinese civilization. For more than 2,000 years, acupuncture needling has been continuously practiced on the largest population in the world. As a system of medical treatment, acupuncture's prevalence and robustness are continuously demonstrated by strong public demand, growing scientific evidence, and vast institutional support. Over the last thirty-odd years, students, scholars, researchers and practitioners of acupuncture and Chinese medicine in the United States have witnessed a swift rise in popular acceptance of acupuncture therapy, hand-in-hand with the profession's steady advancement.
Although the increasing momentum of acupuncture acceptance and awareness in the West is based on a solid foundation of daily work and practice by tens of thousands of practitioners around the world, the acupuncture profession has also been shaped by a succession of historical landmark events. In this article, I attempt to trace the trajectory of acupuncture's development as a global medicine by focusing on the following years: 1958, 1971, 1987, 1997, and 2002. These dates denote significant turning points in terms of forming institutional establishments, pioneering new fields of research, and expanding the presence of acupuncture/Chinese medicine throughout the world.
1997: NIH Consensus
Complementary and alternative medicine achieved substantial forward momentum in the United States during the 1990's. As a modality of complementary and alternative medicine, acupuncture was especially prominent, eliciting an increasing number of clinical trials and mechanism research studies. In November 1997, the National Institutes of Health (NIH) held a conference on acupuncture. This conference was the first of its kind concerning a modality of complementary and alternative medicine. The conference intended to provide health care providers, patients, and the general public with an accurate assessment of the use and effectiveness of acupuncture for a variety of conditions. Participants included a non-federal, non-advocate, 12-member panel representing the following constituencies: acupuncture, pain medicine, psychology, psychiatry, physical medicine and rehabilitation, drug rehabilitation, family practice, internal medicine, health policy, epidemiology, statistics, physiology, biophysics, and the public. In addition, 25 experts from these same fields presented data to the panel and a conference audience of 1,200.
As part of the NIH acupuncture conference, acupuncture-related literature was researched through Medline. An extensive bibliography of references was provided to the panel and the conference audience by experts, with abstracts and relevant citations from the literature. Scientific evidence was given precedence over clinical anecdotal experience. The panel responded to predefined questions, developing their conclusions based on scientific evidence presented both in the open forum and in the scientific literature. The panel drafted a statement, which was read aloud in its entirety, then circulated in written form to the experts and the audience for comment. The panel resolved conflicting opinions and recommendations, releasing a revised statement at the end of the conference. The panel finalized its revisions after the conference. The draft statement was made publicly available on the World Wide Web immediately following its release at the conference, and was updated with the panel's final revisions.
The NIH consensus conference on acupuncture reached the following conclusion: Acupuncture as a therapeutic intervention is widely practiced in the United States. While there have been many studies of its potential usefulness, many of these studies provide equivocal results because of design, sample size, and other factors. The issue is further complicated by inherent difficulties in the use of appropriate controls, such as placebos and sham acupuncture groups. However, promising results have emerged, for example, showing efficacy of acupuncture in adult postoperative and chemotherapy nausea and vomiting and in postoperative dental pain. There are other situations such as addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma, in which acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program. Further research is likely to uncover additional areas where acupuncture interventions will be useful1.
Following the NIH conference, acupuncture became a hot topic in the booming field of complementary and alternative medicine. Acupuncture images appeared repeatedly on the covers of the mainstream news media, and an article, "Acupuncture Works," was published in Time magazine on November 7, 1997.
The milestone NIH conference and the increasing prevalence of acupuncture in the 1990's brought acupuncture to the attention of the American Medical Association, which advised its members to look at acupuncture and complementary medicine seriously. To stimulate scientific and professional inquiry, the AMA suggested designating an entire issue of the Journal of American Medical Association (JAMA) to acupuncture, Chinese herbal medicine, moxibustion, and other modalities of complementary medicine2,3,4. JAMA complied, dedicating its November 11, 1998 issue to alternative medicine.
2002: Assisted-IVF
The establishment and development of professional organizations and affiliations helped to legitimize acupuncture and Chinese medicine in the eyes of the world. Acupuncture continues to consolidate its reputation as an effective medical modality through applications and innovations which represent scientifically-based advances in the field. One striking example of such an innovative application of acupuncture is assisted in vitro fertilization (IVF). In the United States, IVF treatment for infertility began in the 1980s, expanded during the 1990s, and became a standard of care in the 2000s. From 1985 to 2001, IVF treatments produced an average increase of one to two percent per year in positive outcomes, pregnancy or babies. This annual gain disappeared after 2001, but the effort to improve the success ratio of IVF is ongoing. Applying acupuncture to IVF programs represents an innovative effort to enhance the rate of improvement for IVF. This innovation is generally credited to Dr. W. Paulus and his colleagues, working at the Christian-Lauritzen-Institut in Ulm, Germany.
In their pioneering work, published in Fertility and Sterility in 2002, Paulus, et al.,5 attempted to evaluate the effect of acupuncture on the pregnancy rate in assisted reproductive therapy (ART) by comparing a group of patients receiving acupuncture treatment shortly before and after embryo transfer with a control group receiving no acupuncture. The results showed that clinical pregnancies were 42.5% in the acupuncture group, while pregnancy rate was only 26.3% in the control group. The study demonstrated that administering acupuncture before and after ART is a useful technique for improving pregnancy rate. The Paulus protocol and its clinical results provided the impetus for further studies provoking significant follow-ups in the study of acupuncture applications to IVF.
Since the 2002 publication of the clinical trials conducted by Dr. Paulus et al., and the research studies which followed, acupuncture has become the most commonly used adjunct complementary therapy among couples seeking treatment by means of in vitro fertilization and embryo transfer (IVF-ET) at fertility clinics in the United States. With its extensive use in treating infertility, acupuncture application in IVF protocols has become one of the most contested areas in clinical acupuncture research. Most of the studies done in this area suggest a positive effect when combining acupuncture with standard infertility treatment. Fertility and Sterility, an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders; along with the Journal of the American Society of Reproductive Medicine, have become the main platform for these publications. These studies show that employing acupuncture along with IVF may provide a very promising option for couples struggling with infertility, especially if either one has been diagnosed with one of the following conditions: endometriosis, low sperm counts, problems with the uterus or fallopian tubes, problems with ovulation, antibody problems that harm sperm or eggs, the inability of sperm to penetrate or survive in the cervical mucus, or an unexplained fertility problem. Despite the positive findings of most infertility studies, non-supportive evidence appears occasionally in studies that were conducted in different ways and investigating different aspects of the IVF process.
The small paper published in 2002 by Paulus, et al. demonstrates that acupuncture can contribute to emerging medical fields that are open to exploration and innovation far beyond the already-accepted applications of acupuncture in such areas as pain management, stroke rehabilitation and the treatment of many chronic conditions. The Paulus study hints at the potential for global research efforts that will further extend the geographic reach of acupuncture and Chinese medicine, as well as expand its medical applications. Modern applications of acupuncture in diverse areas such as macular degeneration, trigger point therapy acupuncture, and sports-medicine serve as examples of only a few of the potentially-unlimited areas in which acupuncture has been found to be a useful in various countries and cultures throughout the world. Through continued individual discoveries and international collaborations, future breakthroughs will reveal the full potential this medicine has to offer as acupuncture becomes a global medicine.
References
- National Institutes of Health, Acupuncture, Consensus Development Conference Statement, November 3-5, 1997. [url=http://consensus.nih.gov/1997/1997Acupuncture107html.htm]http://consensus.nih.gov/1997/1997Acupuncture107html.htm[/url].
- Cardini F, Weixin H. Moxibustion for correction of breech presentation: a randomized controlled trial. JAMA. 1998 Nov 11;280(18):1580-4.
- Bensoussan A, Talley NJ, Hing M, Menzies R, Guo A, Ngu M. Treatment of irritable bowel syndrome with Chinese herbal medicine: a randomized controlled trial. JAMA. 1998 Nov 11;280(18):1585-9.
- Shlay JC, Chaloner K, Max MB, Flaws B, Reichelderfer P, Wentworth D, Hillman S, Brizz B, Cohn DL. Acupuncture and amitriptyline for pain due to HIV-related peripheral neuropathy: a randomized controlled trial. Terry Beirn Community Programs for Clinical Research on AIDS. JAMA. 1998 Nov 11;280(18):1590-5.
- Paulus WE, Zhang M, Strehler E, El-Danasouri I, Sterzik K. Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy. Fertil Steril. 2002 Apr;77(4):721-4.
