What Is Acupuncture? Traditional and Contemporary Explanations and What Research Can Establish

What is acupuncture

Acupuncture is a technique in which a practitioner inserts fine needles into the skin to treat health problems. The needles may be moved by hand or stimulated with small electrical currents, which is called electroacupuncture. [1] Methods are compared on acupuncture methods. Acupuncture is a needle procedure, so it is different from acupressure, which uses pressure only: see acupressure.

The U.S. National Center for Complementary and Integrative Health (NCCIH) says acupuncture has been used in some form for at least 2,500 years, originated in traditional Chinese medicine, and has become popular worldwide since the 1970s. The World Health Organization reported it in use in 103 of 129 countries with data, and 2.2 percent of U.S. adults used it in 2022. [1]

Traditional explanation

In traditional Chinese medicine, the rationale for acupuncture rests on ideas of qi, usually translated as vital energy, and meridians, the channels along which qi is said to move. [2] These are traditional frameworks, not anatomical structures that modern science has identified. A review that examined the premises of traditional Chinese medicine notes that this rationale has been debated since its beginning. [2] Traditional practitioners also describe a sensation called deqi, literally "the arrival of vital energy," as a sign that a needle is in the right place. [3] For the wider tradition, see what is traditional Chinese medicine and traditional frameworks vs biomedical explanations.

How researchers propose it might work

How acupuncture works is not fully understood. NCCIH describes evidence for three kinds of effect, which are proposed explanations rather than settled facts: [1]

• Nervous system. Studies in animals and people, including brain imaging studies, suggest acupuncture may affect nervous system function.
• Local tissue. There may be direct effects where the needle goes in, as seen in connective tissue.
• Nonspecific effects. Belief in the treatment, the relationship with the practitioner and other incidental factors can matter.

What research can and cannot establish

Acupuncture is hard to test, because the practitioner knows what they are doing and a convincing "fake" is difficult. In many studies, acupuncture beat no treatment by more than it beat sham (simulated) acupuncture, such as a device that pokes the skin without penetrating. [1]

An analysis of individual data from 39 trials and 20,827 people with chronic pain found acupuncture better than both sham and no acupuncture. The gap was about 0.5 standard deviations against no acupuncture and about 0.2 against sham. The authors concluded the benefit could not be explained by placebo effects alone, and that factors beyond needling at the "correct" points also contribute. [4]

What this means in plain terms:

• Supported by reviews, for some pain conditions (promising but limited): a modest benefit over sham and a larger one over no treatment, as shown in the pain pages linked below.


• Mixed: guidelines disagree. The American College of Physicians includes acupuncture among first choices for chronic low back pain, while England's NICE advises against offering it for low back pain. [5][6]


• Not established: that qi or meridians exist as physical things, or that points chosen by traditional theory work better than other points.

Evidence by use

Details are on back and neck pain, knee osteoarthritis, migraine and headache and nausea and other uses.

Safety in brief

Relatively few complications are reported, but they have happened with nonsterile needles and improper treatment, and can include infections, punctured organs and injury to the central nervous system. [1] An overview of 17 systematic reviews said serious harms are rare but can occur, and advised choosing practitioners with credible training. [7] See side effects and precautions and licensing and training.

Who should check first

Do not use acupuncture to put off seeing a health care provider about a health problem. [1] Tell your clinician if you take blood thinners or have a skin infection or condition in the area to be treated, and say if you might be pregnant. [8][9]