The Definitive Guide To Acupuncture
As a therapy to promote healing and treat a growing number of conditions, acupuncture is earning growing respect from the traditional medical community. Millions of Australians are using acupuncture for treating a variety of health problems.
About this guide
Have a question about acupuncture? You’ll likely find the answer here. This guide is designed to provide a complete overview of acupuncture therapy, including:
What acupuncture is
The history of acupuncture
The philosophy of acupuncture
About clinical research studies on acupuncture
What health conditions acupuncture is recommended for
What to expect from your acupuncture session
How to choose an acupuncturist
Table of contents
What is acupuncture?
Learn what acupuncture is, the history of acupuncture and the philosophy behind it.
- How does acupuncture work?
From the clinical research on acupuncture to how acupuncture is performed and what acupuncture can help with, this chapter outlines the practical aspects of acupuncture therapy.
- What do I need to know before my acupuncture therapy?
Find out how to choose the right acupuncturist for you, what to expect from your acupuncture session, and helpful questions to ask your acupuncturist.
What is acupuncture?
Acupuncture, a medical practice based on Traditional Chinese Medicine, is carried out by an Acupuncturist who inserts thin, solid and flexible stainless steel needles into the body to help relieve a variety of symptoms and to provide pain relief. Acupuncture treatments involve stimulating specific lines, acupuncture points or neural zones on or under the skin’s surface.
History of acupuncture
Acupuncture has ancient roots. The theory and practice of acupuncture originated in the area that now occupies much of modern-day China. It has been an integral part of the medical practice of Traditional Chinese Medicine for more than 2,500 years. It actually may have been practised in Eurasia as early as the Stone Age, as archaeologists have unearthed early acupuncture needles made of stone and animal bone, which date back to the Stone Age.
The first written description of diagnosis and treatment using acupuncture needles appears in The Yellow Emperor's Classic of Internal Medicine, written around 300 BC in China. The Chinese developed the practice, creating needles with bamboo, and metals like copper, silver, iron, bronze, or gold. There is some suggestion that the hypodermic needle so often used in Western medical practice was inspired from these early acupuncture needles.
Contemporary acupuncture uses needles made of stainless steel, silver and gold which are considerably thinner (ranging from 0.12 to .3mm) and more flexible than their predecessors.
When discussing acupuncture, it may be helpful to understand the philosophy that acupuncture practice arises from.
According to Traditional Chinese Medicine, one of the body’s life forces, the energy that generally describes the function (rather than substance), is termed Qi (pronounced chee). It is understood to flow along 12 to 14 pathways called meridians, between and through the surface of the body (skin, fascia, muscle, bone) and its internal organs. An imbalance or disruption to this flow of energy can trigger illness.
It is important to understand that much of the language that is used by Acupuncturists and Chinese medicine practitioners to describe Eastern philosophy and medical knowledge is like using Shakespearean language today to describe modern medical terms. There is a lot in translation.
Traditional Chinese medicine theory claims that the human body has between 365 to 2,000 nerve-rich acupuncture points that together create pathways (meridians) of microcirculation and physiological action. Stimulating these acupuncture points, zones and meridians is considered to release blockages and restore the body’s own balance. It is also a way of engaging the somatosensory system. Acupuncture is often used to encourage blood circulation to an area and reduce pain.
How does acupuncture work?
The science behind acupuncture
There may not be one process that describes how acupuncture works scientifically. The body is comprised of multiple systems and therefore there may be more than one process engaged when acupuncture is given.
Numerous research studies suggest that acupuncture (and moxibustion) may activate neurohormonal pathways and trigger biochemical processes in the body. Within this view, ‘findings from basic medical research suggest that acupuncture stimulation causes release of endorphins, serotonin, enkephalins, and γ-aminobutyric acid (GABA, a major inhibitory neurotransmitter of the brain), norepinephrine, and dopamine’ (Lu & Lu, 2013).
The acupuncture needles seem to work by stimulating the specific nerve and biochemical processes that activate the sympathetic nervous system and the parasympathetic nervous system. For example, endorphins and Beta-Endorphins work by binding to opioid receptors in your brain to block the perception of pain, similar to opioid pain medications such as oxycodone or morphine.
In other recent studies, acupuncture decreases pain by reducing pro inflammatory markers or proteins in the body. For example, a study by Lim et al. (2016) suggests that acupuncture can decrease pro inflammatory markers — including TNF and IL-1β — in the body, in turn lowering inflammation and reducing pain.
Another study from Zhao et al. (2015) suggests something similar in the imbalance between Th17 and Treg cells in the disruption of intestinal homeostasis in Crohn’s Disease. This study demonstrates that acupuncture and moxibustion ‘reduced the number of TH17 cells and inhibited the expression of TH17-related molecules IL-17 and RORγt in the intestinal mucosa. It also increased the number of Treg cells and the expression of Treg-specific transcription factor FOXP3, thus restoring the ratio of the two cell types.’
How is acupuncture performed?
Under Australian law, acupuncturists must use pre-sterilised, single-use needles. These needles are crafted of solid, flexible stainless steel and are extremely fine, as thin as a strand of hair (around 0.2 mm wide), and not designed to penetrate arteries or veins. Once inserted into skin, fascia and muscle tissue, they may be stimulated through gentle or specific movements by the acupuncturist, sometimes with the help of an electronic pulse device (electroacupuncture).
Typically, acupuncture needles stay in place for 25 to 40 minutes, shorter time frames for weakened or overly sensitive people, longer for chronic conditions and non-retained needling is usually done with children.
An acupuncturist may combine acupuncture with additional treatments used by Traditional Chinese Medicine. These include:
- Moxibustion - A form of heat therapy, moxa is mugwort, a dried and processed herb that can be applied indirectly or directly. Indirect ways include a bundle or a single stick of moxa burned near the surface of the skin, or the acupuncturist might use a small ball of moxa placed atop a needle. Direct forms use a much higher quality of moxa than that used for indirect applications and are applied with a range of techniques. Direct moxa techniques require further training and a clear rationale for its use. Moxibustion is used to promote the circulation of blood to the acupuncture points, muscle and nerve zones as well as areas of chronic pain or muscle tension.
- Cupping therapy - A technique that in ancient times used cups made of porcelain or bamboo. Today in the modern clinic cups are made from sterilisable glass. They can be applied with a hand pump or a small flame to produce suction. The suction and vacuum pressure provided by cupping can encourage blood flow to the acupuncture points, loosen muscles and sedate the nervous system. It is only ever applied to healthy tissue and relatively strong bodies. Cupping can produce markings on the skin, this is a normal response and generally clears after a few days. Sometimes a practitioner will provide plastic or silicone cups for patients to use at home.
- Tui na (Chinese remedial massage) - Through a combination of massage and acupressure, this Chinese style of remedial massage applies pressure to acupuncture points, and muscle zones to stimulate localised and systemic blood circulation and the nervous system to reduce pain.
- Guasha (Spoon therapy) - Pronounced (gu-wa-sha), this is a fractioning technique applied to the surface of the body that aims to release fascial restriction of the muscles. It is believed to have an adaptogenic effect and can be helpful for long-standing pain and restriction. Traditionally, it has been used in many cultures throughout the world and has been known to be applied using a ceramic spoon, a coin, a well-shaped bone or stone implement. It also produces a marking on the skin, which clears within a few days.
What can acupuncture help with?
What are the benefits of acupuncture? According to an evidence-based review of clinical literature, acupuncture can assist in treating a wide number of physical, neurological, mental and emotional ailments. The ailments that have been backed up by both clinical experience and research include:
- Chronic pain - The efficacy of acupuncture for chronic pain is well-proven. Acupuncture is shown to have a clinically relevant effect on chronic pain that persists over time, including chronic lower back pain, neck pain, shoulder pain and knee osteoarthritis pain.
- Acute pain - Research shows that acupuncture can provide an immediate analgesic effect for acute pain conditions, such as tendinitis, frozen shoulder (adhesive capsulitis), tennis elbow (lateral epicondylitis), sciatica, acute lower back pain, and postoperative pain.
- Allergic rhinitis, acute sinusitis and the common cold - Acupuncture is a safe and effective treatment for patients with allergic rhinitis, acute sinusitis and common cold, reducing nasal and eye symptoms such as itching, sneezing and blocked or runny nose.
- Dental pain - Acupuncture can help with alleviating dental pain, including toothaches, post-extraction pain, temporomandibular joint (TMJ) pain, TMJ clicking and locking, chronic muscle pain or spasms, or nerve pain.
- Tension headaches - Acupuncture has been proven to help alleviate tension headaches, including chronic tension-type and chronic episodic headaches and migraine prophylaxis.
- Anxiety and depression - Numerous studies show that acupuncture can decrease anxiety and enhance the effectiveness of certain antidepressants, helping selective serotonin reuptake inhibitor (SSRIs) treatment work faster to increase serotonin levels. Acupuncture can also reduce the side effects of antidepressants.
- Menstrual irregularities (dysmenorrhea) - Some studies show that acupuncture may be useful in treating menstrual pain and irregularities.
- Infertility - Acupuncture is proven to help support successful conception in women undertaking in vitro fertilisation (IVF), ease stress, anxiety and depression in infertile couples, and reduce depression symptoms in women struggling with infertility.
- Pregnancy & Labour - Acupuncture can help ease morning sickness in pregnant women, as alleviate back or pelvic pain during pregnancy. The use of acupressure, when combined with prenatal interventions, were shown to significantly assist better labour outcomes for women.
- Nausea and vomiting - Acupuncture can lessen nausea and vomiting after chemotherapy treatments and post-operation.
- Weight loss - While there is no magic acupuncture point or treatment to help weight loss, acupuncture can help support the journey toward weight loss through relief from stress or depression, by curbing appetite, improving digestion and boosting metabolism.
- Insomnia - Many studies have demonstrated acupuncture to be an effective treatment for insomnia. Acupuncture can help stimulate melatonin production, induce sleep onset, and reduce sleep disruption and arousal during the night.
- Stroke rehabilitation - A number of recent studies have demonstrated that positive clinical outcomes for the treatment of stroke (rehabilitation) were consistent across multiple scalp acupuncture studies and that acupuncture increases brain activity in stroke victims. Using MRI technology, researchers have documented that acupuncture increased brain activity and functionality and that sham acupuncture and a blank control group did not.
What do I need to know before my acupuncture therapy?
How to choose an acupuncturist
Choosing an acupuncturist can be perplexing, especially if you have never received acupuncture treatment before.
Here are some guidelines to follow:
- Qualifications: Ensure you select a qualified, nationally accredited acupuncturist with formal qualifications. By law, all practising acupuncturists in Australia must be nationally accredited and carry malpractice insurance.
- Current knowledge: Check whether your acupuncturist is well-versed in current research. Make sure your chosen acupuncturist is up-to-date on the latest techniques and practices.
- Expertise relevant to your condition: While an acupuncturist will likely be able to treat most complaints, most acupuncturists have areas where they excel. Ideally, try to find an acupuncturist whose expertise aligns with your specific needs.
- Cleanliness: Ensure your acupuncturists’ treatment room is clean and healthy. Confirm that your acupuncturist uses sealed, single-use needles for their practice. This is a legal requirement in Australia.
Questions to ask your acupuncturist
Once you’ve found a potential acupuncturist, it’s worthwhile to ask them the following questions to ensure they are credible and a good fit for you.
- Are you currently registered in Australia to practice acupuncture?
- What is your training? How long did you study for?
- How many times have you treated this particular condition?
- What is your area of expertise?
- Besides acupuncture, what other modalities or therapies do you use in cases such as mine?
Should I tell my doctor?
Yes. Acupuncture works well in conjunction with many other therapies and complements Western medicine. However, it is possible that a course of acupuncture may reduce your need for some medications. Therefore, it is essential that your GP is aware that you are receiving acupuncture treatments.
Most medical doctors are supportive of acupuncture treatment and it is better for you if all your healthcare practitioners can work together.
What can I expect from my first acupuncture appointment?
Expect an in-depth interview process as your acupuncturist seeks to understand your health condition, including questions you may have never been asked before. Your acupuncturist will usually take an extensive case history, covering many aspects of your health, diet and lifestyle before making a diagnosis.
Although every acupuncturist has a slightly different interviewing process based on their training and personality, there are standard questions that every acupuncturist will ask.
Depending on what you are seeking treatment for, acupuncturists may sometimes ask you questions that appear irrelevant, such as questions about your sleeping quality, digestive and urinary function, sexual function, emotional quality or basic level of stress. Why? Acupuncture takes a holistic approach to health. The different systems in the body are interconnected, but acupuncture has a unique way of viewing those connections. As a result, many conditions that manifest in a specific way (such as skin or neural conditions) may, for example, stem from digestive and intestinal problems.
Answering your acupuncturist’s questions honestly will increase the accuracy of diagnosis and help your acupuncturist to understand how best to treat your condition.
Should I tell the acupuncturist of any medications I am taking?
Yes! When taking your medical history, your acupuncturist will ask you about any medications you are taking. Your acupuncturist needs to have a complete picture of what is influencing your body and symptoms, as well as any side effects or cautions that might need to be considered.
Often pulse taking is used as a diagnostic tool by your acupuncturist and some medications will affect the reading of the pulse.
How does acupuncture feel?
Acupuncture is sought by many to provide relief from pain, not create it. Most new patients are surprised at how painless acupuncture is. When the needles are inserted, you may feel nothing at all or you may feel a mild tingling, warmth, soreness, numbness or heaviness similar to a muscle ache. Depending on what you are seeking treatment for, sometimes acupuncture can be uncomfortable, as pain and stress tend to sensitise us to more pain, but the pain of treatment will never be greater than the pain you are currently experiencing with your symptoms.
A practitioner’s technique is also a factor in your experience of a painless acupuncture treatment, so choose someone who knows what they are doing.
How will I feel after an acupuncture session?
Depending on the type of treatment you receive, you may feel very relaxed and calm or you may feel more clear-headed. Some people feel revitalised, while others feel sleepy. You may also find you experience improvements in your quality of sleep, your moods, reduced stress, improved digestion, mental clarity, and increased energy.
What are the risks of acupuncture?
Adverse side effects of acupuncture in the hands of a properly trained practitioner are extremely rare and often less severe than conventional drug treatments. These may include fatigue, feeling light-headed, soreness at the insertion site, bruising, and emotional release (sensitivity and weepiness).
Soreness will typically dissipate within 24 hours. However, more intensive treatments can cause soreness that may last a few days. Most acupuncturists will warn you if this is a risk before starting the treatment.
How many acupuncture sessions will I need?
This is impossible to know for certain as everyone heals at a different rate. Most people start feeling better right away with just one or a few sessions, but others take time. Typically, more chronic conditions require a more extensive course of treatment.
It is also possible, though generally unlikely, that acupuncture can stimulate or worsen current symptoms or reactivate past symptoms. Each person is unique, and each body contains a unique history of ailments and abilities. It’s important to honestly discuss any symptoms, side effects, or concerns you may have with your acupuncturist.
Chan, Y.Y., Lo, W.Y., Yang, S.N., Chen, Y.H., & Lin, J. G. (2015). The benefit of combined acupuncture and antidepressant medication for depression: A systematic review and meta-analysis. Journal of Affective Disorders, 1(176):106-17. doi: 10.1016/j.jad.2015.01.048
- Chen, L. & Sun, Z. (2014). Research on Treating Stroke by Head Acupuncture Therapy. Clinical Journal of Chinese Medicine 6(1).
- Chinese Medicine Traveller. Acupuncture Anti-Inflammatory Crohn’s Disease.
- Curran, J. (2008). The Yellow Emperor’s Classic of Internal Medicine. BMJ, 336(7647): 777.
- Hua, A. (2010). Treatment of 85 Cases with Chronic Rhinitis by Acupuncture. Journal of Acupuncture and Tuina Science, 8(5): 318.
- Huijuan, C., Xingfang, P, Hua, L. & Jianping, L. (2009). Acupuncture for Treatment of Insomnia: A Systematic Review of Randomized Controlled Trials. Journal of Alternative and Complementary Medicine, 15(11): 1171–1186.
- Levett, K.M., Smith, C.A., Bensoussan, A., & Dahlen, H.G. (Complementary therapies for labour and birth study: a randomised controlled trial of antenatal integrative medicine for pain management in labour. BMJ Open, 6(11).
- Lim, H.D., Kim, M.H., Lee, C.Y. & Namgung, U. (2016). Anti-Inflammatory Effects of Acupuncture Stimulation via the Vagus Nerve. PloS one, 11, 3:4-5. ncbi.nlm.nih.gov/pubmed/26991319
- Linde, K., Allais, G., Brinkhaus, B., Fei, Y., Mehring, M., Shin, B., Vickers, A., & White, A.R. (2016). Acupuncture for tension-type headache. Cochrane Database System Review, 21(1). doi: 10.1002/14651858.CD007587
- Liu, H., Shen, X., Tang, H., Li, J. Ting, X., & Yu, W. (2013). Using MicroPET Imaging in Quantitative Verification of the Acupuncture Effect in Ischemia Stroke Treatment. Scientific Reports, 3(1070).
- Lu, D.P. & Lu, G.P. (2013). A Historical Review and Perspective on the Impact of Acupuncture on U.S. Medicine and Society. Medical Acupuncture, 25(5): 311–316.
- Lu, G. & Needham J. (25 October 2002). Celestial Lancets: A History and Rationale of Acupuncture and Moxa. ISBN 978-0700714582.
- Lu, L., Zheng, H., Zheng, Q., Hao, X., Zhou, S., Zhang, S. Wei, T., Gao, T., Duoxi, D., Zhao, L., Ning, L., & Ying, L. (2017). The long-term effect of acupuncture for patients with chronic tension-type headache: study protocol for a randomized controlled trial. Trials, 18(453).
- MacPherson, H., Vertosick, E. A., Foster, N. E., Lewith, G., Linde, K., Sherman, K. J., et al. (2016). The persistence of the effects of acupuncture after a course of treatment. Pain, 1–22. https://doi.org/10.1097/j.pain.0000000000000747
- McDonald, J. & Janz, S. (2017). The Acupuncture Evidence Project: A Comparative Literature Review. Australian Acupuncture and Chinese Medicine Association Ltd.
- McDonald, J.L., Smith, P. K., Smith, C.A., Xue, C.C., Golianu, B. & Cripps, A.W. (2016). Effect of acupuncture on house dust mite specific IgE, substance P, and symptoms in persistent allergic rhinitis. Annals of Allergy, Asthma & Immunology, 116, 6: 497-505.
- Moffet, H.H. (2002). How might acupuncture work? A systematic review of physiologic rationales from clinical trials. BMC Complement Altern Med 6, 25. doi:10.1186/1472-6882-6-25
- Purnachandrarao, N.N., Kiran, R.A., Yalamanchal, S., Kumar, V.A., Suresh, G., & Vashist, N. (2014). Acupuncture: An Alternative Therapy in Dentistry and Its Possible Applications. Medical Acupuncture, 26(6):308–314.
- VanderPloeg, K. & Yi, X. (2009). Acupuncture in Modern Society. Journal of Acupuncture and Meridian Studies, 2(1), 26-33. ISSN 2005-2901, https://doi.org/10.1016/S2005-2901(09)60012-1.
- Vickers, A.J., Vertosick, E.A., Lewith, G., MacPherson, H., Foster, N.E., Sherman, K.J., Irnich, D., Mitt, C.M. & Linde, K. (2017). Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis. The Journal of Pain, 19(5), 455-474.
- Wang, J.Y., & Robertson, J., (2008) Applied Channel Theory in Chinese Medicine Wang Ju-Yi's: Lectures on Channel Therapeutics. Eastland Press.
- Wang, S., Zhang, J. and Qie, L. (2014). Acupuncture Relieves the Excessive Excitation of Hypothalamic-Pituitary-Adrenal Cortex Axis Function and Correlates with the Regulatory Mechanism of GR, CRH, and ACTHR. Evidence-Based Complementary and Alternative Medicine. https://doi.org/10.1155/2014/495379
- Xiang, A., Cheng, K., Shen, X., Ping, X. & Sheng, L. (2017). The Immediate Analgesic Effect of Acupuncture for Pain: A Systematic Review and Meta-Analysis. Evidence Based Complementary Medicine, doi: 10.1155/2017/3837194
- Yin, C., Buchheit, T. E., & Park, J. J. (2017). Acupuncture for chronic pain: an update and critical overview. Current Opinion in Anaesthesiology, 1. https://doi.org/10.1097/ACO.0000000000000501
- Zhao, C., Bao, C., L, J., Zhu, Y., Wang, S., Yang, L., Liu, H., Dou, C., Ding, G., Wang, X., & Wu, H. (2015). Moxibustion and Acupuncture Ameliorate Crohn's Disease by Regulating the Balance between Th17 and Treg Cells in the Intestinal Mucosa. Evidence Based Complementary Alternative Medicine, doi: 10.1155/2015/938054
ANTA's Scope and Standards of Practice
To view ANTA's commitment to the delivery of quality health care, public safety and promoting informed choices in Acupuncture read our Scope and Standards of Practice.
Scope and Standards of Practice - Acupuncture
Locate an ANTA accredited Acupuncturist
Click here to find an Acupuncturist in your area!
View ANTA Recognised Courses