Acupuncture is the strategic insertion of fine needles into points on the body's surface for the purpose of stimulating healing.

An estimated 20,000 nationally certified acupuncturists are practicing in the United States. Although acupuncture is practiced throughout Asia, Europe and the United States, its history begins in China where it first developed thousands of years ago. The first known recorded reference of acupuncture is found in the ancient Chinese text entitled "Huang Di Nei Jing Su Wen", also known as the "Yellow Emperor's Classic of Internal Medicine Book of Common Questions". Studies of dated printings of the "Huang Di Nei Jing Su Wen" and its companion text the "Ling Shu" suggest that acupuncture descends directly from bloodletting, a therapy used in every traditional medical system, including Early Western medicine.

Unedited texts recovered in 1975 in a Western Han dynasty tomb, sealed in 165 BC and presumably written around 200-220 BC, contain the earliest detailed picture of the vascular system found in Chinese literature. Channels, vessels, or meridians were seen as organic structures filled with blood and Qi. Diseases were identified with particular channels whose path or course coincided with presenting pain or disturbance. Removing blood from the channel also removed the actual pathogenic, or disease-causing, factor or substances occupying adjacent tissue directly associated with the disease-causing factor.

While the Han texts indicate a vessel system of circulating blood and Qi, therapies applied to vital points included bloodletting, cauterization, moxibustion and the application of herbal poultices, or heated paste. Sometime after 165 BC, it was discovered that Qi could be affected when a point on the body was punctured without producing blood. At this point, acupuncture developed into a distinct branch of Chinese medicine.

The first needles used to administer therapeutic effects were made of stone, as opposed to the stainless steel needles used today, and shaped like a tongue depressor. The sharpened stone was used to treat conditions affecting the skin, such as boils, abscesses and cysts, to let blood locally or distally. Other materials used in the early days of acupuncture include bone, silver, gold and bamboo shards.

In the sixth century, acupuncture was introduced to Korea and Japan where it became an integral part of each country's health care system. From there, it made its way south to India and to Southeast Asian countries such as Vietnam. By positively affecting the health of many people across Asia, especially those of royal ancestry and high political standing, acupuncture successfully impacted the entire continent and in the 16th century, was introduced to Europe. Though acupuncture has been used in immigrant Asian communities throughout the US, it has been regulated as a profession only in the last 30 years.

The basis of acupuncture is expressed in the aphorism: 'Bu tong ze tong, tong ze bu tong' which means 'free flow: no pain, no free flow: pain.'

In other words, any kind of pain represents an obstruction in the normal flow of Qi or life force. Simply put, acupuncture moves Qi, restoring free flow. Acupuncture point selection is based on information gathered from the four exams: looking, listening, asking and palpating.After applying needles and or techniques like Gua Sha, Tui Na, Plum Blossom, Cupping or Moxibustion, an area of the body may be palpated again, asking and feeling if its temperature, texture, tightness or tenderness has changed. The practitioner may feel the pulse two or three times to note any changes, or re-examine the Tongue.

Pathology is categorized according to its location and quality. The location can be described according to channel, organ, level, jiao, element of the five phases, or substances (Qi, Blood, Phlegm, Fluid, Food) and whether its nature is fixed or changing in terms of location. Qualities are recognized as wind, heat, cold, damp, dry, full or empty, waxing or waning, yin or yang. Location and quality continually shift. Rather than securing oneself to a firm diagnosis the clinical encounter becomes a circular interactive loop where the next move is guided by the changing terrain. Evaluation becomes treatment and treatment becomes evaluation. Because we are able to understand a phenomenon only by changing it, then more important than the diagnosis itself, is where it yields, and becomes something else. An adept practitioner has a sense of the direction of a disorder by the change in tongue, pulse, stool, urine, menses, sleep, mucous, thirst, sweat, sensation or pain, and even by changes in emotion on the part of patient. Acupuncture point prescriptions are continually modified to fit the changing patient presentation. Shaped by Daoist and Buddhist philosophy, Chinese acupuncture relies on the only constant is change.

Traditional Chinese medicine, including acupuncture, is practiced in every hospital in China, servicing one quarter to one third of the world population. Outside of China, every country and culture using acupuncture has adapted it to unique health needs. Thus there are many approaches that have evolved out of the original 365 'known' points, and five-phase system of correspondences. The following is not an exhaustive list but intended to familiarize the reader with some of these more common treatment approaches. In addition, there are treatment techniques used in acupuncture practice that are culturally and historically related to it.

System of Five Phase Correspondence
This is the well known system that relates organs in coupled pairs to elements of Wood, Fire, Earth, Metal and Water, to seasons of Spring, Summer, Late Summer, Fall and Winter, to climates of Wind, Heat, Dampness, Dryness, and Cold respectively. In addition each element has a related flavor, sound, color, grain, meat, emotion or disposition, pulse location and pattern of imbalance. Depending on the pattern of imbalance a treatment is fashioned that includes selection of points, combination of herbs, and recommendations of food, exercise, behavior and attitude change. The 365 original or common acupuncture points located on the twelve major channels throughout the body are historically connected in the Five Phase System of Correspondence. The Five-Phase System is a functioning blueprint connecting the movement of life force in the body with its environment, history, and destiny, and is probably the original ecologically holistic method. Variations in approaches often use some aspects of the system of correspondence.

Zang Fu Patterns of Disharmony
Zang Fu patterns of disharmony are recognized archetypal pathologies. The Zang Fu (meaning solid/hollow, or internal/external) are organs though not anatomical masses as one would think of Western organs. While they have location as part of their nature, the zang fu are functional activities and relationships of the body. Acupuncture points are selected based on these named patterns and are needled with the intention to harmonize, tonify, disperse, or sedate depending on the nature of the pattern. When the Spleen is deficient, with accumulation of Dampness, points would be chosen that resolve damp and tonify the Spleen. In addition, the technique of needling might augment the desired effect. Herbal medicine prescribing is often based on Zang Fu patterns of disharmony and is the main practice sanctioned by the Peoples Republic of China, referred to as Traditional Chinese Medicine, or TCM.

Classical Chinese Medicine
Classical Chinese medicine refers to a genre of practice that preceded the revolution in China and the state sanctioned Traditional Chinese Medicine (TCM). Classical practice was based more on local culture and custom and varied by region. Where Classical practice might have included many techniques and approaches from acupuncture to herbs to Daoism and Qi Gong, the TCM system focused on herbal medicine with a Western scientific aspiration. The original texts translated from Chinese to English were based on the PRC TCM system. However in years since these original texts, the syncretistic practice of Classical Chinese Medicine has begun to flourish in the West. Therapeutically, choice of acupuncture points in the Classical system can range from a point prescription known to be excellent for a particular disorder, to individualization of treatment based only on palpation. Typically, some combination of methods is used to determine points to be needled, including 5 phase, zang fu, and palpatory skills combined with an evaluation involving history, signs, tongue and pulse.

Japanese Acupuncture and Hara Diagnosis
Japanese acupuncture differs from Chinese acupuncture in that it involves a more sophisticated practice of touch and palpation, along with lighter and shallower techniques of needling. In particular, Hara palpation was advanced in Japan. The Hara, or abdomen, is palpated revealing particular patterns of constriction or flaccidity. Release or balance is discoverable by palpation of points distal to the abdomen. Needling these distal points, along with local points, releases deep patterns of tension facilitating the healing of internal organ illness and disease.

Auricular Acupuncture
Auricular acupuncture is a Western development with its foundation in Chinese medicine. The ear was discovered to be a homunculus (small person), that is, points in the ear are associated with parts of the body that when charted actually looks like an inverted fetus. Needles can be placed in the ear alone to achieve a therapeutic effect anywhere in the body, or can be used in conjunction with other body acupuncture points.

Conditions affecting the body can be detected through the ear by visual or manual examination - evidence of irritation such as skin discoloration and tenderness can pinpoint the root location of a condition. Ear acupuncture is an effective and popular technique for addictive illness and withdrawal from addictive substances. There are many treatment clinics in the US that use ear acupuncture as a form of drug free withdrawal therapy.

Electro Acupuncture
Acupuncture points have demonstrated increased electrical conductivity and decreased electrical resistance. Needling, or even touching known points, produces a small electrical effect known as piezo, within the body's connective tissue. Some practitioners seek to augment the strength of needling by applying a weak current of electricity to the needles. The strength of the electric current varies depending on the desired result of the procedure. This method is used, along with moderate doses of pain medication, as a form of anesthesia for surgery.

Scalp Acupuncture
Scalp acupuncture was developed in modern China. Like auricular acupuncture, scalp acupuncture is a micro system that uses a part of the body and recognizes in it a map of the whole. In scalp acupuncture needles are inserted just under and along the surface of the scalp over areas of the brain that are known to regulate aspects of the body's function. This system can be used when areas of the body cannot be accessed directly, or when treating disorders involving the brain or central nervous system, as in forms of palsy and paralysis.

Korean Hand Acupuncture
Acupuncture practice in Korea has been influenced by its unique history and culture. Korean hand acupuncture is one technique that has become well known in the West. The hand, like the scalp and ear, represents a condensed version of the body. The areas on the hand that correspond to a disturbed part of the body will be exquisitely tender, or be a different color than the surrounding hand tissue. Very small needles are inserted directly into these areas and retained from 10 minutes to hours, depending on the condition and the patient. These areas also respond to touch and other forms of stimulation, like body acupuncture points.

American Acupuncture
Acupuncture practice in the West, particularly in the US, resembles the syncretism of early Classical Chinese practice. While US schools have been heavily influenced by the Peoples Republic sanctioned TCM, there has been in the last 10 years access to acupuncture methods as taught and practiced in other countries. US practitioners, more than any others in history, have the opportunity to choose and blend styles of practice. This has resulted in more emphasis on palpation and individualization of treatments, strengthening acupuncture as a practice distinct from herbal medicine.

The cultural construct of East Asian medicine holds that the human body is a part of nature. Body Qi resonates with the Qi of the natural world, as stated in the aphorism: 'If there is free flow, there is no pain; if there is pain, there is no free flow'. Observing when water flows in a stream, life abounds in and around it. If the stream is blocked, areas below the blockage are deprived, and areas above the blockage collect excess water, which stagnates and rots.

The body is seen as having channels or meridians of streaming Qi, Blood, and Fluid. If moving freely, life is fostered and health is maintained. If obstructed, there is pain, congestion and eventually illness. Acupuncture moves Qi, Blood and Fluids, it supplies where there is deficiency, drains where there is excess, and moves through where there is obstruction.

The modern biomedical construct of Western research has confirmed that acupuncture causes neural and extra neural biomechanical and biochemical changes. We have known for some time that acupuncture stimulates the brain's release of endorphins, but that the endorphin release alone cannot account for all of acupuncture's therapeutic effect. Reflex stimulation accounts for the sympatholytic effect that spreads throughout a body segment releasing vasoconstriction that is caused by muscle shortening common to pain and spasm. When the muscle releases, the pain and spasm resolve.

Extra neural changes are responses outside of the nervous system. When a needle is inserted into a point it penetrates into the connective tissue, causing a tiny wound, discharging injury potential. Platelet derived growth factor (PDGF) is delivered to the injured site which in turn induces DNA synthesis and stimulates collagen formation in the connective tissue. The effects of this stimulation last several days until the tiny wounds heal. Since connective tissue is a contiguous fabric wrapping the entire body, as well as every organ, muscle, vessel, nerve, down to every single cell, it is theorized that the channel system for the streaming of Qi lies in the connective tissue.

Within this connective tissue there is also a measurable electrical phenomenon called 'piezo electric effect'. Acupuncture points are known to have increased electrical conductivity and decreased electrical resistance. They act as little gates or doors where stimulation, even touch, enters deep into the body.