534 clinical research studies using acupuncture are described in great depth. Videos include an acupuncture demonstration and a comprehensive lecture by Wei Liu, Doctor of Chinese Medicine. Also included are body charts, a glossary of acupuncture points, over 60 diagrams, tables relating to the study of acupuncture, full-text search, annotations, bookmarking, and more.
There is scientific agreement that an evidence-based medicine (EBM) framework should be used to assess health outcomes and that systematic reviews with strict protocols are essential. Organisations such as the Cochrane Collaboration and Bandolier publish such reviews.
For the following conditions, the Cochrane Collaboration concluded there is insufficient evidence that acupuncture is beneficial, often because of the paucity and poor quality of the research and that further research would be needed to support claims for efficacy:
For headache, Cochrane concluded that "(o)verall, the existing evidence supports the value of acupuncture for the treatment of idiopathic headaches. However, the quality and amount of evidence are not fully convincing. There is an urgent need for well-planned, large-scale studies to assess the effectiveness and cost-effectiveness of acupuncture under real-life conditions.". Bandolier states: "There is no evidence from high quality trials that acupuncture is effective for the treatment of migraine and other forms of headache. The trials showing a significant benefit of acupuncture were of dubious methodological quality. Overall, the trials were of poor methodological quality."
For nausea and vomiting: The Cochrane review on the use of the P6 acupoint for the reduction of post-operative nausea and vomiting concluded that "compared with anti emetic prophylaxis, P6 acupoint stimulation seems to reduce the risk of nausea but not vomiting" . Bandolier said “P6 acupressure in two studies showed 52% of patients with control having a success, compared with 75% with P6 acupressure." and that one in five adults, but not children showed reduction in early postoperative nausea. A review published by the Scientific Review of Alternative Medicine, however, disagreed.
According to Cochrane: "Electroacupuncture is effective for first day vomiting after chemotherapy, but trials considering modern antivomiting drugs are needed.".
Bandolier also stated: "There were no high quality trials of acupuncture for stroke that showed that it was beneficial."
In practice, EBM does not demand that doctors ignore research outside its "top-tier" criteria.
NIH consensus statement
In 1997, the National Institutes of Health (NIH) issued a consensus statement on acupuncture that concluded that
The statement was not a policy statement of the NIH but rather the assessment of a panel whose impartiality has been questioned by members of the The National Council Against Health Fraud (NCAHF).
The NIH consensus statement said that
and added that
The NIH consensus statement summarized and made a prediction:
The NIH's National Center For Complementary And Alternative Medicine continues to abide by the recommendations of the NIH Consensus Statement.
American Medical Association statement
In 1997, the following statement was adopted as policy of the American Medical Association (AMA) after a report on a number of alternative therapies including acupuncture:
A note on scientific methodology and acupuncture
One of the major criticisms of studies which purport to find that acupuncture is anything more than a placebo is that most such studies are not (in the view of critics) properly conducted. Many are not double blinded and are not randomised. However, double-blinding is not a trivial issue in acupuncture: since acupuncture is a procedure and not a pill, it is difficult to design studies in which the person providing treatment is blinded as to the treatment being given. The same problem arises in double-blinding procedures used in biomedicine, including virtually all surgical procedures, dentistry, physical therapy, etc.; the NIH Consensus Statement notes such issues with regard to sham acupuncture, a technique often used in studies purporting to be double-blinded. See also Criticism of evidence-based medicine. Tonelli, a prominent critic of EBM, argues that complementary and alternative medicine (CAM) cannot be EBM-based unless the definition of evidence is changed. Tonelli also says "the methods of developing knowledge within CAM currently have limitations and are subject to bias and varied interpretation. CAM must develop and defend a rational and coherent method for assessing causality and efficacy, though not necessarily one based on the results of controlled clinical trials.".
Safety and risks
Because acupuncture needles penetrate the skin, many forms of acupuncture are invasive procedures, and therefore not without risk. However, injuries are rare among patients treated by trained practitioners. Forms of acupuncture such as the Japanese Tōyōhari and Shōnishin often use non-invasive techniques, in which specially-designed needles are rubbed or pressed against the skin. These methods are common in Japanese pediatric use.
Hematoma may result from accidental puncture of any circulatory structure. Nerve injury can result from the accidental puncture of any nerve. Brain damage or stroke is possible with very deep needling at the base of the skull. Also rare but possible is pneumothorax from deep needling into the lung, and kidney damage from deep needling in the low back. Needling over an occult sternal foramen (an undetectable hole in the breastbone which can occur in up to 10% of people) may result in a potentially fatal haemopericardium.
Certain acupuncture points have been shown to stimulate the production of adrenocorticotropic hormone (ACTH) and oxytocin; these points are contraindicated for use on pregnant women to avoid inducing abortion or harming the fetus.
The Parliamentary Committee on the Health Care Complaints Commission in the Australian state of New South Wales commissioned a report investigating Traditional Chinese medicine practice. They recommended the introduction of a government appointed registration board that would regulate the profession by restricting use of the titles "acupuncturist", "Chinese herbal medicine practitioner" and "Chinese medicine practitioner". The aim of registration is to protect the public from the risks of acupuncture by ensuring a high baseline level of competency and education of registered acupuncturists, enforcing guidelines regarding continuing professional education and investigating complaints of practitioner conduct. The registration board will hold more power than local councils in respect to enforcing compliance with legal requirements and investigating and punishing misconduct. Victoria is the only state of Australia with an operational registration board. Currently acupuncturists in NSW are bound by the guidelines in the Public Health (Skin Penetration) Regulation 2000 which is enforced at local council level. Other states of Australia have their own skin penetration acts. The act describes explicitly that single-use disposable needles should be used wherever possible, and that a needle labelled as "single-use" should be disposed of in a sharps container and never reused. Any other type of needle that penetrates the skin should be appropriately sterilised (by autoclave) before reuse.
The report noted that:
Dr Stephen Li, Senior Vice President of the Australian Chinese Medical Association, in supporting the recommendations of the report, said:
The NIH consensus panel said:
and "the incidence of adverse effects is substantially lower than that of many drugs or other accepted medical procedures used for the same condition. For example, musculoskeletal conditions, such as fibromyalgia, myofascial pain, and tennis elbow... are conditions for which acupuncture may be beneficial. These painful conditions are often treated with, among other things, anti-inflammatory medications (aspirin, ibuprofen, etc.) or with steroid injections. Both medical interventions have a potential for deleterious side effects but are still widely used and are considered acceptable treatments."
Needles that are not properly sterilized can transfer diseases such as HIV and hepatitis. Most acupuncturists in the USA use sterile one-time-use needles (rather than resterilizing needles after use). In 1996, the FDA changed the status of acupuncture needles from Class III to Class II medical devices, meaning that needles are regarded as safe and effective when used appropriately by licensed practitioners.