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Acupuncture. A rough outline. My background. GP; since 1990 BMAS; British Medical Acupuncture Society ( founded 1980); foundation course 1999 Intermediate study days. Used acupuncture since; few basic conditions, predominantly pain control. Origins of acupuncture. Chinese medicine>2000yrs

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A rough outline

My background
My background

GP; since 1990

BMAS; British Medical Acupuncture Society ( founded 1980); foundation course 1999

Intermediate study days.

Used acupuncture since; few basic conditions, predominantly pain control.

Origins of acupuncture
Origins of acupuncture

  • Chinese medicine>2000yrs

  • Yellow Emperor’s Classic Internal Medicine; 260BC

  • Confusianist beliefs; “pulse”diagnosis

  • Earliest instruments; sharp stones, flints; later wood, bamboo, silver, gold, copper

Yellow emperor
Yellow emperor

Theories of chinese medicine, including acupuncture, and the importance of the balance of life forces

Tcm terms
TCM terms

  • Meridian/channel

  • Qi ( der chi)

  • Cun; chinese inch; still used as unit of measurement

Use in modern medicine
Use in modern medicine

  • Some evidence base developing

  • BMAS; quarterly journal

  • Difficulties in performing trials; effects of “sham” acupunctre.

  • Effects of acupuncture better compared to “usual” treatment or no treatment?

  • Still a subject of great debate

Western medical approach
Western medical approach

  • Much research into physiology of how acupuncture works

  • Gate theory of pain;mediated via dorsal columns, ascending influences on CNS

  • Release endorphins

  • Changes in connective tissues

Mode of action
Mode of action?

  • Peripheral nerve stimulation is integral part of mechanism

  • Increased concentrations neurotransmitters and endorphins measured experimentally

  • Stimulation A delta fibres; inhibition non myelinated C fibres; ascending connections spinothalamic tract, limbic system.

  • Connective tissue effects; fibroblast stimulation.

Nice guidance non specific low back pain 2009
Nice guidance “non specific” low back pain, 2009

  • Mentions acupuncture as a cost effective treatment option

  • ( but guidance heavily criticised by pain specialists; injection treatments not recommended)

Robust clinical evidence
Robust clinical evidence

  • Tension headache/migraine

  • Pain of osteoarthritis

  • Chronic low back pain.

  • Nausea and vomiting

Treatment of nausea and vomiting
Treatment of nausea and vomiting

  • Cochrane review 2009; use of acupuncture at PC6 confirmed to be of benefit.

  • May also be used in palliative care, post operative sickness

Points selection
Points selection

  • Traditional acupuncture points

  • Selection segmental points

  • Use of trigger points

Modes of treatment
Modes of treatment

  • Brief “in and out” needling; often quite superficial

  • Use of single needle into trigger point

  • Use of stimulation; manual/electrical

  • Auricular acupuncture ( Nogier); used in addiction setting

  • Indwelling “press” needles

  • Moxa ; Artemis vulgaris. Adds heat

Gp acupuncture pragmatic approach
GP acupuncture;pragmatic approach


  • SAFE

  • CHEAP?


  • 10 minute treatment, 5-6 needles, no stimulation usually. Up to 6 sessions

  • Use of Visual Analogue Score

Audit 12 months
Audit; 12 months

  • I have treated 16 patients, total of 57 treatments 9(range 2-7); all in 12.5 minute appointments

  • Headaches; 1

  • Hyperemesis; 5

  • Neck and shoulder pain; 8

  • Back pain, sciatica; 2

Are there any risks
Are there any risks?

  • Infection; very low; no need for disinfection skin( review; one case in 66,000)

  • Certain points; pneumothorax

  • Care in immunosuppressed/anticoagulants

  • Minor bleeding/bruising common

  • Care with underlying structures; eg median nerve at PC6.

The acupuncture response
The acupuncture response

  • First treatment can make it worse or have no effect

  • It is estimated that 80% will have a response

  • Some are “strong reactors”; start gently

  • Effect tends to be cumulative and after eg 5-6 sessions benefit can be maintained for months

  • Beware endorphin effects; warn patients


  • The British Medical Acupuncture Society is a registered charity established to encourage the use and scientific understanding of acupuncture within medicine for the public benefit.

  • Members are regulated healthcare professionals who practice acupuncture within the scope of their professional practice.

Foundation course
Foundation course

  • Over 2 weekends, cost £580. 24 hours.

  • Teaching approx 33 points which enable treatment of wide variety of conditions.

  • COBC; certificate of basic competence; or Diploma.

Practical demonstration
Practical demonstration

Any volunteers?