The acupuncture (from latin acus = needle , and punctura < pungere = stinging / sting; chinese 针灸 / 針灸 zhēn jiǔ ) is a treatment method of the traditional Chinese medicine (TCM) at which achieves a therapeutic effect by pinholes at certain points of the body shall be. The traditional form of acupuncture, which has been practiced in China and Japan since the second century before the turn of the times , is based on a "life energy of the body" ( Qi ), which circulates on defined channels or meridians and is supposed to have a controlling influence on all body functions. A disturbed flow of energy is said to cause illnesses and by pricking acupuncture points on the meridians, the disturbance in the flow of Qi should be remedied. Acupressure by exerting blunt pressure and moxibustion by applying heat to acupuncture points have the same therapeutic goal.
The most extensive clinical studies of acupuncture to date have been the GERAC studies . They found a better effect of acupuncture and sham acupuncture for chronic low back pain and chronic knee pain with osteoarthritis of the knee in an open comparison with the guideline-oriented standard therapy. An effect that differentiates acupuncture from sham acupuncture (comparison group) could not be proven. Other studies also show that shama acupuncture ( superficial acupuncture pierced up to a maximum of 3 mm deep and pierced at points in the same area of the body without needle stimulation ) has the same effect as acupuncture performed according to traditional rules. Acupuncture is used to treat many other ailments, but in many cases there is no scientifically recognized evidence of its effectiveness.
At the German Medical Congress in 2003, the additional further training in acupuncture was newly introduced into the (model) further training regulations (MWBO) of the German Medical Association. There were an estimated 96,380 acupuncture users in the EU in 2012, including 80,000 doctors.
The oldest known written mention of acupuncture and moxibustion ( Chinese 針灸zhēn jiǔ - "acupuncture and moxibustion") comes from the second century BC. The Chinese historian Sima Qian first mentioned stone needles in his records. The oldest collection of Chinese medical writings, the Inner Classic of the Yellow Emperor (Huangdi Neijing) from the period between 200 years before and after the turn of the century , provides an overview of the piercing and burning therapies of that time and describes various needles (made of metal) for the first time. , various stitch techniques and gives indications for the use of certain points. A total of 160 points are described.
The first reliably datable work on acupuncture is The Systematic Canon of Stinging and Burning (Zhenjiu jiayijing) by Huangfu Mi (215–282). The author describes 349 acupuncture points in clear terminology and gives systematic information on their effects. Other important writings are the explanations of the 14 main channels by Hua Boren (1341), the investigations of the eight unpaired channels by Li Shizhen (1518–1593), as well as the sum of the Aku-Moxi therapy by Yang Jizhon (1601).
As early as the late 16th and early 17th centuries, Portuguese Jesuits mentioned burning with moxa and needle therapy in letters from Japan. In the 17th and 18th centuries acupuncture was made famous in Europe by two doctors from the Dutch East India Company : Willem ten Rhijne and Engelbert Kaempfer . While moxa is being experimented with as a supposed variant of classic burn therapies, ambiguous formulations by ten Rhijnes and Kaempfers led to the rejection of these forms of therapy by influential scholars such as Lorenz Heister and Georg Ernst Stahl .
The first known acupuncture treatment in Europe was carried out in 1810 by the doctor Louis Berlioz , the father of the composer Hector Berlioz . He reported on it in a price publication published in 1816. From 1819 - mainly around 1825 under Jules Cloquet and Frederik Liubenstein - ending in the 1830s - acupuncture became a frequently used form of therapy in France, even fashion therapy. The French practice was taken up in England in 1821 by the doctor James Morss Churchill. In 1825 Johann Wilhelm von Wiebel accompanied his King Friedrich Wilhelm IV on a state visit to Paris and reported on his impressions from the Parisian acupuncture practice. In the same year, the military doctor and neurologist Jean-Baptiste Sarlandière published a treatise on " electropuncture ", to which he attached two Japanese manuscripts from the estate of Isaac Titsingh . In the USA too, doctors wrote from 1825 onwards about their own experiences with acupuncture based on the French and English models.
The anesthesia carried out in China in the early 1970s as an allegedly alternative method to anesthesia caused a worldwide sensation and heated debates . After the Vietnam War , the US military made inquiries about the benefits of acupuncture anesthesia . In 2012, the US military was funding acupuncture studies.
The majority of the Chinese Medical Association's publications describe scientific medicine rather than traditional methods such as acupuncture.
Suspected mechanisms of action
According to traditional Chinese medicine
- Insertion of needles into the acupuncture points
- Warming the points ( moxibustion )
- Massage of the points ( Tuina , acupressure )
In acupuncture, around 400 acupuncture points are used, which are located on the so-called meridians . To simplify things, the current model of twelve main meridians, each paired in mirror image on both sides of the body, was introduced. Eight extra meridians and a number of so-called extra points complete this model. According to the model of traditional Chinese medicine, the flow of Qi (life energy) is influenced by sticking the needles . The name "Meridian" introduced by George Soulié de Morant is misleading because it is not a question of projection lines. The underlying Chinese term jingluo can be translated as "tracts and canals". According to this understanding, acupuncture belongs to the reversal and regulation therapies .
Since the mechanisms of action assumed by traditional Chinese medicine could not be scientifically proven, these even contradict established knowledge about the function and structure of the human body, and no other mechanism of action can be proven, the placebo effect is often held responsible for the effectiveness . These and similar results from other areas of alternative medicine have led to an intensified discussion about how the effect can also be better exploited in conventional medicine.
According to scientific medicine
From the point of view of some natural scientists , the active principle of acupuncture is based on the stimulation of certain body points, which may influence the regulation of the body. One study measured an increase in endorphins in the cerebrospinal fluid after electrical stimulation of certain acupuncture points . Some scientists assume that the molecule adenosine plays an important role in the action of acupuncture needles. In 2010, neuroscientists reported that in the immediate vicinity of the needle pricks, the adenosine content in the tissue had increased several times. What exactly happens in the body during acupuncture has not yet been clarified. There is no consensus on how acupuncture could work.
From the point of view of other scientists, acupuncture is an expensive placebo. They point out that the result of acupuncture treatment does not depend on where or whether a needle is inserted (sham or dummy acupuncture). Since this is the core component of acupuncture, they conclude that acupuncture does not work. Much of the apparent improvement can be explained by regression towards the center . They also point out that studies on acupuncture include electroacupuncture , which is only transcutaneous electrical nerve stimulation under a different name.
In Japan, practitioners developed a Shōnishin ( 小 児 鍼 , dt. "Infant acupuncture needle") called non-invasive pediatric therapy at the beginning of the 20th century , which was later taken up and further developed by doctors in the West. The concept of ear acupuncture (also called Auriculotherapy) was the French physician Paul Nogier developed. He claimed that on the auricle the entire organism is represented on the smallest area in the form of reactive points with a fixed relationship to body topography and body function ( somatotopia ). In 1954 he reported for the first time in the German Journal for Acupuncture published by the German Society for Acupuncture (founded in 1951 by the doctor Gerhard Bachmann) about his experiences and in 1961 he presented his diagnosis and therapy form at an acupuncture congress in Germany. Treatment via the ear is also known from Chinese acupuncture, but only a few points are used there and these are only rarely used. Other forms of ear acupuncture are implant acupuncture and neuroauriculotherapy (NAT).
Other somatotopias of effective micro-acupuncture systems have been discovered. The concept of the Korean hand acupuncture Su Jok , in which the needles are inserted into the hands, has existed since 1987 . Chinese skull acupuncture was developed by neurosurgeons and is based on neuroanatomy. It is used for the daily care of skull and brain injuries in China. There are also the Yamamoto New Skull Acupuncture ( YNSA ) and foot acupuncture developed by the Japanese doctor Toshikatsu Yamamoto in the 1960s . Oral acupuncture according to Dr. Jochen Gleditsch is based on specific reflex points in the oral mucosa.
Another recent development is the treatment of acupuncture points with a laser with a low power density in the red or infrared range (laser acupuncture, low-level laser therapy ). The Mesotherapy is an injection acupuncture, in which homeopathic be applied or low-dose active ingredients.
Acupressure , in which the points are massaged with the help of the fingertips or with the help of tools, is older than acupuncture , which is why acupressure can also be viewed as a non-invasive form of acupuncture. A relatively new application of acupressure is the acupressure mat , where the user lies down on the mat and the pressure is generated by gravity.
An acupuncture session lasts about 20 to 30 minutes. The patient is positioned calmly and relaxed, typically lying or sitting comfortably. Before a needle is inserted, the area and the immediate area are lightly massaged. As few points as possible are pricked during a session. Some authors give a maximum of 16, but this can be exceeded in individual cases.
Areas of application
An overview of 32 systematic reviews of the Cochrane Collaboration finds a therapeutic effect of acupuncture only in the case of postoperative and chemotherapy-induced occurrence of nausea and vomiting as well as against idiopathic headaches. With these two symptoms, too, reservations are necessary when using acupuncture, as the quality of the primary studies is low, there was no control by sham acupuncture or the type of blinding is unclear.
The World Health Organization (WHO) published a list of indications for acupuncture in 2002 , on which it is classified as an effective treatment for 28 diseases. No cross-assessment was prepared for this publication . The authors were not free from conflicts of interest . The list of indications differs from the results of systematic reviews on acupuncture published in 2006. In retrospect, the lead author (Zhang) said that the list should not be taken as a recommendation. The list was on the WHO information portal until 2014, but has not been listed since then.
The WHO list included the following areas of application:
- Disorders of the respiratory system (such as acute sinusitis )
- Gastrointestinal disorders (such as chronic stomach ulcers )
- sleep disorders
- Bronchial asthma
- Hay fever (seasonal allergic rhinitis)
- Neurological disorders (e.g. after a stroke )
- Eye disorders (such as central retinitis )
- Acupuncture during pregnancy ( antenatal acupuncture )
- Musculoskeletal diseases (such as cervicobrachialgia )
- Diseases of the mouth (such as pain after extractions , gingivitis ).
In 1997, the US National Institutes of Health pointed to promising results that would suggest effectiveness in a number of areas. The same report criticized the often poor quality of many studies. The report was drawn up in a committee dominated by alternative medicine practitioners.
Studies by the Cochrane Collaboration or other meta-studies have shown that there is no good evidence of benefit for the following conditions:
- Obesity ,
- acute stroke,
- Alcohol addiction ,
- Allergy ,
- Alzheimer's disease ,
- Angina pectoris ,
- Asthma ,
- Attention deficit / hyperactivity disorder ,
- Autism ,
- Bell's palsy ,
- chronic constipation ,
- Chronic obstructive pulmonary disease ,
- Depression ,
- diabetic neuropathy ,
- Drug addiction ,
- Dysphagia after stroke ,
- Endometriosis ,
- Enuresis ,
- Epilepsy ,
- Erectile dysfunction ,
- Essential hypertension ,
- Excessive crying in infancy ,
- Birth pains ,
- Labor induction ,
- Glaucoma ,
- gynecological diseases (with the possible exception of fertility and nausea / vomiting),
- Cardiac arrhythmia ,
- Hot flashes ,
- Hordeolum ,
- hypoxic ischemic encephalopathy in newborns,
- Intracerebral hemorrhage ,
- In vitro fertilization (IVF),
- Carpal tunnel syndrome ,
- Ankle sprain,
- Cocaine addiction ,
- Craniomandibular dysfunction ,
- Myopia ,
- Lumbar spinal stenosis ,
- Menstrual cramps ,
- Mumps in children,
- Dry mouth .
- Musculoskeletal disorders of the limbs,
- Neuropathic pain ,
- Opioid addiction,
- Parkinson's disease ,
- Polycystic ovary syndrome ,
- Post-traumatic stress disorder ,
- Premenstrual syndrome ,
- Preoperative anxiety,
- Smoking cessation ,
- Irritable bowel syndrome ,
- Restless legs syndrome ,
- Traumatic brain injury ,
- Schizophrenia ,
- Insomnia ,
- Stroke ,
- Stroke rehabilitation,
- Whiplash , and
- Sensorineural hearing loss ,
- Stress urinary incontinence,
- Dry eye syndrome ,
- Tennis elbow ,
- Tinnitus ,
- Uremic pruritus ,
- Uterine fibroids ,
- vascular dementia
- Indigestion ,
- prenatal depression,
In general, if acupuncture is used properly, there are hardly any side effects . Possible side effects are:
- The formation of a hematoma at the injection site.
- With long dwell times of needles ("permanent needles"), regardless of the material , inflammation can occur.
- Occasional drops of blood can escape.
- Certain points or combinations of points can make the patient dizzy.
- Short-term loss of consciousness can occur (very rarely, with improper choice of points or excessive stimulation ).
- Siliconized acupuncture needles can cause granulomas by depositing tiny amounts of silicon in the skin .
These are the most common undesirable side effects of acupuncture treatment. In the large German health insurance studies, the doctors had to document the side effects that occurred. About eight percent of patients treated with acupuncture were affected. A systematic review of all blood vessel injuries produced by acupuncture and documented in the literature found 21 cases, some of them with very serious complications. Three patients died as a result of these incidents. The authors concluded that vascular incidents are rare. Organ injuries such as a pneumothorax (rarely) caused by an unintentional injury to the lungs are not considered a side effect, but rather a treatment error due to a lack of knowledge and improper needling.
Acupuncture treatment is not recommended for various diseases and conditions. The following are considered contraindications:
- taking anticoagulant coumarin derivatives phenprocoumon , warfarin or the active ingredients known as new oral anticoagulants such as apixaban , dabigatran and rivaroxaban (especially without a stable setting)
- Skin disorders ( eczema , hives , dermatitis , etc.) in the locally affected areas
- certain nervous diseases and sensitivity disorders of the skin (for example polyneuropathies with limited pain perception in the locally affected areas)
- Epilepsy (because of the risk of an epileptic fit )
- serious contagious diseases (e.g. tuberculosis )
- certain types of tumors
- poor general condition
- acute inflammation, broken bones, recent injuries
Electro-acupuncture should not be used on epileptics because the electrical current could trigger epileptic seizures . Even people with a pacemaker are not allowed to have electro-acupuncture because the electrical current could control the pacemaker incorrectly.
Some representatives of conventional western medicine continue to see it as a research task to scientifically pursue the theory of meridians and acupuncture points behind acupuncture . Other proponents consider these ideas so absurd and so often refuted that they see no need for further investigation. The largest worldwide prospective and randomized study (GERAC studies) to date comes to the conclusion that acupuncture is just as effective as a sham treatment at neighboring, but non-classic points (placebo). A systematic review from 2011, were studied in 57 systematic since 2000 published review articles, came to the conclusion that there is little evidence that acupuncture is an effective treatment for pain.
Both proponents and opponents of acupuncture in principle warn against using acupuncture for serious diseases such as cancer , multiple sclerosis or stroke . Proponents argue that such illnesses are contraindications to acupuncture, because a beneficial (in this context, disadvantageous, because the illness promoting) effect of acupuncture could aggravate the illness, for example by stimulating the cells to undesirably multiply in cancer. However, such a promoting effect has never been proven. Opponents of acupuncture consider its use especially dangerous for serious illnesses, because the preference for acupuncture (and other alternative medical methods) means that scientifically founded therapies are often not used or used too late.
GERAC acupuncture studies
The GERAC studies (2002–2007) ( German Acupuncture Trials ) were the world's largest prospective and randomized studies on the effectiveness of acupuncture in comparison to a guideline-oriented standard therapy for the economically relevant indications of chronic low back pain, chronic pain in osteoarthritis of the knee, chronic tension headache and chronic migraine . A management committee at the Ruhr University Bochum (spokesman Hans-Joachim Trampisch) steered the Germany-wide studies with the participation of six universities (Essen, Heidelberg, Marburg, Mainz and Regensburg) and over 500 outpatient doctors. The scientific society, Research Group Acupuncture, played a decisive role in the conception and implementation of the GERAC studies. The three-armed studies compared acupuncture on Chinese acupuncture points (verum) with acupuncture on non-Chinese points (sham) and conventional therapy on a total of 3500 patients. In the case of chronic low back pain and chronic knee pain due to osteoarthritis of the knee, acupuncture and sham acupuncture were found to have a better effect in an open comparison with standard therapy. An effect that differentiates acupuncture from the placebo group (sham acupuncture) could not be proven. In the prophylaxis of chronic migraines, no statistically significant difference was found between acupuncture, sham acupuncture and standard therapy. A significant difference between the two forms of acupuncture, verum and sham, was not shown in any of the studies, analogous to many other studies. However, the study protocol was already freely published during the studies. Some critics consider the value of the GERAC studies to be inferior because of this unblinding.
On the basis of the GERAC studies, the Federal Joint Committee decided that acupuncture has been part of the insurance benefits for back pain and chronic joint pain since January 1, 2007. "The purely historical presentation of the point specificity of Chinese acupuncture points in medical acupuncture training (acupuncture advanced and advanced training seminars) is of little clinical relevance." The international Cochrane reviews updated in 2009 , the résumé of which were significantly influenced by the results of the GERAC studies, are due concluded that acupuncture "represents a valuable non-pharmacological therapy option for patients with frequent episodic tension headaches" and that "acupuncture for migraines is at least as effective, possibly more effective than drug prophylactic therapy, and this with fewer undesirable effects".
Studies as part of the "acupuncture model project"
Some German statutory health insurances , under the leadership of Techniker Krankenkasse , operated the "model project acupuncture", in which it should be checked whether it would make sense to include acupuncture in the service catalog. This project was scientifically supported by the Institute for Social Medicine , Epidemiology and Health Economics at the Charité University Hospital in Berlin and included three studies:
- Acupuncture Safety and Health Economics Studies (ASH)
- Acupuncture in Routine Care Studies (ARC)
- Acupuncture Randomized Trials (ART)
The results were presented in the Deutsches Ärzteblatt and The Lancet , among others . An effect was noted, but it was not lasting. In these studies, too, the exact study protocol was already published during the ongoing studies, which aroused criticism (unblinding).
The results of a large number of Chinese acupuncture studies, all of which are intended to prove the effectiveness of the method, are questioned in the scientific literature due to the methodology. Practically all Chinese studies on acupuncture are not randomized , not prospective and did not work with suitable control groups.
Another approach to research into acupuncture is the attempt to uncover possible physiological mechanisms of action and to provide scientifically tenable evidence of the localization of organ, pain and trigger points . Reliable evidence has not yet been provided.
Reimbursement by health insurance companies
Since January 1, 2007, all German statutory health insurances have been reimbursing acupuncture treatments for chronic pain in the lumbar spine and in the knee joints for osteoarthritis of the knee as part of an overall pain therapy concept in accordance with a resolution of the Federal Joint Committee in Germany. Part of this resolution is the increase of the necessary qualification of the doctors: In addition to the additional medical qualification "acupuncture", proof of the 80-hour courses "special pain therapy" and "basic psychosomatic care" is required. The treatment of headaches by acupuncture was not included in the catalog of services, as no advantage over standard therapy was found. Other indications for acupuncture treatments are not covered by statutory health insurance and must therefore be paid for yourself.
Private health insurances, allowances and the Postbeamtenkrankenkasse pay for acupuncture for the treatment of pain according to the official fee schedule for doctors , after individual decisions usually also for further diagnoses. Non-medical practitioner services are also reimbursed depending on the contract.
Another possibility of assuming the costs or sharing costs is through supplementary health practitioner insurance, as alternative practitioners with TCM training also offer acupuncture.
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- GBA decision (PDF; 97 kB).
- Fee schedule for doctors (GOÄ)
- www.comparis.ch .