Purpose of This PDQ Summary
Overview
General Information
History
Laboratory/Animal/Preclinical Studies
Human/Clinical Studies

Effect of Acupuncture on Immune Function Effect of Acupuncture on Cancer Pain Effect of Acupuncture on Chemotherapy-Induced Nausea and Vomiting Effect of Acupuncture on Cancer or Other Cancer Treatment-Related Symptoms

Adverse Effects
Overall Level of Evidence for Acupuncture Treatment of Cancer-Related Symptoms
Changes to This Summary (01/11/2008)
More Information

Purpose of This PDQ Summary

This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the use of acupuncture as a treatment for cancer. The summary is reviewed regularly and updated as necessary by the PDQ Cancer Complementary and Alternative Medicine Editorial Board ¹.

Information about the following is included in this summary:

• A brief history of acupuncture research.
• The results of clinical studies of acupuncture.
• Possible side effects of acupuncture use.

This summary is intended as a resource to inform and assist clinicians and other health professionals who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.

Some of the reference citations in the summary are accompanied by a level of evidence designation. These designations are intended to help the readers assess the strength of the evidence supporting the use of specific interventions of treatment strategies. The PDQ Cancer Complementary and Alternative Medicine Editorial Board uses a formal evidence ranking system ² in developing its level of evidence designations. These designations should not be used as a basis for reimbursement determinations.

This summary is also available in a patient version ³, which is written in less technical language.

Overview

This complementary and alternative medicine (CAM) information summary provides an overview of the use of acupuncture as a treatment for individuals with cancer or cancer-related disorders. The summary includes a brief history of acupuncture practice, a review of laboratory and animal studies, the results of clinical observations and trials, and possible side effects of acupuncture therapy. Information presented in some sections of the summary can also be found in tables located at the end of those sections.

This summary contains the following key information:

• As part of traditional Chinese medicine, acupuncture has been practiced in China and other Asian countries for thousands of years.
• Acupuncture is defined as the application of stimulation such as needling, moxibustion, cupping, and acupressure on specific sites of the body known as acupuncture points.
• Acupuncture has been practiced in the United States for about 200 years. The U.S. Food and Drug Administration approved the acupuncture needle as a medical device in 1996.
• Acupuncture is used to treat a wide range of illnesses and ailments; however, cancer patients predominantly use it for pain management and nausea and vomiting control.
• To date, most reported acupuncture research on cancer has been carried out in China.
• Laboratory and animal studies to explore the mechanisms of acupuncture for cancer treatment have focused mainly on the role of acupuncture in the activation of immune functions, such as increasing blood cell count and enhancing lymphocyte and natural killer cell activity.
• The aim of most acupuncture clinical observation and clinical trials in cancer patients has been to evaluate the effects of acupuncture on symptom management.
• The most convincing research data on the effects of acupuncture in cancer patients have emerged from studies of the management of chemotherapy -induced nausea and vomiting.

Many of the medical and scientific terms used in this summary are hypertext linked (at first use in each section) to the NCI Dictionary ⁴, which is oriented toward nonexperts. When a linked term is clicked, a definition will appear in a separate window. All linked terms and their corresponding definitions will appear in a glossary in the printable version of the summary.

Reference citations in some PDQ CAM information summaries may include links to external Web sites that are operated by individuals or organizations for the purpose of marketing or advocating the use of specific treatments or products. These reference citations are included for informational purposes only. Their inclusion should not be viewed as an endorsement of the content of the Web sites or of any treatment or product by the PDQ Cancer CAM Editorial Board or the National Cancer Institute.

General Information

Acupuncture, a complementary and alternative (CAM) therapy used in cancer management,[1-4] has been used clinically to manage cancer-related symptoms, treat side effects induced by chemotherapy or radiation therapy, boost blood cell count, and enhance lymphocyte and natural killer (NK) cell activity. In cancer treatment, its primary use is symptom management; commonly treated symptoms are cancer pain,[4,5] chemotherapy-induced nausea and vomiting, [6] and other symptoms that affect a patient’s quality of life, including weight loss, anxiety, depression, insomnia, poor appetite, and diarrhea. [7-9] Acupuncture is generally accepted by children aged 10 years and older.[10]

More than 40 states and the District of Columbia have laws regulating acupuncture practice. The National Certification Commission for Acupuncture and Oriental Medicine offers national certification examinations for practitioners of acupuncture and traditional Chinese medicine (TCM) (www.nccaom.org); most, but not all, states require this certification. More than 50 schools and colleges of acupuncture and Oriental medicine operate in the United States, many of which offer master’s-level programs and are accredited by or have been granted candidacy status by the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM). ACAOM standards for a master's-level degree require a 3-year program (approximately 2,000 hours of study) for acupuncture and a 4-year program for Oriental medicine, which includes acupuncture and herbal therapy (www.ACAOM.org). Some Western medical training, including the study of anatomy, physiology, and clean-needle technique is included in the curriculums of these schools. Postgraduate training programs in medical acupuncture for physicians also exist. In the United States, training to be a licensed acupuncturist (LAc) is regulated according to individual state law. Because the educational and licensing requirements for acupuncture practice vary from state to state, one should inquire from each state board of acupuncture (or other relevant board) for particular information.[11] Third-party reimbursements also vary from state to state. Some insurance companies cover acupuncture or limited acupuncture treatment. Federal payers such as Medicaid and Medicare do not generally reimburse for acupuncture treatment.

Acupuncture has been practiced in China and other Asian countries for more than 4,000 years.[12-14] In China, acupuncture is part of a TCM system of traditional medical knowledge and is practiced along with other treatment modalities such as herbal medicine, tui na (massage and acupressure), mind/body exercise (e.g., qigong and tai chi), and dietary therapy.[15,16] In the United States, several different acupuncture styles are practiced in addition to TCM. These include Japanese acupuncture (e.g., meridian therapy), English acupuncture (e.g., five element or traditional acupuncture), French acupuncture (e.g., French energetic acupuncture), Korean acupuncture (e.g., constitutional acupuncture), and American medical acupuncture. Most of these are derived from ancient Chinese medical philosophy and practices. All are based on the view that the human body must be perceived and treated as a whole and as part of nature; health is the result of harmony among bodily functions and between the body and nature, and disease occurs when this harmony is disrupted. TCM therapeutic interventions, including acupuncture are used to restore the state of harmony.

Acupuncture is closely associated with Chinese meridian theory. According to this theory, there are 12 primary meridians, or channels, and eight additional meridians, each following a particular directional course along the body. A vital energy known as qi flows through these meridians and participates in the homeostatic regulation of various bodily functions. Some 360 points distributed along the meridians serve as both pathognomonic signs of disorder and as loci for acupuncture treatments.[14,17] When the normal flow of energy over a meridian is obstructed (e.g., as a result of tissue injury or a tumor), pain or other symptoms result.

The purpose of acupuncture therapy is to re-open the normal energy flow, thereby relieving the symptoms by stimulating specific sites (acupuncture points) on the meridians.[18] In acupuncture treatment, stainless steel needles, usually ranging from 0.22 to 0.25 mm in diameter, are inserted into relevant acupuncture points to stimulate the affected meridians. A needling sensation known as de qi sensation, in which the patient feels heaviness, numbness, or tightness, is often required during an acupuncture treatment. Length and frequency of treatment vary according to the condition being treated. Chronic conditions usually require a longer treatment period. Typically, two or three sessions per week are required initially and may decrease to once a week after several weeks of treatment. Needles are typically left in place for 15 to 30 minutes after insertion, and their effects may be augmented with manual or electrical stimulation and/or heat (e.g., moxibustion).

Classical techniques of acupuncture include needling, moxibustion, and cupping. Acupressure, using fingers to apply pressure on acupuncture points, is also considered a form of acupuncture treatment. Moxibustion is a method in which an herb (Artemisia vulgaris) is burned above the skin or on an acupuncture point for the purpose of warming it to alleviate symptoms. Cupping promotes blood circulation and stimulates acupuncture points by creating a vacuum or negative pressure on the surface of the skin.[18] During the past several decades, various new auxiliary devices have been developed. Acupuncture devices such as electroacupuncture (EA) machines and heat lamps are commonly used to enhance the effects of acupuncture.

In addition to classical acupuncture techniques, other techniques have been developed and are sometimes used in cancer management. These include trigger point acupuncture, laser acupuncture, acupuncture point injection, and techniques focusing on particular regions of the body: auricular acupuncture, scalp acupuncture, face acupuncture, hand acupuncture, nose acupuncture, and foot acupuncture. Of these, auricular acupuncture is the most commonly used.

Although acupuncture has been practiced for millennia, it has come under scientific investigation only recently. To date, most studies and clinical trials of the mechanisms and efficacy of acupuncture in cancer management have been carried out in China. In 1976, however, the U.S. Food and Drug Administration (FDA) classified acupuncture needles as investigational devices (Class III) (www.fda.gov). This resulted in a number of research studies on the effectiveness and safety of acupuncture.[19] In November 1994, the Office of Alternative Medicine (the predecessor of the National Center for Complementary and Alternative Medicine) at the National Institutes of Health (NIH) sponsored an NIH-FDA workshop on the status of acupuncture needle usage. Two years later, the FDA reclassified acupuncture needles as medical devices (Class II) without, however, giving specific indications for their use (www.fda.gov). In 1997, NIH held a Consensus Development Conference on Acupuncture to evaluate its safety and efficacy. The 12-member panel concluded that promising research results showing the efficacy of acupuncture in certain conditions have emerged and that further research is likely to uncover additional areas in which acupuncture intervention will be useful. The panel stated that “there is clear evidence that needle acupuncture treatment is effective for postoperative and chemotherapy nausea and vomiting.” It also stated that there are “a number of other pain-related conditions for which acupuncture may be effective as an adjunct therapy, an acceptable alternative, or as part of a comprehensive treatment program,” and it agreed that further research is likely to uncover additional areas in which acupuncture intervention will be useful.[19]

These actions by the FDA and NIH have resulted in the establishment of a number of active programs of research into the mechanisms and efficacy of acupuncture, much of which is, or is potentially, relevant to cancer management. To date, the most extensively investigated aspect of these mechanisms has been the effect of acupuncture on pain management. The NIH Consensus Panel concluded that “acupuncture can cause multiple biological responses,” local and distal, “mediated mainly by sensory neurons…within the central nervous system.” Acupuncture “may also activate the hypothalamus and the pituitary gland, resulting in a broad spectrum of systemic effects,” including “alterations in peptides, hormones and neurotransmitters and the regulation of blood flow.”[19] Recent studies show the effect of acupuncture on chronic inflammatory pain.[20,21] Evidence suggests that acupuncture operates through the autonomic nervous system to balance the sympathetic and parasympathetic systems and suggests that the anti-inflammatory effects of acupuncture are mediated by its electrophysiologic effects on neurotransmitters, cytokines, and neuropeptides.[21-30] Reviewed in [1] Many studies provide evidence that opioid peptides are released during acupuncture and that acupuncture analgesia is mediated by the endogenous opioid system.[31,32]

Laboratory and animal cancer studies exploring the mechanisms of acupuncture have focused mainly on the activation and modulation of immune functions. Acupuncture treatment points are located by using standard anatomic landmarks and comparative anatomy. EA is the most commonly used treatment intervention; a few studies have used moxibustion.[33] These studies show that acupuncture may boost animal immune function by increasing blood cells and enhancing NK cell and lymphocyte activity.[33-35] According to one animal behavioral study, acupuncture may be a useful adjuvant for suppressing chemotherapy-induced emesis. [36]

Although several studies published in China examined the effect of acupuncture on the human immune system,[7,28,31,37-40] most cancer-related human clinical studies of acupuncture evaluated its effect on patient quality of life. These investigations mainly focused on cancer symptoms or cancer treatment–related symptoms, predominantly cancer pain [9,22,41-45] and chemotherapy-induced nausea and vomiting.[24,26,46-54] Studies have also been done on the effect of acupuncture on radiation -induced xerostomia (dry mouth), rectitis, dysphonia, weight loss, cough, thoracodynia, hemoptysis, fever, esophageal obstruction, poor appetite, night sweats, hot flashes, dizziness, fatigue, anxiety, and depression in cancer patients.[7-9,55-58] The evidence from most of these clinical studies is inconclusive, despite their positive results; either poor research design or incompletely described methodologic procedures limit their value. The positive results of the studies on chemotherapy-induced nausea and vomiting, which benefit from scientifically sound research designs, are the most convincing.

References

1. Wong R, Sagar CM, Sagar SM: Integration of Chinese medicine into supportive cancer care: a modern role for an ancient tradition. Cancer Treat Rev 27 (4): 235-46, 2001.  [PUBMED Abstract]
   
   
2. Pan CX, Morrison RS, Ness J, et al.: Complementary and alternative medicine in the management of pain, dyspnea, and nausea and vomiting near the end of life. A systematic review. J Pain Symptom Manage 20 (5): 374-87, 2000.  [PUBMED Abstract]
   
   
3. Norheim AJ, Fønnebø V: Attitudes to the contribution of placebo in acupuncture--a survey. Complement Ther Med 10 (4): 202-9, 2002.  [PUBMED Abstract]
   
   
4. Sellick SM, Zaza C: Critical review of 5 nonpharmacologic strategies for managing cancer pain. Cancer Prev Control 2 (1): 7-14, 1998.  [PUBMED Abstract]
   
   
5. Charlton JE: Cancer pain management. Cah Anesthesiol 41 (6): 621-4, 1993.  [PUBMED Abstract]
   
   
6. Vickers AJ: Can acupuncture have specific effects on health? A systematic review of acupuncture antiemesis trials. J R Soc Med 89 (6): 303-11, 1996.  [PUBMED Abstract]
   
   
7. Xia YQ, Zhang D, Yang CX, et al.: An approach to the effect on tumors of acupuncture in combination with radiotherapy or chemotherapy. J Tradit Chin Med 6 (1): 23-6, 1986.  [PUBMED Abstract]
   
   
8. Johnstone PA, Polston GR, Niemtzow RC, et al.: Integration of acupuncture into the oncology clinic. Palliat Med 16 (3): 235-9, 2002.  [PUBMED Abstract]
   
   
9. Niemtzow RC: Integration of complementary disciplines into the oncology clinic. Part I. Acupuncture. Curr Probl Cancer 24 (4): 184-93, 2000 Jul-Aug.  [PUBMED Abstract]
   
   
10. Kemper KJ, Sarah R, Silver-Highfield E, et al.: On pins and needles? Pediatric pain patients' experience with acupuncture. Pediatrics 105 (4 Pt 2): 941-7, 2000.  [PUBMED Abstract]
    
    
11. Mitchell BB: Acupuncture and Oriental Medicine Laws. Gig Harbor, Wash: National Acupuncture Fondation, 2001. 
    
    
12. Liu G, Hyodo A, eds.: Fundamentals of Acupuncture & Moxibustion. Tianjin, China: Tianjin Science & Technology Translation & Publishing Corp, 1994. 
    
    
13. Cheng X, ed.: Chinese Acupuncture and Moxibustion. Beijing, China: Foreign Languages Press, 1987. 
    
    
14. O'Connor J, Bensky D, eds.: Acupuncture: A Comprehensive Text. Chicago, Ill: Eastland Press, 1981. 
    
    
15. Lao L: Traditional Chinese medicine. In: Jonas WB, Levin JS, eds.: Essentials of Complementary and Alternative Medicine. Philadelphia, Pa: Lippincott Williams & Wilkins, 1999, pp 216-233. 
    
    
16. Ergil KV: China's traditional medicine. In: Micozzi MS, ed.: Fundamentals of Complementary and Alternative Medicine. New York, NY: Churchill Livingstone, 1996, pp 185-223. 
    
    
17. Stux G: History of acupuncture. In: Stux G, Pomeranz B: Acupuncture: Textbook and Atlas. New York, NY: Springer-Verlag, 1987, pp 36-7. 
    
    
18. Lao L: Acupuncture techniques and devices. J Altern Complement Med 2 (1): 23-5, 1996.  [PUBMED Abstract]
    
    
19. NIH Consensus Conference. Acupuncture. JAMA 280 (17): 1518-24, 1998.  [PUBMED Abstract]
    
    
20. Lao L, Zhang G, Wei F, et al.: Electro-acupuncture attenuates behavioral hyperalgesia and selectively reduces spinal Fos protein expression in rats with persistent inflammation. J Pain 2 (2): 111-7, 2001.  [PUBMED Abstract]
    
    
21. Zijlstra FJ, van den Berg-de Lange I, Huygen FJ, et al.: Anti-inflammatory actions of acupuncture. Mediators Inflamm 12 (2): 59-69, 2003.  [PUBMED Abstract]
    
    
22. Dang W, Yang J: Clinical study on acupuncture treatment of stomach carcinoma pain. J Tradit Chin Med 18 (1): 31-8, 1998.  [PUBMED Abstract]
    
    
23. Moyad MA, Hathaway S, Ni HS: Traditional Chinese medicine, acupuncture, and other alternative medicines for prostate cancer: an introduction and the need for more research. Semin Urol Oncol 17 (2): 103-10, 1999.  [PUBMED Abstract]
    
    
24. Dundee JW, Ghaly RG, Fitzpatrick KT, et al.: Acupuncture prophylaxis of cancer chemotherapy-induced sickness. J R Soc Med 82 (5): 268-71, 1989.  [PUBMED Abstract]
    
    
25. Hoskin PJ, Hanks GW: The management of symptoms in advanced cancer: experience in a hospital-based continuing care unit. J R Soc Med 81 (6): 341-4, 1988.  [PUBMED Abstract]
    
    
26. Dundee JW, Ghaly RG, Fitzpatrick KT, et al.: Optimising antiemesis in cancer chemotherapy. Br Med J (Clin Res Ed) 294 (6565): 179, 1987.  [PUBMED Abstract]
    
    
27. Harris PF, Remington PL, Trentham-Dietz A, et al.: Prevalence and treatment of menopausal symptoms among breast cancer survivors. J Pain Symptom Manage 23 (6): 501-9, 2002.  [PUBMED Abstract]
    
    
28. Zhou RX, Huang FL, Jiang SR, et al.: The effect of acupuncture on the phagocytic activity of human leukocytes. J Tradit Chin Med 8 (2): 83-4, 1988.  [PUBMED Abstract]
    
    
29. Petti F, Bangrazi A, Liguori A, et al.: Effects of acupuncture on immune response related to opioid-like peptides. J Tradit Chin Med 18 (1): 55-63, 1998.  [PUBMED Abstract]
    
    
30. Johnstone PA, Bloom TL, Niemtzow RC, et al.: A prospective, randomized pilot trial of acupuncture of the kidney-bladder distinct meridian for lower urinary tract symptoms. J Urol 169 (3): 1037-9, 2003.  [PUBMED Abstract]
    
    
31. He CJ, Gong KH, Xu QZ, et al.: Effects of microwave acupuncture on the immunological function of cancer patients. J Tradit Chin Med 7 (1): 9-11, 1987.  [PUBMED Abstract]
    
    
32. Mayer DJ: Biological mechanisms of acupuncture. Prog Brain Res 122: 457-77, 2000.  [PUBMED Abstract]
    
    
33. Wu P, Cao Y, Wu J: Effects of moxa-cone moxibustion at Guanyuan on erythrocytic immunity and its regulative function in tumor-bearing mice. J Tradit Chin Med 21 (1): 68-71, 2001.  [PUBMED Abstract]
    
    
34. Liu LJ, Guo CJ, Jiao XM: [Effect of acupuncture on immunologic function and histopathology of transplanted mammary cancer in mice] Zhongguo Zhong Xi Yi Jie He Za Zhi 15 (10): 615-7, 1995.  [PUBMED Abstract]
    
    
35. Sato T, Yu Y, Guo SY, et al.: Acupuncture stimulation enhances splenic natural killer cell cytotoxicity in rats. Jpn J Physiol 46 (2): 131-6, 1996.  [PUBMED Abstract]
    
    
36. Lao L, Zhang G, Wong RH, et al.: The effect of electroacupuncture as an adjunct on cyclophosphamide-induced emesis in ferrets. Pharmacol Biochem Behav 74 (3): 691-9, 2003.  [PUBMED Abstract]
    
    
37. Wu B, Zhou RX, Zhou MS: [Effect of acupuncture on interleukin-2 level and NK cell immunoactivity of peripheral blood of malignant tumor patients] Zhongguo Zhong Xi Yi Jie He Za Zhi 14 (9): 537-9, 1994.  [PUBMED Abstract]
    
    
38. Wu B, Zhou RX, Zhou MS: [Effect of acupuncture on immunomodulation in patients with malignant tumors] Zhongguo Zhong Xi Yi Jie He Za Zhi 16 (3): 139-41, 1996.  [PUBMED Abstract]
    
    
39. Wei Z: Clinical observation on therapeutic effect of acupuncture at zusanli for leukopenia. J Tradit Chin Med 18 (2): 94-5, 1998.  [PUBMED Abstract]
    
    
40. Ye F, Chen S, Liu W: Effects of electro-acupuncture on immune function after chemotherapy in 28 cases. J Tradit Chin Med 22 (1): 21-3, 2002.  [PUBMED Abstract]
    
    
41. Li QS, Cao SH, Xie GM, et al.: Combined traditional Chinese medicine and Western medicine. Relieving effects of Chinese herbs, ear-acupuncture and epidural morphine on postoperative pain in liver cancer. Chin Med J (Engl) 107 (4): 289-94, 1994.  [PUBMED Abstract]
    
    
42. Alimi D, Rubino C, Leandri EP, et al.: Analgesic effects of auricular acupuncture for cancer pain. J Pain Symptom Manage 19 (2): 81-2, 2000.  [PUBMED Abstract]
    
    
43. He JP, Friedrich M, Ertan AK, et al.: Pain-relief and movement improvement by acupuncture after ablation and axillary lymphadenectomy in patients with mammary cancer. Clin Exp Obstet Gynecol 26 (2): 81-4, 1999.  [PUBMED Abstract]
    
    
44. Filshie J, Redman D: Acupuncture and malignant pain problems. Eur J Surg Oncol 11 (4): 389-94, 1985.  [PUBMED Abstract]
    
    
45. Wen HL: Cancer pain treated with acupuncture and electrical stimulation. Mod Med Asia 13 (2): 12-6, 1977. 
    
    
46. Shen J, Wenger N, Glaspy J, et al.: Electroacupuncture for control of myeloablative chemotherapy-induced emesis: A randomized controlled trial. JAMA 284 (21): 2755-61, 2000.  [PUBMED Abstract]
    
    
47. Dundee JW, Yang J, McMillan C: Non-invasive stimulation of the P6 (Neiguan) antiemetic acupuncture point in cancer chemotherapy. J R Soc Med 84 (4): 210-2, 1991.  [PUBMED Abstract]
    
    
48. Dundee JW, Yang J: Prolongation of the antiemetic action of P6 acupuncture by acupressure in patients having cancer chemotherapy. J R Soc Med 83 (6): 360-2, 1990.  [PUBMED Abstract]
    
    
49. Aglietti L, Roila F, Tonato M, et al.: A pilot study of metoclopramide, dexamethasone, diphenhydramine and acupuncture in women treated with cisplatin. Cancer Chemother Pharmacol 26 (3): 239-40, 1990.  [PUBMED Abstract]
    
    
50. Dundee JW, McMillan CM: Clinical uses of P6 acupuncture antiemesis. Acupunct Electrother Res 15 (3-4): 211-5, 1990.  [PUBMED Abstract]
    
    
51. Dundee JW, Ghaly RG, Fitzpatrick KT, et al.: Acupuncture to prevent cisplatin-associated vomiting. Lancet 1 (8541): 1083, 1987.  [PUBMED Abstract]
    
    
52. Price H, Lewith G, Williams C: Acupressure as an antiemetic in cancer chemotherapy. Complementary Medical Research 5 (2): 93-4. 
    
    
53. Stannard D: Pressure prevents nausea. Nurs Times 85 (4): 33-4, 1989 Jan 25-31.  [PUBMED Abstract]
    
    
54. McMillan C, Dundee JW, Abram WP: Enhancement of the antiemetic action of ondansetron by transcutaneous electrical stimulation of the P6 antiemetic point, in patients having highly emetic cytotoxic drugs. Br J Cancer 64 (5): 971-2, 1991.  [PUBMED Abstract]
    
    
55. Porzio G, Trapasso T, Martelli S, et al.: Acupuncture in the treatment of menopause-related symptoms in women taking tamoxifen. Tumori 88 (2): 128-30, 2002 Mar-Apr.  [PUBMED Abstract]
    
    
56. Zhang ZH: Effect of acupuncture on 44 cases of radiation rectitis following radiation therapy for carcinoma of the cervix uteri. J Tradit Chin Med 7 (2): 139-40, 1987.  [PUBMED Abstract]
    
    
57. Yao W: Prof. Sheng Canruo's experience in acupuncture treatment of throat diseases with yan si xue. J Tradit Chin Med 20 (2): 122-5, 2000.  [PUBMED Abstract]
    
    
58. Feng RZ: Relief of oesophageal carcinomatous obstruction by acupuncture. J Tradit Chin Med 4 (1): 3-4, 1984.  [PUBMED Abstract]
    
    

History

Acupuncture /moxibustion (known as zhen jiu) is part of traditional Chinese medicine (TCM), an indigenous, coherent system of medicine that has been practiced in China for thousands of years. The history of acupuncture/moxibustion in China can be traced back archeologically at least 4,000 years, when bian (stone needles) were in use. During the long history of recorded practice, acupuncture has been applied to many disorders. The earliest written medical text, the ancient classic Huang Di Nei Jing (Yellow Emperor's Inner Classic, second century BC), records nine types of needles and their therapeutic functions.

The dissemination of acupuncture and TCM to other regions dates back centuries: first to Korea and Japan and then to other Asian countries.[1] The use of acupuncture in Europe was documented in the middle of the 16th century.[2] The relatively brief history of acupuncture in the United States can be traced back about 200 years, when Dr. Franklin Bache published a report in the North American Medical and Surgical Journal on his use of acupuncture to treat lower back pain.[3] However, until the 1970s, when U.S.–Chinese diplomatic ties were resumed, the practice of acupuncture in this country was mainly limited to Chinatowns.[4]

For centuries, Chinese acupuncturists treated cancer symptomatically. Ancient literature and acupuncture textbooks classify cancer as a Zheng syndrome or blood stasis condition and document acupuncture treatment principles and methods.[5-7] Since the development of modern conventional medicine, acupuncture has been used clinically only as an adjunct to conventional cancer treatment.

References

1. Lu GD, Needham J: A history of forensic medicine in China. Med Hist 32 (4): 357-400, 1988.  [PUBMED Abstract]
   
   
2. Peacher WG: Adverse reactions, contraindications and complications of acupuncture and moxibustion. Am J Chin Med (Gard City N Y) 3 (1): 35-46, 1975.  [PUBMED Abstract]
   
   
3. Bache F: Cases illustrative of the remedial effects of acupuncture. North American Medical and Surgical Journal 1: 311-21, 1826. 
   
   
4. Ergil KV: China's traditional medicine. In: Micozzi MS, ed.: Fundamentals of Complementary and Alternative Medicine. New York, NY: Churchill Livingstone, 1996, pp 185-223. 
   
   
5. Maciocia G: The Practice of Chinese Medicine: The Treatment of Diseases with Acupuncture and Chinese Herbs. New York, NY: Churchill Livingstone, 1994. 
   
   
6. Maciocia G: Obstetrics and Gynecology in Chinese Medicine. New York, NY: Churchill Livingstone, 1997. 
   
   
7. Kaptchuk T: The Web That Has No Weaver: Understanding Chinese Medicine. New York, NY: Congdon & Weed, 1983. 
   
   

Laboratory/Animal/Preclinical Studies

At least five animal studies investigating the effects of acupuncture in cancer or cancer-related conditions have been reported in the scientific literature (see table ⁵ at end of this section).[1-5] Two of the studies were conducted in China, one of which was published in Chinese with an English abstract. One study was conducted in Japan, one in Sweden, and one in the United States. Four of the studies were ex vivo laboratory investigations using blood samples or tissues; [1-3,5] the remaining study was an animal behavioral study testing the effect of acupuncture on chemotherapy -induced nausea and vomiting. [4]

The four ex vivo studies suggested that acupuncture is useful in anticancer therapy either by actively stimulating immune activity or by preventing chemotherapy suppression of immune activity.

In a study involving normal rats, electroacupuncture (EA) (1 Hz, 5–20 V, 1-millisecond pulse width, 2 hours) applied at the point Tsu-Sanli (S36) for 2 hours daily on 3 consecutive days enhanced the cytotoxicity of splenic natural killer (NK) cells compared with a stimulation of a nonacupuncture control point in the abdominal muscle.[3]

Another study found that NK cell activity and T- lymphocyte transformation rate were increased in a mouse model of transplanted mammary cancer compared with control (P < .05) after eight sessions of acupuncture and moxibustion.[2]

A study involving tumor -bearing mice (sarcoma S180) using moxibustion to warm the acupuncture point Guanyuan (CV4) once a day for 10 days found significantly increased production of erythrocytes, compared with a nontreatment control.[1]

The fourth ex vivo study used a rat model to investigate the effect of EA on nerve growth factor (NGF), which is associated with polycystic ovary syndrome (PCOS). Women with PCOS have an increased risk of endometrial cancer and other diseases. Repeated EA treatments (12 treatments administered over 30 days) in PCO rats significantly lowered the concentrations of NGF in the ovaries, compared with untreated PCO rats.[5]

A study of cyclophosphamide -induced emesis in a ferret behavioral model used acupuncture as an adjunct therapy in treating the emetic side effects of chemotherapy. EA at 100 Hz, 1.5 V, for 10 minutes in combination with subeffective doses of antiemetics such as ondansetron (0.04 mg/kg), droperidol (0.25 mg/kg), and metoclopramide (2.24 mg/kg) significantly reduced the total number of emetic episodes by 52%, 36%, and 73%, respectively (P < .01), in this ferret model.[4]

The findings of these studies suggest that acupuncture may be effective in treating cancer-related symptoms and cancer treatment–related disorders and that acupuncture may be able to activate immune functions [1-3] and regulate the autonomic nervous system.[4,5] Only one study reported a decrease in tumor volume in animals treated with acupuncture compared with control animals; however, the scientific value of this report is limited because of insufficient information about the research methodology.[2]

References

1. Wu P, Cao Y, Wu J: Effects of moxa-cone moxibustion at Guanyuan on erythrocytic immunity and its regulative function in tumor-bearing mice. J Tradit Chin Med 21 (1): 68-71, 2001.  [PUBMED Abstract]
   
   
2. Liu LJ, Guo CJ, Jiao XM: [Effect of acupuncture on immunologic function and histopathology of transplanted mammary cancer in mice] Zhongguo Zhong Xi Yi Jie He Za Zhi 15 (10): 615-7, 1995.  [PUBMED Abstract]
   
   
3. Sato T, Yu Y, Guo SY, et al.: Acupuncture stimulation enhances splenic natural killer cell cytotoxicity in rats. Jpn J Physiol 46 (2): 131-6, 1996.  [PUBMED Abstract]
   
   
4. Lao L, Zhang G, Wong RH, et al.: The effect of electroacupuncture as an adjunct on cyclophosphamide-induced emesis in ferrets. Pharmacol Biochem Behav 74 (3): 691-9, 2003.  [PUBMED Abstract]
   
   
5. Stener-Victorin E, Lundeberg T, Waldenström U, et al.: Effects of electro-acupuncture on nerve growth factor and ovarian morphology in rats with experimentally induced polycystic ovaries. Biol Reprod 63 (5): 1497-503, 2000.  [PUBMED Abstract]
   
   

Human/Clinical Studies

Effect of Acupuncture on Immune Function

At least seven human studies have evaluated the effect of acupuncture on immune system function in patients with cancer (see table ⁷ at end of this section).[1-7] These studies were all conducted in China. Five were reported in English,[1-3,6,7] and two were reported in Chinese with English abstracts.[4,5]

Four randomized controlled trials,[1,2,4,5] a nonrandomized clinical study,[3] and two case series [6,7] found that acupuncture enhanced or regulated immune function.

The first randomized controlled trial found that acupuncture treatment enhanced platelet count and prevented leukocyte decrease after radiation therapy or chemotherapy, in comparison with the control group.[1]

A second study involved a group of 40 postoperative cancer patients, 20 of whom received daily acupuncture treatment and 20 of whom served as a control group. After 3 days, leukocyte phagocytosis was enhanced in the treated group, compared with the baseline measurement (P < .01); no such enhancement was observed in the control group.[2]

A third study observed the effect of acupuncture on interleukin-2 (IL-2) and natural killer (NK) cell activity in the peripheral blood of patients with malignant tumors. The patients were divided into an acupuncture treatment group (n = 25), which received 30 minutes of acupuncture daily for 10 days, and a nonacupuncture control group (n = 20). The data showed that IL-2 level and NK cell activity were significantly increased in the acupuncture group, compared with the control group (P < .01).[4]

A fourth study observed the effect of acupuncture on T- lymphocyte subsets (CD₃+, CD₄+, and CD₈+), soluble IL-2 receptor (SIL-2R), and beta- endorphin (beta-EP) in the peripheral