The Wayback Machine - https://web.archive.org/web/20180602104856/https://www.quackwatch.org/01QuackeryRelatedTopics/acu.html
Be Wary of Acupuncture, Qigong,
and "Chinese Medicine"
Stephen Barrett, M.D.
"Chinese medicine," often called "Oriental medicine"
or "traditional Chinese medicine (TCM)," encompasses
a vast array of folk medical practices based on mysticism. It
holds that the body's vital energy (
chi
or
qi
) circulates
through channels, called
meridians
, that have branches
connected to bodily organs and functions. Illness is attributed
to imbalance or interruption of
chi.
. Ancient practices
such as acupuncture, Qigong, and the use of various herbs are
claimed to restore balance.
Traditional acupuncture, as now practiced, involves the insertion
of stainless steel needles into various body areas. A low-frequency
current may be applied to the needles to produce greater stimulation.
Other procedures used separately or together with acupuncture
include: moxibustion (burning of floss or herbs applied to the
skin); injection of sterile water, procaine, morphine, vitamins,
or homeopathic solutions through the inserted needles; applications
of laser beams (laserpuncture); placement of needles in the external
ear (auriculotherapy); and acupressure (use of manual pressure).
Treatment is applied to "acupuncture points," which
are said to be located throughout the body. Originally there were
365 such points, corresponding to the days of the year, but the
number identified by proponents during the past 2,000 years has
increased gradually to about 2,000 [1]. Some practitioners place
needles at or near the site of disease, whereas others select
points on the basis of symptoms. In traditional acupuncture, a
combination of points is usually used.
Qigong is also claimed to influence the flow of "vital
energy." Internal Qigong involves deep breathing, concentration,
and relaxation techniques used by individuals for themselves.
External Qigong is performed by "Qigong masters" who
claim to cure a wide variety of diseases with energy released
from their fingertips. However, scientific investigators of Qigong
masters in China have found no evidence of paranormal powers and
some evidence of deception. They found, for example, that a patient
lying on a table about eight feet from a Qigong master moved rhythmically
or thrashed about as the master moved his hands. But when she
was placed so that she could no longer see him, her movements
were unrelated to his [2].
Falun
gong
, which China
banned several years ago, is a Qigong varient claimed to be "a
powerful mechanism for healing, stress relief and health improvements."
Most acupuncturists espouse the traditional Chinese view of
health and disease and consider acupuncture, herbal medicine,
and related practices to be valid approaches to the full gamut
of disease. Others reject the traditional approach and merely
claim that acupuncture offers a simple way to achieve pain relief.
The diagnostic process used by TCM practitioners may include questioning
(medical history, lifestyle), observations (skin, tongue, color),
listening (breathing sounds), and pulse-taking. Six pulse aspects
said to correlate with body organs or functions are checked on
each wrist to determine which meridians are "deficient"
in
chi.
(Medical science recognizes only one pulse, corresponding
to the heartbeat, which can be felt in the wrist, neck, feet,
and various other places.) Some acupuncturists state that the
electrical properties of the body may become imbalanced weeks
or even months before symptoms occur. These practitioners claim
that acupuncture can be used to treat conditions when the patient
just "doesn't feel right," even though no disease is
apparent.
TCM (as well as the folk medical practices of various other
Asian countries) is a threat to certain animal species. For example,
black bears—valued for their gall bladders—have been hunted
nearly to extinction in Asia, and poaching of black bears is a
serious problem in North America.
Dubious Claims
The conditions claimed to respond to acupuncture include chronic
pain (neck and back pain, migraine headaches), acute injury-related
pain (strains, muscle and ligament tears), gastrointestinal problems
(indigestion, ulcers, constipation, diarrhea), cardiovascular
conditions (high and low blood pressure), genitourinary problems
(menstrual irregularity, frigidity, impotence), muscle and nerve
conditions (paralysis, deafness), and behavioral problems (overeating,
drug dependence, smoking). However, the evidence supporting these
claims consists mostly of practitioners' observations and poorly
designed studies. A controlled study found that electroacupuncture
of the ear was no more effective than placebo stimulation (light
touching) against chronic pain [3]. In 1990, three Dutch epidemiologists
analyzed 51 controlled studies of acupuncture for chronic pain
and concluded that "the quality of even the better studies
proved to be mediocre. . . . The efficacy of acupuncture in the
treatment of chronic pain remains doubtful." [4] They also
examined reports of acupuncture used to treat addictions to cigarettes,
heroin, and alcohol, and concluded that claims that acupuncture
is effective as a therapy for these conditions are not supported
by sound clinical research [5].
Acupuncture anesthesia is not used for surgery in the Orient
to the extent that its proponents suggest. In China physicians
screen out patients who appear to be unsuitable. Acupuncture is
not used for emergency surgery and often is accompanied by local
anesthesia or narcotic medication [6].
How acupuncture may relieve pain is unclear. One theory suggests
that pain impulses are blocked from reaching the spinal cord or
brain at various "gates" to these areas. Another theory
suggests that acupuncture stimulates the body to produce narcotic-like
substances called
endorphins
, which reduce pain. Other
theories suggest that the placebo effect, external suggestion
(hypnosis), and cultural conditioning are important factors. Melzack
and Wall note that pain relief produced by acupuncture can also
be produced by many other types of sensory hyperstimulation, such
as electricity and heat at acupuncture points and elsewhere in
the body. They conclude that "the effectiveness of all of
these forms of stimulation indicates that acupuncture is not a
magical procedure but only one of many ways to produce analgesia
[pain relief] by an intense sensory input." In 1981, the
American Medical Association Council on Scientific Affairs noted
that pain relief does not occur consistently or reproducibly in
most people and does not operate at all in some people [7].
In 1995, George A. Ulett, M.D., Ph.D., Clinical Professor of
Psychiatry, University of Missouri School of Medicine, stated
that "devoid of metaphysical thinking, acupuncture becomes
a rather simple technique that can be useful as a nondrug method
of pain control." He believes that the traditional Chinese
variety is primarily a placebo treatment, but electrical stimulation
of about 80 acupuncture points has been proven useful for pain
control [8].
The quality of TCM research in China has been extremely poor.
A 1999 analysis of 2,938 reports of clinical trials reported
in Chinese medical journals concluded that that no conclusions
could be drawn from the vast majority of them. The researchers
stated:
In most of the trials, disease was defined and diagnosed according
to conventional medicine; trial outcomes were assessed with objective
or subjective (or both) methods of conventional medicine, often
complemented by traditional Chinese methods. Over 90% of the
trials in non-specialist journals evaluated herbal treatments
that were mostly proprietary Chinese medicines. . . .
Although methodological quality has been improving over the
years, many problems remain. The method of randomisation was
often inappropriately described. Blinding was used in only 15%
of trials. Only a few studies had sample sizes of 300 subjects
or more. Many trials used as a control another Chinese medicine
treatment whose effectiveness had often not been evaluated by
randomised controlled trials. Most trials focused on short term
or intermediate rather than long term outcomes. Most trials did
not report data on compliance and completeness of follow up.
Effectiveness was rarely quantitatively expressed and reported.
Intention to treat analysis was never mentioned. Over half did
not report data on baseline characteristics or on side effects.
Many trials were published as short reports. Most trials claimed
that the tested treatments were effective, indicating that publication
bias may be common; a funnel plot of the 49 trials of acupuncture
in the treatment of stroke confirmed selective publication of
positive trials in the area, suggesting that acupuncture may
not be more effective than the control treatments. [9]
Two scientists at the University of Heidelberg have developed
a "fake needle" that may enable acupuncture researchers
to perform better-designed controlled studies. The device is a
needle with a blunt tip that moves freely within a copper handle.
When the tip touches the skin, the patient feels a sensation similar
to that of an acupuncture needle. At the same time, the visible
part of the needle moves inside the handle so it appears to shorten
as though penetrating the skin. When the device was tested on
volunteers, none suspected that it had not penetrated the skin
[10].
In 2004, a University of Heidelberg team proved the worth of
their "sham acupuncture" technique in a study of postoperative
nausea and vomiting (PONV) in women who underwent breast or gynecologic
surgery. The study involved 220 women who received either acupuncture
or the sham procedure at the acupuncture point "Pericardium
6" on the inside of the forearm. No significant difference
in PONV or antivomiting medication use was found between the two
groups or between the people who received treatment before anesthesia
was induced and those who received it while anesthetized [11].
A subgroup analysis found that vomiting was "significantly
reduced" among the acupuncture patients, but the authors
correctly noted that this finding might be due to studying multiple
outcomes. (As the number of different outcome measures increases,
so do the odds that a "statistically significant" finding
will be spurious.) This study is important because PONV reduction
is one of the few alleged benefits of acupuncture supported by
reports in scientific journals. However, the other positive studies
were not as tightly controlled.
Harriet Hall, a retired family practitioner who is interested in quackery, has summed up the significance of acupuncture research in an interesting way:
Acupuncture studies have shown that it makes no difference where you put
the needles. Or whether you use needles or just pretend to use needles (as
long as the subject believes you used them). Many acupuncture researchers are doing what I call Tooth Fairy science: measuring how much money is left under the pillow without bothering to ask if the Tooth Fairy is real.
Risks Exist
Improperly performed acupuncture can cause fainting, local
hematoma (due to bleeding from a punctured blood vessel), pneumothorax
(punctured lung), convulsions, local infections, hepatitis B (from
unsterile needles), bacterial endocarditis, contact dermatitis,
and nerve damage. The herbs used by acupuncture practitioners
are not regulated for safety, potency, or effectiveness. There
is also risk that an acupuncturist whose approach to diagnosis
is not based on scientific concepts will fail to diagnose a dangerous
condition.
The adverse effects of acupuncture are probably related to
the nature of the practitioner's training. A survey of 1,135 Norwegian
physicians revealed 66 cases of infection, 25 cases of punctured
lung, 31 cases of increased pain, and 80 other cases with complications.
A parallel survey of 197 acupuncturists, who are more apt to see
immediate complications, yielded 132 cases of fainting, 26 cases
of increased pain, 8 cases of pneumothorax, and 45 other adverse
results [12]. However, a 5-year study involving 76 acupuncturists
at a Japanese medical facility tabulated only 64 adverse event
reports (including 16 forgotten needles and 13 cases of transient
low blood pressure) associated with 55,591 acupuncture treatments.
No serious complications were reported. The researchers concluded
that serious adverse reactions are uncommon among acupuncturists
who are medically trained [13].
In 2001, members of the British Acupuncture Council who
participated in two prospective studies reported low complication
rates and no serious complications among patients who underwent
a total of more than 66,000 treatments [14,15]. An accompany editorial
suggested that in competent hands, the likelihood of complcations
is small [16]. Since outcome data are not available, the studies
cannot compare the balance of risks vs benefit. Nor do the studies
take into account the likelihood of misdiagnosis (and failure
to seek appropriate medical care) by practitioners who use traditional
Chinese methods.
There is also financial risk. Online information suggests that the cost
per visit ranges from about $50 to $100 per treatment, with the first visit
to a practitioner costing more. Herbal products, which many practitioners
commonly prescribe, could range anywhere from a few dollars to a few hundred
dollars per month.
Questionable Standards
In 1971, an acupuncture boom occurred in the United States
because of stories about visits to China by various American dignitaries.
Entrepreneurs, both medical and nonmedical, began using flamboyant
advertising techniques to promote clinics, seminars, demonstrations,
books, correspondence courses, and do-it-yourself kits. Today
some states restrict the practice of acupuncture to physicians
or others operating under their direct supervision. In about 20
states, people who lack medical training can perform acupuncture
without medical supervision. The FDA now classifies acupuncture
needles as Class II medical devices and requires labeling for
one-time use by practitioners who are legally authorized to use
them [17]. Acupuncture is not covered under Medicare. The March
1998 issue of the
Journal of the American Chiropractic Association
carried a five-part cover story encouraging chiropractors to get
acupuncture training, which, according to one contributor, would
enable them to broaden the scope of their practice [18].
The
National Certification
Commission for Acupuncture and Oriental Medicine (NCCAOM)
has set voluntary
certification
standards
and offers separate certifications on Oriental medicine, acupuncture, Chinese herbology, and Asian bodywork therapy. In 2007, it reported that its certification programs or exams were be recognized for licensure in 40
states and the District of Columbia and that more than 20,000 practitioners are licensed in the United States [19].
(
The Acupuncture.com Web site provides information on the licensing status of each state
.) The credentials used by acupuncturists include C.A. (certified
acupuncturist), Lic. Ac. (licensed acupuncturist), M.A. (master
acupuncturist), Dip. Ac. (diplomate of acupuncture), Dipl.O.M. (diplomate of Oriental medicine), and O.M.D.
(doctor of Oriental medicine). Some of these have legal significance,
but they do not signify that the holder is competent to make adequate
diagnoses or render appropriate treatment.
In 1990, the U.S. Secretary of Education recognized what is
now called the
Accreditation Commission
for Acupuncture and Oriental Medicine (ACAOM)
as an accrediting
agency. However, such recognition is not based on the scientific
validity of what is taught but upon other criteria [20]. Ulett
has noted:
Certification of acupuncturists is a sham. While a few of
those so accredited are naive physicians, most are nonmedical
persons who only play at being doctor and use this certification
as an umbrella for a host of unproven New Age hokum treatments.
Unfortunately, a few HMOs, hospitals, and even medical schools
are succumbing to the bait and exposing patients to such bogus
treatments when they need real medical care.
The
National Council
Against Health Fraud
has concluded:
- Acupuncture is an unproven modality of treatment.
- Its theory and practice are based on primitive and fanciful
concepts of health and disease that bear no relationship to present
scientific knowledge
- Research during the past 20 years has not demonstrated that
acupuncture is effective against any disease.
- Perceived effects of acupuncture are probably due to a combination
of expectation, suggestion, counter-irritation, conditioning,
and other psychologic mechanisms.
- The use of acupuncture should be restricted to appropriate
research settings,
- Insurance companies should not be required by law to cover
acupuncture treatment,
- Licensure of lay acupuncturists should be phased out.
- Consumers who wish to try acupuncture should discuss their
situation with a knowledgeable physician who has no commercial
interest [21].
The NIH Debacle
In 1997, a Consensus Development Conference sponsored by the
National Institutes of Health and several other agencies concluded
that "there is sufficient evidence . . . of acupuncture's
value to expand its use into conventional medicine and to encourage
further studies of its physiology and clinical value." [22]
The panelists also suggested that the federal government and insurance
companies expand coverage of acupuncture so more people can have
access to it. These conclusions were not based on research done
after NCAHF's position paper was published. Rather, they reflected
the bias of the panelists who were selected by a planning committee
dominated by acupuncture proponents [23]. NCAHF board chairman
Wallace Sampson, M.D., has described the conference "a consensus
of proponents, not a consensus of valid scientific opinion."
Although the report described some serious problems, it failed
to place them into proper perspective. The panel acknowledged
that "the vast majority of papers studying acupuncture consist
of case reports, case series, or intervention studies with designs
inadequate to assess efficacy" and that "relatively
few" high-quality controlled trials have been published about
acupuncture's effects. But it reported that "the World Health
Organization has listed more than 40 [conditions] for which [acupuncture]
may be indicated." This sentence should have been followed
by a statement that the list was not valid.
Far more serious, although the consensus report touched on
Chinese acupuncture theory, it failed to point out the danger
and economic waste involved in going to practitioners who can't
make appropriate diagnoses. The report noted:
- The general theory of acupuncture is based on the premise
that there are patterns of energy flow (Qi) through the body
that are essential for health. Disruptions of this flow are believed
to be responsible for disease. The acupuncturist can correct
imbalances of flow at identifiable points close to the skin.
- Acupuncture focuses on a holistic, energy-based approach
to the patient rather than a disease-oriented diagnostic and
treatment model.
- Despite considerable efforts to understand the anatomy and
physiology of the "acupuncture points," the definition
and characterization of these points remains controversial. Even
more elusive is the scientific basis of some of the key traditional
Eastern medical concepts such as the circulation of Qi, the meridian
system, and the five phases theory, which are difficult to reconcile
with contemporary biomedical information but continue to play
an important role in the evaluation of patients and the formulation
of treatment in acupuncture.
Simply stated, this means that if you go to a practitioner
who practices traditional Chinese medicine, you are unlikely to
be properly diagnosed. Very few publications have mentioned this, which strikes me as very strange. Even
Consumer Reports
magazine has advised readers who want acupuncture treatment to consult a practitioner who is
NCCAOM-certified. I advise people to avoid "certified" practitioners. Because the training needed for certification is based on nonsensical TCM theories, the safest way to obtain acupuncture is from a medical doctor who does research at a university-based medical school and does not expouse such theories.
Diagnostic Variability
In 1998, following a lecture I attended at a local college, an experienced
TCM practitioner diagnosed me by taking my pulse and looking at
my tongue. He stated that my pulse showed signs of "stress"
and that my tongue indicated I was suffering from "congestion
of the blood." A few minutes later, he told a woman that her pulse showed premature ventricular contractions
(a disturbance of the heart's rhythm that could be harmless or
significant, depending on whether the individual has underlying
heart disease). He suggested that both of us undergo treatment
with acupuncture and herbs—which would have cost about $90
per visit. I took the woman's pulse and found that it was completely
normal. I believe that the majority of nonmedical acupuncturists
rely on improper diagnostic procedures. The NIH consensus panel
should have emphasized the seriousness of this problem.
Subsequent research has confirmed that TCM diagnosis has
very little to do with people's real health problems. At least six studies
have found that when multiple practitioners see the same patient, their TCM
diagnoses vary considerably.
In a study published in 2001, a 40-year-old woman with chronic back pain
who visited seven acupuncturists during a 2-week period was diagnosed with
"Qi stagnation" by 6 of them, "blood stagnation"
by 5 , "kidney Qi deficiency" by 2, "yin deficiency"
by 1, and "liver Qi deficiency" by 1. The proposed treatments varied
even more. Among the six who recorded their recommendations, the practitioners
planned to use between 7 and 26 needles inserted into 4 to 16 specific "acupuncture
points" in the back, leg, hand, and foot. Of 28 acupuncture points selected,
only 4 (14%) were prescribed by two or more acupuncturists. [24]. The study
appears to have been designed to make the results as consistent as possible.
All of the acupuncturists had been trained at a school of traditional Chinese
medicine (TCM). Six other volunteers were excluded because they "used
highly atypical practices,"
and three were excluded because they had been in practice for less than three
years. The study's authors stated that the diagnostic findings showed "considerable
consistency" because nearly all of the practitioners found Qi or blood
stagnation. However, the most likely explanation was that these are diagnosed
in nearly everyone.
In another study, six TCM acupuncturists evaluated the same six patients
on the same day. Twenty diagnoses and 65 acupoints were used at least once.
The diagnosis of "Qi/Blood Stagnation with Kidney Deficiency" and the acupoint
UB23 were used for every patient by most acupuncturists. However, consistency
across acupuncturists regarding diagnostic details and other acupoints was
poor. No diagnoses, and only one acupoint, were used preferentially for a
subgroup of patients. Some diagnoses and treatment recommendations were dependent
more on the practitioner than on the patient. Fine-grained diagnoses and
most acupoints were unrelated to either patient or practitioner. The researchers
concluded that TCM diagnoses and treatment recommendations for specific patients
with chronic low back pain vary widely from one practitioner to another
[25].
Another study examined TCM diagnoses and treatments
for patients with chronic low-back pain using two separate sets of treatment
records. Information from more than 150 initial visits was available for
analysis. A diagnosis of "Qi and Blood Stagnation" or "Qi Stagnation" was
made for 85% of patients. A diagnosis of kidney deficiency (or one of its
three subtypes) was made for 33%-51% of patients. Other specific diagnoses
were made for less than 20% of the patients. An average of 12-13 needles
was used in each treatment. Although more than 85 different acupoints were
used in each data set, only 5 or 6 acupoints were used in more than 20
of the treatments in each data set. Only two of those acupoints (UB23,
UB40) were the same for both sources of data. More than half of the patients
received adjunctive treatments, including heat (36%-67%), and cupping (16%-21%).
There was substantial variability in treatments among providers [26].
In a larger study published in 2004, three TCM practitioners examined the
same 39 rheumatoid arthritis (RA) patients separately at the University of
Maryland General Clinical Research Center. Each patient filled out a
questionnaire and underwent a physical examination that included tongue and
pulse diagnosis. Then each practitioner provided both a TCM diagnosis and
a herbal prescription. Agreement on TCM diagnoses among
the 3 pairs of TCM practitioners ranged from 25.6% to 33.3%. The degree to
which the herbal prescriptions agreed with textbook recommended practice
of each TCM diagnosis ranged from 87.2% to 100%. The study's authors concluded:
The total agreement on TCM diagnosis on RA patients among 3 TCM practitioners
was low. When less stringent, but theoretically justifiable, criteria were
employed, greater consensus was obtained. . . . The correspondence between
the TCM diagnosis and the herbal formula prescribed for that diagnosis
was high, although there was little agreement among the 3 practitioners
with respect to the herbal formulas prescribed for individual patients
[27].
The University of Maryland researchers then repeated the above study using
40 RA patients
and three practitioners who had had at least five years of experience. The
results were nearly identical to the previous findings [28].
In another study, 37 participants with frequent headaches were independently
evaluated by three licensed acupuncturists said to be highly trained in
TCM. The acupuncturists identified the meridians and type of dysfunction
they believed were contributing to the participants' symptoms. The acupuncturists
also ascribed one or more TCM diagnoses to each participant and selected
eight acupuncture points for needling. Some variation in TCM pattern diagnosis
and point selection was observed for all subjects. "Liver Yang" and "Qi dysfunction"
were diagnosed in more than two thirds of subjects. Acupuncture points Liver
3, Large Intestine 4, and Governing Vessel (DU) 20 were the most commonly
selected points for treatment [29].
It would be fascinating to see what would happen if a healthy person who needed no medical treatment was
examined by multiple acupuncturists.
The Bottom Line
TCM theory and practice are not based upon the body
of knowledge related to health, disease, and health care that has been
widely accepted by the scientific community.
TCM practitioners disagree
among themselves about how to diagnose patients and which treatments should
go with which diagnoses. Even if they could agree, the TCM theories
are so nebulous that no amount of scientific study will enable TCM
to offer rational care.
For Additional Information
References
- Skrabanek P. Acupuncture: Past, present, and future. In Stalker
D, Glymour C, editors. Examining Holistic Medicine. Amherst,
NY: Prometheus Books, 1985.
- Kurtz P, Alcock J, and others. Testing
psi claims in China: Visit by a CSICOP delegation. Skeptical Inquirer 12:364-375,
1988.
- Melzack R, Katz J.
Auriculotherapy
fails to relieve chronic pain: A controlled crossover stud
y. JAMA
251:10411043, 1984.
- Ter Reit G, Kleijnen J, Knipschild P.
Acupuncture
and chronic pain: A criteria-based meta-analysis
. Clinical Epidemiology 43:1191-1199,
1990.
- Ter Riet G, Kleijnen J, Knipschild P.
A
meta-analysis of studies into the effect of acupuncture on addiction
. British
Journal of General Practice 40:379-382, 1990.
- Beyerstein BL, Sampson W.
Traditional
Medicine and Pseudoscience in China: A Report of the Second CSICOP
Delegation (Part 1)
. Skeptical Inquirer 20(4):18-26, 1996.
- American Medical Association Council on Scientific Affairs.
Reports of the Council on Scientific Affairs of the American
Medical Association, 1981. Chicago, 1982, The Association.
- Ulett GA. Acupuncture update 1984. Southern Medical Journal
78:233234, 1985.
- Tang J-L, Zhan S-Y, Ernst E.
Review
of randomised controlled trials of traditional Chinese medicine
.
British Medical Journal 319:160-161, 1999.
- Streitberger K, Kleinhenz J.
Introducing
a placebo needle into acupuncture research
. Lancet 352:364-365,
1998.
- Streitberger K and others.
Acupuncture
compared to placebo-acupuncture for postoperative nausea and
vomiting prophylaxis: A randomised placebo-controlled patient
and observer blind trial.
Anesthesia 59:142-149, 2004.
- Norheim JA, Fennebe V. Adverse effects of acupuncture. Lancet
345:1576, 1995.
- Yamashita H and others. Adverse events related to acupuncture.
JAMA 280:1563-1564, 1998.
- White A and others.
Adverse
events following acupuncture: Prospective surgery of 32,000 consultations
with doctors and physiotherapists
. BMJ 323:485-486, 2001.
- MacPherson H and others.
York
acupuncture safety study: Prospective survey of 24,000 treatments
by traditional acupuncturists
. BMJ 323:486-487, 2001.
- Vincent C.
The
safety of acupuncture
. BMJ 323:467-468, 2001.
- Acupuncture
needle status changed
. FDA Talk Paper T96-21, April 1, 1996
- Wells D. Think acu-practic: Acupuncture benefits for chiropractic.
Journal of the American Chiropractic Association 35(3):10-13,
1998.
- NCCAOM 25th Anniversary Booklet
. Burtonsville, MD: NCCAOM, 2007.
- Department of Education, Office of Postsecondary Education.
Nationally Recognized Accrediting Agencies and Associations.
Criteria and Procedures for Listing by the U.S. Secretary For
Education and Current List. Washington, D.C., 1995, U.S. Department
of Education.
- Sampson W and others.
Acupuncture:
The position paper of the National Council Against Health Fraud
.
Clinical Journal of Pain 7:162-166, 1991.
- Acupuncture.
NIH Consensus Statement 15:(5), November 3-5, 1997
.
- Sampson W.
On the National Institute of Drug Abuse Consensus Conference on Acupuncture
. Scientific Review of Alternative Medicine 2(1):54-55,
1998.
- Kalauokalani D and others.
Acupuncture
for chronic low back pain: Diagnosis and treatment patterns among
acupuncturists evaluating the same patient
. Southern Medical
Journal 94:486-492, 2001.
- Hogeboom CJ and others.
Variation
in diagnosis and treatment of chronic low back pain by traditional Chinese
medicine acupuncturists
. Complementary
Therapies in Medicine 9:154-166, 2001.
- Sherman KJ and others.
The
diagnosis and treatment of patients with chronic low-back pain by traditional
Chinese medical acupuncturists
. Alternative
and Complementary Medicine 7:641-650, 2001.
- Zhang GG and others.
The
variability of TCM pattern diagnosis and herbal prescription on rheumatoid
arthritis patients
. Alternative Therapies
in Health and Medicine 10:58-63, 2004.
- Zhang GG and others.
Variability
in the traditional Chinese medicine (TCM) diagnoses and herbal prescriptions
provided by three TCM practitioners for 40 patients with rheumatoid arthritis
. Alternative Therapies in Health
and Medicine 11:415-421, 2005.
- Coetaux RR and others.
Variability
in the diagnosis and point selection for persons with frequent headache
by traditional Chinese medicine acupuncturists
. Alternative
and Complementary Medicine 12:863-872, 2006.
This article was revised on January 12, 2011.