Given the Western, biomedical model, acupuncture is difficult to comprehend. There is, however, an intriguing and growing body of research on this technique. In one study involving stimulation of an acupuncture point located on the lateral aspect of the foot that corresponds to the visual cortex, magnetic resonance imaging detected activity of the visual cortex of the brain equivalent to the activity seen when a light is shone in the eye. No activity was seen when an acupuncture needle was placed 1 cm away from the designated acupuncture point (15). Many of the CAM approaches that claim to have an effect and yet seem to be inconsistent with the biomedical model deserve further investigation.
A 1997 National Institutes of Health Consensus Panel established that there was convincing evidence for the use of acupuncture in the treatment of postoperative dental pain as well as nausea and vomiting (16). Other indications that were considered promising and worthy of more research included headache, low-back pain, stroke, addiction, asthma, premenstrual syndrome, osteoarthritis, carpal tunnel syndrome, and tennis elbow. There is an extensive body of animal research supporting the neurophysiologic effects of acupuncture on the endorphin system.
Bruising and minor bleeding are the most common complications of acupuncture and occur in about 2% of all needles placed (17). They rarely require treatment other than local pressure to the needle site. The most significant risk of acupuncture is infection, and cases of hepatitis have been documented when needles were reused. The risk of transmissible infection is eliminated by onetime use of disposable needles, which is now standard practice in the United States. Pneumothorax is the second most significant risk of acupuncture. The needles used are 32 gauge or smaller; therefore, a chest tube usually is not required for treatment.
Currently there is no national licensure for acupuncture. Educational requirements for state licensure for acupuncture vary. Forty states either license or register acupuncturists as doctors of oriental medicine or acupuncture physicians. About two-thirds of these states grant licenses. To get licensed in most states, the practitioner must provide proof that he or she has attended and graduated from an accredited school or from a school that is in the process of being accredited by the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM) (18). These schools provide 3-or 4-year training programs in oriental medicine. The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) administers a standardized examination to test entry-level capabilities in acupuncture that consists of a comprehensive written examination, point location examination, and demonstration of clean needle technique (11). An acupuncturist must pass this examination and meet continuing education requirements every 4 years to retain certification and licensure. In the US, many states adopted this examination as the basis for licensure. Medical doctors can practice acupuncture. Physician acupuncture practitioners may not be as fully trained in the art as nonphysician licensed acupuncturists. To be certified by the American Board of Medical Acupuncture, physicians must take a minimum of 300 hours in training (19).
Homeopathy Homeopathic medicine is a CAM alternative medical system based on the work of the German physician and chemist Samuel Hahnemann approximately 200 years ago. In homeopathic medicine, there is a belief in “the law of infinitesimals” and that “like cures like.” Small, highly diluted quantities of medicinal substances are given to cure symptoms when the same substances given at higher or more concentrated doses would actually cause those symptoms.