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Objective: Laser acupuncture has become increasingly attractive in clinical practice, especially for patients with needle phobias well as elderly people and children. However, literature concerning the safety of laser acupuncture has been limited. This systematic review synthesizes the current available literature on the safety of laser acupuncture. Methods: Ovid MEDLINE,® Epub Ahead of Print, In-Process & Other Non-Indexed Citations Daily, Ovid Embase, Scopus, and EBM Reviews—Cochrane Central Register of Controlled Trials databases were searched for available randomized controlled trials (RCTs) on laser acupuncture. Safety data were extracted from the included studies. Adverse events (AEs) data were extracted and assessed in terms of severity and causality. Results: Of 737 articles, 21 RCTs were included. The majority of these RCTs reported that laser acupuncture was safe, without AEs; 6 trials reported AEs (including tingling, pain flare-ups, and transient fatigue). All AEs were mild and resolved spontaneously within 24 hours. The causal relationship between AEs and laser acupuncture was felt to be “certain” in 4 studies, “probable” in 1 study, and “possible” in 1 study. AEs were collected and monitored by evaluation methods in 7 trials: 5 with AE questionnaires, 1 with a checklist, and 1 with oral reports. Conclusions: Laser acupuncture appears to be a safe therapy associated with few mild and transient AEs. However, given the heterogeneity of current studies, large, well-designed placebo-controlled RCTs with rigorous evaluation methods are needed to assess the safety of laser acupuncture more completely.

Background: Laser acupuncture (LA)-the use of nonthermal, low-intensity laser irradiation to stimulate acupuncture points-has become more common among acupuncture practitioners in recent years. LA is promoted as a safer pain-free alternative to traditional acupuncture, with minimal adverse effects and greater versatility. However, little is known about the mechanism of action of LA, laser characteristics, and effectiveness of LA therapy. Objective: This concise review of LA describes basic parameters and procedures, potential mechanisms of action, and the current evidence for its clinical efficacy. The article also highlights the need for more robust research on LA that can be translated into evidence-based clinical practices. Conclusions: LA has many features that make it an attractive option as a treatment modality, including minimal sensation; short duration of treatment; and minimal risks of infection, trauma, and bleeding complications. Future studies with high-quality methodologies, ample sample sizes, and consistent and reproducible laser parameters are critically needed to increase understanding and establish potential future clinical applications.

Background: Accumulating evidence from anatomical, physiologic, and neuroimaging research shows that Classical acupuncture points stimulate nerve trunks or their branches in the head, trunk, and extremities. The first part of this series revealed that phenomenon in the extremities. Principal meridian distributions mirror those of major peripheral nerves there and Classical acupuncture points are proximate to peripheral nerves there. These relationships were shown to be consistent with the linear neuroembryologic development of the extremities. The second part of this series revealed that, in the trunk, a neuroanatomical basis for the Principal meridians exists consistent with lateral folding in early fetal neuroembryologic development. Objective: The aim of this Part is to provide anatomical data that corroborates a neuroanatomical basis for the Principal meridians in the head and neck, which is consistent with the longitudinal and lateral folding that occurs in early fetal neuroembryologic development. Methods: Adobe Photoshop software was used to apply Classical acupuncture points and Principal meridians as layers superimposed on neuroanatomic images of the head and neck, allowing demonstration of their anatomical relationships. Results: The Principal meridian distributions in the head and region can be conceptualized as connecting branches of the cranial and/or cervical spinal nerves. Conclusions: Anatomical data support the conceptualization of acupuncture Principal meridians in the head and neck as connecting branches of the cranial and/or cervical spinal nerves and are consistent with neuroembryologic development. Overall, the acupuncture Principal meridians can be conceptualized to have a neuroanatomical substrate that is corroborated by developmental neuroembryology.

Acupuncture has been used to treat health conditions including pain for over 3000 years, yet it has only been in the last half a century that biochemistry and neural imaging advances have allowed scientific understanding of its physiological mechanisms. This treatise reviews the multiple lines of evidence that the endogenous opioid system is involved in acupuncture's pain-relieving mechanisms, and that the peripheral and central nervous systems are intimately involved in the transduction of acupuncture point stimulation via needling. Large, scientifically rigorous, controlled clinical trials of acupuncture for treating neck, lumbar, migraine, knee osteoarthritis, and other pain conditions have been performed in the last 2 decades that confirm acupuncture's clinical efficacy in treating chronic pain. Beyond its demonstrated efficacy in treating chronic pain, acupuncture's excellent safety record and cost-effectiveness compared to other interventions for chronic pain offer the potential that increased incorporation of acupuncture in managing patients with chronic pain could reduce the costs associated with their health care.

Each year, there are an estimated 12 000 individuals who sustain a spinal cord injury (SCI) in the United States. Improved understanding of the pathophysiology of SCI and its sequelae has over the past 50 years led to the development of medical treatments (especially urologic) that have enhanced short- and long-term survival from these injuries. The prevalence of individuals with SCI in this country is ~250 000 individuals; and beyond the incalculable personal consequences of these devastating neurologic injuries, substantial direct and indirect societal costs result from the sequelae of SCI including paralysis, sensory loss, chronic pain, decubiti and bladder and/or bowel incontinence. The purpose of this treatise is to review the allopathic and traditional Chinese medicine (TCM) literature available through MEDLINE, PubMed and eCAM search engines that discuss the potential uses of acupuncture to treat acute and chronic spinal cord injuries and their sequelae, and present the neurophysiologic mechanisms for acupuncture's beneficial effects. There is evidence that use of electroacupuncture in acute SCI may significantly improve long-term neurologic recovery from these injuries both in terms of motor, sensory and bowel/bladder function with essentially no risk. Acupuncture may even improve neurourologic function in individuals with chronic SCI, and help with management with chronic pain associated with these injuries.

Background: The locations of most of the 361 classical acupuncture points are determined in clinical practice by measuring their traditionally described positions using the cun system. Some data suggest the routinely taught methods of cun measurement may lead to inaccurate acupoint localizations. Objectives: To determine the accuracy of the traditional cun measuring techniques in localizing acupoints LU 4 and TE 8 compared with tape measure determination of their optimal locations, and to assess if the ability to accurately localize these points correlates with the length of acupuncture experience. Design, Setting, and Participants: Nonrandomized, experimental study conducted with 20 physician-acupuncturists on 2 adult volunteers at a medical acupuncture conference in Fall 2009. Eleven acupuncturists independently marked the location of LU 4, and 9 acupuncturists marked the location of TE 8 by traditional cun measuring techniques on the 2 volunteers, utilizing a novel point-marking method that bl...

Background: Acupuncture methodology has evolved over millennia with the introduction of new technologies. Modern laser “needle” systems can transmit light energy deep enough through the skin to influence channel acupoints and trigger points. Objectives: To compare whether musculoskeletal pain treatment outcomes with acupuncture are clinically equivalent whether using laser or traditional metal needles; and to determine statistical power estimates of cohort size for future double-blinded studies. Design: Prospective nonblinded cohort study using neuroanatomically based point selection in a crossover protocol alternating between laser and metal needles. Setting: Outpatient clinic at Mayo Clinic Florida in Jacksonville, FL. Participants: Thirty adults with degenerative joint or spine pain whose pain did not respond to allopathic interventions and were receiving metal needle acupuncture. Intervention: Laser stimulation at prescribed neuroanatomically based acupoints was alternated at successive treat...

Background: Conceptually, acupuncture Principal Meridians course through the myofascial layer of the body and send branches to one another and the organs they influence. Recent literature has described the concept of “myofascial meridians” as anatomical pathways that transmit strain and movement through the body's muscle and fascia. Objective: To qualitatively explore the relationship of acupuncture Principal Meridians to myofascial meridians that have been identified by analysis of human anatomy. Design and Setting: The 12 acupuncture Principal Meridians were qualitatively compared by visual estimation (using computer software with human figure outlines) with the 9 myofascial meridians to determine whether any correlations existed in their described distributions. Main Outcome Measure: Overlap of Principal Meridians and myofascial meridians on the simulated human anatomical model. Results: In 8 (89%) of 9 comparisons, there was substantial overlap in the distributions of the anatomically derived...

Background: Urinary incontinence related to thoracolumbar upper motor neuron spinal cord injuries has been reported to have poor long-term prognosis for recovery. There is limited research on the use of acupuncture for this condition. Objective: To describe acupuncture therapy for urinary incontinence due to spinal cord injury. Design, Setting, and Patients: Two men (63 and 84 years) presented with incontinence following back injury or chronic back pain. Both men had received pharmacological agents and surgical intervention, with minimal improvement. Intervention: For patient 1, electroacupuncture at GB 25 (negative) to the crossed handles of BL 23 and BL 52 (positive), bilaterally, for 15 minutes, followed by Kidney-Bladder distinct meridian input focused to the crossed handles of BL 31 and BL 34, bilaterally, for another 15 minutes. BL 31 and BL 34 as well as GV 1 were also stimulated. For patient 2, an approach identical to that of patient 1 was performed bilaterally for 15 minutes. Percutaneo...

Three basic classes of acupuncture points are described: the 361 classical (“channel”) acupoints, extra (extraordinary) points that are almost always off-channel, and Ah Shi local tender points. The classical acupuncture points are the oldest and most clinically important points. Their locations, as well as those of the extra points, have traditionally been described and taught using the Chinese “cun” measurement system, 1 cun being defined as the width of the interphalangeal joint of the thumb. Recent research demonstrates that the use of the traditional cun method to find acupuncture points is inaccurate and may lead acupuncturists to needle sites that are as far as 2 cm away from these points' actual (true) locations. Although acupuncture clinical trials in the past 2 decades have demonstrated improved reporting of the acupuncture points selected, needling techniques, and modes of needle stimulation, their methodologies do not address a fundamental issue raised by these point location studies:...

To the Editor:The review by Simons and Dommerholt ([1]) that discussed my 2006 study ([2]) makes several comments that either do not accurately reflect my paper's contents or are unsupported.The re...

1 Department of Neurology, Mayo Clinic San Pablo Road South, Jacksonville Florida 32224, USA 2 Department of Physical Medicine and Rehabilitation, Mayo Clinic, San Pablo Road South, Jacksonville, Florida 32224 USA 3 Department of Cardiology, Mayo Clinic 4500 San Pablo Road South, Jacksonville Florida 32224, USA 4 Department of Pathology, Mayo Clinic 200 First Street SW, Rochester, Minnesota 55905, USA

Peter T. Dorsher, MS, MD, provides an interesting commentary on the findings of a study by Tan and colleagues that was highlighted in the December issue of the Archives as displaying potential deficiencies in a number of sham acupuncture devices. Dr. Dorsher's comments, while focused on acupuncture, are interesting in their own right. However, a little thought shows that his insights into the nature of an adequate placebo provide an improved understanding of the issues involved in the design and validation of control interventions in general.

The use of surgically implanted electronic devices for vagus nerve stimulation (VNS) is expanding in contemporary allopathic medical practice as a treatment option for selected clinical conditions, such as epilepsy, depression, tremor, and pain conditions, that are unresponsive to standard pharmacologic interventions. Although VNS device surgeries are considered minimally invasive, they are costly and have surgical and device-related risks; they can also cause serious adverse effects from excessive vagus nerve stimulation.For millennia, acupuncturists have treated those same clinical conditions by piquering acupoints that are located proximate to the sternocleidomastoid muscle site where the VNS device is implanted on the vagus nerve. The hypothesis of this study is that these acupuncture points produce clinical benefits through stimulation of the vagus nerve and/or its branches in the head and neck region.By using reference anatomic and acupuncture texts, classical and extraordinary acupoints in the head and neck region were identified that are anatomically proximate to vagus nerve pathways there, where the VNS electrode is surgically implanted. The clinical indications of these acupuncture points, as described in the acupuncture reference texts, were examined for similarities to those of VNS.This analysis demonstrated marked correspondences of the indications for those lateral head and neck acupoints to the clinical effects (beneficial and adverse) documented for the VNS device in the medical literature. This clinical correspondence, in conjunction with the anatomic proximity of the acupoints to the vagus nerve in the lateral neck, strongly suggests that vagus nerve (and hence the autonomic nervous system) stimulation is fundamental in producing the clinical effects of the acupoints.By having anatomic access to the vagus nerve and parasympathetic chain that permits electrical stimulation of those nerves in clinical practice, acupuncture may offer a less costly and safer alternative to implanted VNS devices for treating medically refractory epilepsy, tremor, depression, and pain conditions.

Congenital anomalies such as meningomyelocele and diseases/damage of the central, peripheral, or autonomic nervous systems may produce neurogenic bladder dysfunction, which untreated can result in progressive renal damage, adverse physical effects including decubiti and urinary tract infections, and psychological and social sequelae related to urinary incontinence. A comprehensive bladder-retraining program that incorporates appropriate education, training, medication, and surgical interventions can mitigate the adverse consequences of neurogenic bladder dysfunction and improve both quantity and quality of life. The goals of bladder retraining for neurogenic bladder dysfunction are prevention of urinary incontinence, urinary tract infections, detrusor overdistension, and progressive upper urinary tract damage due to chronic, excessive detrusor pressures. Understanding the physiology and pathophysiology of micturition is essential to select appropriate pharmacologic and surgical interventions to achieve these goals. Future perspectives on potential pharmacological, surgical, and regenerative medicine options for treating neurogenic bladder dysfunction are also presented.

Though separated by different millennia, languages, levels of scientific advancement, and views of human physiology, both prehistoric and modern cultures have expressed concepts of evaluating and treating human illness that have remarkable overlap with those of Traditional Chinese Medicine (TCM). These similarities suggest these healing traditions likely are expressing a common, fundamental aspect of human anatomy and/or physiology. Prehistoric, ancient Egyptian, TCM, Mayan, myofascial pain, and myofascial meridian concepts of health and healing are discussed. Anatomical, clinical, and physiologic evidence is presented that suggests neuroanatomy is likely the common thread that unites these ancient and modern healing concepts. These findings should lead to an increased understanding of the anatomical and physiologic substrates of the beneficial clinical effects of acupuncture in treating pain and visceral disorders. This, in turn, should lead to novel, safer treatment techniques that combine modern technologies with ancient clinical acumen.

For millennia, traditional Chinese medicine (TCM) practitioners have treated cancer with Chinese medicinal herbs (CMHs), which continue to be used in combination with conventional chemotherapy and radiotherapy in contemporary oncologic care in Asia. Recent advances in biochemistry and immunology have allowed discovery of the biologically active components of CMH and the mechanisms of their anti-cancer activities. This chapter provides an overview of CMH use in treating cancer, including discussion of the anti-cancer mechanisms for individual herbs that are commonly used to treat cancer in contemporary TCM practice. Most CMH cancer research studies have involved in vitro and in vivo animal studies, with a relative paucity of well designed, placebo-controlled human clinical trials. Despite this, there is evidence that CMH may mitigate immunosuppression from conventional chemotherapy and radiotherapy, reduce side effects from those treatments, and improve cancer patients’ overall clinical status. Chinese medicinal herbs may produce tumour apoptosis, reduce metastases, and increase survival, either alone or in combination with conventional chemotherapy. Some CMHs interfere with conventional chemotherapy when administered simultaneously, yet enhance conventional chemotherapy efficacy when administered sequentially. Further controlled clinical trials of CMH with/without conventional chemotherapy and radiotherapy in cancer patients are needed to determine which herbs (and herb combinations) to use and the optimal timing of their administration to optimize cancer patients’ survival, reduce tumour burden, enhance immunologic function and improve quality of life while minimizing the side effects (e.g. nausea/vomiting, anorexia and fatigue) of conventional radiotherapy or chemotherapy.

Acupuncture involves treating illness by inserting needles at specified body locations (acupoints). The Principal meridians are pathways that join acupoints with related physiologic effects. Despite nearly 5000 years of continuous clinical study, an accepted anatomic or physiologic basis for acupuncture's clinical effects has remained elusive. Some acupoints overlie peripheral nerves, and fMRI studies demonstrate that acupoints have specific effects on central nervous system processing. Traditional Chinese Medicine (TCM) founders described the body's viscera based on anatomic dissections yet not a discrete nervous system. By applying computer graphics and virtual human imaging techniques to human developmental neuroanatomy, this paradox may potentially be explained: acupuncture Principal meridians likely are TCM's representation of the nervous system. This neuroanatomic model of the Principal meridians is consistent with acupuncture's known neurophysiologic effects, and may allow 5 millennia of accumulated TCM observations regarding human health and illness to be understood in modern anatomic and physiologic terms.

The Consolidated Standards of Reporting Trials (CONSORT) guidelines were developed in 1996 by researchers and journal editors to improve the quality of reporting of biomedical research by providing a standardized format for researchers to present information on randomized controlled clinical trials (RCTs). This improved data reporting allows readers to independently assess the quality and conclusions of these studies, and has been widely incorporated in contemporary research reports. In 2001, a supplemental set of criteria that specifically address the reporting of design and implementation issues for RCTs involving the use of acupuncture was introduced, termed the STRICTA (Standards for Reporting Interventions in Controlled Trials of Acupuncture) recommendations.The CONSORT guidelines are stated to be part of a broader effort to improve the quality of research, as they can be used by researchers to optimize the design of future trials. Similarly, the STRICTA recommendations outline research reporting standards that are and should be considered when designing controlled clinical trials that involve the use of acupuncture. The CONSORT and STRICTA recommendations thus not only serve to improve research reporting, but also serve to provide guidance for optimizing the designs of future clinical trials.This paper presents a review of the STRICTA recommendations for reporting the results of controlled trials utilizing acupuncture, discusses their potential limitations, and offers suggestions for additions/enhancements to those standards based on research issued subsequent to the issuance of the STRICTA recommendations in 2001.

Background: The immediate onset of severe postoperativepain,especiallypainradiatingdistantfromtheincision site, is uncommon after dermatologic surgery. Observation: A 37-year-old woman undergoing excision of a nevus from the left side of her midback had an exquisitelytenderspotalongtheincisionlines.Thistender spot was hard to anesthetize and was clinically visible, after excision of the nevus, as a fibrous bundle in the subcutaneous plane. She presented in the immediate postoperative period with referred (distant) pain extending down the ipsilateral arm that was caused by a thoracic subcutaneous trigger point. Conclusion: Surgeons and pain management specialists shouldbeawareofthispotentialcauseofimmediatepostoperative pain to prevent unnecessary medical or surgical interventions in the postoperative period.

Fibromyalgia is believed to affect at least 2% of the population. Despite advances in the scientific understanding of the derangements of central and peripheral pain processing mechanisms in fibromyalgia, no current models of its pathophysiology account for the other clinical conditions associated with it such as fatigue, migraine headache, irritable bowel syndrome, and sleep cycle abnormalities. A neuroendocrinologic model of fibromyalgia is presented that accommodates both its known central and peripheral pain mechanisms as well as the myriad of hormonal, visceral, and psychological symptoms associated with that disorder. This model also provides a unifying pathophysiologic basis of fibromyalgia and chronic muscle pain, and offers the potential for developing new avenues of research and treatment for these enigmatic, frequently disabling medical conditions.

A 1977 study by Melzack et al. reported 100% anatomic and 71% clinical pain correspondences of myofascial trigger points and classical acupuncture points in the treatment of pain disorders. A reanalysis of this study's data using different acupuncture resources by Birch a quarter century later concluded that correlating trigger points to classical acupuncture points was not conceptually possible and that the only class of acupuncture points that could were the a shi points. Moreover, Birch concluded that no more than 40% of the acupuncture points examined by Melzack et al. correlated clinically for the treatment of pain (correlation was more like 18%-19%).To examine Birch's claims that myofascial trigger points cannot conceptually be compared to classical acupuncture points and that most (at least 60%) of the classical acupuncture points examined by the study of Melzack et al. are not recommended for treating pain conditions, negating their findings of a 71% clinical pain correspondence of trigger points and acupuncture points.Acupuncture references and literature were reviewed to examine the validity of the Birch study findings.Acupuncture references support the conceptual comparison of trigger points to classical acupuncture points in the treatment of pain disorders, and their clinical correspondence in this regard is likely 95% or higher.Although separated by 2000 years temporally, the acupuncture and myofascial pain traditions have fundamental clinical similarities in the treatment of pain disorders. Myofascial pain data and research may help elucidate the mechanisms of acupuncture's effects.

Pain pressure threshold (PPT) measurement by handheld algometer has been validated as a tool to identify and quantitate myofascial pain sites in an individual. The average of 3 readings at a given muscle site is used, so the standard error of measurement of these devices must be considered when determining whether PPT differences between muscle sites represent true changes. This commentary discusses this issue.

SINCE 2000, THERE HAS BEEN increasing difficulties for all physicians with declining reimbursement for services, compounded by increasing overhead, in no small part due to increasing costs to comply with documentation and privacy regulations. Despite the compelling evidence of acupuncture’s efficacy produced since the 1997 NIH Consensus Conference on Acupuncture for conditions including neck pain,1 low back pain,2 migraines,3,4 and osteoarthritis,5 there are still few insurers (including Medicare) that offer acupuncture benefits to their insured. With the rapidly increasing health insurance premiums and deductibles that individuals and families must bear, compounded by increases in energy and food costs, fewer patients are able or willing to pay out-of-pocket for complementary therapies. To compound matters, if an individual wishes to pursue acupuncture for a health condition, then how does he/she choose a practitioner? There are a variety of different types of acupuncture styles that promote theirs as “the best” including, among others (alphabetically), Auricular acupuncturists, Five Element acupuncturists, French Energetic acupuncturists, Korean Hand acupuncturists, Medical acupuncturists, Traditional Chinese Medicine acupuncturists, and Yamamoto Scalp acupuncturists. Though none of these acupuncture techniques can provide evidence that its interventions are safer or clinically more efficacious, some acupuncture subspecialists continue to attempt to claim, via professional organizations and legislative avenues, that their practitioners are the only ones appropriately trained to provide acupuncture services. Some acupuncturists have even used these avenues to pursue physical therapists who have been given state board permission in Maryland and Colorado to perform local trigger point releases with acupuncture needles (dry needling) after sanctioned training, suggesting that the physical therapists’ use of acupuncture needles to deactivate trigger points constitutes performing acupuncture services.6 With no ability or even attempt to demonstrate that one form or another of acupuncture has primacy in patient care, the attempts of any acupuncturists to claim theirs is the only “true” acupuncture is not only unsupportable but ethically, fails to promote patient welfare and the advancement of acupuncture. The ultimate goal of those practitioners then appears to be mostly to protect professional “turf.” That a vocal minority of acupuncturists cling to this untenable position is evidenced in a recent editorial by Birch,7 which evidences a myopic and misinformed view that medical doctors should be satisfied to be relegated to “trigger point acupuncture” and that no one should try to advance the modern scientific understanding of acupuncture’s effects. I believe like-minded licensed acupuncturists are likely a rather small minority (however vocal and determined they might be), and that the vast majority of licensed acupuncturists are personally and professionally secure and not threatened by the concept of medical doctors performing acupuncture. It is ironic that acupuncturists from the cradle of TCM in China are actively collaborating with Medical Acupuncture to foster acupuncture science and practice,8 and that acupuncture researchers from the China Academy of Chinese Medical Sciences in Beijing have been open and welcoming to medical doctors’ work in expanding the scientific understanding of acupuncture and its mechanisms,9 while some academic acupuncture researchers from the United States and Europe (such as Birch) seem to dismiss medical acupuncturists. I believe that the best way for medical acupuncturists to further their position in both the acupuncture and allopathic medicine community must come from 2 fronts, namely research and communication. Some of the best clinical evidence of acupuncture’s beneficial effects has been provided through rigorously designed research studies by physician acupuncturists in Europe and the United States. More highquality research is needed from medical acupuncturists both