Most Nucleus readers will have come across acupuncture. Perhaps a consultant anaesthetist was using it occasionally in a pain clinic you sat in on, and there did not appear to be any obvious 'spiritual' activity going on. Perhaps you've seen the charts of meridians in a local 'health' shop, alongside all sorts of weird and wonderful New Age alternative therapies and there did not appear to be any helpful 'medical' aspect then. Perhaps you've already had acupuncture treatment yourself, and some of your Christian friends have said you thereby came under occult influence, while other Christian friends wanted the details of your therapist and wondered 'Would acupuncture do anything for me?'

This article assesses acupuncture from both Christian and scientific medical perspectives. Whilst working as a GP in the 1980s I sat on CMF's Medical Study Group as it investigated the whole phenomenon of alternative medicine, considering the key concepts in general and then certain therapies in particular. Acupuncture was one of those we studied in detail and my views were largely formed then.

What is acupuncture?

It is a traditional form of Chinese medicine which involves stimulating the skin at strategic places, called acupuncture points, to produce therapeutic benefits. Usually this stimulation is done using fine needles which ought to be sterile and used once only, but variations on a theme include:

• acupressure - the use of blunt pressure, without puncture, over the same points
• laser acupuncture - use of lasers on the same points
• electroacupuncture - using electric current
• moxibustion - various substances are burnt on the skin at the acupuncture points

Where did acupuncture originate?

The treatment has probably been used in China since around 1600 BC but the term 'acupuncture' is European, the idea having been brought to Europe from Nagasaki by Willem ten Rhyne in 1683.1 During the Ching dynasty (AD 1644-1911) acupuncture fell out of favour in China but has become more widely used there since the Communist revolution and it is of course very popular now in the West.

What explanations are there for how acupuncture might work?

Because of this Chinese origin the first explanation for acupuncture came out of Chinese culture and belief. They held (and many in China and elsewhere still do) that there are two opposing life forces (Yin and Yang) which circulate in special channels (meridians) throughout the body. Disease is caused by an imbalance of these forces and can be rectified by regulating the flow of energy in these meridians. This can be achieved by stimulating acupuncture points located along these meridians.

This general philosophy lives on in today's 'traditional Chinese medicine' and acupuncture is a major part of this concept. Professor Edzard Ernst, head of the department of complementary medicine at the University of Exeter, and a man who has gained widespread respect in both the orthodox and alternative communities for applying to alternative medicine the same rigorous criteria demanded in orthodox medicine, comments:2 'Neither the meridians nor the acupuncture points have ever been shown to exist in an anatomical sense, nor has the existence of Yin and Yang been demonstrated convincingly. For these and other reasons, critics tend to reject traditional acupuncture.'

However, given that there is some objective evidence of limited benefit (see below), conventional Western medical thinking has some suggestions of 'scientific' mechanisms that might be involved:

1. Counter-irritant action

This is an obvious if over-simplistic suggestion. Mothers worldwide know that 'rubbing it better' helps their child's bruised knee, and the many rubefacients on the market work by 'taking your mind off' the pain underneath the area being stimulated. (It may be of course that the touch alone has some therapeutic benefit.) However, this concept would not explain how needling the knee can relieve period pains, if indeed it can. Two more recent concepts are:

2. 'Gate theory'

In 1965 Melzack and Wall proposed a new theory for pain mechanisms, whereby only certain nerve signals could get in and out of the 'gate' into consciousness at any one time. On this electrophysiological model, acupuncture may exert its analgesic effect partly through the selective excitation of efferent pain inhibitory pathways. This poorly understood but probably respectable concept might allow a scientific explanation of how a needle in one area of the body could affect another part of the body.

3. Endorphins

These central nervous system chemical transmitters might provide another explanation for the analgesic effect of acupuncture as there is experimental evidence that endorphins (in the cerebrospinal fluid) and enkephalins (in the serum) are released in response to acupuncture. Naloxone, a drug which reverses the effect of exogenous opiates (which themselves work on endorphin receptors) can in most instances reverse the analgesic effects of acupuncture. This perhaps adds further weight to the suggestion that acupuncture may work through endorphins.

Whatever the explanation, today, the two schools of 'traditional Chinese' acupuncture and 'Western' acupuncture exist in our culture side by side. The former is typically practised by non-medically trained practitioners, the latter by qualified physicians. In the private sector a typical session would cost between £20 and £50, but one session is rarely enough. Most therapists would recommend six to twelve sessions, and to repeat treatments at regular intervals.

What evidence is there that acupuncture works?

In the helpful general review quoted earlier,2 Professor Ernst summarised the results of the 200 or so controlled clinical trials of acupuncture which had sought to determine whether or not it was more effective than other treatments, including 'sham' acupuncture (which has usually meant sticking needles into non-acupuncture points). After a 'systematic review' evaluation of all the available data he has concluded that acupuncture is of proven benefit for:

• nausea and vomiting
• dental pain
• low back pain when not caused by a specific disease.

The same review approach suggests strongly that acupuncture is no more effective than sham acupuncture for:

• losing weight
• stopping smoking

He lists many conditions 'for which trial data are available, and where the evidence is neither convincingly positive nor negative. This can be because results are conflicting, or the trials are of poor quality'. These conditions are:

• osteoarthrosis
• inflammatory rheumatic diseases such as rheumatoid arthritis
• stroke
• drug addictions
• asthma
• neck pain
• tinnitus

Claims are made about many other conditions but Professor Ernst refuses to rule on these in the absence of evidence. He concludes 'the bottom line is that acupuncture seems to be more than 'just a placebo' for some conditions, but it is clearly not a 'cure-all''.

Has acupuncture got harmful physical side-effects?

The answer is 'yes'. The most frequently reported adverse effects are bruising and pain felt during the needling, and (interestingly) fainting and drowsiness directly after an acupuncture session .[2]

The use of non-sterile needles may cause infections. One overview documents 126 cases of hepatitis,[3] and three cases of HIV infection have been suggested though causality has not been established beyond reasonable doubt.[4,5] A British Medical Journal leading article[6] details one case of subacute bacterial endocarditis due to infection with Propionibacterium acnes apparently via ear acupuncture, similar infections with Pseudomonas aeruginosa and Staphylococcus aureus, three cases (one fatal) of staphylococcal septicaemia, and one of bilateral psoas abscesses due to Staphylococcus aureus.

The inevitable tissue trauma can also cause complications. At least 65 cases of pneumothorax have been reported, [3] as have several cases of cardiac tamponade, one fatal.[7] Other serious complications range from retained needles to injury of the spinal cord and peripheral nerves.[2] Probably many complications go unreported, but difficulties with quantification also mean that we do not know accurately the incidence of problems, as nobody knows how many acupuncture treatments are performed.

With sterile needles and some understanding of the underlying anatomy (!), acupuncture could and should be a relatively safe treatment, in terms of physical harms.

What about spiritual harm?

All the above constitutes a pretty mainstream, orthodox, textbook outline of acupuncture, but as Christians we are also concerned about possible spiritual harm. By associating in whatever way, however remote, with a therapy perhaps permeated by non-Christian or even anti-Christian ideology, are patients not at risk of spiritual harm?

To help us think through the spiritual aspects of acupuncture I refer to a checklist I have set out elsewhere.[9] It can be applied to the assessment of any alternative therapy, and seeks overall to answer, in both Christian and medical terms, the question: 'What is the truth here?' I venture to suggest this is the most important question we can ask about any subject! There are six specific questions in the checklist and I will apply each in turn.

A Christian checklist

1. Do the claims made for it fit the facts?

The 'traditional Chinese medicine' approach has seen acupuncture as a 'cure-all'. Within that context, claims about longevity and positive enhancement of health are made, for which there is no supportive evidence. Within the 'Western medical' context there is limited evidence of some objective benefit so that acupuncture may have a genuinely useful role to play, for example in the nausea and vomiting associated with pregnancy or with chemotherapy, or in non-specific low back pain.

Conclusion: acupuncture sometimes has objective benefit.

2. Is there a rational scientific basis to the therapy?

Some suggestions have been outlined above. We must acknowledge that our understanding is currently limited, but there do seem to be some possible rational scientific explanations for the occasional benefits of acupuncture.

Conclusion: acupuncture can be understood within a worldview we hold to be true. It is not necessary to seek 'occult' explanations.

3. Is it the methodology or is it the principle which is the effective element?

When CMF's Medical Study Group investigated acupuncture in the mid-1980s, we quizzed Dr Felix Mann, then Britain's best known practitioner and the person chiefly responsible for introducing acupuncture into clinical practice in the UK. He denied holding a religious faith himself, and he put no weight on the claims of Yin-Yang theories. Dr Mann believes the ancients stumbled upon something that worked empirically, needed (as human beings always do) an explanation for this, and therefore expressed their understanding in the terms of their own cultural beliefs. He sees the methodology as having limited but definite benefit (and he was refreshingly sceptical about how close you have to get the needle to the 'acupuncture points') and sees no need to invoke any mystical or spiritual explanations. I found his healthy common sense convincing.

Conclusion: the methodology works, sometimes. We do not need to invoke spiritual principles.

4. What are the assumptions of the world view behind the therapy?

The response to these checklist questions gets a bit monotonous when applied to acupuncture! The questions are merely diagnostic tools seeking to explore from slightly different angles the truth claims for a particular therapy. As has been emphasised above, we can accept acupuncture within a scientific Western world view which we hold to be truthful as far as it goes.

Conclusion: acupuncture can be understood without invoking non-Christian world views.

5. Does the therapy involve the occult?

I should by now have made clear that the therapy itself need not involve the occult, but let me now emphasise the most important warning in this article: while the therapy might not involve the occult, the therapist might! As with most if not all alternative practices the question is not so much about the nature of the therapy, but about the nature of the therapist. Who is this person I am about to place myself under?

In all therapeutic relationships, there is a power imbalance and the patient, the client, the counsellee, is potentially submitting to a lot when they place themselves 'under' the therapist. I am therefore in general more concerned about the acupuncturist in question than about the acupuncture. Let me give you an example.

As General Secretary of CMF, I spoke once on the phone to a lay Christian, an ordinary person without any training or expertise in health matters. He told me how he had visited an acupuncturist in his village, and after half a dozen treatments he had indeed achieved relief of the chronic painful condition he'd first gone with. He put this down to the therapy (though I must say I wondered if the condition had got better anyway over the two month period in question!). But what he went on to say was concerning. He told me that while the acupuncturist was twiddling the needles he was always muttering something inaudible under his breath, in what sounded like an incantation. He noticed too that progressively over that two month period his own spiritual life had begun to dry up. He found it hard to pray, he lost interest in going to church, he lost some of his love for the Lord. Eventually he came to realise that perhaps he'd come under some harmful spiritual influence from the acupuncturist. Simple repentance and prayer was immediately completely effective in restoring his spiritual life.

I have heard a few other anecdotes like that. I don't necessarily believe every element, but I take them seriously.

Conclusion: acupuncture need not involve the occult, but the acupuncturist might!

6. Has the therapy stood the test of time?

This question is generally weaker in its diagnostic power, but applied to acupuncture, three and a half thousand years may suggest acupuncture has got some point!

Conclusion: probably!

Summary

There is evidence that acupuncture works for a few painful conditions and there are suggestions for a rational scientific basis such that no belief need be placed in Eastern religion. I do not believe acupuncture necessarily involves the occult at all, though as in all alternative treatments I advise great caution about the therapist. I believe that performed for a proper indication by a reliable practitioner (preferably medically qualified) acupuncture can be acceptable. I suggest traditionalists using it in other situations and for other indications should be avoided as of course should anything that might be occult.

I know from much experience of discussing acupuncture that this conclusion will be controversial for some. Finally, and as a token contribution to that bigger debate, I would add that I never advise anyone to go against their conscience. Paul's discussion of conscience and meat offered to idols in 1 Corinthians 10: 14-33 may be relevant here. If you have any doubts or qualms at all, don't go for acupuncture. You probably won't miss much.