**1. A constant board game**

This is a short chapter, with intention to be introductory for the nature and purpose of the book subject matter, as well as the significance of its contents for the readers. The field of acupuncture as a scientifically accepted therapy in the West is constantly evolving. All proponents of acupuncture are well convinced of the value of this therapy, and they are quite satisfied with the current documentation regarding its safety, efficiency, effectiveness, and cost-benefit ratio [1]. However, there are still many gaps on this knowledge, equally evidenced in the scholar literature. Very often, proponents of acupuncture have to justify all over again and again their point to the academic-scientific community, since critics are always remembering the flaws.

This duality looks like the antagonism in a board game, represented by the clash between the positive and negative aspects of the technique. In this analogy, the pieces of both sides are in a continuous struggle between the forces strengthening the validity of acupuncture and the movements reducing its legitimacy (**Figure 1**). The positive aspects include everything science recognizes and endorses objectively, added to everything the patients who use the technique feel subjectively. The negative aspects include everything acupuncture is objectively owing to science while researches do not provide all the answers, added to everything subjectively derived from prejudice and ignorance against this technique.

Following this analogy, the new pathways are represented by the strategies the proponents of acupuncture will use to strengthen their arguments and weaken the detractors' arguments, to advance beyond this standoff. This chapter will put the reader on the position of a player interested on the acupuncture advancement. The adversary is virtual, embodying all the closed minds focused only on the acupuncture frailties. To win any game, the player must know his own strengths as well as his own weaknesses. Then, the player will identify threats and opportunities on the distribution of pieces along the board. Finally, he will work to keep the maximum amount of pieces, at the same time eliminating the opponent pieces. The lines below will discourse about intriguing this game.

### **2. The pieces on our part of the board**

#### **2.1 A millenary tradition**

The longevity of acupuncture already speaks enough for itself. Acupuncture and correlated techniques have been practiced in China and other Asian countries for millennia. The generally accepted history of acupuncture in China can be

#### **Figure 1.**

*This board game is an allegory on the constant clash between the elements that sustain acupuncture (the white pieces, on the first-person player's side) and the weaknesses that destabilize acupuncture (the black pieces, on the side of the opponent).*

traced back at least 3000 years (the sources diverge, some cites 4000 years), when rudimentary stone needles were used. Besides these archeological clues, the earliest recorded mention of acupuncture is on the classic Yellow Emperor's Inner Classic, written on the second century B.C. Currently, it is routinely practiced in China, Japan, Korea, Hong Kong, and Taiwan as part of the whole healthcare system.

#### **2.2 Worldwide diffusion and acceptance**

Acupuncture arrived in Europe in the seventeenth century through the contact of Christian missionaries and European merchants with the Chinese. A resurgent interest among clinicians came only by the nineteenth century in Britain, France, and Germany, when acupuncture arrived also to North America. However, the advances of standard medicine and biological sciences have marginalized acupuncture, and this technique was almost restricted to the Eastern districts of large cities. Acupuncture has gained popularity in the media just about 40 years ago. While in China in 1971, James Reston, a famous journalist and vice president of the New York Times, had an acute appendicitis. Chinese physicians performed an emergency appendectomy, and his postoperative pain was relieved by acupuncture. Reston reported his experience in an historical article in his newspaper [2]. This fact brought great publicity to acupuncture and renewed Western interest in this form of treatment.

#### **2.3 Scientific acceptance through the front door**

Scientific publication on acupuncture grew slowly from the 1970s and quickly increased in the last few decades. Some milestones are noteworthy: the

**3**

with the WHO.

conditions [6].

*Introductory Chapter: Acupuncture - What Controversies? What Pathways?*

North American National Institutes of Health Consensus Development Panel on Acupuncture, published in 1998 [3], and the World Health Organization (WHO) Review and Analysis of Reports on Controlled Clinical Trials, in 2002 [4]. Today, an extensive bibliography supports the appropriateness of acupuncture use for many defined clinical conditions. Both efficacy and effectiveness of acupuncture have been examined through research with strong methodology. Efficacy is a concept related to mechanisms of action, mainly the effects beyond the placebo. Efficacy measures the impact of an intervention on outcome in ideal conditions, with an emphasis on controlling for placebo effects. Effectiveness is related to how something works in clinical healthcare. This real-world benefit is a measure of the overall impact of an intervention on outcome, as would be expected in routine care. Some trials attempting to address the questions of efficacy and effectiveness are designed with three arms, including true acupuncture, sham procedure, and a comparison treatment.

The integration of this strange needling therapy was facilitated with the concept of "Western Medical Acupuncture," a method of peripheral neural stimulation, adapting the Chinese tradition to the knowledge of physiology and other sciences. In such approach, the classic acupoints are selected considering the best places to stimulate the nervous system, inducing local and distant reflexes and neuromodulation. Old and new approaches need not to be mutually exclusive, since modern Western ideas can complement Eastern millennial wisdom. The Eastern thought has holistic views, nonlinear logic, and empirical observation. The Western reasoning is based on reductionist theories, linear causalities, and scientific endorsement. If

Since 1979, the WHO has proclaimed acupuncture as a clinical practice. In 1996, the North American Food and Drug Administration (FDA) reclassified the needles to a category of accepted medical instruments. In Brazil, acupuncture is officially recognized as a medical specialty since 1995. In the United Kingdom, acupuncture is used in many National Health Service general practices, as well as the majority of pain clinics and hospices. In 2010, the United Nations Educational,

Intangible Cultural Heritage of Humanity. The World Federation of Acupuncture-Moxibustion Societies is currently one of the non-state actors in official relations

A CT is a procedure used along with standard treatments, although it is not considered orthodox. On the other hand, an alternative therapy is used instead of standard treatments, which is not the best medical practice. In the last decades, acupuncture left the category of a suspect doubtful alternative therapy to become a respectable complementary therapy. Acupuncture can be offered in full compatibility with conventional treatment, because no conceptual conflict surges if they are simultaneously used. This characteristic is different from some alternative therapies, in which some paradigm conflict with conventional treatment, and even sometimes demands its abandonment. This appraisal boosts acupuncture to figure among treatment options in clinical guidelines for many

Scientific and Cultural Organization (UNESCO) decreed acupuncture as

*DOI: http://dx.doi.org/10.5772/intechopen.86382*

**2.4 East and West can learn with each other**

opposites attract themselves, this can be a perfect marriage [5].

**2.5 Multi-institutional acknowledgement of acupuncture**

**2.6 A respectable complementary therapy (CT)**

*Introductory Chapter: Acupuncture - What Controversies? What Pathways? DOI: http://dx.doi.org/10.5772/intechopen.86382*

North American National Institutes of Health Consensus Development Panel on Acupuncture, published in 1998 [3], and the World Health Organization (WHO) Review and Analysis of Reports on Controlled Clinical Trials, in 2002 [4]. Today, an extensive bibliography supports the appropriateness of acupuncture use for many defined clinical conditions. Both efficacy and effectiveness of acupuncture have been examined through research with strong methodology. Efficacy is a concept related to mechanisms of action, mainly the effects beyond the placebo. Efficacy measures the impact of an intervention on outcome in ideal conditions, with an emphasis on controlling for placebo effects. Effectiveness is related to how something works in clinical healthcare. This real-world benefit is a measure of the overall impact of an intervention on outcome, as would be expected in routine care. Some trials attempting to address the questions of efficacy and effectiveness are designed with three arms, including true acupuncture, sham procedure, and a comparison treatment.

#### **2.4 East and West can learn with each other**

*Acupuncture - Resolving Old Controversies and Pointing New Pathways*

traced back at least 3000 years (the sources diverge, some cites 4000 years), when rudimentary stone needles were used. Besides these archeological clues, the earliest recorded mention of acupuncture is on the classic Yellow Emperor's Inner Classic, written on the second century B.C. Currently, it is routinely practiced in China, Japan, Korea, Hong Kong, and Taiwan as part of the whole healthcare system.

*This board game is an allegory on the constant clash between the elements that sustain acupuncture (the white pieces, on the first-person player's side) and the weaknesses that destabilize acupuncture (the black pieces, on* 

Acupuncture arrived in Europe in the seventeenth century through the contact of Christian missionaries and European merchants with the Chinese. A resurgent interest among clinicians came only by the nineteenth century in Britain, France, and Germany, when acupuncture arrived also to North America. However, the advances of standard medicine and biological sciences have marginalized acupuncture, and this technique was almost restricted to the Eastern districts of large cities. Acupuncture has gained popularity in the media just about 40 years ago. While in China in 1971, James Reston, a famous journalist and vice president of the New York Times, had an acute appendicitis. Chinese physicians performed an emergency appendectomy, and his postoperative pain was relieved by acupuncture. Reston reported his experience in an historical article in his newspaper [2]. This fact brought great publicity to acupunc-

**2.2 Worldwide diffusion and acceptance**

ture and renewed Western interest in this form of treatment.

Scientific publication on acupuncture grew slowly from the 1970s and quickly increased in the last few decades. Some milestones are noteworthy: the

**2.3 Scientific acceptance through the front door**

**2**

**Figure 1.**

*the side of the opponent).*

The integration of this strange needling therapy was facilitated with the concept of "Western Medical Acupuncture," a method of peripheral neural stimulation, adapting the Chinese tradition to the knowledge of physiology and other sciences. In such approach, the classic acupoints are selected considering the best places to stimulate the nervous system, inducing local and distant reflexes and neuromodulation. Old and new approaches need not to be mutually exclusive, since modern Western ideas can complement Eastern millennial wisdom. The Eastern thought has holistic views, nonlinear logic, and empirical observation. The Western reasoning is based on reductionist theories, linear causalities, and scientific endorsement. If opposites attract themselves, this can be a perfect marriage [5].

#### **2.5 Multi-institutional acknowledgement of acupuncture**

Since 1979, the WHO has proclaimed acupuncture as a clinical practice. In 1996, the North American Food and Drug Administration (FDA) reclassified the needles to a category of accepted medical instruments. In Brazil, acupuncture is officially recognized as a medical specialty since 1995. In the United Kingdom, acupuncture is used in many National Health Service general practices, as well as the majority of pain clinics and hospices. In 2010, the United Nations Educational, Scientific and Cultural Organization (UNESCO) decreed acupuncture as Intangible Cultural Heritage of Humanity. The World Federation of Acupuncture-Moxibustion Societies is currently one of the non-state actors in official relations with the WHO.

#### **2.6 A respectable complementary therapy (CT)**

A CT is a procedure used along with standard treatments, although it is not considered orthodox. On the other hand, an alternative therapy is used instead of standard treatments, which is not the best medical practice. In the last decades, acupuncture left the category of a suspect doubtful alternative therapy to become a respectable complementary therapy. Acupuncture can be offered in full compatibility with conventional treatment, because no conceptual conflict surges if they are simultaneously used. This characteristic is different from some alternative therapies, in which some paradigm conflict with conventional treatment, and even sometimes demands its abandonment. This appraisal boosts acupuncture to figure among treatment options in clinical guidelines for many conditions [6].

### **2.7 An advantageous treatment in many senses**

Respecting the indications and contraindications, the combination of acupuncture with conventional resources tends to lead to more complete and long-lasting results [7]. An important factor for such acceptance is acupuncture is a relatively safe technique. Acupuncture is a minimally invasive procedure with good risk-benefit ratio. Acupuncture is suitable for almost all people (including children), with few exceptions in very specific conditions. Potential harm is generally restricted to minor adverse effects, such as pain at needling site, bruises, drowsiness, and skin irritation. Major harm is rarely reported, and most serious adverse events appear to be related to negligence, recklessness, and/or malpractice.

### **2.8** *Vox populi, vox Dei* **(the voice of the people is the voice of God)**

Despite the astonishing advancements of conventional medicine and technology in the last decades, there was also a parallel growing interest in complementary therapies among many people [8]. More and more patients express their desire to consume less medication, as they say pharmacological approach has limited results, many side effects, and high cost. The clinician really engaged on a real patientcentered care has to be updated with modern developments on acupuncture. The contemporary concept of integrative medicine is a healthcare approach that partners the patient and the clinician on a healing journey. This is done through the appropriate use of both conventional and complementary techniques. The priority of this combination is to use, whenever possible, natural and less invasive interventions, provided they are safe and worthy. Such comprehensive approach takes selectively the most beneficial effects from different disciplines; at the same time, it meets the patient's values.
