Acupuncture (PDQ®)–Health Professional Version

This cancer information summary provides an overview of the use of acupuncture as a treatment for individuals with cancer or cancer-related disorders. The summary includes a brief history of acupuncture practice, a review of laboratory and animal studies, the results of clinical observations and trials, and possible side effects of acupuncture therapy. Information presented in some sections of the summary can also be found in tables located at the end of those sections.

This summary contains the following key information:

Many of the medical and scientific terms used in this summary are hypertext linked (at first use in each section) to the NCI Dictionary of Cancer Terms, which is oriented toward nonexperts. When a linked term is clicked, a definition will appear in a separate window.

Reference citations in some PDQ cancer information summaries may include links to external websites that are operated by individuals or organizations for the purpose of marketing or advocating the use of specific treatments or products. These reference citations are included for informational purposes only. Their inclusion should not be viewed as an endorsement of the content of the websites, or of any treatment or product, by the PDQ Integrative, Alternative, and Complementary Therapies Editorial Board or the National Cancer Institute.

Acupuncture, a complementary therapy used in symptom management,[1-4] is used clinically to manage cancer-related symptoms, treat side effects induced by anticancer therapies, boost blood cell count, and enhance lymphocyte and natural killer (NK) cell activity. In cancer treatment, its primary use is symptom management; commonly treated symptoms are cancer pain,[4,5] chemotherapy-induced nausea and vomiting (N/V),[6,7] and other symptoms that affect a patient’s quality of life, including weight loss, anxiety, depression, insomnia, poor appetite, fatigue, xerostomia, hot flashes, chemotherapy-induced peripheral neuropathy, gastrointestinal symptoms (constipation and diarrhea), and postoperative ileus.[8-10] Acupuncture is acceptable and safe for children.[11,12] See Pediatric Population and Acupuncture for more information.

Cancer patients are receptive to receiving acupuncture for symptom control. A 2018 cross-sectional study of breast cancer survivors showed that an equal percentage of patients preferred acupuncture versus medication for pain management.[13] A similar study in 2020 showed that fear of analgesic side effects is significantly associated with preference for acupuncture.[14] On the other hand, the most common barriers to using acupuncture for these patients were lack of knowledge about acupuncture, concerns about lack of insurance coverage, cost, and difficulty finding qualified acupuncturists. For acupuncture to become part of the standard of care for cancer patients, further education about acupuncture, improved insurance coverage, and accessibility to qualified acupuncturists are needed.[15]

More than 40 states and the District of Columbia have laws regulating acupuncture practice. The National Certification Commission for Acupuncture and Oriental Medicine offers national certification examinations for practitioners of acupuncture and traditional Chinese medicine (TCM) (www.nccaom.org); most, but not all, states require this certification. More than 50 schools and colleges of acupuncture and Oriental medicine operate in the United States, many of which offer master’s-level programs and are accredited by or have been granted candidacy status by the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM). ACAOM standards for a master's-level degree require a 3-year program (approximately 2,000 hours of study) for acupuncture and a 4-year program for Oriental medicine, which includes acupuncture and herbal therapy (www.ACAOM.org). In recent years, some schools have begun to offer programs for Doctor of Acupuncture and Oriental Medicine with an additional 1,200 hours of clinical-based doctoral training. Some Western medical training, including the study of anatomy, physiology, and clean-needle technique, is included in the curriculums of these schools. Postgraduate training programs in medical acupuncture for physicians also exist. In the United States, training to be a licensed acupuncturist is regulated according to individual state law. Because the educational and licensing requirements for acupuncture practice vary from state to state, one should inquire from each state board of acupuncture (or other relevant board) for information (www.nccaom.org). Third-party reimbursements also vary from state to state. Some insurance companies cover acupuncture or limited acupuncture treatment. Federal payers such as Medicare and Medicaid do not generally reimburse for acupuncture treatment.

Acupuncture has been practiced in China and other Asian countries for more than 4,000 years.[16-18] In China, acupuncture is part of a TCM system of traditional medical knowledge and is practiced along with other treatment modalities such as herbal medicine, tui na (massage and acupressure), mind/body exercise (e.g., qigong and tai chi), and dietary therapy.[19,20] In the United States, several different acupuncture styles are practiced in addition to TCM. These include Japanese acupuncture (e.g., meridian therapy), English acupuncture (e.g., five-element or traditional acupuncture), French acupuncture (e.g., French energetic acupuncture), Korean acupuncture (e.g., constitutional acupuncture), and American medical acupuncture. Most of these styles are derived from ancient Chinese medical philosophy and practices. All are based on the view that the human body must be perceived and treated as a whole and as part of nature; health is the result of harmony among bodily functions and between the body and nature, and disease occurs when this harmony is disrupted. TCM therapeutic interventions, including acupuncture, are used to restore the state of harmony.

Acupuncture is closely associated with Chinese meridian theory. According to this theory, there are 12 primary meridians, or channels, and eight additional meridians, each following a particular directional course along the body. A vital energy known as qi flows through these meridians and participates in the homeostatic regulation of various bodily functions. Along the meridians are approximately 360 points that serve as both pathognomonic signs of disorder and as loci for acupuncture treatments.[18,21] When the normal flow of energy over a meridian is obstructed (e.g., as a result of tissue injury or a tumor), pain or other symptoms result. Chinese medicine proposes that the purpose of acupuncture therapy is to normalize energy flow, thereby relieving the symptoms by stimulating specific sites (acupuncture points) on the meridians.[22] In acupuncture treatment, stainless steel needles, usually ranging from 0.22 mm to 0.25 mm in diameter, are inserted into relevant acupuncture points to stimulate the affected meridians. A needling sensation known as de qi sensation occurs, in which the patient may feel heaviness, numbness, or tingling during an acupuncture treatment. Length and frequency of treatment vary according to the condition being treated. An acupuncture treatment course for cancer symptoms or treatment of side effects is often given as multiple sessions per week.[23] Needles are typically left in place for 15 to 30 minutes after insertion, and their effects may be augmented with manual or electrical stimulation and/or heat (e.g., moxibustion or heat lamps).

Classical techniques of acupuncture include the following:

Acupressure, using fingers or mechanical devices to apply pressure on acupuncture points is based on the same principles as acupuncture. Moxibustion is a method in which an herb (Artemisia vulgaris) is burned above the skin or on an acupuncture point for the purpose of warming it to alleviate symptoms. Cupping promotes blood circulation and stimulates acupuncture points by creating a vacuum or negative pressure on the surface of the skin.[22] During the past several decades, various new auxiliary devices have been developed. Acupuncture devices such as electroacupuncture (EA) machines and heat lamps are commonly used to enhance the effects of acupuncture.

In addition to classical acupuncture techniques, other techniques have been developed and are sometimes used in cancer management. These include trigger point acupuncture, laser acupuncture, acupuncture point injection, and techniques focusing on particular regions of the body such as:

Of these, auricular acupuncture is the most commonly used.

In clinical practice, most acupuncturists in the United States use the traditional theories and principles of Chinese medicine. A 2017 survey of 472 licensed acupuncturists in the San Francisco Bay area reported that 77% were caring for patients with cancer, and 44% have training specific to the needs of patients with cancer.[24]

Although acupuncture has been practiced for millennia, it has come under rigorous scientific investigation only recently. In 1976, the U.S. Food and Drug Administration (FDA) classified acupuncture needles as investigational devices (class III) (www.fda.gov), resulting in a number of research studies on the effectiveness and safety of acupuncture.[25] In November 1994, the Office of Alternative Medicine (the predecessor of the National Center for Complementary and Integrative Health) at the National Institutes of Health (NIH) sponsored an NIH-FDA workshop on the status of acupuncture needle usage. Two years later, the FDA reclassified acupuncture needles as medical devices (class II) without, however, giving specific indications for their use.[26] In 1997, NIH held a Consensus Development Conference on acupuncture to evaluate its safety and efficacy. The 12-member panel concluded that promising research results showing the efficacy of acupuncture in certain conditions have emerged and that further research is likely to uncover additional areas in which acupuncture intervention will be useful. The panel stated that “there is clear evidence that needle acupuncture treatment is effective for postoperative and chemotherapy N/V.” It also stated that there are “a number of other pain-related conditions for which acupuncture may be effective as an adjunct therapy, an acceptable alternative, or as part of a comprehensive treatment program,” and it agreed that further research is likely to uncover additional areas in which acupuncture intervention will be useful.[25]

These actions by the FDA and NIH have resulted in the establishment of several active programs of research into the mechanisms and efficacy of acupuncture, much of which is, or is potentially, relevant to cancer management. The most extensively investigated aspect of these mechanisms has been the effect of acupuncture on pain management. The NIH Consensus Panel concluded that “acupuncture can cause multiple biological responses,” local and distal, “mediated mainly by sensory neurons…within the central nervous system.” Acupuncture “may also activate the hypothalamus and the pituitary gland, resulting in a broad spectrum of systemic effects,” including “alterations in peptides, hormones and neurotransmitters and the regulation of blood flow.”[25] The effect of acupuncture on chronic inflammatory pain has been studied.[27,28] Evidence suggests that acupuncture operates through the autonomic nervous system to balance the sympathetic and parasympathetic systems and suggests that the anti-inflammatory effects of acupuncture are mediated by its electrophysiologic effects on neurotransmitters, cytokines, and neuropeptides.[1,28-37] Many studies provide evidence that opioid peptides are released during acupuncture and that acupuncture analgesia is mediated by the endogenous opioid system.[38,39]

Although the mechanism of acupuncture is not fully understood, it has been proposed that beneficial results are mediated by changes in neurohormones and cytokines. Animal research suggests that acupuncture achieves its anesthetic effect by stimulating nerves in the muscle, which then relay the signal to the spinal cord, midbrain, and hypothalamus-pituitary system, ultimately triggering release of neurotransmitters and hormones, such as endorphins and enkephalins.[40,41]

Laboratory and animal cancer studies have also explored the mechanisms of acupuncture through the activation and modulation of the immune system. Previous animal and human studies have suggested that acupuncture worked through immunomodulation, with significant changes in cytokines including interleukin (IL)-1, IL-6, IL-8, IL-10, and tumor necrosis factor-alpha (TNF-alpha).[42-46] These studies were limited by small sample size and occasional conflicting results. Acupuncture has been associated with significant changes in proinflammatory cytokines including IL-1-beta, IL-6, IL-17, and TNF-alpha.[42-47] In addition, studies showed that acupuncture needle manipulation stimulated surrounding connective tissues and sensory nerves [48] and affected adenosine-mediated peripheral sensory modulation.[49]

Acupuncture treatment points are located by using standard anatomic landmarks and comparative anatomy. EA is the most commonly used treatment intervention; a few studies have used moxibustion.[50] These studies show that acupuncture may boost animal immune function by enhancing NK cell and lymphocyte activity.[50-52] According to one animal study, acupuncture may be a useful adjuvant for suppressing chemotherapy-induced emesis.[53]

Although several studies published in China examined the effect of acupuncture on the human immune system,[8,35,38,54-57] most cancer-related human clinical studies of acupuncture evaluated its effect on patient quality of life. These investigations mainly focused on cancer symptoms or cancer treatment–related symptoms, predominantly cancer pain [10,29,58-62] and chemotherapy-induced N/V.[31,33,63-71] Studies have also evaluated the effect of acupuncture on radiation-induced xerostomia (dry mouth), proctitis, dysphonia, weight loss, cough, thoracodynia, hemoptysis, fever, esophageal obstruction, poor appetite, night sweats, hot flashes in women and men,[72] dizziness, fatigue, anxiety, and depression in cancer patients.[8-10,73-76] The evidence from most of these clinical studies is inconclusive, despite their positive results; either poor research design or incompletely described methodologic procedures limit their value.[77] There is controversy about the most appropriate control for acupuncture, which also limits the interpretability of the results of clinical trials.[78] The positive results of the studies on chemotherapy-induced N/V, which benefit from scientifically sound research designs, are the most convincing.

A 2018 retrospective analysis of prospectively collected data of 375 cancer survivors who received acupuncture treatments at the MD Anderson Cancer Center Integrative Medicine Center outpatient clinic showed that patients experienced short- and long-term improvement in multiple symptoms including hot flashes, fatigue, numbness, tingling, and nausea.[79]

References

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11. Kemper KJ, Sarah R, Silver-Highfield E, et al.: On pins and needles? Pediatric pain patients' experience with acupuncture. Pediatrics 105 (4 Pt 2): 941-7, 2000. [PUBMED Abstract]
12. Chokshi SK, Ladas EJ, Taromina K, et al.: Predictors of acupuncture use among children and adolescents with cancer. Pediatr Blood Cancer 64 (7): , 2017. [PUBMED Abstract]
13. Bao T, Li SQ, Dearing JL, et al.: Acupuncture versus medication for pain management: a cross-sectional study of breast cancer survivors. Acupunct Med 36 (2): 80-87, 2018. [PUBMED Abstract]
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15. Bao T, Li Q, DeRito JL, et al.: Barriers to Acupuncture Use Among Breast Cancer Survivors: A Cross-Sectional Analysis. Integr Cancer Ther 17 (3): 854-859, 2018. [PUBMED Abstract]
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21. Stux G: History of acupuncture. In: Stux G, Pomeranz B: Acupuncture: Textbook and Atlas. Springer-Verlag, 1987, pp 36-7.
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24. Abrams D, McCulloch M, Cohen M, et al.: A Survey of Licensed Acupuncturists in the San Francisco Bay Area: Prevalence of Treating Oncology Patients. Integr Cancer Ther 17 (1): 92-98, 2018. [PUBMED Abstract]
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28. Zijlstra FJ, van den Berg-de Lange I, Huygen FJ, et al.: Anti-inflammatory actions of acupuncture. Mediators Inflamm 12 (2): 59-69, 2003. [PUBMED Abstract]
29. Dang W, Yang J: Clinical study on acupuncture treatment of stomach carcinoma pain. J Tradit Chin Med 18 (1): 31-8, 1998. [PUBMED Abstract]
30. Moyad MA, Hathaway S, Ni HS: Traditional Chinese medicine, acupuncture, and other alternative medicines for prostate cancer: an introduction and the need for more research. Semin Urol Oncol 17 (2): 103-10, 1999. [PUBMED Abstract]
31. Dundee JW, Ghaly RG, Fitzpatrick KT, et al.: Acupuncture prophylaxis of cancer chemotherapy-induced sickness. J R Soc Med 82 (5): 268-71, 1989. [PUBMED Abstract]
32. Hoskin PJ, Hanks GW: The management of symptoms in advanced cancer: experience in a hospital-based continuing care unit. J R Soc Med 81 (6): 341-4, 1988. [PUBMED Abstract]
33. Dundee JW, Ghaly RG, Fitzpatrick KT, et al.: Optimising antiemesis in cancer chemotherapy. Br Med J (Clin Res Ed) 294 (6565): 179, 1987. [PUBMED Abstract]
34. Harris PF, Remington PL, Trentham-Dietz A, et al.: Prevalence and treatment of menopausal symptoms among breast cancer survivors. J Pain Symptom Manage 23 (6): 501-9, 2002. [PUBMED Abstract]
35. Zhou RX, Huang FL, Jiang SR, et al.: The effect of acupuncture on the phagocytic activity of human leukocytes. J Tradit Chin Med 8 (2): 83-4, 1988. [PUBMED Abstract]
36. Petti F, Bangrazi A, Liguori A, et al.: Effects of acupuncture on immune response related to opioid-like peptides. J Tradit Chin Med 18 (1): 55-63, 1998. [PUBMED Abstract]
37. Johnstone PA, Bloom TL, Niemtzow RC, et al.: A prospective, randomized pilot trial of acupuncture of the kidney-bladder distinct meridian for lower urinary tract symptoms. J Urol 169 (3): 1037-9, 2003. [PUBMED Abstract]
38. He CJ, Gong KH, Xu QZ, et al.: Effects of microwave acupuncture on the immunological function of cancer patients. J Tradit Chin Med 7 (1): 9-11, 1987. [PUBMED Abstract]
39. Mayer DJ: Biological mechanisms of acupuncture. Prog Brain Res 122: 457-77, 2000. [PUBMED Abstract]
40. Han JS: Acupuncture: neuropeptide release produced by electrical stimulation of different frequencies. Trends Neurosci 26 (1): 17-22, 2003. [PUBMED Abstract]
41. Berman B: A 60-year-old woman considering acupuncture for knee pain. JAMA 297 (15): 1697-707, 2007. [PUBMED Abstract]
42. Joos S, Schott C, Zou H, et al.: Immunomodulatory effects of acupuncture in the treatment of allergic asthma: a randomized controlled study. J Altern Complement Med 6 (6): 519-25, 2000. [PUBMED Abstract]
43. Petti FB, Liguori A, Ippoliti F: Study on cytokines IL-2, IL-6, IL-10 in patients of chronic allergic rhinitis treated with acupuncture. J Tradit Chin Med 22 (2): 104-11, 2002. [PUBMED Abstract]
44. Jeong HJ, Kim BS, Oh JG, et al.: Regulatory effect of cytokine production in asthma patients by SOOJI CHIM (Koryo Hand Acupuncture Therapy). Immunopharmacol Immunotoxicol 24 (2): 265-74, 2002. [PUBMED Abstract]
45. Wu HG, Zhou LB, Pan YY, et al.: Study of the mechanisms of acupuncture and moxibustion treatment for ulcerative colitis rats in view of the gene expression of cytokines. World J Gastroenterol 5 (6): 515-517, 1999. [PUBMED Abstract]
46. Jeong HJ, Hong SH, Nam YC, et al.: The effect of acupuncture on proinflammatory cytokine production in patients with chronic headache: a preliminary report. Am J Chin Med 31 (6): 945-54, 2003. [PUBMED Abstract]
47. Arrieta Ó, Hernández-Pedro N, Fernández-González-Aragón MC, et al.: Retinoic acid reduces chemotherapy-induced neuropathy in an animal model and patients with lung cancer. Neurology 77 (10): 987-95, 2011. [PUBMED Abstract]
48. Langevin HM, Bouffard NA, Badger GJ, et al.: Subcutaneous tissue fibroblast cytoskeletal remodeling induced by acupuncture: evidence for a mechanotransduction-based mechanism. J Cell Physiol 207 (3): 767-74, 2006. [PUBMED Abstract]
49. Goldman N, Chen M, Fujita T, et al.: Adenosine A1 receptors mediate local anti-nociceptive effects of acupuncture. Nat Neurosci 13 (7): 883-8, 2010. [PUBMED Abstract]
50. Wu P, Cao Y, Wu J: Effects of moxa-cone moxibustion at Guanyuan on erythrocytic immunity and its regulative function in tumor-bearing mice. J Tradit Chin Med 21 (1): 68-71, 2001. [PUBMED Abstract]
51. Liu LJ, Guo CJ, Jiao XM: [Effect of acupuncture on immunologic function and histopathology of transplanted mammary cancer in mice] Zhongguo Zhong Xi Yi Jie He Za Zhi 15 (10): 615-7, 1995. [PUBMED Abstract]
52. Sato T, Yu Y, Guo SY, et al.: Acupuncture stimulation enhances splenic natural killer cell cytotoxicity in rats. Jpn J Physiol 46 (2): 131-6, 1996. [PUBMED Abstract]
53. Lao L, Zhang G, Wong RH, et al.: The effect of electroacupuncture as an adjunct on cyclophosphamide-induced emesis in ferrets. Pharmacol Biochem Behav 74 (3): 691-9, 2003. [PUBMED Abstract]
54. Wu B, Zhou RX, Zhou MS: [Effect of acupuncture on interleukin-2 level and NK cell immunoactivity of peripheral blood of malignant tumor patients] Zhongguo Zhong Xi Yi Jie He Za Zhi 14 (9): 537-9, 1994. [PUBMED Abstract]
55. Wu B, Zhou RX, Zhou MS: [Effect of acupuncture on immunomodulation in patients with malignant tumors] Zhongguo Zhong Xi Yi Jie He Za Zhi 16 (3): 139-41, 1996. [PUBMED Abstract]
56. Wei Z: Clinical observation on therapeutic effect of acupuncture at zusanli for leukopenia. J Tradit Chin Med 18 (2): 94-5, 1998. [PUBMED Abstract]
57. Ye F, Chen S, Liu W: Effects of electro-acupuncture on immune function after chemotherapy in 28 cases. J Tradit Chin Med 22 (1): 21-3, 2002. [PUBMED Abstract]
58. Li QS, Cao SH, Xie GM, et al.: Combined traditional Chinese medicine and Western medicine. Relieving effects of Chinese herbs, ear-acupuncture and epidural morphine on postoperative pain in liver cancer. Chin Med J (Engl) 107 (4): 289-94, 1994. [PUBMED Abstract]
59. Alimi D, Rubino C, Leandri EP, et al.: Analgesic effects of auricular acupuncture for cancer pain. J Pain Symptom Manage 19 (2): 81-2, 2000. [PUBMED Abstract]
60. He JP, Friedrich M, Ertan AK, et al.: Pain-relief and movement improvement by acupuncture after ablation and axillary lymphadenectomy in patients with mammary cancer. Clin Exp Obstet Gynecol 26 (2): 81-4, 1999. [PUBMED Abstract]
61. Filshie J, Redman D: Acupuncture and malignant pain problems. Eur J Surg Oncol 11 (4): 389-94, 1985. [PUBMED Abstract]
62. Wen HL: Cancer pain treated with acupuncture and electrical stimulation. Mod Med Asia 13 (2): 12-6, 1977.
63. Shen J, Wenger N, Glaspy J, et al.: Electroacupuncture for control of myeloablative chemotherapy-induced emesis: A randomized controlled trial. JAMA 284 (21): 2755-61, 2000. [PUBMED Abstract]
64. Dundee JW, Yang J, McMillan C: Non-invasive stimulation of the P6 (Neiguan) antiemetic acupuncture point in cancer chemotherapy. J R Soc Med 84 (4): 210-2, 1991. [PUBMED Abstract]
65. Dundee JW, Yang J: Prolongation of the antiemetic action of P6 acupuncture by acupressure in patients having cancer chemotherapy. J R Soc Med 83 (6): 360-2, 1990. [PUBMED Abstract]
66. Aglietti L, Roila F, Tonato M, et al.: A pilot study of metoclopramide, dexamethasone, diphenhydramine and acupuncture in women treated with cisplatin. Cancer Chemother Pharmacol 26 (3): 239-40, 1990. [PUBMED Abstract]
67. Dundee JW, McMillan CM: Clinical uses of P6 acupuncture antiemesis. Acupunct Electrother Res 15 (3-4): 211-5, 1990. [PUBMED Abstract]
68. Dundee JW, Ghaly RG, Fitzpatrick KT, et al.: Acupuncture to prevent cisplatin-associated vomiting. Lancet 1 (8541): 1083, 1987. [PUBMED Abstract]
69. Price H, Lewith G, Williams C: Acupressure as an antiemetic in cancer chemotherapy. Complementary Medical Research 5 (2): 93-4, 1991.
70. Stannard D: Pressure prevents nausea. Nurs Times 85 (4): 33-4, 1989 Jan 25-31. [PUBMED Abstract]
71. McMillan C, Dundee JW, Abram WP: Enhancement of the antiemetic action of ondansetron by transcutaneous electrical stimulation of the P6 antiemetic point, in patients having highly emetic cytotoxic drugs. Br J Cancer 64 (5): 971-2, 1991. [PUBMED Abstract]
72. Lee MS, Kim KH, Shin BC, et al.: Acupuncture for treating hot flushes in men with prostate cancer: a systematic review. Support Care Cancer 17 (7): 763-70, 2009. [PUBMED Abstract]
73. Porzio G, Trapasso T, Martelli S, et al.: Acupuncture in the treatment of menopause-related symptoms in women taking tamoxifen. Tumori 88 (2): 128-30, 2002 Mar-Apr. [PUBMED Abstract]
74. Zhang ZH: Effect of acupuncture on 44 cases of radiation rectitis following radiation therapy for carcinoma of the cervix uteri. J Tradit Chin Med 7 (2): 139-40, 1987. [PUBMED Abstract]
75. Yao W: Prof. Sheng Canruo's experience in acupuncture treatment of throat diseases with yan si xue. J Tradit Chin Med 20 (2): 122-5, 2000. [PUBMED Abstract]
76. Feng RZ: Relief of oesophageal carcinomatous obstruction by acupuncture. J Tradit Chin Med 4 (1): 3-4, 1984. [PUBMED Abstract]
77. Garcia MK, McQuade J, Haddad R, et al.: Systematic review of acupuncture in cancer care: a synthesis of the evidence. J Clin Oncol 31 (7): 952-60, 2013. [PUBMED Abstract]
78. Moffet HH: Sham acupuncture may be as efficacious as true acupuncture: a systematic review of clinical trials. J Altern Complement Med 15 (3): 213-6, 2009. [PUBMED Abstract]
79. Lopez G, Garcia MK, Liu W, et al.: Outpatient acupuncture effects on patient self-reported symptoms in oncology care: a retrospective analysis. J Cancer 9 (19): 3613-3619, 2018. [PUBMED Abstract]

The generally accepted history of acupuncture/moxibustion (known as zhen jiu) is part of traditional Chinese medicine (TCM), an indigenous, coherent system of medicine that has been practiced in China for thousands of years. The history of acupuncture/moxibustion in China can be traced back archaeologically at least 4,000 years, when bian (stone needles) were in use. During the long history of recorded practice, acupuncture has been applied to many disorders. The earliest written medical text, the ancient classic Huang Di Nei Jing (Yellow Emperor's Inner Classic, second century BC), records nine types of needles and their therapeutic functions.

The dissemination of acupuncture and TCM to other regions dates back centuries, first to Korea and Japan and then to other Asian countries.[1] The use of acupuncture in Europe was documented in the middle of the 16th century.[2] The relatively brief history of acupuncture in the United States can be traced back about 200 years, when Dr. Franklin Bache published a report in the North American Medical and Surgical Journal on his use of acupuncture to treat lower back pain.[3] However, until the 1970s, when U.S.-Chinese diplomatic ties were resumed, the practice of acupuncture in this country was mainly limited to Chinatowns.[4]

For centuries, Chinese acupuncturists treated cancer symptomatically. Ancient literature and acupuncture textbooks classify cancer as a Zhi syndrome or blood stasis condition and document acupuncture treatment principles and methods.[5-7] Since the development of modern conventional medicine, acupuncture has primarily been used clinically as an adjunct to conventional cancer treatment.

References

1. Lu GD, Needham J: A history of forensic medicine in China. Med Hist 32 (4): 357-400, 1988. [PUBMED Abstract]
2. Peacher WG: Adverse reactions, contraindications and complications of acupuncture and moxibustion. Am J Chin Med (Gard City N Y) 3 (1): 35-46, 1975. [PUBMED Abstract]
3. Bache F: Cases illustrative of the remedial effects of acupuncture. North American Medical and Surgical Journal 1: 311-21, 1826.
4. Ergil KV: Traditional medicine of China and East Asia. In: Micozzi M S: Fundamentals of Complementary, Alternative, and Integrative Medicine. 6th ed. Elsevier, 2019, pp 483-510.
5. Maciocia G: The Practice of Chinese Medicine: The Treatment of Diseases with Acupuncture and Chinese Herbs. 2nd ed. Churchill Livingstone, 2007.
6. Maciocia G: Obstetrics and Gynecology in Chinese Medicine. 2nd ed. Churchill Livingstone, 2011.
7. Kaptchuk T: The Web That Has No Weaver : Understanding Chinese Medicine. 2nd ed. McGraw-Hill Education, 2000.

At least seven animal studies investigating the effects of acupuncture in cancer or cancer-related conditions have been reported in the scientific literature.[1-5] Two of the studies were conducted in China, one of which was published in Chinese with an English abstract. One study was conducted in Japan, one in Sweden, and one in the United States. Four of the studies were ex vivo laboratory investigations using blood or tissue samples;[1-3,5] the remaining study was an animal behavioral study testing the effect of acupuncture on chemotherapy-induced nausea and vomiting. [4]

The four ex vivo studies suggested that acupuncture is useful in anticancer therapy either by actively stimulating immune activity or by preventing chemotherapy suppression of immune activity.[1-3,5]

In a study involving normal rats, electroacupuncture (EA) (1 Hz, 5–20 V, 1-millisecond pulse width, 2 hours) applied at the point Zu-Sanli (S36) for 2 hours daily on 3 consecutive days enhanced the cytotoxicity of splenic natural killer (NK) cells compared with a stimulation of a nonacupuncture control point in the abdominal muscle.[3]

Another study found that NK cell activity and T-lymphocyte transformation rate were increased in a mouse model of transplanted mammary cancer compared with a control (P < .05) after eight sessions of acupuncture and moxibustion.[2]

A study involving tumor-bearing mice (sarcoma S180) using moxibustion to warm the acupuncture point Guanyuan (CV4) once a day for 10 days found significantly increased production of erythrocytes, compared with a nontreatment control.[1]

The fourth ex vivo study used a rat model to investigate the effect of EA on nerve growth factor (NGF), which is associated with polycystic ovary syndrome (PCOS). Women with PCOS have an increased risk of endometrial cancer and other diseases. Repeated EA treatments (12 treatments administered over 30 days) in PCO rats significantly lowered the concentrations of NGF in the ovaries, compared with untreated PCO rats.[5]

A study of cyclophosphamide-induced emesis in a ferret behavioral model used acupuncture as an adjunct therapy in treating the emetic side effects of chemotherapy. EA at 100 Hz, 1.5 V, for 10 minutes in combination with subeffective doses of antiemetics such as ondansetron (0.04 mg/kg), droperidol (0.25 mg/kg), and metoclopramide (2.24 mg/kg) significantly reduced the total number of emetic episodes by 52%, 36%, and 73%, respectively (P < .01), in this ferret model.[4]

A rat model has been established by injecting AT-3.1 prostate cancer cells into the tibia of the adult male Copenhagen rat, which closely mimics prostate cancer-induced bone cancer pain.[6] The cancer-caused pain was treated with 10 Hz EA for 30 minutes a day at acupuncture point gallbladder 30 (GB30) from days 14 to 18 after cancer-cell injection. For sham control, EA needles were inserted into GB30 without stimulation. Thermal hyperalgesia, a decrease in paw withdrawal latency to a noxious thermal stimulus, and mechanical hyperalgesia, a decrease in paw withdrawal pressure threshold, were measured at baseline and 20 minutes after EA. EA significantly attenuated the hyperalgesia compared with sham control. Moreover, the EA inhibited up-regulation of preprodynorphin mRNA and dynorphin as well as interleukin-1beta (IL-1beta) and its mRNA compared with sham control. Intrathecal injection of antiserum against dynorphin A (1–17) and IL-1 receptor antagonist significantly inhibited the cancer-induced hyperalgesia. These data suggests that EA alleviates bone cancer pain at least in part by suppressing spinal dynorphin and IL-1beta expression.[7,8]

Another cutaneous cancer pain model has been established by injecting B16-BL6 melanoma cells into the plantar region of one hind paw of C57BL/6 mice. A single EA treatment showed significant analgesia on day 8 but not on day 20. EA treatments once every other day starting on day 8 showed analgesia at day 20, but EA starting on day 16 did not. The results indicate that EA exerts antihyperalgesic effects on early stage but not on late stage cutaneous cancer pain.[9] These animal studies support the clinical use of EA in the treatment of cancer pain.

The findings of these studies suggest that acupuncture may be effective in treating cancer-related symptoms and cancer treatment–related disorders and that acupuncture may be able to activate immune functions [1-3] and regulate the autonomic nervous system.[4,5] Only one study reported a decrease in tumor volume in animals treated with acupuncture compared with control animals; however, the scientific value of this report is limited because of insufficient information about the research methodology. [2]

References

1. Wu P, Cao Y, Wu J: Effects of moxa-cone moxibustion at Guanyuan on erythrocytic immunity and its regulative function in tumor-bearing mice. J Tradit Chin Med 21 (1): 68-71, 2001. [PUBMED Abstract]
2. Liu LJ, Guo CJ, Jiao XM: [Effect of acupuncture on immunologic function and histopathology of transplanted mammary cancer in mice] Zhongguo Zhong Xi Yi Jie He Za Zhi 15 (10): 615-7, 1995. [PUBMED Abstract]
3. Sato T, Yu Y, Guo SY, et al.: Acupuncture stimulation enhances splenic natural killer cell cytotoxicity in rats. Jpn J Physiol 46 (2): 131-6, 1996. [PUBMED Abstract]
4. Lao L, Zhang G, Wong RH, et al.: The effect of electroacupuncture as an adjunct on cyclophosphamide-induced emesis in ferrets. Pharmacol Biochem Behav 74 (3): 691-9, 2003. [PUBMED Abstract]
5. Stener-Victorin E, Lundeberg T, Waldenström U, et al.: Effects of electro-acupuncture on nerve growth factor and ovarian morphology in rats with experimentally induced polycystic ovaries. Biol Reprod 63 (5): 1497-503, 2000. [PUBMED Abstract]
6. Zhang RX, Liu B, Wang L, et al.: Spinal glial activation in a new rat model of bone cancer pain produced by prostate cancer cell inoculation of the tibia. Pain 118 (1-2): 125-36, 2005. [PUBMED Abstract]
7. Zhang RX, Li A, Liu B, et al.: Electroacupuncture attenuates bone cancer pain and inhibits spinal interleukin-1 beta expression in a rat model. Anesth Analg 105 (5): 1482-8, table of contents, 2007. [PUBMED Abstract]
8. Zhang RX, Li A, Liu B, et al.: Electroacupuncture attenuates bone-cancer-induced hyperalgesia and inhibits spinal preprodynorphin expression in a rat model. Eur J Pain 12 (7): 870-8, 2008. [PUBMED Abstract]
9. Mao-Ying QL, Cui KM, Liu Q, et al.: Stage-dependent analgesia of electro-acupuncture in a mouse model of cutaneous cancer pain. Eur J Pain 10 (8): 689-94, 2006. [PUBMED Abstract]

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106. Bao T, Seidman AD, Piulson L, et al.: A phase IIA trial of acupuncture to reduce chemotherapy-induced peripheral neuropathy severity during neoadjuvant or adjuvant weekly paclitaxel chemotherapy in breast cancer patients. Eur J Cancer 101: 12-19, 2018. [PUBMED Abstract]
107. Greenlee H, Crew KD, Capodice J, et al.: Randomized sham-controlled pilot trial of weekly electro-acupuncture for the prevention of taxane-induced peripheral neuropathy in women with early stage breast cancer. Breast Cancer Res Treat 156 (3): 453-464, 2016. [PUBMED Abstract]
108. Chien TJ, Liu CY, Fang CJ, et al.: The Efficacy of Acupuncture in Chemotherapy-Induced Peripheral Neuropathy: Systematic Review and Meta-Analysis. Integr Cancer Ther 18: 1534735419886662, 2019 Jan-Dec. [PUBMED Abstract]
109. Li K, Giustini D, Seely D: A systematic review of acupuncture for chemotherapy-induced peripheral neuropathy. Curr Oncol 26 (2): e147-e154, 2019. [PUBMED Abstract]
110. Han X, Wang L, Shi H, et al.: Acupuncture combined with methylcobalamin for the treatment of chemotherapy-induced peripheral neuropathy in patients with multiple myeloma. BMC Cancer 17 (1): 40, 2017. [PUBMED Abstract]
111. Rostock M, Jaroslawski K, Guethlin C, et al.: Chemotherapy-induced peripheral neuropathy in cancer patients: a four-arm randomized trial on the effectiveness of electroacupuncture. Evid Based Complement Alternat Med 2013: 349653, 2013. [PUBMED Abstract]
112. Lu W, Giobbie-Hurder A, Freedman RA, et al.: Acupuncture for Chemotherapy-Induced Peripheral Neuropathy in Breast Cancer Survivors: A Randomized Controlled Pilot Trial. Oncologist 25 (4): 310-318, 2020. [PUBMED Abstract]
113. Schröder S, Liepert J, Remppis A, et al.: Acupuncture treatment improves nerve conduction in peripheral neuropathy. Eur J Neurol 14 (3): 276-81, 2007. [PUBMED Abstract]
114. Kanakura Y, Niwa K, Kometani K, et al.: Effectiveness of acupuncture and moxibustion treatment for lymphedema following intrapelvic lymph node dissection: a preliminary report. Am J Chin Med 30 (1): 37-43, 2002. [PUBMED Abstract]
115. Alem M, Gurgel MS: Acupuncture in the rehabilitation of women after breast cancer surgery--a case series. Acupunct Med 26 (2): 87-93, 2008. [PUBMED Abstract]
116. Cassileth BR, Van Zee KJ, Chan Y, et al.: A safety and efficacy pilot study of acupuncture for the treatment of chronic lymphoedema. Acupunct Med 29 (3): 170-2, 2011. [PUBMED Abstract]
117. Cassileth BR, Van Zee KJ, Yeung KS, et al.: Acupuncture in the treatment of upper-limb lymphedema: results of a pilot study. Cancer 119 (13): 2455-61, 2013. [PUBMED Abstract]
118. de Valois B, Asprey A, Young T: "The Monkey on Your Shoulder": A Qualitative Study of Lymphoedema Patients' Attitudes to and Experiences of Acupuncture and Moxibustion. Evid Based Complement Alternat Med 2016: 4298420, 2016. [PUBMED Abstract]
119. Smith CA, Pirotta M, Kilbreath S: A feasibility study to examine the role of acupuncture to reduce symptoms of lymphoedema after breast cancer: a randomised controlled trial. Acupunct Med 32 (5): 387-93, 2014. [PUBMED Abstract]
120. Yao C, Xu Y, Chen L, et al.: Effects of warm acupuncture on breast cancer-related chronic lymphedema: a randomized controlled trial. Curr Oncol 23 (1): e27-34, 2016. [PUBMED Abstract]
121. Bao T, Iris Zhi W, Vertosick EA, et al.: Acupuncture for breast cancer-related lymphedema: a randomized controlled trial. Breast Cancer Res Treat 170 (1): 77-87, 2018. [PUBMED Abstract]
122. Meng ZQ, Garcia MK, Chiang JS, et al.: Electro-acupuncture to prevent prolonged postoperative ileus: a randomized clinical trial. World J Gastroenterol 16 (1): 104-11, 2010. [PUBMED Abstract]
123. Deng G, Wong WD, Guillem J, et al.: A phase II, randomized, controlled trial of acupuncture for reduction of Postcolectomy Ileus. Ann Surg Oncol 20 (4): 1164-9, 2013. [PUBMED Abstract]
124. Ng SS, Leung WW, Mak TW, et al.: Electroacupuncture reduces duration of postoperative ileus after laparoscopic surgery for colorectal cancer. Gastroenterology 144 (2): 307-313.e1, 2013. [PUBMED Abstract]
125. Liu YH, Dong GT, Ye Y, et al.: Effectiveness of Acupuncture for Early Recovery of Bowel Function in Cancer: A Systematic Review and Meta-Analysis. Evid Based Complement Alternat Med 2017: 2504021, 2017. [PUBMED Abstract]
126. Wang Y, Yang JW, Yan SY, et al.: Electroacupuncture vs Sham Electroacupuncture in the Treatment of Postoperative Ileus After Laparoscopic Surgery for Colorectal Cancer: A Multicenter, Randomized Clinical Trial. JAMA Surg 158 (1): 20-27, 2023. [PUBMED Abstract]
127. Tong QY, Liu R, Gao Y, et al.: Effect of Electroacupuncture Based on ERAS for Preoperative Anxiety in Breast Cancer Surgery: A Single-Center, Randomized, Controlled Trial. Clin Breast Cancer 22 (7): 724-736, 2022. [PUBMED Abstract]
128. Feng Y, Wang XY, Li SD, et al.: Clinical research of acupuncture on malignant tumor patients for improving depression and sleep quality. J Tradit Chin Med 31 (3): 199-202, 2011. [PUBMED Abstract]
129. Garland SN, Xie SX, DuHamel K, et al.: Acupuncture Versus Cognitive Behavioral Therapy for Insomnia in Cancer Survivors: A Randomized Clinical Trial. J Natl Cancer Inst 111 (12): 1323-1331, 2019. [PUBMED Abstract]
130. Yang M, Liou KT, Garland SN, et al.: Acupuncture versus cognitive behavioral therapy for pain among cancer survivors with insomnia: an exploratory analysis of a randomized clinical trial. NPJ Breast Cancer 7 (1): 148, 2021. [PUBMED Abstract]
131. Tong T, Pei C, Chen J, et al.: Efficacy of Acupuncture Therapy for Chemotherapy-Related Cognitive Impairment in Breast Cancer Patients. Med Sci Monit 24: 2919-2927, 2018. [PUBMED Abstract]
132. Zhang ZJ, Man SC, Yam LL, et al.: Electroacupuncture trigeminal nerve stimulation plus body acupuncture for chemotherapy-induced cognitive impairment in breast cancer patients: An assessor-participant blinded, randomized controlled trial. Brain Behav Immun 88: 88-96, 2020. [PUBMED Abstract]
133. Liou KT, Root JC, Garland SN, et al.: Effects of acupuncture versus cognitive behavioral therapy on cognitive function in cancer survivors with insomnia: A secondary analysis of a randomized clinical trial. Cancer 126 (13): 3042-3052, 2020. [PUBMED Abstract]
134. Yildirim D, Kocatepe V, Talu GK: The efficacy of acupressure in managing opioid-induced constipation in patients with cancer: A single-blind randomized controlled trial. Support Care Cancer 30 (6): 5201-5210, 2022. [PUBMED Abstract]
135. Xia YQ, Zhang D, Yang CX, et al.: An approach to the effect on tumors of acupuncture in combination with radiotherapy or chemotherapy. J Tradit Chin Med 6 (1): 23-6, 1986. [PUBMED Abstract]
136. Johnstone PA, Polston GR, Niemtzow RC, et al.: Integration of acupuncture into the oncology clinic. Palliat Med 16 (3): 235-9, 2002. [PUBMED Abstract]
137. Zhang ZH: Effect of acupuncture on 44 cases of radiation rectitis following radiation therapy for carcinoma of the cervix uteri. J Tradit Chin Med 7 (2): 139-40, 1987. [PUBMED Abstract]
138. Yao W: Prof. Sheng Canruo's experience in acupuncture treatment of throat diseases with yan si xue. J Tradit Chin Med 20 (2): 122-5, 2000. [PUBMED Abstract]
139. Feng RZ: Relief of oesophageal carcinomatous obstruction by acupuncture. J Tradit Chin Med 4 (1): 3-4, 1984. [PUBMED Abstract]
140. Ge AX, Ryan ME, Giaccone G, et al.: Acupuncture treatment for persistent hiccups in patients with cancer. J Altern Complement Med 16 (7): 811-6, 2010. [PUBMED Abstract]
141. de Valois BA, Young TE, Melsome E: Assessing the feasibility of using acupuncture and moxibustion to improve quality of life for cancer survivors with upper body lymphoedema. Eur J Oncol Nurs 16 (3): 301-9, 2012. [PUBMED Abstract]
142. Bettini E, Idiokitas R, Mahmood L, et al.: Safety and Acceptance of Acupuncture and Acupressure in Children, Adolescents, and Young Adults Undergoing Hematopoietic Stem Cell Transplant. Cancer Nurs 46 (3): E204-E207, 2023 May-Jun 01. [PUBMED Abstract]
143. Dupuis LL, Kelly KM, Krischer JP, et al.: Acupressure bands do not improve chemotherapy-induced nausea control in pediatric patients receiving highly emetogenic chemotherapy: A single-blinded, randomized controlled trial. Cancer 124 (6): 1188-1196, 2018. [PUBMED Abstract]
144. Lown EA, Banerjee A, Vittinghoff E, et al.: Acupressure to Reduce Treatment-Related Symptoms for Children With Cancer and Recipients of Hematopoietic Stem Cell Transplant: Protocol for a Randomized Controlled Trial. Glob Adv Health Med 8: 2164956119870444, 2019. [PUBMED Abstract]
145. Jindal V, Ge A, Mansky PJ: Safety and efficacy of acupuncture in children: a review of the evidence. J Pediatr Hematol Oncol 30 (6): 431-42, 2008. [PUBMED Abstract]
146. Ladas EJ, Rooney D, Taromina K, et al.: The safety of acupuncture in children and adolescents with cancer therapy-related thrombocytopenia. Support Care Cancer 18 (11): 1487-90, 2010. [PUBMED Abstract]
147. Chokshi SK, Ladas EJ, Taromina K, et al.: Predictors of acupuncture use among children and adolescents with cancer. Pediatr Blood Cancer 64 (7): , 2017. [PUBMED Abstract]

Serious adverse effects of acupuncture are rare. Reported accidents and infections appear to be related to violations of sterile procedure, negligence of the practitioner, or both.[1,2] A systematic review of case reports on the safety of acupuncture, involving 98 papers published in the English language from 22 countries during the period from 1965 to 1999, found only 202 incidents. The number of incidents appeared to decline as training standards and licensure requirements were enhanced. Among the 118 (60%) reported incidents involving infection, 94 (80%) involved hepatitis, occurring mainly in the late 1970s and early 1980s. Very few hepatitis or other infections associated with acupuncture have been reported since 1988, when widespread use of disposable needles was introduced and national certification requirements for clean-needle techniques were developed and enforced as an acupuncture licensure requirement.[3,4] Because cancer patients who are undergoing chemotherapy or radiation therapy are immunocompromised, precautions must be taken and strict clean-needle techniques must be applied when acupuncture treatment is given.[5]

Minor adverse effects of acupuncture such as the following, have been reported:

These minor adverse effects can be minimized by appropriate patient management, including local pressing and massage at the needling site after treatment.[6,7]

References

1. Lao L: Acupuncture techniques and devices. J Altern Complement Med 2 (1): 23-5, 1996. [PUBMED Abstract]
2. MacPherson H: Fatal and adverse events from acupuncture: allegation, evidence, and the implications. J Altern Complement Med 5 (1): 47-56, 1999. [PUBMED Abstract]
3. Lao L, Zhang G, Wong RH, et al.: The effect of electroacupuncture as an adjunct on cyclophosphamide-induced emesis in ferrets. Pharmacol Biochem Behav 74 (3): 691-9, 2003. [PUBMED Abstract]
4. National Acupuncture Foundation: Clean Needle Technique Manual for Acupuncturists: Guidelines and Standards for the Clean and Safe Clinical Practice of Acupuncture. 6th ed. National Acupuncture Foundation, 2009.
5. Shen J, Wenger N, Glaspy J, et al.: Electroacupuncture for control of myeloablative chemotherapy-induced emesis: A randomized controlled trial. JAMA 284 (21): 2755-61, 2000. [PUBMED Abstract]
6. Cheng X: Chinese Acupuncture and Moxibustion. 3rd ed. Foreign Languages Press, 2018.
7. O'Connor J, Bensky D, eds.: Acupuncture: A Comprehensive Text. Eastland Press, 1981.

To assist readers in evaluating the results of human studies of integrative, alternative, and complementary therapies for cancer, the strength of the evidence (i.e., the levels of evidence) associated with each type of treatment is provided whenever possible. To qualify for a level of evidence analysis, a study must:

Separate levels of evidence scores are assigned to qualifying human studies on the basis of statistical strength of the study design and scientific strength of the treatment outcomes (i.e., endpoints) measured. The resulting two scores are then combined to produce an overall score. For an explanation of the scores and additional information about levels of evidence analysis, see the Levels of Evidence for Human Studies of Integrative, Alternative, and Complementary Therapies.

It is noteworthy that almost all reported clinical studies on the effects of acupuncture on cancer or cancer therapy–related symptoms focus on symptom management rather than the disease itself. Investigations into the effects of acupuncture on chemotherapy-induced nausea and vomiting, many of which were randomized and well-controlled, produced the most convincing findings. A number of randomized controlled trials have reported on the effect of acupuncture in alleviating other cancer treatment-associated side effects, with many showing promising evidence supporting the use of acupuncture. Additional phase III clinical trials are ongoing.

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Editorial changes were made to this summary.

This summary is written and maintained by the PDQ Integrative, Alternative, and Complementary Therapies Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ® Cancer Information for Health Professionals pages.