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Acupuncture and Physical Disability

Laurance Johnston, Ph.D.

Acupuncture, a key element of Traditional Chinese Medicine, has become a widely popular alternative medicine with the American public in recent years. This treatment has considerable potential for treating problems associated with physical disability, including spinal cord injury (SCI) and multiple sclerosis. Acupuncture’s potential includes the intriguing possibility of restored function.The Du Meridian in acupuncture, an alternative medicine for spinal cord injury (SCI) and physical disability


Although acupuncture has a 5,000-year tradition, the transition to the west has been slow. Sixteenth century Jesuit missionaries first reported the procedure. Troops from far-east military invasions brought the procedure back to France in the 1800s. In 1825, Benjamin Franklin’s great-grandson translated French work on acupuncture. However, after a flurry of interest, acupuncture receded into oblivion in the United States until President Nixon went to China in the early 1970s. Soon after Nixon’s visit, the American Medical Association (AMA) pressured the Food and Drug Administration (FDA) to ban acupuncture needles unless used in an investigation. In turn, the ban provided the justification to deny health-insurance coverage.

Nevertheless, acupuncture’s popularity grew.  In spite of technically violating federal law, many states authorized its use, and schools and accrediting organizations were established. In 1996, after a million Americans used the procedure every year, FDA finally reclassified acupuncture needles, and insurance began to covered the treatment. Last year, a prestigious National Institutes of Health (NIH) Consensus Conference endorsed specific acupuncture applications.

 Treatment and Diagnosis:

Acupuncture-related therapies consist of stimulating specific points on the skin by inserting needles or applying heat, pressure, or massage.  Acupuncture usually is combined with a variety of other Eastern therapies, such as herbal treatments, food and nutrition therapy, exercise, and meditation.  The thin, usually disposable, needles rarely draw blood, and any discomfort is mild.

The World Health Organization (WHO) has listed over 100 disorders that may be amenable to acupuncture treatment, including respiratory, eye, mouth gastrointestinal, neurological, orthopedic, bronchopulmonary, reproductive, hypertension, insomnia, skin, arthritic, allergic, and addictive disorders. It is rarely used to treat infectious disease. Acupuncture seems to work better at early stages before impaired body function progresses into organic or tissue damage. It is often a preventive measure to preserve good health. Adverse reactions are rare, especially compared to drugs or other medical treatments.

Acupuncture emphasizes diagnosis. The Western name for a disorder (for example, asthma) has little diagnostic relevance. Two patients with the identical disorder may receive very different treatments according to their specific energy imbalances. Diagnostic methods include patient observation, history taking, and touch. Examining the tongue and feeling the pulse are especially important.

Evaluating the pulse is much more involved than in Western medicine. A yin and yang pulse is at three locations on each wrist, measured by deep and light-touch pressure. Each of these 12 different pulses corresponds to a specific organ. When the pulse of both wrists are taken simultaneously, the relative differences indicate the body’s energy balance with respect to specific organs.

Although both medical doctors (MDs) and non-MDs can practice acupuncture, non-physician practitioners usually have had much more extensive training.  Physicians can pefrorm acupuncture after 200 hours of training; non-MDs must train over three years in an accredited school of oriental medicine.

Dr. Claire Cassidy, of the Traditional Acupuncture Institute in Columbia, Md., recently surveyed approximately 600 Chinese-medicine patients from six U.S. clinics. According to her study’s data, acupuncture appears to be doing something right compared to Western medicine.  This survey indicated that 87% of the people who used acupuncture and oriental medicine were very satisfied with their care, 91% with their practitioner, 70% were happy with the cost, and 91% report that their presenting problem has improved. In comparison, only 30 % were satisfied with conventional biomedical care, 43% satisfied with their physician, and 26% satisfied with the price.

Eastern Origins:

 With origins in Taoist philosophy, acupuncture evolved from observing that a disorder was associated with an increased sensitivity in specific areas of skin. These were consistently linked to a specific organ and followed a defined topographical pattern.  These patterns or meridians serve as pathways for life-force energy called qi (pronounced chee). The body is endowed at birth with a fixed amount of qi which is then depleted through activities of daily living and supplemented by energy obtained from food or air. Energy imbalance, whether excessive or lacking, is the cause of all illness; the absence of qi is death. qi circulates throughout the body in a well-defined cycle, moving from meridian to meridian and from organ to organ.

Qi is characterized by the dynamic interaction of two antagonistic, yet complimentary energy forces called yin and yang, each of which includes a portion of the other (see figure). Yin, the feminine, is associated with cold, dark, passive, and that which is deep or hidden. In contrast, yang, the masculine, represents heat, light, active, and that which is on the surface. Yin and Yang are constantly interacting and changing, and one never exists in isolation from the other.

According to Chinese tradition, all substances are formed from fire, water, earth, metal, and wood. Fire contains the most yang and water the most yin. The elements are created or destroyed by specific cyclical interactions. For example, fire melts metal, metal cuts down wood, wood covers earth, earth absorbs water, and water puts out fire.

To each element is assigned one yin and one yang organ. Under this model, a bad heart (a fire organ) will adversely affect the lungs (a metal organ), which will in turn affect the liver (wood). Each organ has a meridian associated with it containing a series of acupuncture points. Stimulating these points regulates energy flow in the meridians. Overall, it is a closed system in which the excess of energy in one area reduces the energy in another area.

Eastern medicine is interactive and holistic - everything affects everything. In contrast, western medicine emphasizes component parts (e.g., kidney) without seeing a relationship to the whole. The focus is on the symptoms, which according to Eastern medicine are merely the “footprints” left by energy imbalances.

Scientific Basis:

Although the theory behind acupuncture is based on centuries of empirical, clinical observations, it was developed without the benefit of modern physiological and anatomical insights. Because the idea of an intangible life-force qi flowing through anatomically undefined meridians seemed far-fetched to those trained in western medicine, it was dismissed for many years.  Any effects were often attributed to heightened suggestibility, although the critics could not explain how such suggestibility would work in animals and young children.

Scientists have now proposed a number of physiological mechanisms for acupuncture:

·        The procedure stimulates neural pathways and mediates a variety of neurotransmitter systems. For example, acupuncture has been shown to stimulate muscle sensory nerves, which send messages to the spinal cord, midbrain, and pituitary. This stimulation releases pain-reducing molecules called endorphins and cortisol-producing hormones that help conditions such as arthritis.

·        Acupuncture points often correspond to skin areas with unique anatomical and electrical properties.

·        Through the release of specific molecules, it appears that acupuncture can dilate blood vessels, thereby improving circulation.

Since Eastern medicine assumes that physiological and molecular alterations are based on changes in energy flow, are acupuncture-induced hormonal and neurotransmitter changes secondary to a still scientifically undefined “qi” mechanism? Some investigators now believe this is so. They propose that the body’s qi energy may correspond to very subtle bioelectromagnetic fields.  Acupuncture perturbs these fields; the perturbation is then magnified through more traditional physiological mechanisms.  Most living systems are sensitive to such low fields.  The contribution of these fields to our biological understanding has been minimal due to difficulties measuring them and the traditional emphasis on molecular mechanisms.

Some people suggest that integrating molecular and energy-field approaches would greatly reduce the division between Eastern and Western medicine. Like yin and yang, harmoniously integrating Eastern and Western medicine may represent a more balanced approach to health care.

Clinical Trials:

A key difficulty in proving acupuncture’s effectiveness is the FDA requirement to use double-blind, randomized clinical trials. In such a trial, neither the patient nor doctor knows who is receiving treatment as opposed to a placebo control. Although these trials generally work well for drugs, they do not for acupuncture.

As a placebo control, many clinical studies attempted to insert needles in “sham” acupuncture points (i.e., wrong points). Because the results of such studies were ambiguous at best, they reinforced the skeptics. However, these studies were fundamentally flawed for a number of reasons.  A major one was that the sham acupuncture points were not neutral controls.  Although not as effective as true acupuncture points, sham points also evoked a physiological response.

Overall, criticism leveled at acupuncture should be placed within the context of the following NIH Consensus Conference statement: “While it is often thought that there is substantial research evidence to support conventional medical practices, this is frequently not the case…the data in support of acupuncture are as strong as those for many accepted western medical therapies.”

Acupuncture & Spinal Cord Dysfunction:

People with spinal cord dysfunction can benefit from most acupuncture applications just as readily as able-bodied individuals can. Given the health problems common to those with spinal cord dysfunction, some of these applications may provide a valuable treatment option in addition to more conventional approaches, such as drugs.


Evidence suggests that acupuncture has the potential to restore some function in both acute and chronic SCI. Virtually all chronic injuries have some intact, but dormant, neurons running through the injury site. Acupuncture may work by somehow turning on these dormant neurons. Animal studies suggest that only a small percentage of turned-on neurons are needed to have significant function.

The number of published studies focused on acupuncture’s SCI benefits has grown considerably in recent years; several are summarized below

bulletGao et al (China) treated 261 individuals with SCI, of which 79% had been injured at least one year. Ninety-five percent had some improvement, such as improved sensation, bowel-and-bladder function, spasticity, and walking. The authors speculate that acupuncture improves regeneration-promoting circulation around the spinal cord.  
bullet  Wang (China) summarized the treatment of 82 cases of SCI with electroacupuncture of bladder-meridian points (lateral to the vertebrae). Ninety-three percent accrued functional benefits, including improved lower-limb and bowel-and-bladder function.
bulletCheng and colleagues (Taiwan) showed that electroacupuncture-treated patients achieved balanced voiding in fewer days than controls. Patients starting acupuncture within three weeks of injury required fewer treatments compared to those treated later.
bulletWong et al., (China) treated acutely injured patients with electrical and auricular (i.e., ear) acupuncture starting in the emergency room and measured functional improvement one-year post injury with the commonly used ASIA (i.e., American Spinal Injury Association) assessment standards. Compared to controls, treated patients recovered more function.
bulletIn eight patients with SCI, Honjo et al., (Japan) demonstrated that acupuncture increases bladder capacity, decreasing urinary incontinence.
bulletNayek and colleagues. (Newark, NJ) reported that 50% of acupuncture-treated patients with SCI had chronic pain relief.
bulletDyson-Hudson et al. (West Orange, NJ) found acupuncture reduced chronic shoulder pain in wheelchair users with SCI (14).
bulletRapson et al. (Toronto, Canada) treated 36 subjects with below-level central neuropathic pain characterized by generalized burning with electroacupuncture. Twenty-four had reduced pain (15).

Anecdotal Stories

Artie’s First Session: Artie, a combat-injured Vietnam veteran, was treated by acupuncturist Kelly for the first time.  As is the case with many long-time wheelchairs users, Artie had chronic, overuse problems with his shoulders and other areas. Although a wheelchair, who had recently ridden across Vietnam in a hand cycle, he was, nevertheless, initially apprehensive.  

Artie noted, “After years of being treated and analyzed by detached medical professionals, I was amazed how relaxed I quickly became. Kelly had a gentle, soothing style with an intuitive appreciation and understanding of the body. I didn’t have to tell her; she quickly identified my sore-point areas. Furthermore, I was surprised that half the time, I didn’t even know that the needles had been inserted. That night, my bad arm had no pain; I didn’t even have to take my usual pills.”

Jim’s Story: “I am a 49-year old Vietnam veteran. Due to depression resulting from post-traumatic stress combined with overmedication, I attempted suicide. I stuck a gun to my chest and shot myself. The bullet missed my heart and deflected off my sternum into my spine.  My discharge summary reads T-12 SCI, permanent paralysis.”

“After attending a wedding in Bolivia, I hooked up with a South Korean acupuncturist. I ended up having 30 days of inexpensive treatment and continued it back home. The speed at which I am rehabilitating is overpowering. Two weeks ago, I walked on a treadmill for almost two minutes (kafo on left leg and plastic afo on right leg). Presently, I can walk 45 feet with the kafo unlocked assisted by a rolling walker. The improvement I have gained is a direct result of my acupuncture treatments.”


Dr. Naeser (Journal of Alternative and Complementary Medicine,Vol. 2, 1996, pp.211-248) has summarized the results of various acupuncture studies involving the treatment central nervous system paralysis, including spinal cord injury and multiple sclerosis (MS). The SCI studies basically parallel the results reported above. For MS, the studies, involving 42 people, indicated that acupuncture improved muscle spasms, vision, sleep, sexual functioning, and bladder control. In one case, a woman, who had not been able to walk unassisted in 15 years, was able to walk unaided 100 feet after one-year of treatment.

Also, check out the article on acupuncture and MS.

yin and yang, a symbol of Traditional Chinese Medicine and ccupuncture

In conclusion, acupuncture has considerable potential to treat health problems associated with spinal cord dysfunction and in some cases, restore significant, quality-of-life-enhancing function.

For further information, including practitioners in your area: and


Cassidy CM. Chinese medicine users in the United States. J Altern Complement Med 1998; 4(1): 17-27.

Cheng PT, Wong MK, Chang PL. A therapeutic trial of acupuncture in neurogenic bladder of spinal cord injured patients – a preliminary report. Spinal Cord 1998; 36(7): 476-480.

Dyson-Hudson TA, Shilett SC, Kirshblum SC, et al. Acupuncture and Trager psychophysical integration in the treatment of wheelchair user’s shoulder pain in individuals with spinal cord injury. Arch Phys Med Rehabil 2001; 82(8): 1038-1046.

Gao, X, Gao C, Gao J, et al. Acupuncture treatment of complete traumatic paraplegia; Analysis of 261 Cases. J Traditional Chinese Medicine 1996; 16(2): 134-137.

Han JS. Physiology of acupuncture; review of thirty years of research. J Altern Complement Med 1997; 3, Supplement 1: 101-108.

Honjo H, Kitakoji H, Kawakita K, et al. Acupuncture for urinary incontinence in patients with chronic spinal cord injury. A preliminary report. Nippon Hinyokika Gakkai Zasshi 1998; 89(7): 665-669.

Kaplan G. A brief history of acupuncture’s journey to the West. J Altern Complement Med 1997; 3, Supplement 1: 5-10.

Liboff AR. Bioelectromagnetic fields and acupuncture. J Altern Complement Med 1997; 3, Supplement 1:77-87.

Naeser, MA. Acupuncture in the treatment of paralysis due to central nervous system damage. J Altern Complement Med 1996; 2(1): 211-248.

Nayak S, Shiflett SC, Schoenberg NE, et al. Is acupuncture effective after treating chronic pain after spinal cord injury? Arch Phys Med Rehabil 2001; 82(11): 1578-1586.

NIH Consensus Development Conference on Acupuncture.

Paola FA, Arnold M. Clinical review: acupuncture and spinal cord medicine. J Spinal Cord Med 2003; 26(1): 12-20.

Pomeranz B. Scientific research into acupuncture for the relief of pain. J Altern Complement Med 1996; 2(1): 53-60.

Rapson LM, Wells N, Pepper J, et al. Acupuncture as a promising treatment for below-level central neuropathic pain: a retrospective study. J Spinal Cord Med 2003; 26(1): 21-26.

Terral C, Rabischong P. A scientific basis for acupuncture. J Altern Complement Med 1997; 3, Supplement 1: 55-65.

Wang HJ. A survey of the treatment of traumatic paraplegia by traditional Chinese medicine, J Chin Med 1992; 12(4): 296-303.

Wong AM, Leong CP, Su TY, et al. Clinical trial of acupuncture for patients with spinal cord injury. Am J Phys Med Rehabil 2003; 82(1): 21-27.

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