Alternative Health

What Is Acupuncture? A Beginner’s Guide to How It Works and How It May Improve Your Health

Lauren Bedosky
By Medically Reviewed by 
Reviewed:
Medically Reviewed
Volunteering to have a licensed practitioner stick needles in you for healing may sound out there, but acupuncture, a traditional Chinese medicine (TCM) practice of penetrating the skin with tiny, stainless steel needles, continues growing in popularity. More than 10 million patient acupuncture sessions happen in the United States every year.

The reason for its appeal? Acupuncture is generally safe and may be an effective therapy to help address a variety of health concerns.

Here, we outline the potential benefits of acupuncture, safety considerations to keep in mind, what to expect at your first session, and how to get started.

Brief History of Acupuncture in the U.S.

Acupuncture is thought to have originated thousands of years ago in China. The first document to describe acupuncture dates from around 100 B.C., according to a past historical review.

Acupuncture didn’t gain attention in the United States as a potentially effective complementary therapy until 1972, when a physician to President Nixon wrote an article about witnessing acupuncture during a trip to China.

In 1997, the National Institutes of Health (NIH) formally acknowledged acupuncture for its value in relieving pain and nausea after surgery or chemotherapy, as well as its potential as an adjunct treatment for headaches, menstrual cramps, low back pain, and myofascial pain. This has led to increased research, clarification on licensure for practitioners nationally, insurance coverage reform, and incorporation of basic concepts into many medical schools’ curriculums.

Today, acupuncture is primarily seen as a pain-management modality — especially for migraines, and low back and neck discomfort, according to the National Center for Complementary and Integrative Health, the leading research organization for complementary health topics.

Recent surveys estimate that between 1 and 10 percent of U.S. adults have experienced acupuncture therapy.

How Acupuncture Works

An acupuncture practitioner inserts thin metal needles through the skin at strategic points (known as acupoints) on the body. According to Johns Hopkins Medicine, traditional TCM texts and teachings reference more than 2,000 acupoints on the human body, which are believed to be connected by pathways (meridians) along which energy (known as qi) flows throughout the body. Balance in this energy flow leads to overall health, whereas disruption of qi is believed to cause disease.

By stimulating specific points along these meridians with needles, TCM practitioners believe energy flow can be rebalanced, thereby restoring health, according to Mayo Clinic.

Acupuncture is only one approach used by TCM practitioners, who also recommend herbal remedies, body work called tui na, and guidance on nutrition, lifestyle, tai chi, and other therapies, for example.


Over the years, researchers in the U.S. have examined acupuncture to identify the mechanisms behind it. “We know so much more about how acupuncture works now,” says Rosanne Sheinberg, MD, a medical acupuncturist and the director of integrative medicine for anesthesiology and critical care medicine at Johns Hopkins Hospital in Baltimore.

For one thing, they discovered that acupoints aren’t random sites on the body. “Scientists took tissue samples from those points and looked at them under a microscope. They found that the tissues have anatomic characteristics that make them different from other points in the body,” Dr. Sheinberg says.

According to a past review, microscopic examinations found that acupoints have a high density of nerve endings, fibers that mediate hot and cold sensations, and a high concentration of mast cells.

Mast cells are white blood cells that contain vital immune-regulating chemicals such as histamine, heparin, cytokine, and growth factors.

Acupuncture needles are inserted into the fascia, a type of connective tissue that wraps around every muscle and organ in your body. “The fascia itself is richly innervated with the autonomic nervous system, which is that involuntary part of the nervous system,” says Sheinberg.

In other words, when a licensed acupuncture practitioner puts a needle into the fascia and stimulates an acupoint, the fascia sends “SOS signals” to the rest of the body, which prompts a response. “When the body feels that something is out of pocket, it brings blood flow, lymph flow, and other things to clear out whatever is going on there,” says Sheinberg.

Acupuncture is generally considered safe, but it’s essential to seek treatment from a qualified practitioner, says Grant Chu, MD, an acupuncture practitioner, board-certified internal medicine physician, and an associate director of education at the UCLA Center for East-West Medicine in Torrance, California.

According to the National Center for Complementary and Integrative Health (NCCIH), while most states require a license, certification, or registration to practice acupuncture, education and training standards and requirements for securing these credentials vary from state to state.

You should check the practitioner’s credentials before scheduling an appointment.
The NCCIH notes that most states require that practitioners obtain a diploma from the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM).

Sheinberg also recommends finding an acupuncturist who’s been trained by the American Academy of Medical Acupuncture (AAMA). Depending on the state, MDs and DOs who have undergone proper training for physicians are also able to practice acupuncture.

Types of Acupuncture

The most common form of acupuncture — the placement of needles without additional stimulation — is only one of several types of acupuncture. Here are some others.

Electroacupuncture

This type of acupuncture adds weak pulses of an electrical current to acupuncture needles to apply more stimulation to acupoints. “We don’t quite understand the mechanism behind how it works, but in my mind, I think of it as blasting away the dams in the flow of energy,” Sheinberg says.

According to Dr. Chu, electroacupuncture has been used in studies examining the effects of acupuncture on pain, nausea, and blood pressure.

Dry Needling

Also known as myofascial trigger point dry needling, this procedure can be used by acupuncturists, chiropractors, medical doctors, and physical therapists to treat pain in the muscles and fascia, according to the Cleveland Clinic.

On the surface, dry needling and acupuncture may seem identical. But acupuncture is used to stimulate specific acupoints in the body (according to TCM and related fundamental theories and traditional practices), and dry needling targets isolated trigger points: tight bands or knots in a muscle fiber that can restrict range of motion or cause pain in other areas of the body.

Inserting a needle into a trigger point may decrease tightness, increase blood flow, and reduce pain, according to Mayo Clinic.

Acupuncture With Moxibustion

According to the American Institute of Alternative Medicine (AIAM), moxibustion is a TCM technique in which dried mugwort (a small, spongy herb) is burned to promote healing.

“This can be done away from the skin, on the skin, or with acupuncture needles,” says Chu.

The idea behind moxibustion is to warm the meridians to create a smoother flow of blood and energy, notes the AIAM.

Moxibustion has been frequently studied as a means of turning a breech baby so they’re facing the correct direction for birth (but there's no consensus in the United States about its effectiveness for this purpose), Chu says.


Acupressure

Acupressure is essentially acupuncture without needles. A practitioner (or patient at home) applies pressure to your acupoints with their fingers, according to the University of Michigan Health Rogel Cancer Center.

Ear Seeding

Ear seeding is a form of acupressure performed on the ear, called auriculotherapy.

It involves placing ear seeds (small latex stickers containing a ripe seed from the Vaccaria plant, which grows in China and parts of central and southern Europe) on specific acupoints in the ear that correspond with parts of the body where you may experience discomfort or pain.

”Patients can have the seeds on for up to [a few] days, and they can stimulate the point themselves [under guidance from their acupuncturist],” Sheinberg says.

Ear seeding may also be beneficial to address anxiety, depression, infertility, migraines, and stress, according to the Cleveland Clinic.

Like other forms of acupuncture, ear seeding should only be practiced by a qualified practitioner, or under their guidance.

Possible Benefits of Acupuncture

Results from a number of studies suggest that acupuncture may be an effective therapy for a number of health concerns and conditions. Here are several potential benefits of acupuncture, though this is only a sampling.

Relieves Chronic Pain

One of acupuncture’s most-researched perks is its effectiveness for easing chronic pain. In meta-analyses of randomized controlled trials that included roughly 18,000 patients with chronic musculoskeletal pain, researchers found that acupuncture was substantially more effective at treating discomfort than standard care approaches like physical therapy.

And a past review of drug-free treatment options for lower back pain found that acupuncture reduced pain and improved back function immediately following the therapy. The reviewers also stated it’s unclear how acupuncture may help with lower back pain in the long term.

Helps With Insomnia

Acupuncture may offer relief for common sleep problems like insomnia. In a small study, researchers gave acupuncture or sham acupuncture (in this study, the sham control needles did not penetrate the skin) to people with insomnia three times per week for four weeks. Researchers found that the acupuncture intervention group was effective at improving insomnia symptoms during therapy. In addition, people reported significant improvements in anxiety two and four weeks after acupuncture.

Eases Nausea From Chemotherapy

Chemotherapy can come with several unpleasant side effects, including nausea. According to a past review of 41 randomized controlled trials, acupuncture is an effective complementary therapy for uncontrolled nausea and vomiting from chemotherapy.

Reduces Migraines

Research suggests that acupuncture may help prevent episodic migraines. The authors of a past review found that available evidence supported adding acupuncture to symptomatic treatment of migraine attacks to reduce the frequency of headaches. The available trials also found that acupuncture was at least as effective as prophylactic drugs.

Helps With Overall Symptoms in Hospitalized Cancer Patients

Acupuncture may be an effective complementary therapy for patients recovering from surgery. According to one small study, 172 patients who received acupuncture following surgery reported significant improvements in sleep, anxiety, pain, fatigue, nausea, and drowsiness.

Eases Menstrual Cramps

Acupuncture may offer relief for painful periods. According to a meta-analysis of 49 randomized controlled trials, manual acupuncture and electroacupuncture were more helpful for reducing menstrual pain than nonsteroidal anti-inflammatory drugs (NSAIDs). The authors concluded that acupuncture might be used as a safe and effective treatment for women who experience severe menstrual discomfort.

Acupuncture Safety and Side Effects

Acupuncture is generally safe, but as with any treatment or procedure, there are some risks involved.

According to Chu, potential side effects of acupuncture may include pain from needle insertion, minor bleeding or bruising with needle removal, light-headedness or dizziness, and nausea. Infections are rare, but they can happen if the skin is improperly cleaned prior to needle insertion, or if acupuncture needles are handled inappropriately, he adds.

But the majority of acupuncture’s side effects can be avoided if you visit a qualified practitioner. “People who get less training tend to have higher rates of complications,” says Sheinberg. Practitioners with less training and experience are more likely to cause injury to blood vessels, nerves, or even organs, she adds.

The greatest concern lies with needles applied to the core of the body — in particular, the belly and the chest. “If you go too far inserting a needle into the belly you can hit the bowels and gut, and that can cause problems,” Sheinberg says. If a practitioner goes too far into the chest cavity, there’s a risk of collapsing a lung. “It’s a fairly rare complication, but it is possible,” says Sheinberg.

To minimize your risk of side effects, receive acupuncture only from qualified practitioners. The NCCAOM and the AAMA both offer directories of practitioners who have undergone the necessary training to perform acupuncture safely.

Who Might Want to Try (or Avoid) Acupuncture

Relatively few acupuncture complications have been reported, and a number of studies suggest that it may help with a variety of health complaints.

Acupuncture may even be safe for people who take anticoagulants (also known as blood thinners), Sheinberg says. A past review of studies examining acupuncture in patients receiving anticoagulants concluded that acupuncture appears to be safe, provided that the needles are placed in the correct location and at the correct depth.


But some populations may need to take extra care when seeking acupuncture therapy — or even avoid it altogether.

For example, people with dementia, or those in the recovery room waking up from anesthesia, may not be ideal for acupuncture because they're likely unable to lie still. “You don’t want people moving around when you’re inserting acupuncture needles; they have to be [aware],” says Sheinberg.

People with a phobia of needles may also want to steer clear of acupuncture, as any fear and anxiety will likely make the therapy an uncomfortable experience, Chu says.

He advises patients with pacemakers to avoid electroacupuncture specifically, as the electrical stimulation may affect pacemaker function.

Acupuncture is likely safe for pregnant women, according to a past review.

In traditional texts, certain acupuncture points are said to stimulate labor, though this has not been clearly proven in research settings. “Pregnant women should be aware that certain acupuncture points are traditionally believed to facilitate labor, and those acupuncture points should not be used during pregnancy,” Chu says. Your best bet is to work with a practitioner who specializes in acupuncture during pregnancy, or at the very least, inform your practitioner if you are pregnant.

Tips for Getting Started With Acupuncture

Here are a few tips to get you started with acupuncture.

Chat With Your Professional Healthcare Provider First

Acupuncture may be used as an adjunct therapy for a variety of health conditions and complaints, but it’s best to discuss it with your medical doctor before you pursue it.

Find a Qualified Practitioner

While acupuncture is generally safe, it’s important to receive treatment from qualified practitioners.

To find practitioners in your area, search the directories offered by the NCCAOM and the AAMA. For best results, look for a practitioner who specializes in treating people with your particular health condition or concern. Sheinberg recommends asking the acupuncturist about their experience and training before making an appointment. It can be helpful to find someone you connect with and feel comfortable with, qualities you'd look for in a primary care doctor.

Check Your Expectations

It can take several visits to see lasting results from acupuncture, especially if you’re hoping to treat a specific health condition. “Most people think they can go one week, and then maybe again a couple of weeks later, and then you’re done, but you’re not going to get the benefits for an acute indication with that approach,” Sheinberg says.

For example, if you’re developing peripheral neuropathy (nerve damage in the hands or feet that leads to weakness, numbness, or tingling) as a side effect of chemotherapy, you may need an intensive course of acupuncture to receive the maximum benefits. “You may need to go two or three times a week for 10 weeks in a row,” says Sheinberg.

Come Prepared

Chu recommends arriving at your acupuncture appointment well-hydrated. It’s also a good idea to eat a snack or small meal. Receiving acupuncture when you’re hungry or dehydrated can make you feel uncomfortable or light-headed, notes the AIAM.

Also, it’s sometimes recommended to avoid stimulants like caffeine for at least two hours before your treatment to facilitate your body’s relaxation response.

What to Expect Before, During, and After Acupuncture

Acupuncture treatments can be done in clinics, hospitals, medical spas, chiropractic offices, and wellness centers. “The physical environment may be a conventional clinic or resemble a spa,” Chu says. The treatment room is typically a quiet, private space, and patients are often given a means of communicating with the practitioner through a bell or call device, he adds.

New patients should expect to complete a medical history intake form upon arrival, just like at any other healthcare visit. You’ll also spend time, from a few minutes to longer, discussing with the provider your concerns, similar to a medical doctor taking a history. “There’s a little back-and-forth of questioning and diagnosing,” Sheinberg says. This helps the provider understand any health concerns you’re hoping to address through acupuncture, so they can create the best treatment plan for you, usually in a collaborative way.

From there, you may undress, lie on the treatment table, and cover yourself with the sheets, as you would prepare for a traditional massage. Or, the practitioner may provide you with a gown to wear over your undergarments.

Once you’re on the table, the practitioner will insert the acupuncture needles. Acupuncture needles typically range from 0.5 to 2.5 inches in length, and are often tiny enough that people refer to them as “painless needles.”

You may feel nothing or you may feel a mild discomfort when the needles are placed in the skin, but there shouldn’t be any pain once the needles are in place. “If there is persistent pain, notify the practitioner,” Chu says.

While you shouldn’t feel pain, you should feel a deep ache or pressure in the regions where the needles were inserted. That deep ache signifies that the needles have been inserted at just the right level within the fascia to stimulate the acupoint. “Sometimes, I ask patients for feedback because I want to ensure I’m in the right place,” Sheinberg says.

Acupuncture sessions can last for a few minutes of up to an hour, depending on the purpose of your visit and the provider’s style of practice. Forty-five to 60 minutes is pretty typical, Sheinberg says.

According to Johns Hopkins Medicine, some people report that acupuncture makes them feel energized, whereas others say they feel relaxed.

What’s more, you may feel sleepy, drowsy, or light-headed after your acupuncture session. “Drinking warm water or tea afterward is encouraged,” Chu says.

Before leaving the clinic, check your body to make sure all acupuncture needles were removed. “It’s uncommon, but acupuncture needles are sometimes unintentionally left in,” Chu says. Don’t be alarmed if you find a needle; simply notify the practitioner and they’ll remove it.

The results of acupuncture typically aren’t immediate. It can take several months of weekly treatments to see lasting changes, depending on your desired outcome. Some short-term effects may indicate that the acupuncture sessions are working. One sign is you notice slight improvements in your symptoms. Curiously, the other is a worsening of symptoms. “It’s actually not a bad sign if you feel worse after acupuncture,” Sheinberg says. “It means we’ve stirred things up.”

On the other hand, if you don’t notice any changes following acupuncture, that may indicate that you haven’t landed on the right acupoints yet. “Just like everything in medicine, there’s a bit of experimenting to find what works best for any one person,” says Sheinberg. Take notice of how you feel after your acupuncture sessions and share that information with the practitioner at the next appointment. This will help the practitioner fine-tune your treatment.

What Does an Acupuncture Therapy Session Cost?

The cost of acupuncture varies depending on the practitioner, region, and whether your insurance will cover sessions. In one out-of-pocket cost analysis, researchers gathered prices from 723 acupuncture clinics throughout 39 metropolitan areas in the United States.

They found that the cost range for a first-time acupuncture visit was $15 to $400.

Your health insurance may or may not cover acupuncture, so it’s a good idea to check with your provider before receiving acupuncture treatments.

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