1. General consideratio 1. General considerations 1.1 Definition Acupuncture literally means to puncture with a needle. However, the application of needles is often used in combination with moxibustion -the burning on or over the skin of selected herbs -and may also involve the application of other kinds of stimulation to certain points. In this publication the term "acupuncture is used in its broad sense to include traditional body needling, moxibustion, electric acupuncture (electro-acupuncture), laser acupuncture (photo- acupuncture), microsystem acupuncture such as ear(auricular), face, hand and alp acupuncture, and acupressure(the application of pressure at selected sites 1.2 Need for evaluation Acupuncture originated in China many centuries ago and soon spread to Japan, the Korean peninsula and elsewhere in Asia. Acupuncture is widely used in health care systems in the countries of this region; it is officially recognized by governments and well received by the general public Ithough acupuncture was introduced to Europe as long ago as the early seventeenth century, scepticism about its effectiveness continues to exist in countries where modern Western medicine is the foundation of health care especially in those where acupuncture has not yet been widely practised. People question whether acupuncture has a true therapeutic effect, or whether it works merely through the placebo effect, the power of suggestion, or the enthusiasm with which patients wish for a cure. There is therefore a need for scientific studies that evaluate the effectiveness of acupuncture under controlled clinical conditions This publication reviews selected studies on controlled clinical trials. Some of these studies have provided incontrovertible scientific evidence that acupuncture is more successful than placebo treatments in certain conditions. For example, the proportion of chronic pain relieved by acupuncture is generally in the range 55- 85%, which compares favourably with that of potent drugs(morphine helps in 70% of cases)and far outweighs the placebo effect(30-35%)(1-3). In addition, the mechanisms of acupuncture analgesia have been studied extensively since the ate 1970s, revealing the role of neural and humoral factors 1.3 Evaluation methodology Unlike the evaluation of a new drug, controlled clinical trials of acupuncture are extremely difficult to conduct, particularly if they have to be blind in design and the acupuncture has to be compared with a placebo. Various"sham"or placebo"acupuncture procedures have been designed, but they are not easy to1. General considerations 1. General considerations 1.1 Definition Acupuncture literally means to puncture with a needle. However, the application of needles is often used in combination with moxibustion—the burning on or over the skin of selected herbs—and may also involve the application of other kinds of stimulation to certain points. In this publication the term “acupuncture” is used in its broad sense to include traditional body needling, moxibustion, electric acupuncture (electro-acupuncture), laser acupuncture (photo￾acupuncture), microsystem acupuncture such as ear (auricular), face, hand and scalp acupuncture, and acupressure (the application of pressure at selected sites). 1.2 Need for evaluation Acupuncture originated in China many centuries ago and soon spread to Japan, the Korean peninsula and elsewhere in Asia. Acupuncture is widely used in health care systems in the countries of this region; it is officially recognized by governments and well received by the general public. Although acupuncture was introduced to Europe as long ago as the early seventeenth century, scepticism about its effectiveness continues to exist in countries where modern Western medicine is the foundation of health care, especially in those where acupuncture has not yet been widely practised. People question whether acupuncture has a true therapeutic effect, or whether it works merely through the placebo effect, the power of suggestion, or the enthusiasm with which patients wish for a cure. There is therefore a need for scientific studies that evaluate the effectiveness of acupuncture under controlled clinical conditions. This publication reviews selected studies on controlled clinical trials. Some of these studies have provided incontrovertible scientific evidence that acupuncture is more successful than placebo treatments in certain conditions. For example, the proportion of chronic pain relieved by acupuncture is generally in the range 55– 85%, which compares favourably with that of potent drugs (morphine helps in 70% of cases) and far outweighs the placebo effect (30–35%) (1–3). In addition, the mechanisms of acupuncture analgesia have been studied extensively since the late 1970s, revealing the role of neural and humoral factors. 1.3 Evaluation methodology Unlike the evaluation of a new drug, controlled clinical trials of acupuncture are extremely difficult to conduct, particularly if they have to be blind in design and the acupuncture has to be compared with a placebo. Various “sham” or “placebo” acupuncture procedures have been designed, but they are not easy to 3