licensing mandates of a state should be checked to ensure the qualifications of a practitioner before a patient begins acupuncture treatment by that practitioner. With the growth of integrative medicine, more physicians are seeking formal training in medical acupuncture. Physicians trained in medical acupuncture may be desirable practitioners, especially in complex cases in which conventional allopathic therapies need to be considered in developing an integrative treatment plan. The American Academy of Medical Acupuncture is a physician resource for training and certification. WHAT ARE THE COMMON INDICATIONS FOR ACUPUNCTURE? The Chinese people continue to use acupuncture as a primary healing modality for the prevention and treatment of most ailments. In the United States, physicians and patients most frequently request acupuncture as an adjuvant therapy for managing conditions associated with acute and chronic pain. These conditions range across different neurologic, musculoskeletal, and gastrointestinal symptoms (Table). As acceptance of acupuncture increases within the medical community, the scope of acupuncture practice will likely broaden to mirror what is practiced worldwide to include nonepainrelated conditions. These changing trends are likely to lead to additional research efforts focused on conditions in which a paucity of evidence for use exists. WHAT DOES THE EVIDENCE SHOW? Although acupuncture has been used for thousands of years in Asia, the research community has started studying it only in the past few decades. The nature of acupuncture therapy involves tailoring treatments to the individual patient, and thus research on acupuncture has been difficult because of variable treatment interventions, techniques, and study size. Metaanalysis studies of acupuncture are limited because of the heterogeneity of pooling acupuncture treatment data. In 2005, Sood et al20 analyzed the considerable methodologic diversity in the Cochrane systematic reviews on acupuncture, which could introduce bias and complexity when reviewing acupuncture literature. The number of acupuncture studies and randomized controlled trials has increased substantially since the 1997 National Institutes of Health Consensus Conference highlighted several medical conditions in which acupuncture is effective or may be useful.21 In 2003, a review and analysis of reports on controlled clinical trials by the World Health Organization identified 28 diseases or conditions for which acupuncture has been proved effective.22 With the advent of such technological advances as functional magnetic resonance imaging, emerging evidence and research have found much promise in improving the understanding of acupuncture. Review of acupuncture research highlights a number of common conditions in which acupuncture may be efficacious (Table). CONCLUSION In recent years, the practice and acceptance of acupuncture in the medical community and MAYO CLINIC PROCEEDINGS 1144 Mayo Clin Proc. n October 2013;88(10):1141-1146 n http://dx.doi.org/10.1016/j.mayocp.2013.06.009 www.mayoclinicproceedings.org the general US public continue to increase. However, there are still challenges on how to fully integrate acupuncture into the Western medical paradigm. As acupuncture continues to withstand the test of time, the medical community must continue to investigate and provide evidence of its merits. Correspondence: Address to Tony Y. Chon, MD, Division of General Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (chon.tony@mayo.edu). REFERENCES 1. Veith I. The Yellow Emperor’s Classic of Internal Medicine. Berkeley, CA: University of California Press; 2002. 2. Kee CP. Acupuncture: an ancient Chinese art of healing. Singapore Med J. 1963;3:151-157. 3. Hsu E. Outline of the history of acupuncture in Europe. J Chin Med. 1989;29:28-32. 4. Reston J. Now, about my operation in Peking; now, let me tell you about my appendectomy in Peking. New York Times. July 26, 1971:1. 5. Becker RO, Reichmanis M, Marino AA, Spadaro JA. Electrophysiological correlates of acupuncture points and meridians. Psychoenergetic Systems. 1976;1:105-112. 6. Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965;150(3699):971-979. TABLE. Evidence-Based Indications for Acupuncture Therapy Indication Example Comments Common Neurologic Migraine Tension headache Evidence suggests acupuncture can be helpful for management of migraine and tension-type headaches Musculoskeletal Osteoarthritis (knee) Fibromyalgia Back pain Neck pain Postoperative pain Evidence suggests acupuncture can be helpful for management of osteoarthritis of the knee, fibromyalgia, and back, neck, and postoperative pain Gastrointestinal Nausea and vomiting Constipation Postoperative ileus IBS Evidence suggests acupuncture can be helpful for management of chemotherapy-induced nausea and postoperative nausea and vomiting Inconsistent evidence suggests efficacy of acupuncture for management of constipation, postoperative ileus, and IBS Further research may be helpful Gynecologic/reproductive Hot flashes Infertility PMS Inconsistent evidence suggests efficacy of acupuncture for management of hot flashes, infertility, and PMS Further research may be helpful Psychiatric/mood Stress Anxiety