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Asthma is a chronic inflammatory disorder of the airways characterised by variable airflow obstruction and airway hyper-responsiveness, and the presence of symptoms (more than one of wheeze, breathlessness, chest tightness and cough) (British Thoracic Society 2012). Around 5.4 million people in the UK are currently treated for asthma – 4.3 million adults and 1.1 million children (Asthma UK). Up to 5% of adults with the condition have severe disease that responds poorly to treatment (Dennis 2008), while childhood asthma can be difficult to distinguish from viral wheeze (Keeley 2005). Many people with asthma are atopic and, when they are exposed to certain stimuli, have inflammatory and structural changes in their airways (Duff 1992, Chan Yueng 1995). There are many such stimuli, for example, environmental allergens, occupational sensitising agents and respiratory viral infections (Duff 1992, Chan Yueng 1995) There are many published studies investigating the mechanisms by which acupuncture may have an effect in asthma, showing that it may help relieve asthma by: having regulatory effects on mucosal and cellular immunity in patients with allergic asthma, as shown, for example, by changes in levels of immunoglobulins, eosinophils, T-lymphocytes and cytokines (Yang 2013, Carneiro 2010, Joos 2000); reducing bronchial immune-mediated inflammation, particularly through the balance between T helper 1 and 2 cells and their associated cytokines (Carneiro 2010; Carneiro 2005, Jeong 2002). Reducing inflammation in general by promoting release of vascular and immunomodulatory factors (Kavoussi 2007, Zijlstra 2003); regulating expression of surfactant proteins, that help to reduce airways resistance biophysically and also modulate the immune response (Yan 2010); inhibiting structural changes in the airways, and hence reducing airways resistance, possibly by inhibiting T-type calcium channel protein in airway smooth muscle cells (Wang 2012); regulating the expression of genes and proteins that control the airways inflammatory response (Mo 2012, Xu 2012, Yin 2009); acting on areas of the brain known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the ‘analytical’ brain, which is responsible for anxiety and worry (Hui 2010).

'When I was first diagnosed with severe, debilitating anxiety, I was at a complete loss. What I was going through went beyond the random, stray worry that most people experience. I suffered from a host of physical symptoms including losing 20 pounds in two weeks, chest pains, non-stop body sweats, insomnia, exhaustion, a clenched jaw, stomach issues, and more. It all came together in a whirlwind convergence of physical and mental symptoms that sidelined me from daily life for a few months... After a month of regular treatments, I couldn’t help but notice a difference. I would always have the best sleep of the week the night after my acupuncture appointment. And I would also feel lighter. My chest wouldn’t be clenched as tightly and the raw current of anxiety that seems to continuously float just beneath the surface of my skin was dissipate for a while, allowing me to experience a semblance of normalcy, if only for a little while. And I’m not the only one finding relief for anxiety with acupuncture.'

Back pain can affect anyone at any age and most people will suffer from it at some point in their lives. It is the UK’s leading cause of disability and one of the main reasons for work-related sickness absence. The condition affects more than 1.1 million people in the UK, with 95% of patients suffering from problems affecting the lower back. Back pain currently costs the NHS and community care services more than £1 billion each year*. Most lower back pain is caused not by serious damage or disease, but by sprains, muscle strains, minor injuries, or a pinched or irritated nerve. It can also occur during pregnancy, or because of stress, viral infection or a kidney infection. Acupuncture can help back pain by: providing pain relief – by stimulating nerves located in muscles and other tissues, acupuncture leads to release of endorphins and other neurohumoral factors and changes the processing of pain in the brain and spinal cord (Pomeranz 1987; Zhao 2008). reducing inflammation – by promoting release of vascular and immunomodulatory factors (Kim 2008, Kavoussi 2007;Zijlstra 2003). improving muscle stiffness and joint mobility – by increasing local microcirculation (Komori 2009), which aids dispersal of swelling and bruising. reducing the use of medication for back complaints (Thomas 2006). providing a more cost-effective treatment over a longer period of time (Radcliffe 2006;Witt 2006). improving the outcome when added to conventional treatments such as rehabilitation exercises (Ammendolia 2008; Yuan 2008).

Type-2 diabetes (adult-onset or non-insulin-dependent diabetes) is a common metabolic disorder in which the body is unable to regulate the amount of glucose in the blood. The condition affects nearly 1.5 million people in the UK (Diabetes UK, 2004), and may be undiagnosed in as many as a million more. It develops when insufficient insulin is produced by the body, or when the body’s cells no longer respond to insulin (insulin resistance). The four common symptoms of type-2 diabetes are: excessive thirst, passing large amounts of urine, tiredness and weight loss. Over time, the high blood sugar levels caused by type-2 diabetes causes damage to blood vessels. This leads to atheroma, which can cause problems such as poor circulation, angina, heart attacks and stroke. It can result in diabetic complications, including eye disorders, nerve damage, foot problems, kidney disease and impotence. Studies indicate that acupuncture may: regulate insulin production (Lin et al, 2004) and blood sugar levels (Lin 2004; Chang 2006; Cabioğlu 2006; Jiang 2006) improve the blood lipid profile (Cabioğlu 2005; Jiang 2006) (dyslipidaemia is common in patients with type-2 diabetes and may lead to cardiovascular morbidity and mortality). improve blood circulation (Tsuchiya 2007), thus helping to slow the onset and progression of diabetic circulatory complications moderate the stress response (Sakai 2007) Most people use acupuncture as part of an integrated diabetes treatment plan because they are already using Western medication. Acupuncture can be safely and effectively combined with Western biomedicine and other treatments such as relaxation exercises and herbal medicine. In addition to offering acupuncture and related therapies, acupuncturists will often make suggestions as to dietary and other lifestyle changes that may be beneficial. Eating a healthy balanced diet, taking regular physical exercise, reducing stress and maintaining a healthy body weight can help to prevent or delay the onset of type-2 diabetes and slow the progression of the disease. Working with a supportive therapist can help people commit to these positive lifestyle changes.

Dysmenorrhoea is painful cramps originating in the uterus just prior to or during menstruation. It can be primary (i.e. without any organic pathology) or secondary (i.e. associated with a pathological condition, such as endometriosis or ovarian cysts). The pain usually lasts between 8 and 72 hours.(Fraser 1992) Acupuncture may help reduce symptoms of dysmenorrhoea by: regulating neuroendocrine activities and the related receptor expression of the hypothalamus-pituitary-ovary axis (Liu 2009; Yang 2008) increasing nitric oxide levels, which relaxes smooth muscle and hence may inhibit uterine contractions (Wang 2009) increasing relaxation and reducing tension (Samuels 2008). Acupuncture can alter the brain’s mood chemistry, reducing serotonin levels (Zhou 2008) and increasing endorphins (Han, 2004) and neuropeptide Y levels (Lee 2009), which can help to combat negative affective states stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors, and changes the processing of pain in the brain and spinal cord (Pomeranz, 1987; Zijlstra 2003; Cheng 2009); reducing inflammation, by promoting release of vascular and immunomodulatory factors (Zijlstra 2003; Kavoussi 2007)

Acupuncture is one of the longest established forms of healthcare in the world. It originated in China approximately 2,500 years ago is now practised across the globe. For acupuncturists, who use a traditional theory, the focus is on the individual, rather than an isolated complaint. The physical, emotional, and mental aspects of life are seen as interdependent. Acupuncturists use subtle diagnostic techniques, such taking the pulse and observing the tongue, that have been developed and refined for thousands of years. Treatment involves the insertion of very fine needles into specific points on the body to regulate the flow of ‘qi’ along pathways in the body known as ‘meridians’. Acupuncturists may also use other techniques such as moxibustion, cupping, tuina/massage, and guasha.

Endometriosis is a chronic condition characterised by growth of endometrial tissue in sites other than the uterus, most commonly in the pelvic cavity, but also in other parts of the body (RCOG 2006). This ectopic tissue responds to the hormonal changes of the menstrual cycle, with subsequent bleeding, inflammation, and pain. If the ovaries are affected, endometriotic ovarian cysts may develop (Bulun 009). Although the condition may be asymptomatic, common symptoms include dysmenorrhoea, dyspareunia, non-cyclical pelvic and abdominal pain, and subfertility (RCOG 2006). When endometriosis remains untreated, the disease progresses in around a third of women, but seems either to resolve or does not progress in the rest (DTB 1999). The prevalence is estimated to vary from 2-22% of women and, in women with dysmenorrhoea, the incidence of endometriosis is 40-60% (Johnson 2007). It has been shown that acupuncture treatment may specifically be of benefit in people with endometriosis by: providing pain relief – by stimulating nerves located in muscles and other tissues, acupuncture leads to release of endorphins and other neurohumoral factors, and changes the processing of pain in the brain and spinal cord (Zhao 2008, Han 2004, Zijlstra 2003, Pomeranz 1987). reducing inflammation – by promoting release of vascular and immunomodulatory factors Kavoussi 2007, Zijlstra 2003). regulating levels of prostaglandins (Jin 2009) combining acupuncture with Chinese herbal medicine for endometriosis has been shown in animal studies to down-regulate the abnormal increase of matrix metalloproteinase-2 (MMP-2) levels that is associated with ectopic activity of endometrial cells. The treated rats had reduced areas of ectopic tissue (Chen 2008). MMP-2 is required for the anchoring of the placenta to the uterine wall in pregnancy but over-production can lead to endometriosis.

Acupuncture is used extensively, and worldwide, in substance misuse treatment centres. This stems from the development of a simple 5-point auricular acupuncture protocol at New York’s Lincoln Hospital in the 1970’s, originally for drug users but subsequently extended to tobacco, alcohol and other addictive substances and behaviours. The protocol was designed to operate within Western health settings and mutual peer support systems, not as an isolated treatment. In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body’s homeostatic mechanisms, thus promoting physical and emotional well-being. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the ‘analytical’ brain, which is responsible for anxiety and worry (Wu 1999). Acupuncture may help relieve symptoms of drug withdrawal by: normalising the release of dopamine in the mesolimbic system. This reduces the over-stimulating effects of abused drugs and modifies behaviours associated with addiction such as those around desire and reward. Several brain neurotransmitter systems, for example serotonin, opioid and GABA, are implicated in this (Lee 2009a, Yang 2008, Zhao 2006) reducing anxiety (Samuels 2008). Acupuncture can alter the brain’s mood chemistry, reducing serotonin levels (Zhou 2008) and increasing endorphins (Han 2004) and neuropeptide Y levels (Lee 2009b; Cheng 2009); modulating postsynaptic neuronal activity in the nucleus accumbens and the striatum to reduce nicotine addiction (Chae 2004) and increasing corticotrophin-releasing factor to attenuate anxiety-like behaviour following nicotine withdrawal (Chae 2008)