W.H.O Benchmarks For The Practice of Acupuncture
W.H.O Benchmarks For The Practice of Acupuncture
W.H.O Benchmarks For The Practice of Acupuncture
THE PRACTICE
OF ACUPUNCTURE
WHO BENCHMARKS FOR
THE PRACTICE
OF ACUPUNCTURE
WHO benchmarks for the practice of acupuncture
ISBN 978-92-4-001688-0 (electronic version)
ISBN 978-92-4-001689-7 (print version)
Foreword iv
Preface v
Acknowledgements vi
Glossary vii
1. Introduction 1
2. Procedures 3
2.1 Preparation 3
2.2 Techniques 3
2.3 Records 4
3. Facilities 5
4. Safety 7
4.1 Precautions 7
4.2 Contraindications 7
4.3 Infection prevention and control 7
4.4 Incident management 8
References 9
iii
Foreword
The World Health Organization (WHO) is currently implementing its 13th General Programme of Work
(GPW13) to support countries in reaching all health-related Sustainable Development Goals (SDGs).
GPW13 is structured around three interconnected strategic priorities: achieving universal health coverage;
addressing health emergencies; and promoting healthier populations. These strategic priorities are
supported by three strategic shifts: stepping up leadership; driving public health impacts in every country;
and focusing global public goods on impact.
Traditional medicine has always had a role in this collective endeavour. The Declaration of Astana, renewed
from the Declaration of Alma-Ata towards universal health coverage and the SDGs, reaffirms the role of
traditional medicine in strengthening primary health care, a cornerstone of health systems, in pursuit of
health for all. This has also been reflected in the WHO global report on traditional and complementary
medicine 2019, in which 88% of WHO Member States acknowledge the use of traditional and
complementary medicine in health care.
Taking note of the growing importance of traditional medicine in the provision of health care nationally
and globally, WHO and its Member States have strived to explore ways to integrate, as appropriate, safe
and evidence-based traditional and complementary medicine services within national or subnational
health systems, as committed to in the Political Declaration of the High-level Meeting on Universal Health
Coverage.
WHO aims to provide policy and technical guidance to Member States; promote the safe and effective
use of traditional and complementary medicine through appropriate regulation of products, practices and
practitioners; and support Member States in harnessing the contribution of traditional and complementary
medicine to people-centred health care in implementing the WHO Traditional Medicine Strategy
2014–2023.
Setting norms and standards is a unique function of WHO. The normative work is driven by needs and
could be translated into real impact in relevant countries through appropriate policy options. This series
of benchmarks, covering various systems and interventions of traditional, complementary and integrative
medicine, aims to provide a reference point to which actual practice and practitioners can be evaluated.
I am very pleased to introduce this series to policy-makers, health workers and the general public, and I
firmly believe it will serve its purpose.
Zsuzsanna Jakab
Deputy Director-General
World Health Organization
iv
Preface
Integrated health services are essential for the World Health Organization (WHO) in the implementation
of its 13th General Programme of Work, which aims to support countries in achieving universal health
coverage and the health-related Sustainable Development Goals. The overarching mission for the
Department of Integrated Health Services is to accelerate equitable access to quality health services that
are integrated and people-centred, and that can be monitored and evaluated.
WHO is unique in its mandate to provide independent normative guidance. Its normative products
encompass a wide range of global public health goods, including norms and standards. It is therefore
the primary role of the Department of Integrated Health Services to generate and produce relevant global
goods. Key to improving its work in this area is ensuring global public health goods are driven by country
needs and can deliver tangible impacts at the country level.
As of 2018, when 88% of WHO Member States acknowledged the use of traditional and complementary
medicine, WHO’s support in evaluating the safety, quality and effectiveness of traditional and complementary
medicine has continuously ranked in the top areas of need, according to the WHO global report on
traditional and complementary medicine 2019.
WHO prioritizes normative products based on an assessment of demands. To address increasing needs
and to drive impact in countries, this series of benchmarks captures the main systems and interventions
of traditional, complementary and integrative medicine by setting up required norms and standards on
training and practice.
WHO’s guiding principles and quality assurance procedures have been strictly followed in designing and
formulating these benchmarks. WHO will not only assess the quality of these normative products but
also streamline systems and plans for monitoring and evaluation.
I am pleased to present this series of benchmarks and invite you to join us in measuring and documenting
their impact.
Edward Kelley
Director
Department of Integrated Health Services
World Health Organization
v
Acknowledgements
The World Health Organization (WHO) acknowledges the financial support of the National Administration
of Traditional Chinese Medicine, China, without which the production of this document would not have
been possible.
Thanks are due to the China Association of Acupuncture-Moxibustion and Guangzhou University of
Chinese Medicine, China, which kindly provided logistic support to the WHO working group meetings
on this document.
Special thanks go to Baoyan Liu, Jia Liu and Nicola Robinson, who have actively and diligently contributed
to the drafting and editing of this document. WHO is indebted to all experts who have provided their
inputs to the WHO working group meetings and the peer review process.
Qi Zhang and Qin Liu undertook revision work under the guidance of Edward Kelley. Colleagues within
the WHO headquarters team for traditional, complementary and integrative medicine provided secretarial
support.
vi
Glossary
Acupuncture manipulation
Movement of the needle applied after insertion to increase the effectiveness of acupuncture, basically
including thrusting, lifting, twirling and rotating manipulations.
Pressing hand
The acupuncture practitioner’s hand that presses the puncturing site to facilitate needle insertion.
Puncturing hand
The acupuncture practitioner’s hand that holds and inserts the needle.
vii
Executive summary
A standardized protocol for acupuncture treatment, against which actual practice can be compared and
evaluated, has been lacking. With the increasing use of acupuncture in clinical settings worldwide, there
is an urgent need to develop benchmarks for the practice of acupuncture to ensure its safety, quality
and effectiveness.
This document will join the updated benchmarks for the training of acupuncture to form an integral part
of the serial benchmarks, targeting key modalities of traditional medicine intervention and contributing
to the establishment of a reference toolkit for countries.
In line with WHO established principles and processes for benchmark development, the WHO Secretariat
made the planning proposal and clarified the scope of work. The first draft was prepared by selected
leading experts based on the framework provided by WHO. This draft was presented to the working
group meeting for discussion.
Twenty-three experts from 14 countries across the WHO regions joined the first working group meeting.
After three days of intensive discussion on the scope, structure and content of the draft document, the
meeting was concluded with consensus and advice on further improvement, which guided production
of the second draft. This draft was then ready for extended peer review.
A total of 196 experts from 59 countries covering all six WHO regions were consulted in the external peer
review process. They represented a wide range of expertise needed in developing these benchmarks.
Eventually, 571 concrete suggestions encompassing every aspect of the document, from overall structural
arrangement to a specialized technical issue, were received. This valuable feedback strongly informed the
production of the third draft, which was then ready for further review at the second working group meeting.
The second working group meeting aimed to conclude the consulting process by inviting selected experts
to finalize the document. Seventeen experts from nine countries across the WHO regions joined the
consultation and contributed to the development of the fourth draft, which became the last technical
version of the benchmark before formatting and printing.
1 See: https://apps.who.int/iris/bitstream/handle/10665/66007/WHO_EDM_TRM_99.1.pdf
viii
What does this benchmark cover?
This document is structured in four parts:
Introduction: gives a short briefing on the background and objectives of the document.
Procedures: presents stepwise guidance for the administration of acupuncture treatment.
Facilities: provides the minimum infrastructure requirements for delivering an acupuncture service.
Safety: emphasizes the key elements for the safe practice of acupuncture.
These four parts constitute a complete set of benchmarks for the practice of acupuncture.
Qi Zhang
Head
Unit of Traditional, Complementary and Integrative Medicine
Department of Integrated Health Services
World Health Organization
ix
x
1 Introduction
Acupuncture remains the most common form of traditional medicine practice, with its use acknowledged
by 113 Member States in the WHO global report on traditional and complementary medicine 2019 (1).
In 1999, the World Health Organization (WHO) published the Guidelines on basic training and safety in
acupuncture (2). These guidelines presented what professional experts and health regulators considered
to be appropriate training programmes for acupuncture practitioners.
There has, however, been a lack of standardized protocols for acupuncture treatment by which the
practice can be compared and evaluated. By setting up benchmarked requirements for the practice of
acupuncture, this document tries to reduce the gaps and ensure the safety, quality and effectiveness of
acupuncture services.
In addition to the introduction, this document incorporates three essential components – procedures,
facilities and safety – to constitute a set of benchmarks for the practice of acupuncture.
1
2
2 Procedures
2.1 Preparation
2.1.1 Acupuncture needles
Selecting: the practitioner should select acupuncture needles according to the patient’s age, physical
constitution and state of illness, and the location of the selected acupoint (3).
Examining: the practitioner should check the acupuncture needles carefully before each treatment and
discard any imperfect needles (4).
2.1.2 Acupoints
Locating: the practitioner should select the most appropriate methods to locate the acupoints to be
needled (5,6).
Disinfecting: the practitioner should prepare the needling site correctly according to local infection
control guidelines.
Sitting:
backward-sitting position is suggested for acupuncture treatment to the forehead, face, neck,
upper limbs and chest;
forward-sitting position is suggested for acupuncture treatment to the vertex, occiput, shoulders
and back.
Other positions can be decided by the practitioner and patient for the convenience of providing treatment.
2.2 Techniques
2.2.1 Holding
The practitioner should pay strict attention to appropriate disinfection of their hands before administering
acupuncture.
The practitioner should hold the handle or the body of the acupuncture needle appropriately with
two or three fingers.
3
2.2.2 Inserting
The practitioner should decide the most appropriate insertion method according to the location of the
acupoint and the selection of needles.
The practitioner should insert the needle by using the puncturing hand and the pressing hand in an
appropriate manner.
The practitioner should insert the needle at the appropriate angle and depth according to the acupoint
location, purpose of treatment and physical condition of the patient, to ensure safe and effective practice.
2.2.3 Manipulating
The practitioner should perform appropriate thrusting, lifting, twirling and rotating manipulations to
obtain the needling sensation and treatment effectiveness (7).
The practitioner could perform pressing manipulation along the meridian with the fingers to enhance
the needling sensation.
2.2.4 Retaining
The practitioner should determine the duration of time required for needle retention according to the
patient’s situation.
The practitioner could perform needle retention with or without intermittent needling manipulation
as appropriate.
2.2.5 Withdrawing
The practitioner should lift the needle slightly until the release of a tight sensation around the shaft
and then withdraw the needle.
The practitioner should hold a clean swab to assist withdrawing and may press the acupuncture site
immediately after withdrawing.
2.3 Records
2.3.1 Information to be recorded
chief complaint and medical history;
physical examination;
pattern differentiation and therapeutic principle;
acupuncture prescription and patient’s consent;
needling details and patient’s response;
treatment outcomes and any incidents (8);
further advice, including follow-up, if needed.
4
3 Facilities
5
6
4 Safety
4.1 Precautions
4.1.1 Before treatment
The patient should be informed of the possible benefits and potential risks associated with the treatment.
The practitioner should obtain informed consent from the patient before treatment, either orally or
in writing.
4.2 Contraindications
4.2.1 By disease and syndrome
Acupuncture treatment should not be administered to people with a disturbance of blood coagulation.
Acupuncture treatment should not be administered to people with unstable epilepsy.
4.2.2 By condition
Acupuncture treatment should not be administered to infants on the fontanelle before it has closed.
Acupuncture treatment should not be administered to the lower abdomen or lumbosacral region in
women who are pregnant, to avoid contraction of the uterus.
7
sterilization of reusable acupuncture needles;
disinfection of other apparatus;
hygiene of the practitioner’s hands (9);
hygiene of the acupoint sites;
disinfection of the materials;
disinfection of the treatment area.
8
References
1. WHO global report on traditional and complementary medicine 2019. Geneva: World Health
Organization; 2019 (https://apps.who.int/iris/bitstream/handle/10665/312342/9789241515436-eng.
pdf, accessed 28 July 2020).
2. Guidelines on basic training and safety in acupuncture. Geneva: World Health Organization; 1999
(https://apps.who.int/iris/bitstream/handle/10665/66007/WHO_EDM_TRM_99.1.pdf, accessed 28
July 2020).
4. Standardized manipulation of acupuncture and moxibustion part 20: basic techniques of filiform
needle. Beijing: Standardization Administration of People’s Republic of China; 2009.
6. WHO standard acupuncture point locations in the Western Pacific region. Manila: World Health
Organization; 2008.
7. Standardized manipulation of acupuncture and moxibustion part 21: filiform needle manipulation by
basic applying technique. Beijing: Standardization Administration of People’s Republic of China; 2013.
8. Minimal information model for patient safety incident reporting and learning systems. Geneva: World
Health Organization; 2016 (https://apps.who.int/iris/bitstream/handle/10665/255642/WHO-HIS-SDS-
2016.22-eng.pdf, accessed 28 July 2020).
9. WHO guidelines on hand hygiene in health care. Geneva: World Health Organization; 2009 (https://
apps.who.int/iris/bitstream/handle/10665/44102/9789241597906_eng.pdf, accessed 28 July 2020).
10. Handling methods for acupuncture abnormal conditions. Beijing: Standardization Administration of
People’s Republic of China; 2016.
9
10
Annex 1. Disinfection requirements during
acupuncture treatment
Disinfection required during acupuncture provision should be conducted according to local infection
control guidelines by considering the following principles:
Sterilization of reusable acupuncture needles: reusable acupuncture needles should be sterilized.
Disposable single-use sterile needles are strongly recommended and shouldn’t be reused.
Disinfection of other apparatus: apparatus in direct contact with acupuncture needles should be
properly disinfected before each application.
Hygiene of the practitioner’s hands: the practitioner should clean and disinfect their hands and fingers
before and after providing acupuncture treatment.
Hygiene of the acupoint sites: acupoints and the surrounding areas should be disinfected before
acupuncture treatment is given.
Disinfection of the materials: materials in direct contact with the patient, including but not limited to
sheets and towels, should be disinfected or disposable. Materials without direct contact, including but
not limited to mattress and pillow, should be hygienically maintained for each use.
Disinfection of the treatment area: the treatment room, equipment and devices should be kept clean
and tidy.
11
Annex 2. Protocol for incident management
during acupuncture treatment
A2.1 Fainting
Stop needling immediately.
Withdraw all needles from the patient.
Have the patient lie down and rest in a comfortable position.
Assess and refer as appropriate.
12
A2.6 Pneumothorax
Stop needling immediately.
Withdraw all needles from the patient.
Reassure the patient.
Have the patient rest in a suitable position.
Assess and refer to other health-care professionals as appropriate.
13
Annex 3. First working group meeting
Participants
WHO Region of the Americas
Terry Wai-Tin Hui, Cosmos Integrative Health Centre, Canada
Jian Kong, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, United
States of America
Paulo Roberto Sousa Rocha, Consultant, National Policy of Integrative and Complementary Medicine
Practices, Primary Health Care Department, Ministry of Health, Brazil
Weidong Yu, Chair, Traditional Chinese Medicine-Acupuncture Program Advisory Committee, Kwantlen
Polytech University, Canada
Koosnadi Saputra, National Institute of Health Research and Development, Ministry of Health, Indonesia
Kim Kun Hyung, Department of Acupuncture and Moxibustion, Korean Medicine Hospital, Pusan National
University, Republic of Korea
Farisah Binti Shaari, Senior Principal Assistant Director, Traditional and Complementary Division, Ministry
of Health, Malaysia
Chunzhi Tang, Dean, Acupuncture and Tuina School, Guangzhou University of Chinese Medicine, China
14
Nenggui Xu, Vice President, Guangzhou University of Chinese Medicine, China
Charlie Changli Xue, Dean, School of Health Sciences, RMIT University, Australia
Fang Zeng, Vice Dean, Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine,
China
Observers
Zhaoxiang Bian, Director and Chair Professor of Clinical Division, School of Chinese Medicine, Hong Kong
Baptist University, Hong Kong Special Administrative Region, China
Yi Feng, Associate Professor, Institute of Acupuncture Research, Shanghai Medical College, Fudan
University, China
WHO Secretariat
Qi Zhang, Coordinator, Traditional, Complementary and Integrative Medicine, Service Delivery and Safety,
WHO, Switzerland
Lin Zheng, Volunteer, Traditional, Complementary and Integrative Medicine, Service Delivery and Safety,
WHO, Switzerland
Local Secretariat
Jia Liu, China Academy of Chinese Medical Sciences, China
Guoxin Zhong, Acupuncture and Tuina School, Guangzhou University of Chinese Medicine, China
15
Annex 4. Second working group meeting
Participants
WHO African Region
Anastasia Michaelina Yirenkyi, Acting Director, Traditional and Alternative Medicine, Ministry of Health,
Ghana
Hedwig Luxenburger, President, International Council of Medical Acupuncture and Related Techniques,
Germany
Longxiang Huang, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical
Sciences, China
Yong-Suk Kim, Chief, Department of Acupuncture and Moxibustion, Hospital of Korean Medicine, Kyung
Hee University, Republic of Korea
Lixing Lao, Director, School of Chinese Medicine, University of Hong Kong, Hong Kong Special
Administrative Region, China
Yachan Li, Director, WHO Collaborating Centre for Traditional Medicine, Health Bureau, Macao Special
Administrative Region, China
Fengxia Liang, Vice Dean, College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine, China
16
Christopher Zaslawski, Discipline Leader, Chinese Medicine, School of Life Sciences, University of
Technology Sydney, Australia
Hong Zhao, Vice President, Acupuncture and Moxibustion Hospital, China Academy of Chinese Medical
Sciences, China
Observer
Salih Mollahaliloglu, Ankara Yildirim Beyazit University, Turkey
WHO Secretariat
Qi Zhang, Coordinator, Traditional, Complementary and Integrative Medicine, Service Delivery and Safety,
WHO, Switzerland
Qin Liu, Technical Officer, Traditional, Complementary and Integrative Medicine, Service Delivery and
Safety, WHO, Switzerland
Local Secretariat
Jingzhi Wang, Hubei University of Chinese Medicine, China
17
Department of Integrated Health Services
World Health Organization (WHO)
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