Acupuncture Methods: Manual, Electro- and Auricular Acupuncture and Acupressure

Different methods, different questions

"Acupuncture" is an umbrella word. NCCIH, the US National Center for Complementary and Integrative Health, describes it as a technique in which practitioners insert fine needles into the skin, and notes that the needles may be moved by hand or stimulated with small electrical currents (electroacupuncture). [1] Research on one method does not automatically apply to another, so this page keeps them apart. The canonical overview of the whole practice is What Is Acupuncture?.

Two groups are worth separating. Needle methods (manual, electro-, auricular) pierce the skin, so they carry the risks of any needle procedure. Acupressure uses pressure only, and has its own page, Acupressure.

Manual acupuncture

This is the form most people picture and the one most trials describe. Fine, solid needles are placed and may be moved by hand. [1] A UK hospital trust leaflet describes the treatment as needles that stimulate nerves in skin and muscle, with no drugs injected through them. [2] For what a practitioner does in general terms, see Manual Acupuncture: What Practitioners Do in General Terms.

Much of the research on back and neck pain and headache and migraine tests manual needling. NCCIH reports that, in reviews of back or neck pain, the difference between acupuncture and no treatment was greater than the difference between acupuncture and sham acupuncture. [1] That gap is one reason people debate how much of the benefit comes from the needling itself and how much from expectation, attention and other non-specific effects. NCCIH says there is evidence of effects on the nervous system and other tissues as well as nonspecific (placebo) effects. [1] See Sham Acupuncture and Placebo Controls.

Electroacupuncture

Needles are connected to a device that passes a small electrical current. [1] Evidence label: promising but limited, strongest for one condition. A 2017 trial in China randomized 504 women with stress urinary incontinence to 18 sessions over 6 weeks of electroacupuncture or sham electroacupuncture with no skin penetration; the electroacupuncture group had a larger drop in urine leakage on a pad test. [3] A separate network meta-analysis of knee osteoarthritis trials found electroacupuncture associated with more pain relief than manual acupuncture, but the overall certainty of evidence was very low. [4] Full detail: Electroacupuncture.

Auricular (ear) acupuncture

Auricular acupuncture stimulates specific areas of the ear. [1] NCCIH reports promising results for chronic back pain and cancer pain. [1] A widely used ear technique called battlefield acupuncture fared worse in a 2021 meta-analysis, which found no significant improvement in pain intensity. [5] Evidence label: promising but limited for ear methods in general, mixed for battlefield acupuncture. See Auricular Acupuncture and Battlefield Acupuncture. Ear seeds and other needle-free ear methods are covered under Ear Seeds and Auricular Acupressure.

Other methods with their own pages

• Scalp Acupuncture and Laser Acupuncture.
• Warm needle, fire needling and heat methods, which add heat and carry burn risks.
• Acupuncture combined with cupping, moxibustion and other adjuncts.

Choosing between methods

The method matters less than the reason you are seeking care. Ask why a method is suggested, what the evidence is for your problem, and how many sessions are expected before results are judged. If you have severe, sudden or worsening symptoms, see a doctor rather than waiting for a course of treatment. Read how to choose an acupuncturist and licensing and training.