Acupuncture Safety Record
National Acupuncture Foundation (NAF)

December 1, 2001


Due to the growing demand for acupuncture services, regulators throughout the United States are faced with setting standards to protect the public. One of the first questions which surfaces in discussing legislation is the risk of harm involved in acupuncture.

The evidence shows that, when performed by trained individuals, acupuncture is an extremely safe procedure and has a remarkably low record of accidents.

In 1983 – 84, recognizing that it was essential to set standards of competence, the acupuncture profession in the United States established the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM). One of the primary reasons for setting national standards was – and is – to protect the public from unqualified practitioners.

Potential harm to the public falls into two primary categories, the risk of accidental injury to internal organs and complications due to improper sterilization and clean needle technique, including the possible spread of infectious disease.

The chart (available for download below), Safety Record of Acupuncture, reflects reports in the medical literature in English since 1958 from the United States, West Germany, England, Israel, Ireland, Australia, Japan, China, Spain, Belgium and Switzerland. Three additional articles in foreign languages cited in the English literature are also included, one each from Belgium, West Germany and Japan.

The chart shows a remarkable safety record for acupuncture throughout the world. This is particularly true considering that in three of the countries listed, China, Korea and Japan, acupuncture is a frequent form of health care for hundreds of thousands of people.

Regarding the risk of injury to internal organs, the first risk, acupuncturists are trained in exact needle placement, angle and insertion depth. This results in an extremely low risk of injury when acupuncture is performed by a competent individual. This is demonstrated by the following:

  • In China and Japan, both of which have excellent training programs for acupuncturists and thousands of treatments annually, only ten injuries to internal organs have been reported since 1972.
  • No injuries have been reported from Korea.
  • In the United States, only ten incidents of injury have been reported since 1965.
  • Of the ten cases in the United States, one was noted as a “one-in-a-million” complication, another as a bizarre set of circumstances involving self-inflicted injury by an untrained individual.
  • Of the reports from the United States, only one specified that the treatment had been performed by a licensed or certified acupuncturist and that individual was licensed without examination or standards of competency.
  • In the reports from the other Western countries, in most of which only M.D.s may practice acupuncture, it was unclear who had performed the treatment.
  • In the seventeen years that the NCCAOM has certified over 10,000 individuals in acupuncture, NCCAOM has never had reason to take action against a Diplomate due to negligent or harmful treatment to a patient.

Additionally, in the cases in which there was damage to internal organs, in most cases, except the two unusual cases noted above, the patient recovered and the damage was minimal. In fact, in the cases of retained or broken needle, the needle had been in place up to 35 years without complications.

From the outset, the acupuncture profession in the United States recognized the second risk of harm to the public, the risk inherent in the use of unsterile needles and lack of clean needle technique. Thus, one of the first tasks of the profession was to establish standards for clean needle technique (CNT). Therefore, in concert with the Center for Disease Control in Atlanta, Georgia, the profession developed the Clean Needle Technique Manual, published by the National Acupuncture Foundation. The CNT Manual serves as the basis for questions on the NCCAOM written examination as well as for the national CNT Course offered by the Council of Colleges of Acupuncture and Oriental Medicine (CCAOM). Passage of the CNT Course is required for NCCAOM certification and for licensure in most states.

The chart demonstrates that complications due to improper clean needle technique occur in countries, states or professions that have not set standards of clean needle technique for acupuncture practice. Additionally, of the seven complications due to improper clean needle technique in the United States, only three were due to treatment by acupuncturists. One individual was not licensed or certified, one was licensed without exam and the status and background of the third was not mentioned. No such incident to date has been reported involving a nationally certified acupuncturist who has met national CNT requirements.

In the entire literature search, only four fatalities were reported. Three of these involved patients with significant health problems which the authors stated contributed to the death. The fourth involved self-treatment for a heart condition.

The second series of charts beginning on page 5, Safety Record of Certified, Licensed or Registered Acupuncturists, reemphasizes the safety of acupuncture when performed by trained individuals. These charts show the responses received from three surveys of state licensing boards regarding injuries due to acupuncture reported to them. It shows a remarkable record, particularly considering several of the states have permitted practice for over twenty years and have hundreds of licensed acupuncturists


The evidence clearly shows that acupuncture is extremely safe when performed by well-trained individuals who have met solid standards of practice. Thus, the only significant danger to the public lies in lack of standards and in performance of acupuncture by improperly or poorly trained individuals. For this reason, regulations establishing standards of competence are essential to protect the public.