Arthur Yin Fan, Hongjian He

Academically, we agree with the recent Education and Practice paper by Zhou et al,1 which states that, for the treatment of musculoskeletal disorders, dry needling and acupuncture overlap greatly in their origin, techniques and theories, and dry needling is one subcategory of Western medical acupuncture, and is thus acupuncture. As current training and clinical practice of acupuncturists involve both Traditional Chinese Medicine (TCM) and Western medicine, at least in China, where acupuncture originated, we have the following comments. The term ‘acupuncture’ is a translation of 针刺术 (zhen ci shu in Chinese pin yin) or in short 针 (zhen), and is literally equivalent to the term ‘needling’ or ‘needling technique’. Based on the traditional and official definition, the term acupuncture refers to the actual insertion of a needle (usually a solid needle) into the body,2 which describes a family of procedures involving the stimulation of points on the body using a variety of techniques. The acupuncture technique that has been most often studied scientifically involves penetrating the skin with thin, solid, metallic needles that are usually manipulated by hand or by electrical stimulation. Practised in China and other Asian countries for thousands of years, acupuncture is one of the key components of TCM.3 Acupuncture is currently practised internationally, and has attracted more and more interest in Western countries, especially in the UK4 and the USA. Dry needling literally is acupuncture, although the term is more commonly used instead of acupuncture by physiotherapists in Western countries. As stated in the article by Zhou et al,1 dry needling is a subcategory of Western medical acupuncture. Taken literally, the term acupuncture includes both Western medical and traditional acupuncture, and thus obviously covers dry needling. Historically, dry needling is acupuncture. In China, especially in the East, the term dry needling (干 针, gan zhen in Chinese pin yin) has been a folk name for acupuncture since Western medicine arrived in China in the late 1800s, when the term of dry needling was created in order to differentiate it from the needles used for injections by Western trained doctors. Many people in China still refer to acupuncture as dry needling, especially after acupuncture point injection therapy and aquapuncture therapy were developed in China in the early 1950s.5 The term dry needling (gan zhen) has already become a synonym for acupuncture used by many Chinese practitioners. For example, when searching using the Chinese term 干针 in the Amazon book department (http://www. amazon.cn), all results are acupuncture books. With their combined education in both Western and Chinese medicine, modern acupuncturists from China are well equipped with knowledge and skills not only in TCM but also conventional medicine. Because of heterogeneous understanding and emphasis in training at different academic schools or different styles of practice, various types of acupuncture have developed all over the world, including Fu’s acupuncture, scalp acupuncture, wrist and ankle acupuncture, abdominal acupuncture and others, which undoubtedly include dry needling. Because of the rapid development of science and technology, and significant progress in modern research into acupuncture, the potential therapeutic mechanisms of acupuncture have been explored and include Pavlovian conditioned reflexes, nerve segment theory, gate theory, somato-autonomic nerve reflexes and others.6 All of these mechanistic concepts of acupuncture are based on modern biomedicine. Clearly, traditional acupuncture is being explained by modern science. In conclusion, dry needling is not only a subcategory of Western medical acupuncture but also an integral part of acupuncture per se. Although not all Western medicine practitioners may agree, dry needling is an important part of traditional acupuncture. 

Arthur Yin Fan(1) Hongjian He(2) 

1 McLean Center for Complementary and Alternative Medicine, PLC, Vienna, Virginia, USA 

2 Oriental Family Medicine, Clearwater, Florida, USA 

Correspondence to Dr Arthur Yin Fan, McLean Center for Complementary and Alternative Medicine, PLC, 8214A Old Courthouse Road, Vienna, VA 22182, USA; ArthurFan@ChineseMedicineDoctor.US 

Acknowledgements The author would like to thank Ms Sarah Faggert for editing support. 

Contributors AYF and HH drafted and approved the letter, and contributed equally to the content. Competing interests None declared. Provenance and peer review Not commissioned; internally peer reviewed. 

To cite Fan AY, He H. Acupunct Med Published Online First: [please include Day Month Year] doi:10.1136/acupmed-2015-011010 Accepted 25 November 2015 

REFERENCES 

1 Zhou K, Ma Y, Brogan MS. Dry needling versus acupuncture: the ongoing debate. Acupunct Med 2015;33:485–490. 

2 Kaptchuk TJ. Acupuncture: theory, efficacy, and practice. Ann Intern Med 2002;136:374–83. 

3 National Institutes of Health. Acupuncture. https://nccih.nih.gov/ health/acupuncture 

4 Dascanio VC. Acupuncture in physiotherapy: a contemporary UK perspective. Acupunct Med doi:10.1136/acupmed-2015-010977. 

5 Li P . Clinical acu-point injection therapy. Beijing: Military Medicine Press, 2003:15 (in Chinese). 

6 Jin GY, Jin JJX. Contemporary medical acupuncture: a systems approach. Beijing: Higher Education Press-Springer, 2007.