The vast majority of contraindications for acupuncture are relative rather than absolute contraindications.
- Unexplained or undiagnosed medical or surgical conditions—In my mind, this is an absolute contraindication. Please never send your patient to an acupuncturist if you have not thoroughly investigated your patients’ problems, as this can delay or miss a medical diagnosis that can lead to dire consequences. A meticulous history, physical exam, and continuing observations and diligent follow-ups are always the best practice.
- Sepsis and overwhelming infection— although acupuncture has been implemented in situations of shock and resuscitation (#20, #21), at the present time, there is insufficient evidence to recommend routine use of acupuncture in a patient inflicted with overwhelming infection or sepsis. Resuscitation with fluids and antibiotics using our current critical care knowledge remains the mainstay of treatment.
- Unexplained and/or unstable syncope or seizure—these situations need to be addressed and stabilized with all modern medicine can offer before any acupuncture can be considered.
- Damaged heart valves and endocarditis—although manually or electrically stimulated acupuncture needles are thought to have a bacteriostatic or even bacteriocidal effect, acupuncture needs to be used with extreme caution in a patient who is susceptible to endocarditis. Any disruption of the skin should also be avoided in severely neutropenic patients, as seen after myelosuppresive chemotherapy (#4). Similarly, for patients who are severely immuno-compromised, it is best to avoid acupuncture therapy.
- Pacemaker or AICD (automatic implantable cardioverter-defibrillator) patients should avoid electroacupuncture or electrical stimulation (#4).
- Bleeding disorders and use of anticoagulants—these are not absolute contraindications, as acupuncture needles are nearly always thinner or much finer than the phlebotomy needles and intravenous catheters routinely administered to these patients in hospitals. However, the acupuncturist should always be notified regarding any bleeding risks (#4).
- Pregnancy—this is not an absolute contraindication. Acupuncture has been studied extensively for gestational conditions such as breech presentations, pregnancy-associated nausea and labor pain. In fact, there are certain acupuncture points that are known to induce labor; thus, if your patient is pregnant, her acupuncturist should definitely be informed (#4).
- Local contraindications of acupuncture include active infection, skin lesions, or malignancy at the insertion sites, since there is the risk of worsening the condition, such as spreading the infection, creating more inflammation, or causing the dispersal or metastatic tumor cells, respectively (#4).