WMA (Western Medical Acupuncture) is mainly practised by conventional doctors, physiotherapists, nurses and other healthcare practitioners working within the Western health service, mostly in primary care but also in rheumatology, orthopaedic and pain clinics.24 It is practised using the principles of evidence based medicine, though it has to be admitted that there is scope for more clinical trials, and treatment in many clinical areas relies on clinical experience.

The most widespread application of acupuncture is for pain relief, most commonly musculoskeletal pain but also other forms of chronic pain such as neuralgia and cancer pain. In practice, it is less often used to suppress procedural pain, postoperative pain or nausea though it has been shown to be effective in these situations.9 It is used in management of infertility, particularly as an adjunct to conventional treatments such as in vitro fertilisation, though the evidence is equivocal.

Practitioners who employ a WMA approach to acupuncture would not generally consider using it as a "tonic" for generalised ill health, nor claim that it can maintain good health, both of which have been traditional indications for acupuncture.

Treatment with WMA follows when a conventional medical examination, appropriate investigations and diagnosis confirm that the symptoms are suitable for treatment with acupuncture. Needles are inserted and stimulated to obtain the required physiological effect, and may be local to, or segmentally linked with, the presenting condition. Additionally, extrasegmental or general effects may be sought by needling general points, particularly in hands and feet, that are common to many Chinese formulae.

Traditional acupuncture holds that individual points have specific effects, but in WMA attention is less focused on choice of one point over another. Classical points are used by many - though not all - practitioners of WMA on the assumption that they are probably optimal for sensory stimulation of the nervous system. More attention is focused on the tissue level (eg, muscle rather than skin) and the type and amount of stimulation given. The classical nomenclature of points is generally used for convenience of communication with other acupuncturists.

Thus there are relatively few differences between traditional acupuncture and WMA in terms of treatment techniques. Both manual and electrical stimulation of needles are used; duration of needling is variable, ranging from very brief to up to 20 or 30 minutes.