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Rapid response to:


Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis

BMJ 2008; 336 doi: (Published 06 March 2008) Cite this as: BMJ 2008;336:545

Rapid Response:

What about "forbidden points"?

The interesting research by Manheimer et al. highlights the effects of acupuncture on the female reproductive organs [1]. These effects are well-known, and a lot of acupuncturist treat various gynaecological problems[2, 3, 4] . On the other side, every clinical acupuncturist is aware of the potential contraindications of this therapy. So we found contradiction between some of the points reported in the studies cited in the meta-analysis and the so-called “forbidden points” of acupuncture.

These points are mentioned in every acupunctural manual [for example 5] and they are reported of common use in China as a simple technique to realize abortion [6]. In fact the stimulation of San Yin Chiao (Spleen 6) and He Gu (Liver 4) were forbidden for pregnant women even in ancient books like the Su Wen (Essential Questions) of the Huang Di Nei Jing (The Yellow emperor’s Internal Medicine)[7]. These acupoints could cause cervical dilatation [8]; Li-4 has a dual effect on the uterine smooth muscle through the regulation of the CNS; the stimulation of SP-6 may result in contraction of uterus by exciting the pelvic neuroplex through sympathetic nerves [9, 10, 11]. The stimulation of Li-4, Sp-6 and Neiguan (Pericardium 6), associated with Kunlun (Bladder 60), increased complete abortion rate of medicine-induced abortion [12].

The ear acupuncture could be dangerous for pregnant women as well. In fact, the auriculotherapy manuals recommend not to treat a pregnant woman. Oleson [13] reports that Chinese studies have shown that stimulation of the Uterus and Ovaries points on the ear can induce abortion. So it is possible to get opposite results as expected by Manheimer’s meta- analysis.

Francesco Crestani -


[1] Manheimer E, Zhang G, Udoff L, Langenberg P, Barman BM et al. Effects of acupuncture on rates of pregnancy and the live birth among women undergoing in vitro fertilisation: systematic review and meta- analysis. BMJ 2008; Feb 7 [Epub ahead of print]- doi:10.1136/bmj.39471.430451.

[2] Mo X, Li D, Pu Y, Xi G, Le X, Fu Z. Clinical studies on the mechanism for acupuncture stimulation of ovulation. J Tradit Chin Med, 1993 Jun; 13(2):115-9.

[3] Anderson BJ, Haimovici F, Ginsburg ES, Schust DJ, Wayne PM. In vitro fertilization and acupuncture: clinical efficacy and mechanistic basis. Altern Ther Health Med. 2007 May-Jun;13(3):38-48.

[4] Fan Q, Jue Z. Electro-acupuncture in relieving labor pain. Evid Based Complement Alternat Med. 2007;4(1)125-30.

[5] Focks C. Atlas Akupunktur. Fischer Verlag; Ulm, 1998.

[6] Amaro J. The “forbidden points” of acupuncture! Dynamic Chiropractic. May 1,2000, 18, Issue 10.

[7] Huang LX. Series of ancient classics on Acu-moxibustion Science, Hua-xia press, Beijing, China, 1997.

[8] Ying YK, Lin JT, Robins J. Acupuncture for the induction of cervical dilatation in preparation for first-trimester abortion and its influence on HCG. J Reprod Med. 1985 Jul;30(7):530:4.

[9] Liu Jy, Bian DL et al. Progress of acupuncturing Hegu (LI 4) during labour. Chinese Journal of information on TCM. 2005;12(5):108-110.

[10] Yang ZX. Treatment with acupuncturing at Hegu and Sanyinjiao, Zejiang Journal of Chinese Medicine. 2004(10):445-46

[11] Yang ZX. Clinical experience in treating diseases with acupuncturing at Hegu and Sanyinjiao. Zejiang Journal of Sichuan Traditional Chinese Medicine. 2002;20(7):75-6.

[12] Liang S, Guo Q, Bi XX, Zhang Y, Li TJ, Lin ZC. Clinical pathological observation on acupuncture increasing medicine-induced complete abortion rate. Zhongguo Zhen Jiu. 2005 Oct;25(10):696-8.

Competing interests: None declared

Competing interests: No competing interests

14 February 2008
Francesco Crestani
Pain Therapy
Salvatore Preteroti, Pain Therapy
San Luca Hospital, 45030 Trecenta (Rovigo), Italy