It.estricts.he.se of wArds like “Acupuncture” and “Registered Acupuncturist”. citation needed At least 28 countries in Europe have professional associations for acupuncturists. 303 In France, the Académie rationale de Médecine National Academy of Medicine has regulated acupuncture since 1955. 304 ^ From Latin, aces needle and puncture to puncture 1 ^ a b c sigh & Ernst 2008 stated, “Scientists transdermal electrical nerve stimulation TENS masquerading as acupuncture”. 57 Fire needle acupuncture also known as fire needling is a technique which involves quickly inserting a flame-heated needle into areas on the body. 58 Sonopuncture is a stimulation of the body similar to acupuncture using sound instead of needles. 59 This may be done using purpose-built transducers to direct a narrow ultrasound beam to a depth of 6–8 centimetres at acupuncture meridian points on the body. 60 Alternatively, tuning forks or oether sound emitting devices are used. 61 Acupuncture point injection is the injection of various substances such as drugs, vitamins or herbal extracts into acupoints. 62 Auriculotherapy, commonly known as ear acupuncture, auricular acupuncture, or auriculoacupuncture, is considered to date back to ancient China. In.ther.ords,.sham' or 'placebo' acupuncture generally produces the same effects as 'real' acupuncture and, in some cases, does better.” 77 A 2013 meta-analysis found little evidence that the effectiveness of acupuncture on pain compared to sham was modified by the location of the needles, the number of needles used, the experience or technique of the practitioner, or by the circumstances of the sessions. 78 The same analysis also suggested that the number of needles and sessions is important, as greater numbers improved the outcomes of acupuncture compared to non-acupuncture controls. 78 There has been little systematic investigation of which components of an acupuncture session may be important for any therapeutic effect, including needle placement and depth, type and intensity of stimulation, and number of needles used. 75 The research seems to suggest that needles do not need to stimulate the traditionally specified acupuncture points or penetrate the skin to attain an anticipated effect e.g. psychosocial factors. 2 A response to “sham” acupuncture in osteoarthritis may be used in the elderly, but placebos have usually been regarded as deception and thus unethical. 79 However, some physicians and ethicists have suggested circumstances for applicable uses for placebos such as it might present a theoretical advantage of an inexpensive treatment without adverse reactions or interactions with drugs or other medications. 79 As the evidence for most types of alternative medicine such as acupuncture is far from strong, the use of alternative medicine in regular healthcare can present an ethical question. 80 Using the principles of evidence-based medicine to research acupuncture is controversial, and has produced different results. 71 Some research suggests acupuncture can alleviate pain but the majority of research suggests that acupuncture's effects are mainly due to placebo. 9 Evidence suggests that any benefits of acupuncture are short-listing. 14 There is insufficient evidence to support use of acupuncture compared to mainstream medical treatments . 81 Acupuncture is not better than mainstream treatment in the long term. 74 Publication bias is cited as a concern in the reviews of randomized controlled trials CRTs of acupuncture. 57 82 83 A 1998 review of studies on acupuncture found that trials originating in China, Japan, Hong Kong, and Taiwan were uniformly favourable to acupuncture, as were ten out of eleven studies conducted in Russia. 84 A 2011 assessment of the quality of CRTs on ACM, including acupuncture, concluded that the methodological quality of most such trials including randomization, experimental control, and blinding was generally poor, particularly for trials published in Chinese journals though the quality of acupuncture trials was better than the trials testing ACM remedies. 85 The study also found that trials published in non-Chinese journals tended to be of higher quality. 85 Chinese authors use more Chinese studies, which have been demonstrated to be uniformly positive. 86 A 2012 review of 88 systematic reviews of acupuncture published in Chinese journals found that less than half of these reviews reported testing for publication bias, and that the majority of these reviews were published in journals with impact factors of zero. 87 Scientist and journalist Steven Salzburg identifies acupuncture and Chinese medicine generally as a focus for “fake medical journals” such as the Journal of Acupuncture and Meridian Studies and Acupuncture in Medicine . 88 The conclusions of many trials and numerous systematic reviews of acupuncture are largely inconsistent with each other. 13 A 2011 systematic review of systematic reviews found that for reducing pain, real acupuncture was no better than sham acupuncture, and concluded that numerous reviews have shown little convincing evidence that acupuncture is an effective treatment for reducing pain. 10 The same review found that neck pain was one of only four types of pain for which a positive effect was suggested, but cautioned that the primary studies used carried a considerable risk of bias. 10 A 2009 overview of Cochran reviews found acupuncture is not effective for a wide range of conditions, and suggested that it may be effective for only chemotherapy-induced nausea/vomiting, postoperative nausea/vomiting, and idiopathic headache. 13 A 2014 systematic review suggests that the nocebo effect of acupuncture is clinically relevant and that the rate of adverse events may be a gauge of the nocebo effect. 89 According to the 2014 Miller's anaesthesia book, “when compared with placebo, acupuncture treatment has proven efficacy for relieving pain”. 44 A 2012 meta-analysis conducted by the Acupuncture Trialists' Collaboration found “relatively modest” efficiency of acupuncture in comparison to sham for the treatment of four different types of chronic pain back and neck pain, knee osteoarthritis, chronic headache, and shoulder pain and on that basis concluded that it “is more than a placebo” and a reasonable referral option. 90 Commenting on this meta-analysis, both Eduard Ernst and David Colquhoun said the results were of negligible clinical significance. 91 92 Eduard Ernst later stated that “I fear that, once we manage to eliminate this bias that operators are not blind … we might find that the effects of acupuncture exclusively are a placebo response.” 93 A 2010 systematic review suggested that acupuncture is more than a placebo for commonly occurring chronic pain conditions, but the authors acknowledged that it is still unknown if the overall benefit is clinically meaningful or cost-effective. 94 A 2010 review found real acupuncture and sham acupuncture produce similar improvements, which can only be accepted as evidence against the efficacy of acupuncture. 95 The same review found limited evidence that real acupuncture and sham acupuncture appear to produce biological differences despite similar effects. 95 A 2009 systematic review and meta-analysis found that acupuncture had a small analgesic effect, which appeared to lack any clinical importance and could not be discerned from bias. 15 The same review found that it remains unclear whether acupuncture reduces pain independent of a psychological impact of the needling ritual. 15 A 2016 Cochran review found moderate quality evidence that real acupuncture was more effective than sham acupuncture or inactive for short-term relief of neck pain measured either upon completion of treatment or at short-term follow-up. 96 A 2013 meta-analysis found that acupuncture was better than no treatment for reducing lower back pain, but not better than sham acupuncture, and concluded that the effect of acupuncture “is likely to be produced by the non-specific effects of manipulation”. 97 A 2013 systematic review found supportive evidence that real acupuncture may be more effective than sham acupuncture with respect to relieving lower back pain, but there were methodological limitations with the studies. 98 A 2013 systematic review found that acupuncture may be effective for non-specific lower back pain, but the authors noted there were limitations in the studies examined, such as heterogeneity in study characteristics and low methodological quality in many studies. 99 A 2012 systematic review found some supporting evidence that acupuncture was more effective than no treatment for chronic non-specific low back pain; the evidence was conflicting comparing the effectiveness over other treatment approaches. 12 A 2011 systematic review of systematic reviews found that “for chronic low back pain, individualized acupuncture is not better in reducing symptoms than formula acupuncture or sham acupuncture with a toothpick that does not penetrate the skin.” 10 A 2010 review found that sham acupuncture was as effective as real acupuncture for chronic low back pain. 2 The specific therapeutic effects of acupuncture were small, whereas its clinically relevant benefits were mostly due to contextual and psychosocial circumstances. 2 Brain imaging studies have shown that traditional acupuncture and sham acupuncture differ in their effect on limbic structures, while at the same time showed equivalent analgesic effects. 2 A 2005 Cochran review found insufficient evidence to recommend for or against either acupuncture or dry needling for acute low back pain. 100 The same review found low quality evidence for pain relief and improvement compared : 10.1093/rheumatology/ken161 . Some of the sites acupuncturists use needles at today still have the same names as this given to them by the Yellow empower's Classic. 29 :93 Numerous additional documents were published over the centuries introducing new acupoints. 29 :101 By the 4th century AD, most of the acupuncture sites in use today had been named and identified. 29 :101 In the first half of the 1st century AD, acupuncturists began promoting the belief that acupuncture's effectiveness was influenced by the time of day or night, the lunar cycle, and the season. 29 :140-141 The Science of the Yin-Yang Cycles yen chi Hsüeh was a set of beliefs Needles. 48 Japanese acupuncturists use extremely thin needles that are used superficially, sometimes without penetrating the skin, and surrounded by a guide tube a 17th-century invention adopted in China and the West.

Medical.cupuncture.ttempts to integrate reflexological concepts, the trigger point model, and anatomical insights such as dermatome distribution into acupuncture practice, and emphasizes a more formulaic approach to acupuncture point location. 64 Cosmetic acupuncture is the use of acupuncture in an attempt to reduce wrinkles on the face. 65 Bee venom acupuncture is a treatment approach operation; these demonstration cases were also frequently rdeceiving morphine surreptitiously through an intravenous drip that observers were told contained only fluids and nutrients. 281 One patient receiving open heart surgery while awake was ultimately found to have received a combination of three powerful sedatives as well as large injections of a local aesthetic into the wound. 57 After the National Institute of Health expressed support for acupuncture for a limited number of conditions, adoption in the US grew further. 27 In 1972 the first legal acupuncture canter in the US was established in Washington DC 282 and in 1973 the American Internal Revenue Service allowed acupuncture to be deducted as a medical expense. 283 In 2006, a BBC documentary Alternative Medicine filmed a patient undergoing open heart surgery allegedly under acupuncture-induced anaesthesia. A.Oman.eceiving fire pain via the local release of adenosine, which then triggered close-by A1 receptors “caused more tissue damage and inflammation relative to the size of the animal in mice than in humans, such studies unnecessarily muddled a finding that local inflammation can result in the local release of adenosine with analgesic effect.” 77 It has been proposed that acupuncture's effects in gastrointestinal disorders may relate to its effects on the parasympathetic and sympathetic nervous system, which have been said to be the “Western medicine” equivalent of “yin and yang”. 263 Another mechanism whereby acupuncture may be effective for gastrointestinal dysfunction involves the promotion of gastric peristalsis in subjects with low initial gastric motility, and suppressing peristalsis in subjects with active initial motility. 264 Acupuncture has also been found to exert anti-inflammatory effects, which may be mediated by the activation of the vague nerve and deactivation of inflammatory macrophages . 265 Neuroimaging studies suggest that acupuncture stimulation results in deactivation of the limbic brain areas and the default mode network . 266 Acupuncture chart from the Ming dynasty c. 1368–1644 Acupuncture, along with moxibustion, is one of the oldest practices of Traditional Chinese Medicine. 29 Most historians believe the practice began in China, though there are some conflicting narratives on when it originated. 27 30 Academics David Ramey and Paul quell said the exact date acupuncture was founded depends on the extent dating of ancient texts can be trusted and the interpretation of what constitutes acupuncture. 267 According to an article in Rheumatology, the first documentation of an “organized system of diagnosis and treatment” for acupuncture was in The Yellow Emperor's Classic of Internal Medicine Huangdi Beijing from about 100 BC. 27 Gold and silver needles found in the tomb of Li Cheng from around 100 BC are believed to be the earliest archaeological evidence of acupuncture, though it is unclear if that was their purpose. 267 According to Dr. amid   Association of Canada are used in provinces without government regulation. 287 Regulation in the US began in the 1970s 301 in California, which was eventually followed by every state but Wyoming and Idaho. 299 302 Licensing requirements vary greatly from state to state. Needles may be manipulated in various ways, including spinning, are still unable to find a shred of evidence to support the existence of meridians or C'i”, 21 “The traditional principles of acupuncture are deeply flawed, as there is no evidence at all to demonstrate the existence of C'i or meridians” 22 and “As yin and yang, acupuncture points and meridians are not a reality, but merely the product of an ancient Chinese philosophy”. 23 Tyne, D.; Shenker, N.

The.Judy.lso.ncludes.arnings.gainst.ractising acupuncture on infants, as well as on children who are over-fatigued, very weak, or have overeaten. 240 When used on children, acupuncture is considered safe when administered by well-trained, licensed practitioners using sterile needles; however, a 2011 review found there was limited research to draw definite conclusions about the overall safety of paediatric acupuncture. 3 The same review found 279 adverse events, 25 of them serious. 3 The adverse events were mostly mild in nature e.g. bruising or bleeding. 3 The prevalence of mild adverse events ranged from 10.1% to 13.5%, an estimated 168 incidences among 1,422 patients. 3 On rare occasions adverse events were serious e.g. cardiac rupture or hemoptysis ; much might have been a result of substandard practice. 3 The incidence of serious adverse events was 5 per one million, which included children and adults. 3 When used during pregnancy, the majority of adverse events caused by acupuncture were mild and transient, with few serious adverse events. 241 The most frequent mild adverse event was needling or unspecified pain, followed by bleeding. 241 Although two deaths one stillbirth and one neonatal death were reported, there was a lack of acupuncture-associated maternal mortality. 241 Limiting the evidence as certain, probable or possible in the causality evaluation, the estimated incidence of adverse events following acupuncture in pregnant women was 131 per 10,000. 241 Although acupuncture is not contraindicated in pregnant women, some specific acupuncture points are particularly sensitive to needle insertion; these spots, as well as the abdominal region, shGould be avoided during pregnancy. 2 Four adverse events associated with moxibustion were bruising, burns and cellulitis, spinal epidural abscess, and large superficial basal cell carcinoma. 16 Ten adverse events were associated with cupping. 16 The minor ones were keloid scarring, burns, and bullae ; 16 the serious ones were acquired haemophilia A, stroke following cupping on the back and neck, factitious panniculitis, reversible cardiac hypertrophy, and iron deficiency anaemia . 16 A 2013 meta-analysis found that acupuncture for chronic low back pain was cost-effective as a complement to standard care, but not as a substitute for standard care except in cases where co morbid depression presented. 19 The same meta-analysis found there was no difference between sham and non-sham acupuncture. 19 A 2011 systematic review found insufficient evidence for the cost-effectiveness of acupuncture in the treatment of chronic low back pain. 20 A 2010 systematic review found that the cost-effectiveness of acupuncture could not be concluded. operation; these demonstration cases were also frequently receiving morphine surreptitiously through an intravenous drip that observers were told contained only fluids and nutrients. 281 One patient receiving open heart surgery while awake was ultimately found to have received a combination of three powerful sedatives as well as large injections of a local aesthetic into the wound. 57 After the National Institute of Health expressed support for acupuncture for a limited number of conditions, adoption in the US grew further. 27 In 1972 the first legal acupuncture canter in the US was established in Washington DC 282 and in 1973 the American Internal Revenue Service allowed acupuncture to be deducted as a medical expense. 283 In 2006, a BBC documentary Alternative Medicine filmed a patient undergoing open heart surgery allegedly under acupuncture-induced anaesthesia. Even.f.hey.ould.agree, the ACM theories are so nebulous that no amount of scientific study will enable ACM to offer rational care.” 5 Some modern practitioners support the use of acupuncture to treat pain, but have abandoned the use of qi, meridians, yin, yang and other energies based in mysticism, as explanatory frameworks. 8 25 26 The use of qi as an explanatory framework has been decreasing in China, even as it becomes more prominent during discussions of acupuncture in the US. 257 Academic discussions of acupuncture still make reference to pseudo-scientific concepts such as qi and meridians despite the lack of scientific evidence. 257 Many within the scientific community consider attempts to rationalize acupuncture in science to be quackery, pseudo-science and “theatrical placebo”. 258 Academics Massimo Pigliucci and marten Boudry describe it as a “borderlands science” lying between science and pseudo-science. 259 Many acupuncturists attribute pain relief to the release of endorphins when needles penetrate, but no longer support the idea that acupuncture can affect a disease. 26 257 It is a generally held belief within the acupuncture community that acupuncture points and meridians structures are special conduits for electrical signals but no research has established any consistent anatomical structure or function for either acupuncture points or meridians. n 1 24 Human tests to determine whether electrical continuity was significantly different near meridians than other places in the body have been inconclusive. 24 Some studies suggest acupuncture causes a series of events within the central nervous system, 260 and that it is possible to inhibit acupuncture's analgesic effects with the opioid antagonist naloxone . 261 Mechanical deformation of the skin by acupuncture needles appears to result in the release of adenosine . 2 The anti-nociceptive effect of acupuncture may be mediated by the adenosine A1 receptor . 262 A 2014 Nature Reviews Cancer review article found that since the key mouse studies that suggested acupuncture relieves in China repeatedly, depending on the country's political leadership and the favour of rationalism or Western medicine. 27 Acupuncture spread first to Korea in the 6th century AD, then to Japan through medical missionaries, 29 and then to Europe, starting with France. 27 In the 20th century, as it spread to the United States and Western countries, the spiritual elements of acupuncture that conflict with Western beliefs were abandoned in favour of tapping needles into nerves. 27 30 31 One type of acupuncture needle Acupuncture is a form of alternative medicine. 2 It is commonly used for pain relief, 10 11 though it is also used to treat a wide range of conditions. 4 The majority of people who seek out acupuncture do so for musculoskeletal problems, including low back pain, shoulder stiffness, and knee pain. 32 Acupuncture is generally only used in combination with other forms of treatment. 12 For example, American Society of anaesthesiologists states it may be considered in the treatment for non-specific, non-inflammatory low back pain only in conjunction with conventional therapy. 33 Acupuncture is the insertion in the skin of thin needles. 3 According to the Mayo Foundation for Medical Education and Research Mayo Clinic, a typical session entails lying still while approximately five to twenty needles are inserted; for the majority of cases, the needles will be left in place for ten to twenty minutes. 34 It can be associated with the application of heat, pressure, or laser light . 3 Classically, acupuncture is individualized and based on philosophy and intuition, and not on scientific research. 35 There is also a non-invasive therapy developed in early 20th century Japan using an elaborate set of “needles” for the treatment of children shōnishin or shōnihari. 36 37 Clinical practice varies depending on the country. 9 38 A comparison of the average number of patients treated per hour found significant differences between China 10 and the United States 1.2. 39 Chinese herbs are often used. 40 There is a diverse range of acupuncture approaches, involving different philosophies. 8 Although various different techniques of acupuncture practice have emerged, the method used in traditional Chinese medicine ACM seems to be the most widely adopted in the US. 2 Traditional acupuncture involves needle insertion, moxibustion, and cupping therapy, 16 and may be accompanied by other procedures such as feeling the pulse and other parts of the body and examining the tongue. 2 Traditional acupuncture involves the belief that a “life force” qi circulates within the body in lines called meridians. 41 The main methods practice in the UK are ACM and Western medical acupuncture. 42 The term Western medical acupuncture is used to indicate an adaptation of Acupuncture ACM-based acupuncture which focuses less on ACM. 41 43 The Western medical acupuncture approach involves using acupuncture after a medical diagnosis. 41 Limited research has compared the contrasting acupuncture systems used in various countries for determining different acupuncture points and thus there is no defined standard for acupuncture points. 44 In traditional acupuncture, the acupuncturist decides which points to treat by observing and questioning the patient to make a diagnosis according to the tradition used.