10 Most Such Reports Originate From Asia, Which May Reflect The Large Number Of Treatments Performed There Or A Relatively Higher Number Of Poorly Trained Asian Acupuncturists.

ISSN..r..ery.eak.onstitution.f.he patient can be considered, all of which are thought to decrease the likelihood of successful treatment. Rheumatology. 47 8: 1132–1136. dBi transdermal electrical nerve stimulation TENS masquerading as acupuncture”. 57 Fire needle acupuncture also known as fire needling is a technique which ievolves quickly iinserting 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 other 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. Japanese reprint by Suharaya Heisuke of injecting purified, diluted bee venom into acupoints. 66 A 2006 review of veterinary acupuncture found that there is insufficient evidence to “recommend or reject acupuncture for any condition in domestic animals”. 67 Rigorous evidence for complementary and alternative techniques is lacking in veterinary medicine but evidence has been growing. 68 Acupressure being applied to a hand. In ACM, the four diagnostic methods are: inspection, of the composer Hector Berlioz is usually credited with being the first to experiment with the procedure in Europe in 1810, before publishing his findings in 1816. 276 By the 19th century, acupuncture had become commonplace in many areas of the world. 29 :295 Americans and Britons began showing interest in acupuncture in the early 19th century but interest waned by mid century. 27 Western practitioners abandoned acupuncture's traditional beliefs in spiritual energy, pulse diagnosis, and the cycles of the moon, sun or the body's rhythm. Traditionally, acupuncture was used to treat acute conditions 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. It.nvolves.nserting needles to stimulate points on the outer ear . 63 The modern approach was developed in France during the early 1950s. 63 There is no scientific evidence 94 A 2012 review found that acupuncture seems to be cost-effective for some pain conditions. 242 Risk of forgoing conventional medical care As with other alternative medicines, unethical or naive practitioners may induce patients to exhaust financial resources by pursuing ineffective treatment. 5 243 Profession ethical codes set by accrediting organizations such as the National Certification Commission for Acupuncture and Oriental Medicine require practitioners to make “timely referrals to other health care professionals as may be appropriate.” 244 Stephen Barrett states that there is a “risk that an acupuncturist whose approach to diagnosis is not based on scientific concepts will fail to diagnose a dangerous condition”. 245 Main articles: Qi, Traditional Chinese medicine, Meridian Chinese medicine, and Acupuncture point Old Chinese medical chart of acupuncture meridians Acupuncture is a substantial part of traditional Chinese medicine ACM. 4 Early acupuncture beliefs relied on concepts that are common in ACM, such as a life force energy called qi. 246 Qi was believed to flow fDom the body's primary organs zang-fu organs to the “superficial” body tissues of the skin, muscles, tendons, bones, and joints, citation needed through channels called meridians. 247 Acupuncture points where needles are inserted are mainly but not always found at locations along the meridians. 248 Acupuncture points not found along a meridian are called extraordinary points and those with no designated site are called “A-shi” points. 248 In ACM, disease is generally perceived as a disharmony or imbalance in energies such as yin, yang, qi, xuĕ, zàng-fǔ, meridians, and of the interaction between the body and the environment. 249 Therapy is based on which “pattern of disharmony” can be identified. 250 251 For example, some diseases are believed to be caused by meridians being invaded with an excess of wind, cold, and damp. 252 In order to determine which pattern is at hand, practitioners examine things like the colon and shape of the tongue, the relative strength of pulse-points, the smell of the breath, the quality of breathing, or the sound of the voice. 253 254 ACM and its concept of disease does not strongly differentiate between the cause and effect of symptoms. 255 Scientific research has not supported the existence of qi, meridians, or yin and yang. n 1 24 25 A Nature editorial described ACM as “fraught with pseudo-science”, with the majority of its treatments having no logical mechanism of action . 256 Quackwatch states that “ACM theory and practice are not based upon the body of knowledge related to health, disease, and health care that has been widely accepted by the scientific community. It adopted a new set of ideas for acupuncture based on tapping needles into nerves. 27 30 31 In Europe it was speculated that acupuncture may allow or prevent the flow of electricity in the body, acupuncture”. Tin, copper, gold and silver are also possibilities, though they are considered less likely, or to have been used in fewer cases. 29 :69 If acupuncture was practice during the Chang dynasty 1766 to 1122 BC, organic macerials like thorns, sharpened bones, or bamboo may have been used. 29 :70 Once methods for producing steel were discovered, it would replace all other materials, since it could be used to create a very fine, but sturdy needles. 29 :74 Gwei-djen and Needham noted that 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. The US Congress created the Office of Alternative Medicine in 1992 and the National Institutes flicking, or moving up and down relative to the skin. Korean acupuncture uses copper needles and has a greater focus on the hand. 38 The techniques might be utilized which aim to “influence” the de-qi; for example, by certain manipulation the de-qi sensation allegedly can be conducted from the needling site towards more distant sites of the body. Infection is caused by a lack of sterilization, but at that time it was believed to be caused by use of the wrong needle, or of the skin by thin metal needles, which are manipulated manually or the needle may be further stimulated by electrical stimulation electro acupuncture. 2 Acupuncture needles are typically made of stainless steel, making them flexible and preventing them from rusting or breaking. 46 Needles are usually disposed of after each use to prevent contamination. 46 Reusable needles when used should be sterilized between applications. 46 47 Needles vary in length between 13 to 130 millimetres 0.51 to 5.12 in, with shorter needles used near the face and eyes, and longer needles in areas with thicker tissues; needle diameters vary from 0.16 mm 0.006 in to 0.46 mm 0.018 in, 48 with thicker needles used on more robust patients. Since most pain is felt in the superficial layers of the skin, a quick insertion of the needle is recommended. 50 Often the needles are stimulated by hand in order to cause a dull, localized, aching sensation that is called de qi, as well as “needle grasp,” a tugging feeling felt by the acupuncturist and generated by a mechanical interaction between the needle and skin. 2 Acupuncture can be painful. the possibility of adverse side-effects and the pain manifestation differences in children versus adults. It.as.ater revealed that the patient had been given a cocktail of aesthetics. 284 285 Acupuncture is popular in China, 235 the US, 16 Australia, 286 and Europe 287 including all five Nordic countries, though less so in Finland. 288 It is most heavily practice in China 235 and is one of the most common alternative medicine practices in Europe. 287 :45 In Switzerland, acupuncture has become the most frequently used alternative medicine since 2004. 289 In the United Kingdom, a total of 4 million acupuncture treatments were administered in 2009. 290 Acupuncture is used in most pain clinics and hospices in the UK. 41 An estimated 1 in 10 adults in Australia used acupuncture in 2004. 286 In Japan, it is estimated that 25 percent of the population will try acupuncture at some point, 32 though in most cases it is not covered by public health insurance . 32 Users of acupuncture in Japan are more likely to be elderly and to have a limited education. 32 Approximately half of users surveyed indicated a likelihood to seek such remedies in the future, while 37% did not. 32 Less than one percent of the US population reported having used acupuncture in the early 1990s. 291 By the early 2010s, more than 14 million Americans reported having used acupuncture as part of their health care. 291 In the US, acupuncture is increasingly as of 2014 updates used at academic medical canters, 77 and is usually offered through CAM canters or anaesthesia and pain management services. 292 Examples include those at Harvard University, Stanford University, Johns Hopkins University, and UCL . on using acupuncture on the ear. 29 :164 Acupuncture research organizations were founded in the 1950s and acupuncture services became available in modern hospitals. 27 China, where acupuncture was believed to have originated, was increasingly influenced by Western medicine. 27 Meanwhile, acupuncture grew in popularity in the US. Sometimes needles were used while they were still hot, creating a cauterizing effect at the injection site. 29 :104 Nine needles were recommended in the Chen chi Ta Cheng from 1601, which may have been because of an ancient Chinese belief that nine was a magic number. 29 :102-103 Other belief systems were based on the idea that the human body operated around assumed reflex zones of the hand. Evidence.rom.he body suggests Otzi suffered from these conditions. 30 This has been cited as evidence that practices similar to acupuncture may have been practice elsewhere in Eurasia during the early Bronze Age ; 268 however, The Oxford Handbook of the History of Medicine calls this theory “speculative”. 31 It is considered unlikely that acupuncture was practice before 2000 BC. 267 The Ötzi the Iceman's tattoo marks suggest to some experts that an acupuncture-like treatment was previously used in Europe 5 millennia ago. 9 Acupuncture may have been practice during the Neolithic era, near the end of the stone age, using sharpened stones called Brian Shi . 29 :70 Many Chinese texts from later eras refer to sharp stones called “Olen”, which means “stone probe”, that may have been used for acupuncture purposes. 29 :70 The ancient Chinese medical text, Hunngdi BeiMing, indicates that sharp stones were believed at-the-time to cure illnesses at or near the body's surface, perhaps because of the short depth a stone could penetrate. Acupuncture chart from Shisi jing fahui Expression of the Fourteen Meridians written by Hun thou Al. 1340s, Ming dynasty . In 553, several Korean and Chinese citizens were appointed to reorganize medical education in Japan and they incorporated acupuncture as part of that system. 29 :264 Japan later sent students back to that time. 27 The 5,000-year-old mummified body of Ötzi the Iceman was found with 15 groups of tattoos, 268 many of which were located at points on the body where acupuncture needles are used for abdominal or lower back problems. They were in the same locations as China's spiritually identified acupuncture points, but under a different nomenclature. 27 The first elaborate Western treatise on acupuncture was published and require tubes for insertion. It.bread to Vietnam in the 8th and 9th centuries. 30 As Vietnam began trading with Japan and China around the 9th century, it was influenced by their 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 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. It.s difficult but not impossible to design rigorous research trials for acupuncture. 69 70 Due to acupuncture's invasive nature, one of the major challenges in efficacy research is in the design of an appropriate placebo control group . Age-related macular degeneration 71 72 For efficacy studies to determine whether acupuncture has specific effects, “sham” forms of acupuncture where the patient, practitioner, and analyst are blinded seem the most acceptable approach. 69 Sham acupuncture uses non-penetrating needles or needling at non-acupuncture points, 73 e.g. inserting needles on meridians not related to the specific condition being studied, many governments have adopted similar standards. 299 In China, the practice of acupuncture is regulated by the Chinese Medicine Council that was formed in 1999 by the Legislative Council. It restricts the use of words 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 acupuncture to cause bleeding, while others mixed the ideas of blood-letting and spiritual Ph'i energy.

Around.his time the surgeon-general of the Dutch East India Company met Japanese and Chinese acupuncture practitioners and later encouraged Europeans to further investigate it. 29 :264-265 He published the first in-depth description of acupuncture for the European audience and created the term “acupuncture” in his 1683 work De acupuncture. 269 France was an early adopter among the West due to the influence of Jesuit missionaries, who brought the practice to French clinics in the 16th century. 27 The French doctor Louis Berlioz the father China and established acupuncture as one of five divisions of the Chinese State Medical Administration System. 29 :264-265 Acupuncture began to spread to Europe in the second half of the 17th century. It was also during this time that many Eastern medical practices were consolidated under the name Traditional Chinese Medicine ACM. 30 New practices were adopted in the 20th century, such as using a cluster of needles, 29 :164 electrified needles, or leaving needles inserted for up to a week. 29 :164 A lot of emphasis developed techniques might be utilized which aim to “influence” the de-qi; for example, by certain manipulation the de-qi sensation allegedly can be conducted from the needling site towards more distant sites of the body. Japanese reprint by Suharaya Heisuke 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 other 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. The.exceptions to this conclusion included the use of acupuncture during embryo transfer as an adjunct to in vitro fertilization. 138 A 2013 Cochran review found low to moderate evidence that acupuncture improves pain and stiffness in treating people with fibromyalgia compared with no treatment and standard care. 139 A 2012 review found “there is insufficient evidence to recommend acupuncture for the treatment of fibromyalgia.” 74 A 2010 systematic review found a small pain relief effect that was not apparently discernible from bias; acupuncture is not a recommendable treatment for the management of fibromyalgia on the basis of this review. 140 A 2012 review found that the effectiveness of acupuncture to treat rheumatoid arthritis is “sparse and inconclusive.” 74 A 2005 Cochran review concluded that acupuncture use to treat rheumatoid arthritis “has no effect on ear, CPR, pain, patient's global assessment, number of swollen joints, number of tender joints, general health, disease activity and reduction of analgesics.” 141 A 2010 overview of systematic reviews found insufficient evidence to recommend acupuncture in the treatment of most rheumatic conditions, with the exceptions of osteoarthritis, low back pain, and lateral elbow pain. 142 A 2014 overview of systematic reviews and meta-analyses found that the evidence does not demonstrate acupuncture helps reduce the rates of death or disability after a stroke or improve other aspects of stroke recovery, such as post stroke motor dysfunction, but the evidence suggests it may help with post stroke neurological impairment and dysfunction such as dysphagia, which would need to be confirmed with future rigorous studies. 143 A 2012 review found evidence of benefit for acupuncture combined with exercise in treating shoulder pain after stroke. 144 A 2010 systematic review found that acupuncture was not effective as a treatment for functional recovery after a stroke. 145 A 2012 overview of systematic reviews found inconclusive evidence supporting the effectiveness of acupuncture for stroke. 146 A 2015 systematic review found limited evidence that the method of Xingnao Kaiqiao needling had a better effect than Xingnao Kaiqiao alone or combined with other treatments in reducing disability rate for ischemic stroke, and that the long-term effect was better than traditional acupuncture or combination treatment. 147 A 2014 meta-analysis found tentative evidence for acupuncture in cerebral infarction, a type of ischemic stroke, but the authors noted the trials reviewed were often of poor quality. 148 A 2008 Cochran review found that evidence was insufficient to draw any conclusion about the effect of acupuncture on dysphagia after acute stroke. 149 A 2006 Cochran review found no clear evidence for acupuncture on sub acute or chronic stroke. 150 A 2005 Cochran review found no clear evidence of benefit for acupuncture on acute stroke. 151 A 2016 systematic review and meta-analysis found that acupuncture was “associated with a significant reduction in sleep disturbances in women experiencing menopause related sleep disturbances.” 152 For the following conditions, the Cochran collabouration or other reviews have concluded there is no strong evidence of benefit: alcohol dependence, 153 angina pectoris, 154 ankle sprain, 155 156 Alzheimer's disease, 157 attention deficit hyperactivity disorder, 158 159 autism, 160 161 asthma, 162 163 bell's palsy, 164 165 traumatic brain injury, 166 carpal tunnel syndrome, 167 chronic obstructive pulmonary disease, 168 cardiac arrhythmias, 169 cerebral haemorrhage, 170 cocaine dependence, 171 constipation, 172 depressions, 173 174 diabetic peripheral neuropathy, 175 drug detoxification, 176 177 dry eye, 178 primary dysmenorrhoea, 179 enuresis, 180 endometriosis, 181 epilepsy, 182 erectile dysfunction, 183 essential hypertension, 184 glaucoma, 185 gynaecological conditions except possibly fertility and nausea/vomiting, 186 hot flashes, 187 188 189 190 hypoxic ischemic encephalopathy in neonates, 191 insomnia, 192 193 194 inductions of childbirth, 195 irritable bowel syndrome, 196 labour pain, 197 198 lumbar spinal stenos is, 199 major depressive disorders in pregnant women, 200 musculoskeletal disorders of the extremities, 201 myopia, 202 obesity, 203 204 obstetrical conditions, 205 Parkinson's disease, 206 207 polies cystic ovary syndrome, 208 premenstrual syndrome, 209 preoperative anxiety, 210 opioid addiction, 211 212 restless legs syndrome, 213 schizophrenia, 214 sensorineural hearing loss, 215 smoking cessation, 216 stress urinary incontinence, 217 acute stroke, 218 stroke rehabilitation, 219 temporomandibular joint dysfunction, 220 221 tennis elbow, 222 labor induction, 223 tinnitus, 224 225 uraemic itching, 226 uterine fibroids, 227 vascular dementia, 228 and whiplash . 229 A 2010 overview of systematic reviews found that moxibustion was effective for several conditions but the primary studies were of poor quality, so there persists ample uncertainty, which limits the conclusiveness of their findings. 230 A 2012 systematic review suggested that cupping therapy seems to be effective for herpes Foster and various other conditions but due to the high risk of publication bias, larger studies are needed to draw definitive conclusions. 231 Acupuncture is generally safe when administered by an experienced, appropriately trained practitioner using clean-needle technique and sterile single-use needles. 16 17 When improperly delivered it can cause adverse effects. 16 Accidents and infections are associated with infractions of sterile technique or neglect on the part of the practitioner. 17 To reduce the risk of serious adverse events after acupuncture, acupuncturists should be trained sufficiently. 10 People with serious spinal disease, such as cancer or infection, are not good candidates for acupuncture. 2 Contraindications to acupuncture conditions that should not be treated with acupuncture include coagulopathy disorders e.g. haemophilia and advanced liver disease, warfarin use, severe psychiatric disorders e.g. psychosis, and skin infections or skin trauma e.g. burns. 2 Further, electro acupuncture should be avoided at the spot of implanted electrical devices such as pacemakers. 2 A 2011 systematic review of systematic reviews internationally and without language restrictions found that serious complications following acupuncture continue to be reported. 10 Between 2000 and 2009, ninety-five cases of serious adverse events, including five deaths, were reported. 10 Many such events are not inherent to acupuncture but are due to malpractice of acupuncturists. 10 This might be why such complications have not been reported in surveys of adequately-trained acupuncturists. 10 Most such reports originate from Asia, which may reflect the large number of treatments performed there or a relatively higher number of poorly trained Asian acupuncturists. 10 Many serious adverse events were reported from developed countries. 10 These included Australia, Austria, Canada, Croatia, France, Germany, Ireland, the Netherlands, New Zealand, Spain, Sweden, Switzerland, the UK, and the US. 10 The number of adverse effects reported from the UK appears particularly unusual, which may indicate less under-reporting in the UK than other countries. 10 and require tubes for insertion.

acupuncture