In.007,.he NatioCal Health Interview Survey NHS conducted by the National enter For Health Statistics NHS estimated that approximately 150,000 children had received acupuncture treatment for a variety of conditions. acupuncture practiceds as well. 27 China and Korea sent “medical missionaries” that spread traditional Chinese medicine to Japan, starting around 219 AD. Medical acupuncture attempts 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 all the ancient materials that could have been used for acupuncture and which often produce archaeological evidence, such as sharpened bones, bamboo or stones, were also used for other purposes. 29 An article in Rheumatology said that the absence of any mention of acupuncture in documents found in the tomb of Ma-Wang-Dui from 198 BC suggest that acupuncture was not practice by that time. 27 Several and sometimes conflicting belief systems emerged regarding acupuncture. They.ere in the same locations as China's spiritually identified acupuncture points, but under a different nomenclature. 27 The first elabourate Western treatise on acupuncture was published 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. Moxibustion could be direct the cone was placed directly on the skin and allowed to burn the skin, producing a blister and eventually a scar, or indirect either a cone of moxa was placed on a slice of garlic, ginger or other vegetable, or a cylinder of moxa was held above the skin, close enough to either warm or burn it. 54 Cupping therapy is an ancient Chinese form of alternative medicine in which a local suction is created on the skin; practitioners believe this mobilizes blood flow in order to promote healing. 55 Ti na is a ACM method of attempting to stimulate the flow of qi by various barehanded techniques that do not involve needles. 56 Electroacupuncture is a form of acupuncture in which acupuncture needles are attached to a device that generates continuous electric pulses this has been described as “essentially 2008. 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. needling in the wrong place, or at the wrong time. 29 :102-103 Later, many needles were heated in boiling water, or in a flame. In 1999, the National enter for Complementary and Texts dated to be from 156–186 BC document early beliefs in channels of life force energy called meridians that would later be an element in early acupuncture beliefs. 267 Ramey and quell said the “practice and theoretical underpinnings” of modern acupuncture were introduced in the Yellow Emperor's Classic Huangdi Beijing around 100 BC. 28 267 It introduced the concept of using acupuncture to manipulate the flow of life energy qi in a network of meridian channels in the body. 267 272 The network concept was made up of acu-tracts, such as a line down the arms, where it said acupoints were located. Although acupuncture declined in China during this time period, it was also growing in popularity in other countries. 30 the body, and eventually to balancing Yin and Yang energies as well. 28 According to Dr. ISSN 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. Korean acupuncture uses copper needles and has a greater focus on the hand. 38 The Ed, 1. year Kyōhō = 1716. 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 collaboration 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 flicking, or moving up and down relative to the skin. “Demystifying 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. Plinio Prioreschi, the earliest known historical record of acupuncture is the Shih-Chi “Record of History”, written by a historian around 100 BC. 28 It is believed that this text was documenting what was established practice at on a rhythm and acupuncture had to be applied at the right point in the rhythm to be effective. 29 :140-141 In some cases a lack of balance between Yin and Yang were believed to be the cause of disease. 29 :140-141 In the 1st century AD, many of the first books about acupuncture were published and recognized acupuncturist experts began to emerge. Around this 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 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.
MoxibusFion.ould.e.irect.he cone was placed directly on the skin and allowed to burn the skin, producing a blister and eventually a scar, or indirect eiether a cone of moxa was placed on a slice of garlic, ginger or other vegetable, or a cylinder of moxa was held above the skin, close enough to either warm or burn it. 54 Cupping therapy is an ancient Chinese form of alterCaFive medicine in which a local suction is created on the skin; practitioners believe this mobilizes blood flow in order to pDomote healing. 55 Ti na is a ACM method of attempting to stimulate the flow of qi by various barehanded techniques that do not involve needles. 56 Electroacupuncture is a form of acupuncture in which acupuncture needles are attached to a device that generates continuous electric pulses this has been described as “essentially that curing diseases relied on the alignment of both heavenly then and earthly ti forces that were attuned to cycles like that of the sun and moon. 29 :140-141 There were several belief systems that relied on a number of celestial and earthly bodies or elements that rotated and only became aligned at certain times. 29 :140-141 According to Needham and Gwei-djen, these “arbitrary predictions” were depicted by acupuncturists in complex charts and through a set of special terminology. 29 Acupuncture needles during this period were much thicker than most modern ones and often resulted in infection. Evidence.rom.he body suggests Otzi suffered from these conditions. 30 This has been cited as evidence that practiceds 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, Huangdi Beijing, 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. 51 The skill level of the acupuncturist may influence how painful the needle insertion is, and a sufficiently skilled practitioner may be able to insert the needles without causing any pain. 50 De-qi Chinese : 得气; pin yin : d q; “arrival of qi” refers to a sensation of numbness, distension, or electrical tingling at the needling site which might radiate along the corresponding meridian . Although acupuncture declined in China during this time period, it was also growing in popularity in other countries. 30 all the ancient materials that could have been used for acupuncture and which often produce archaeological evidence, such as sharpened bones, bamboo or stones, were also used for other purposes. 29 An article in Rheumatology said that the absence of any mention of acupuncture in documents found in the tomb of Ma-Wang-Dui from 198 BC suggest that acupuncture was not practice by that time. 27 Several and sometimes conflicting belief systems emerged regarding acupuncture. The Imperial Medical Service and the Imperial Medical College, which both supported acupuncture, became more established and created medical colleges in every province. 29 :129 The public was also exposed to stories about royal figures being cured of their diseases by prominent acupuncturists. 29 :129–135 By time The Great Compendium of Acupuncture and Moxibustion was published during the Ming dynasty 1368–1644 AD, most of the acupuncture practices used in the modern era had been established. 27 By the end of the Song dynasty 1279 AD, acupuncture had lost much of its status in China. 273 It became rarer in the following centuries, and was associated with less prestigious professions like alchemy, shamanism, midwifery and moxibustion. 274 patients and which treatments should go with which diagnoses. In.ther.Ards, '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 oriental medicine 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 acupuncture”. The US Congress created the Office of Alternative Medicine in 1992 and the National Institutes 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.
