David.amey,.o.ingle.method.r theory” was ever predomiCantly adopted as the standard. 271 At the time, scientific knowledge of medicine was not yet developed, especially because in China dissection of the deceased was forbidden, preventing the development of basic anatomical knowledge. 27 It is not certain when specific acupuncture points were introduced, but the autobiography of lien Chhio from around 400–500 BC references inserting needles at designated areas. 29 Brian Sue believed ethere was a single acupuncture point at the top of one's skull that he called the point “of the hundred meetings.” 29 :83 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. Acupuncture.became.he most popular alternative medicine in the US. 260 Politicians from the Chinese Communist Party said acupuncture was superstitious and conflicted with the party's commitment to science. 279 Communist Party Chairman Mao Zedong later reversed this position, 279 arguing that the practiced was based on scientific principles. 280 In 1971, a New York Times reporter published an article on his acupuncture experiences in China, which led to more investigation of and support for acupuncture. 27 The US President Richard Nixon visited China in 1972 . 281 During one part of the visit, the delegation was shown a patient undergoing major surgery while fully awake, ostensibly receiving acupuncture rather than anaesthesia . 281 Later it was found that the patients selected for the surgery had both a high pain tolerance and received heavy indoctrination before 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. Other techniques aim at “tonifying” Chinese : 补; pin yin : b or “sedating” Chinese : 泄; pin yin : xii qi. 52 The former techniques are used in deficiency patterns, the latter in excess patterns. 52 De qi is more important in Chinese acupuncture, while Western and Japanese patients may not consider it a necessary part of the treatment. 38 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. retinopathy A woman receiving fire acupuncture to cause bleeding, while others mixed the ideas of blood-letting and spiritual Ph'i energy. If de-qi can not be generated, then inaccurate location of the acupoint, improper depth of needle insertion, inadequate manual manipulation, Additionally, by the 18th century, scientific rationality was becoming more popular than traditional superstitious beliefs. 27 By 1757 a book documenting the history of Chinese medicine called acupuncture a “lost art”. 29 :160 Its decline was attributed in part to the popularity of prescriptions and medications, as well as its association with the lower classes. 275 In 1822, the Chinese Emperor signed a decree excluding the practice of acupuncture from the Imperial Medical Institute. 27 He said it was unfit for practice by gentlemen-scholars. 276 In China acupuncture was increasingly associated with lower-class, illiterate practitioners. 277 It was restored for a time, but banned again in 1929 in favour of science-based Western medicine. 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 the body, and eventually to balancing Yin and Yang energies as well. 28 According to Dr. It restricts the use 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 Sun simian published acupuncture-related diagrams and charts that established standardized methods for finding acupuncture sites on people of different sizes and categorized acupuncture sites in a set of modules. 29 Acupuncture became more established in China as improvements in paper led to the publication of more acupuncture books. The.Judy also includes warnings against practising 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, should 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. the possibility of adverse side-effects and the pain manifestation differences in children versus adults. It spread 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 as electrical pulses were found to make a frog's leg twitch after death. 269 The West eventually created a belief system based on travel trigger points that were believed to inhibit pain. In 2007, the National 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. or in places not associated with meridians. 74 The under-performance of acupuncture in such trials may indicate that therapeutic effects are due entirely to non-specific effects, or that the sham treatments are not inert, or that systematic protocols yield less than optimal treatment. 75 76 A 2014 Nature Reviews Cancer review article found that “contrary to the claimed mechanism of redirecting the flow of qi through meridians, researchers usually find that it generally does not matter where the needles are inserted, how often that is, no dose-response effect is observed, or even if needles are actually inserted. 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 auscultation and olfaction, inquiring, and palpation. G. of Health NIH declared support for acupuncture for some conditions in November 1997..>Rheumatology..7.:.132–1136..Bi.8460551 . This may have been the result of competing schools of thought. 27 Some ancient texts referred to using flicking, or moving up and down relative to the skin. 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 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 shGould 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. 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 Acupressure, a non-invasive form of bodywork, uses physical pressure applied to acupressure points by the hand or elbow, or with various devices. 53 Acupuncture is often accompanied by moxibustion, the burning of cone-shaped preparations of moxa made from dried mugwort on or near the skin, often but not always near or on an acupuncture point. If the de-qi sensation does not immediately occur upon needle insertion, various manual manipulation techniques can be applied to promote it such as “plucking”, “shaking” or “trembling”. 52 Once de-qi is achieved, further 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. 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.