104 The Same Review Found Evidence That Suggested That Acupuncture Might Be Considered A Helpful Non-pharmacological Approach For Frequent Episodic Or Chronic Tension-type Headache.

Infection.s.aused.y..ack.f.terilization,.ut at that time it was believed to be caused by use of the wrong needle, or 1462-0324 . ACM practitioners disagree among themselves about how to diagnose or in places not associated with meridians. 74 The under-performance of acupuncture in suPh trials mDy 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. A.Oman.deceiving.ire to no treatment or sham therapy for chronic low back pain only in the short term immediately after treatment. 100 The same review also found that acupuncture is not more effective than conventional therapy and other alternative medicine treatments. 100 Two separate 2016 Cochran reviews found that acupuncture could be useful in the prophylaxis of tension-type headaches and episodic migraines . 101 102 The 2016 Cochran review evaluating acupuncture for episodic migraine prevention concluded that true acupuncture had a small effect beyond sham acupuncture and found moderate-quality evidence to suggest that acupuncture is at least similarly effective to prophylactic medications for this purpose. 102 A 2012 review found that acupuncture has demonstrated benefit for the treatment of headaches, but that safety needed to be more fully documented in order to make any strong recommendations in support of its use. 103 A 2009 Cochran review of the use of acupuncture for migraine prophylaxis treatment concluded that “true” acupuncture was no more efficient than sham acupuncture, but “true” acupuncture appeared to be as effective as, or possibly more effective than routine care in the treatment of migraines, with fewer adverse effects than prophylactic drug treatment. 104 The same review stated that the specific points chosen to needle may be of limited importance. 104 A 2009 Cochran review found insufficient evidence to support acupuncture for tension-type headaches. 104 The same review found evidence that suggested that acupuncture might be considered a helpful non-pharmacological approach for frequent episodic or chronic tension-type headache. 104 A 2014 review concluded that “current evidence supports the use of acupuncture as an alternative to traditional analgesics in osteoarthritis patients.” 105 As of 2014 updates, a meta-analysis showed that acupuncture may help osteoarthritis pain but it was noted that the effects were insignificant in comparison to sham needles. 106 A 2013 systematic review and network meta-analysis found that the evidence suggests that acupuncture may be considered one of the more effective physical treatments for alleviating pain due to knee osteoarthritis in the short-term compared to other relevant physical treatments, though much of the evidence in the topic is of poor quality and there is uncertainty about the efficacy of many of the treatments. 107 A 2012 review found “the potential beneficial action of acupuncture on osteoarthritis pain does not appear to be clinically relevant.” 74 A 2010 Cochran review found that acupuncture shows statistically significant benefit over sham acupuncture in the treatment of peripheral joint osteoarthritis; however, these benefits were found to be so small that their clinical significance was doubtful, and “probably due at least partially to placebo effects from incomplete blinding”. 108 A 2014 systematic review found moderate quality evidence that acupuncture was more effective than sham acupuncture in the treatment of lateral elbow pain. 109 A 2014 systematic review found that although manual acupuncture was effective at relieving short-term pain when used to treat tennis elbow, its long-term effect in relieving pain was “unremarkable”. 110 A 2007 review found that acupuncture was significantly better than sham acupuncture at treating chronic knee pain; the evidence was not conclusive due to the lack of large, high-quality trials. 111 Nausea and vomiting and post-operative pain A 2014 overview of systematic reviews found insufficient evidence to suggest that acupuncture is an effective treatment for postoperative nausea and vomiting pond in a clinical setting. 112 A 2013 systematic review concluded that acupuncture might be beneficial in prevention and treatment of pond. 113 A 2009 Cochran review found that stimulation of the P6 acupoint on the wrist was as effective or ineffective as anti emetic drugs and was associated with minimal side effects. 112 114 The same review found “no reliable evidence for differences in risks of postoperative nausea or vomiting after P6 acupoint stimulation compared to anti emetic drugs.” 114 A 2014 overview of systematic reviews found insufficient evidence to suggest that acupuncture is effective for surgical or post-operative pain. 112 For the use of acupuncture for post-operative pain, there was contradictory evidence. 112 A 2014 systematic review found supportive but limited evidence for use of acupuncture for acute post-operative pain after back surgery. 115 A 2014 systematic review found that while the evidence suggested acupuncture could be an effective treatment for postoperative gastroparesis, a firm conclusion could not be reached because the trials examined were of low quality. 116 Acupuncture is an unproven treatment for allergic immunologic conditions. 117 A 2015 meta-analysis suggests that acupuncture might be a good option for people with allergic rhinitis A, 118 and a number of randomized clinical trials CRTs support the use of acupuncture for A and itch . 119 There is some evidence that acupuncture might have specific effects on perennial allergic rhinitis PA, though all the efficacy studies were small and conclusions should be made with caution. 120 There is mixed evidence for the symptomatic treatment or prevention of A. 121 For seasonal allergic rhinitis SA, the evidence failed to demonstrate specific effects for acupuncture. 121 Using acupuncture to treat other allergic conditions such as contact eczema, drug rashes, or anaphylaxis is not recommended. 119 A 2015 Cochran review found that there is insufficient evidence to determine whether acupuncture is an effective treatment for cancer pain in adults. 122 A 2014 systematic review found that acupuncture may be effective as an adjunctive treatment to palliative care for cancer patients. 123 A 2013 overview of reviews found evidence that acupuncture could be beneficial for people with cancer-related symptoms, but also identified few rigorous trials and high heterogeneity between trials. 124 A 2012 systematic review of randomised clinical trials CRTs using acupuncture in the treatment of cancer pain found that the number and quality of CRTs was too low to draw definite conclusions. 125 A 2014 systematic review reached inconclusive results with regard to the effectiveness of acupuncture for treating cancer-related fatigue. 126 A 2013 systematic review found that acupuncture is an acceptable adjunctive treatment for chemotherapy-induced nausea and vomiting, but that further research with a low risk of bias is needed. 127 A 2013 systematic review found that the quantity and quality of available CRTs for analysis were too low to draw valid conclusions for the effectiveness of acupuncture for cancer-related fatigue . 128 A 2012 systematic review and meta-analysis found very limited evidence regarding acupuncture compared with conventional intramuscular injections for the treatment of hiccups in cancer patients. 129 The methodological quality and amount of CRTs in the review was low. 129 A 2015 systematic review and meta-analysis found some evidence that acupuncture was effective for CD, but also called for further well-designed, long-term studies to be conducted to evaluate its efficacy for this condition. 130 A 2014 Cochran review found that “it remains unknown whether manual acupuncture or electro acupuncture is more effective or safer than other treatments” for functional dyspepsia CD. 131 A 2014 systematic review and meta-analysis found poor quality evidence for use of acupuncture in infertile men to improve sperm motility, sperm concentration, and the pregnancy rate; the evidence was rated as insufficient to draw any conclusion regarding efficacy. 132 A 2013 Cochran review found no evidence of acupuncture for improving the success of in vitro fertilization VF. 133 A 2013 systematic review found no benefit of adjutant acupuncture for VF on pregnancy success rates. 134 A 2012 systematic review found that acupuncture may be a useful adjunct to VF, 135 but its conclusions were rebutted after re-evaluation using more rigorous, high quality meta-analysis standards. 136 A 2012 systematic review and meta-analysis found that acupuncture did not significantly improve the outcomes of in vitro fertilization. 137 A 2011 overview of systematic reviews found that the evidence that acupuncture was effective was not compelling for most gynecologic conditions. In.53, 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 in 1683 by Willem ten Rhine . 278 In China, the popularity of acupuncture rebounded in 1949 when Mao Zedong took power and sought to unite China behind traditional cultural values. Korean acupuncture uses copper needles and has a greater focus on the hand. 38 The 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. 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 Phi 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 acupuncture to cause bleeding, while others mixed the ideas of blood-letting and spiritual ch'i energy. If.e-qi can not be generated, then inaccurate location of the acupoint, improper depth of needle insertion, inadequate manual manipulation, 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 from 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. Needles.ay be manipulated in various ways, including spinning, 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 includes a licensing exam and registration, as well as degree courses approved by the board. 300 Canada has acupuncture licensing programs in the provinces of British Columbia, Ontario, Alberta and Quebec; standards set by the Chinese Medicine and Acupuncture and require tubes for insertion. Japanese reprint by Suharaya Heisuke 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. 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 the body, and eventually to balancing Yin and Yang energies as well. 28 According to Dr.

Other.echniques 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 the possibility of adverse side-effects and the pain manifestation differences in children versus adults. 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 materials 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 nneedles. 29 :74 Gwei-djen and Needham noted that operation; these demonstration cases were also frequently receiving morphine surreptitiously cupping 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. In ACM, the four diagnostic methods are: inspection, 292 293 This usage has been criticized owing to there being little scientific evidence for explicit effects, or the mechanisms for its supposed effectiveness, for any condition that is discernible from placebo. 77 Acupuncture has been called 'theatrical placebo', 57 and David Gorski argues that when acupuncture proponents advocate 'harnessing of placebo effects' or work on developing 'meaningful placebos', they essentially concede it is little more than that. 77 The use of acupuncture in Germany increased by 20% in 2007, after the German acupuncture trials supported its efficacy for certain uses. 294 In 2011, there were more than one million users, 294 and insurance companies have estimated that two-thirds of German users are women. 294 As a result of the trials, German public health insurers began to cover acupuncture for chronic low back pain and osteoarthritis of the knee, but not tension headache or migraine. 295 This decision was based in part on socio-political reasons. 295 Some insurers in Germany chose to stop reimbursement of acupuncture because of the trials. 296 For other conditions, insurers in Germany were not convinced that acupuncture had adequate benefits over usual care or sham treatments. 297 Highlighting the results of the placebo group, researchers refused to accept a placebo therapy as efficient. 298 Main article: Regulation of acupuncture There are various governments and trade association regulatory bodies for acupuncture in the United Kingdom, the United States, Saudi Arabia, Australia, Japan, Canada, and in European countries and elsewhere. The.eedles used in acupuncture are regulated in the US by the Food and Drug Administration . 302 In some states acupuncture is regulated by a board of medical examiners, while in others by the board of licensing, health or education. 299 In Japan, acupuncturists are licensed by the skin is sterilized and needles are inserted, frequently with a plastic guide tube. A woman receiving fire 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.

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