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Acupuncture is a form of
alternative medicine Alternative medicine is any practice that aims to achieve the healing effects of medicine Medicine is the science Science (from the Latin word ''scientia'', meaning "knowledge") is a systematic enterprise that Scientific method, builds ...
and a key component of
traditional Chinese medicine#REDIRECT Traditional Chinese medicine {{Redirect category shell, 1= {{R from other capitalisation ...
(TCM) in which thin needles are inserted into the body. Acupuncture is a
pseudoscience Pseudoscience consists of statements, beliefs, or practices that claim to be both scientific and factual but are incompatible with the scientific method. Pseudoscience is often characterized by contradictory, exaggerated or falsifiability, un ...
, the theories and practices of TCM are not based on
scientific knowledge Science (from the Latin Latin (, or , ) is a classical language belonging to the Italic languages, Italic branch of the Indo-European languages. Latin was originally spoken in the area around Rome, known as Latium. Through the power of the ...

scientific knowledge
, and it has been characterized as
quackery Quackery, often synonymous with health fraud, is the promotion of fraud In law, fraud is intentional deception Deception or falsehood is an act or statement which misleads, hides the truth, or promotes a belief, concept, or idea that is ...
. There is a range of acupuncture variants which originated in different philosophies, and techniques vary depending on the country in which it is performed, but can be divided into two main foundational philosophical applications and approaches, the first being the modern standardized form called eight principal TCM and the second an older system that is based on the ancient Taoist Wuxing or better known as the five elements or phases in the West. Acupunture is most often used to attempt pain relief, though acupuncturists say that it can also be used for a wide range of other conditions. Acupuncture is generally used only in combination with other forms of treatment. The conclusions of trials and
systematic review Systematic reviews are a type of review A review is an evaluation of a publication, service, or company such as a film, movie (a Film criticism, movie review), video game (video game review), musical composition (music criticism, music review ...
s of acupuncture are inconsistent, which suggests that it is not effective. An overview of
Cochrane reviews Cochrane (previously known as the Cochrane Collaboration) is a British international charitable organisation formed to organise medical research findings to facilitate evidence-based medicine, evidence-based choices about health interventions i ...
found that acupuncture is not effective for a wide range of conditions. A systematic review conducted by medical scientists at the universities of
Exeter Exeter () is a city in Devon, South West England. It is situated on the River Exe, approximately northeast of Plymouth and southwest of Bristol. In Roman Britain, Exeter was established as the base of Legio II Augusta under the personal comm ...

Exeter
and
Plymouth Plymouth () is a port and in . It is located on the south coast of , approximately south-west of and south-west of . It is bordered by to the west and south-west. Plymouth's early history extends to the when a first settlement emerged ...
found little evidence of acupuncture's effectiveness in treating pain. Overall, the evidence suggests that short-term treatment with acupuncture does not produce long-term benefits. Some research results suggest that acupuncture can alleviate some forms of pain, though the majority of research suggests that acupuncture's apparent effects are . A systematic review concluded that the analgesic effect of acupuncture seemed to lack clinical relevance and could not be clearly distinguished from bias. One
meta-analysis A meta-analysis is a statistical analysis that combines the results of multiple Randomized controlled trial, scientific studies. Meta-analyses can be performed when there are multiple scientific studies addressing the same question, with each i ...
found that acupuncture for chronic
low back pain Low back pain (LBP) or lumbago is a common musculoskeletal disorders, disorder involving the muscles, nerves, and bones of the back, inbetween the lower edge of the ribs and the lower fold of the buttocks. Pain can vary from a dull constant ache ...

low back pain
was
cost-effective Cost-effectiveness analysis (CEA) is a form of economic analysis that compares the relative costs and outcomes (effects) of different courses of action. Cost-effectiveness analysis is distinct from cost–benefit analysis, which assigns a monetary ...
as an adjunct to standard care, while a separate systematic review found insufficient evidence for the cost-effectiveness of acupuncture in the treatment of chronic low back pain. Acupuncture is generally safe when done by appropriately trained practitioners using clean needle technique and single-use needles. When properly delivered, it has a low rate of mostly minor
adverse effects An adverse effect is an undesired harmful effect resulting from a medication A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to medical diagnosis, diagnose, cure, therapy, t ...
. Accidents and infections do occur, though, and are associated with neglect on the part of the practitioner, particularly in the application of sterile techniques. A review conducted in 2013 stated that reports of infection transmission increased significantly in the preceding decade. The most frequently reported adverse events were
pneumothorax A pneumothorax is an abnormal collection of air in the pleural space between the lung The lungs are the primary organs of the respiratory system in human Humans (''Homo sapiens'') are the most populous and widespread species of pri ...

pneumothorax
and infections. Since serious adverse events continue to be reported, it is recommended that acupuncturists be trained sufficiently to reduce the risk. Scientific investigation has not found any
histological Histology, also known as microscopic anatomy or microanatomy, is the branch of biology Biology is the natural science that studies life and living organisms, including their anatomy, physical structure, Biochemistry, chemical processes, Mol ...

histological
or
physiological Physiology (; ) is the scientific Science () is a systematic enterprise that Scientific method, builds and organizes knowledge in the form of Testability, testable explanations and predictions about the universe."... modern science is ...
evidence for traditional Chinese concepts such as '''', meridians, and acupuncture points, and many modern practitioners no longer support the existence of life force energy (''qi'') or meridians, which was a major part of early belief systems. Acupuncture is believed to have originated around 100 BC in China, around the time ''The Yellow Emperor's Classic of Internal Medicine'' (
Huangdi Neijing ''Huangdi Neijing'' (), literally the ''Inner Canon of the Yellow Emperor'' or ''Esoteric Scripture of the Yellow Emperor'', is an ancient Chinese medical text that has been treated as the fundamental doctrinal source for Chinese medicine Tr ...
) was published, though some experts suggest it could have been practiced earlier. Over time, conflicting claims and belief systems emerged about the effect of lunar, celestial and earthly cycles,
yin and yang In Ancient Chinese philosophy Chinese philosophy originates in the Spring and Autumn period () and Warring States period (), during a period known as the "Hundred Schools of Thought", which was characterized by significan ...

yin and yang
energies, and a body's "rhythm" on the effectiveness of treatment. Acupuncture fluctuated in popularity in China due to changes in the country's political leadership and the preferential use of rationalism or Western medicine. Acupuncture spread first to Korea in the 6th century AD, then to Japan through medical missionaries, and then to Europe, beginning with France. In the 20th century, as it spread to the United States and Western countries, spiritual elements of acupuncture that conflicted with Western beliefs were sometimes abandoned in favor of simply tapping needles into acupuncture points.


Clinical practice

Acupuncture is a form of alternative medicine. It is used most commonly for pain relief, though it is also used to treat a wide range of conditions. Acupuncture is generally only used in combination with other forms of treatment. For example, the
American Society of Anesthesiologists The American Society of Anesthesiologists (ASA) is an educational, research and scientific association of physicians A physician (American English American English (AmE, AE, AmEng, USEng, en-US), sometimes called United States English ...
states it may be considered in the treatment for nonspecific, noninflammatory low back pain only in conjunction with conventional therapy. Acupuncture is the insertion of thin needles into the skin. According to the
Mayo Foundation for Medical Education and Research Mayo Clinic () is a nonprofit A nonprofit organization (NPO), also known as a non-business entity, not-for-profit organization, or nonprofit institution, is a legal entity organized and operated for a collective, public or social benefit, i ...
(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. It can be associated with the application of heat, pressure, or
laser light A laser is a device that emits light Light or visible light is electromagnetic radiation within the portion of the electromagnetic spectrum that can be visual perception, perceived by the human eye. Visible light is usually defined as ...

laser light
. Classically, acupuncture is individualized and based on philosophy and intuition, and not on scientific research. There is also a
non-invasive A medical procedure is defined as ''non-invasive'' when no break in the skin is created and there is no contact with the mucosa, or skin break, or internal body cavity beyond a natural or artificial body orifice. For example, deep palpation and per ...
therapy developed in early 20th century Japan using an elaborate set of instruments other than needles for the treatment of children (''shōnishin'' or ''shōnihari''). Clinical practice varies depending on the country. A comparison of the average number of patients treated per hour found significant differences between China (10) and the United States (1.2).
Chinese herbs Chinese herbology () is the theory of traditional Chinese herbal therapy, which accounts for the majority of treatments in traditional Chinese medicine Traditional Chinese medicine (TCM) is a branch of traditional medicine in China. It has b ...
are often used. There is a diverse range of acupuncture approaches, involving different philosophies. Although various different techniques of acupuncture practice have emerged, the method used in traditional Chinese medicine (TCM) seems to be the most widely adopted in the US. Traditional acupuncture involves needle insertion,
moxibustion 240px, First page of Shimetarō Hara: "Effects of Moxa on hemoglobin and RBC count". ''Iji Shinbun'', no. 1219, 10 Sept. 1927. (Summary in Esperanto) Moxibustion () is a traditional Chinese medicine therapy which consists of burning dried mug ...

moxibustion
, and
cupping therapy Cupping therapy is a form of alternative medicine Alternative medicine is any practice that aims to achieve the healing effects of medicine Medicine is the science Science (from the Latin word ''scientia'', meaning "knowledge") is a ...
, and may be accompanied by other procedures such as feeling the
pulse In medicine Medicine is the science Science () is a systematic enterprise that builds and organizes knowledge Knowledge is a familiarity, awareness, or understanding of someone or something, such as facts ( descriptive knowledge) ...

pulse
and other parts of the body and examining the tongue. Traditional acupuncture involves the belief that a "life force" ('''') circulates within the body in lines called meridians. The main methods practiced in the UK are TCM and Western medical acupuncture. The term Western medical acupuncture is used to indicate an adaptation of TCM-based acupuncture which focuses less on TCM. The Western medical acupuncture approach involves using acupuncture after a medical diagnosis. 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. 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. In TCM, the four diagnostic methods are: inspection, auscultation and olfaction, inquiring, and palpation. Inspection focuses on the face and particularly on the tongue, including analysis of the tongue size, shape, tension, color and coating, and the absence or presence of teeth marks around the edge. Auscultation and olfaction involve listening for particular sounds such as wheezing, and observing body odor. Inquiring involves focusing on the "seven inquiries": chills and fever; perspiration; appetite, thirst and taste; defecation and urination; pain; sleep; and
menses Menstruation (also known as a period and many other colloquial Colloquialism or colloquial language is the style (sociolinguistics), linguistic style used for casual communication. It is the most common functional style of speech, the idiom no ...
and
leukorrhea Leukorrhea or (leucorrhoea American and British English spelling differences, British English), also known as fluor albus, is a thick, whitish, yellowish or greenish vaginal discharge. It has also been referred to as "the whites". There are many ...
. Palpation is focusing on feeling the body for tender ''"A-shi"'' points and feeling the pulse. Cheng, 1987, chapter 12.


Needles

The most common mechanism of stimulation of acupuncture points employs penetration of the skin by thin metal needles, which are manipulated manually or the needle may be further stimulated by electrical stimulation (electroacupuncture). Acupuncture needles are typically made of stainless steel, making them flexible and preventing them from rusting or breaking. Needles are usually disposed of after each use to prevent contamination. Reusable needles when used should be sterilized between applications. In many areas, only sterile, single-use acupuncture needles are allowed, including the State of California, USA. Needles vary in length between , with shorter needles used near the face and eyes, and longer needles in areas with thicker tissues; needle diameters vary from 0 to 0, Aung & Chen, 2007, p
116
with thicker needles used on more robust patients. Thinner needles may be flexible and require tubes for insertion. The tip of the needle should not be made too sharp to prevent breakage, although blunt needles cause more pain. Apart from the usual filiform needle, other needle types include three-edged needles and the Nine Ancient Needles. 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). Korean acupuncture uses copper needles and has a greater focus on the hand.


Needling technique


Insertion

The skin is sterilized and needles are inserted, frequently with a plastic guide tube. Needles may be manipulated in various ways, including spinning, flicking, or moving up and down relative to the skin. Since most pain is felt in the superficial layers of the skin, a quick insertion of the needle is recommended. Aung & Chen, 2007, pp
113–14
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. Acupuncture can be painful. 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.


''De-qi'' sensation

''De-qi'' (; "arrival of qi") refers to a claimed sensation of numbness, distension, or electrical tingling at the needling site. If these sensations are not observed then inaccurate location of the
acupoint Acupuncture is a form of alternative medicine and a key component of traditional Chinese medicine (TCM) in which thin needles are inserted into the body. Acupuncture is a pseudoscience, the theories and practices of TCM are not based on Science ...
, improper depth of needle insertion, inadequate manual manipulation, are blamed. If ''de-qi'' is not immediately observed upon needle insertion, various manual manipulation techniques are often applied to promote it (such as "plucking", "shaking" or "trembling"). Once ''de-qi'' is observed, techniques might be used which attempt to "influence" the ''de-qi''; for example, by certain manipulation the ''de-qi'' can allegedly be conducted from the needling site towards more distant sites of the body. Other techniques aim at "tonifying" () or "sedating" () ''qi''. The former techniques are used in
deficiency A deficiency is generally a lack of something. It may also refer to: *A deficient number, in mathematics, a number ''n'' for which ''σ''(''n'') < 2''n''. * Angular deficiency, in geometry, the difference between a sum of angles and the c ...
patterns, the latter in excess patterns. ''De qi'' is more important in Chinese acupuncture, while Western and Japanese patients may not consider it a necessary part of the treatment.


Related practices

*
Acupressure Acupressure (Chinese - Tui na), is an alternative medicine technique often used in conjunction with acupuncture Acupuncture is a form of alternative medicine and a key component of traditional Chinese medicine Traditional Chinese medi ...
, a non-invasive form of bodywork, uses physical pressure applied to acupressure points by the hand or elbow, or with various devices. * Acupuncture is often accompanied by
moxibustion 240px, First page of Shimetarō Hara: "Effects of Moxa on hemoglobin and RBC count". ''Iji Shinbun'', no. 1219, 10 Sept. 1927. (Summary in Esperanto) Moxibustion () is a traditional Chinese medicine therapy which consists of burning dried mug ...

moxibustion
, the burning of cone-shaped preparations of moxa (made from dried
mugwort Mugwort is a common name Common may refer to: Places * Common, a townland in County Tyrone, Northern Ireland * Boston Common Boston Common (also known as the Common) is a central public park in downtown Boston, Massachusetts. It is someti ...
) on or near the skin, often but not always near or on an acupuncture point. Traditionally, acupuncture was used to treat acute conditions while moxibustion was used for
chronic diseases A chronic condition is a human health Health is a state of physical, mental and social well-being Well-being, also known as ''wellness'', ''prudential value'' or ''quality of life'', refers to what is intrinsically valuable relative ''to'' s ...
. 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). *
Cupping therapy Cupping therapy is a form of alternative medicine Alternative medicine is any practice that aims to achieve the healing effects of medicine Medicine is the science Science (from the Latin word ''scientia'', meaning "knowledge") is a ...
is an ancient Chinese form of
alternative medicine Alternative medicine is any practice that aims to achieve the healing effects of medicine Medicine is the science Science (from the Latin word ''scientia'', meaning "knowledge") is a systematic enterprise that Scientific method, builds ...
in which a local suction is created on the skin; practitioners believe this mobilizes blood flow in order to promote healing. *
Tui na ''Tui na'' (; ) is form of alternative medicine Alternative medicine is any practice that aims to achieve the healing effects of medicine Medicine is the Art (skill), art, science, and Praxis (process) , practice of caring for a patien ...
is a TCM method of attempting to stimulate the flow of ''qi'' by various bare-handed techniques that do not involve needles. *
Electroacupuncture Electroacupuncture is a form of acupuncture where a small electric current is passed between pairs of acupuncture needles. According to some acupuncturists, this practice augments the use of regular acupuncture, can restore health and well-being ...
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 transdermal electrical nerve stimulation
TENSTENS or tens may refer to: Numbers and years * Second column of Order of magnitude, magnitude in the decimal system * 10 (number) * 10s, the decade from January 1, 10 AD to December 31, 19 AD * The years 10–19 of any century; see List of decades ...
] masquerading as acupuncture"). * Fire needle acupuncture also known as fire needling is a technique which involves quickly inserting a flame-heated needle into areas on the body. * Sonopuncture is a stimulation of the body similar to acupuncture using sound instead of needles. This may be done using purpose-built transducers to direct a narrow
ultrasound Ultrasound is s with higher than the upper audible limit of human . Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hear it. This limit varies from person to person and is appro ...

ultrasound
beam to a depth of 6–8 centimetres at acupuncture meridian points on the body. Alternatively,
tuning fork A tuning fork is an acoustic Acoustic may refer to: Music Albums * Acoustic (Bayside EP), ''Acoustic'' (Bayside EP) * Acoustic (Britt Nicole EP), ''Acoustic'' (Britt Nicole EP) * Acoustic (Joey Cape and Tony Sly album), ''Acoustic'' (Joey Cap ...

tuning fork
s or other sound emitting devices are used. * Acupuncture point injection is the injection of various substances (such as drugs,
vitamin A vitamin is an organic molecule , CH4; is among the simplest organic compounds. In chemistry, organic compounds are generally any chemical compounds that contain carbon-hydrogen chemical bond, bonds. Due to carbon's ability to Catenation, ...
s or herbal extracts) into acupoints. This technique combines traditional acupuncture with injection of what is often an effective dose of an approved pharmaceutical drug, and proponents claim that it may be more effective than either treatment alone, especially for the treatment of some kinds of chronic pain. However, a 2016 review found that most published trials of the technique were of poor value due to methodology issues and larger trials would be needed to draw useful conclusions. *
Auriculotherapy Auriculotherapy (also auricular therapy, ear acupuncture, and auriculoacupuncture) is a form of alternative medicine based on the idea that the ear is a micro system, which reflects the entire body, represented on the Pinna (anatomy), auricle, the ...

Auriculotherapy
, commonly known as ear acupuncture, auricular acupuncture, or auriculoacupuncture, is considered to date back to ancient China. It involves inserting needles to stimulate points on the
outer ear The outer ear, external ear, or auris externa is the external part of the ear, which consists of the auricle (anatomy), auricle (also pinna) and the ear canal. It gathers sound energy and focuses it on the eardrum (tympanic membrane). Stru ...
. The modern approach was developed in France during the early 1950s. There is no scientific evidence that it can cure disease; the evidence of effectiveness is negligible. * Scalp acupuncture, developed in Japan, is based on reflexological considerations regarding the
scalp The scalp is the anatomical area bordered by the human at the front, and by the at the sides and back. Structure The scalp is usually described as having five layers, which can conveniently be remembered as a : * S: The on the head from w ...
. * Hand acupuncture, developed in Korea, centers around assumed reflex zones of the hand. 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. * Cosmetic acupuncture is the use of acupuncture in an attempt to reduce wrinkles on the face. * Bee venom acupuncture is a treatment approach of injecting purified, diluted
bee venom Apitoxin, or honey bee A honey bee (also spelled honeybee) is a eusocial flying insect within the genus ''Apis'' of the bee clade, all native to Eurasia. They are known for their construction of wiktionary:perennial, perennial Colony (biology) ...
into acupoints. * Veterinary acupuncture is the use of acupuncture on domesticated animals. Rigorous evidence for complementary and alternative techniques is lacking in veterinary medicine but evidence has been growing. File:Acupuncture point Hegu (LI 4).jpg, Acupressure being applied to a hand. File:Sujichim (hand acupuncture).jpg, ''Sujichim'', hand acupuncture File:A Dose of Moxa.jpg, Japanese moxibustion File:Fire cupping in Haikou - 02.JPG, A woman receiving
fire cupping Cupping therapy is a form of alternative medicine in which a local suction is created on the skin with the application of heated cups. Its practice mainly occurs in Asia but also in Eastern Europe, the Middle East, and Latin America. Cupping has ...

fire cupping
in China.


Efficacy

Acupuncture has been researched extensively; as of 2013, there were almost 1,500 randomized controlled trials on
PubMed PubMed is a free search engine accessing primarily the MEDLINE bibliographic database, database of references and abstracts on life sciences and biomedical topics. The United States National Library of Medicine (NLM) at the National Institutes ...

PubMed
with "acupuncture" in the title. The results of reviews of acupuncture's efficacy, however, have been inconclusive. In January 2020, David Gorski analyzed a 2020 review of systematic reviews ("Acupuncture for the Relief of Chronic Pain: A Synthesis of Systematic Reviews") concerning the use of acupuncture to treat chronic pain. Writing in ''
Science-Based Medicine ''Science-Based Medicine'' is a website with articles covering issues in science Science (from the Latin word ''scientia'', meaning "knowledge") is a systematic enterprise that Scientific method, builds and Taxonomy (general), organizes k ...
,'' Gorski said that its findings highlight the conclusion that acupuncture is "a theatrical placebo whose real history has been
retcon Retroactive continuity, or retcon for short, is a literary device in which established diegetic Diegesis (; from the Greek Greek may refer to: Greece Anything of, from, or related to Greece Greece ( el, Ελλάδα, , ), officially the ...
ned beyond recognition." He also said this review "reveals the many weaknesses in the design of acupuncture clinical trials".


Sham acupuncture and research

It is difficult but not impossible to design rigorous research trials for acupuncture. Due to acupuncture's invasive nature, one of the major challenges in
efficacy Efficacy is the ability to perform a task to a satisfactory or expected degree. The word comes from the same roots as ''effectiveness Effectiveness is the capability of producing a desired result or the ability to produce desired output. When ...

efficacy
research is in the design of an appropriate placebo
control group In the design of experiments The design of experiments (DOE, DOX, or experimental design) is the design of any task that aims to describe and explain the variation of information under conditions that are hypothesized to reflect the variation. ...

control group
. 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. Sham acupuncture uses non-penetrating needles or needling at non-acupuncture points, e.g. inserting needles on meridians not related to the specific condition being studied, or in places not associated with meridians. 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. A 2014
review A review is an evaluation Evaluation is a system A system is a group of interacting Interaction is a kind of action that occurs as two or more objects have an effect upon one another. The idea of a two-way effect is essential in the ...
in ''
Nature Reviews Cancer ''Nature Reviews Cancer'' is a monthly review journal covering the field of oncology. Oncology journals Nature Research academic journals Publications established in 2001 {{oncology-journal-stub ...
'' 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 other words, 'sham' or 'placebo' acupuncture generally produces the same effects as 'real' acupuncture and, in some cases, does better." 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. 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. 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. 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). A response to "sham" acupuncture in osteoarthritis may be used in the elderly, but placebos have usually been regarded as deception and thus unethical. 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. 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. Using the principles of
evidence-based medicine Evidence-based medicine (EBM) is "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients." The aim of EBM is to integrate the experience of the clinician, the values of th ...
to research acupuncture is controversial, and has produced different results. Some research suggests acupuncture can alleviate pain but the majority of research suggests that acupuncture's effects are mainly due to placebo. Evidence suggests that any benefits of acupuncture are short-lasting. There is insufficient evidence to support use of acupuncture compared to . Acupuncture is not better than mainstream treatment in the long term. The use of acupuncture 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. Acupuncture has been called 'theatrical placebo', and
David Gorski David Henry Gorski is an American surgical oncologist, professor of surgery at Wayne State University School of Medicine, and a surgical oncologist at the Barbara Ann Karmanos Cancer Institute, specializing in breast cancer surgery. He is an o ...
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.


Publication bias

Publication bias #REDIRECT publication bias#REDIRECT publication bias Publication bias is a type of bias Bias is a disproportionate weight ''in favor of'' or ''against'' an idea or thing, usually in a way that is closed-minded, prejudicial, or unfair. Biases ...
is cited as a concern in the reviews of
randomized controlled trial A randomized controlled trial (or randomized control trial; RCT) is a form of scientific experiment An experiment is a procedure carried out to support, refute, or validate a hypothesis. Experiments provide insight into Causality, cause-and- ...
s of acupuncture. 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. A 2011 assessment of the quality of randomized controlled trials on traditional chinese medicine, 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 traditional chinese medicine remedies). The study also found that trials published in non-Chinese journals tended to be of higher quality. Chinese authors use more Chinese studies, which have been demonstrated to be uniformly positive. 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 factor #REDIRECT Impact factor #REDIRECT Impact factor#REDIRECT Impact factor The impact factor (IF) or journal impact factor (JIF) of an academic journal is a scientometric index calculated by Clarivate that reflects the yearly average number of citat ...
s of zero. A 2015 study comparing pre-registered records of acupuncture trials with their published results found that it was uncommon for such trials to be registered before the trial began. This study also found that selective reporting of results and changing outcome measures to obtain statistically significant results was common in this literature. Scientist and journalist
Steven Salzberg Steven Lloyd Salzberg (born 1960) is an United States, American Computational biology, computational biologist and computer scientist who is a Bloomberg Distinguished Professorships, Bloomberg Distinguished Professor of Biomedical Engineering, Compu ...

Steven Salzberg
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''.


Specific conditions


Pain

The conclusions of many trials and numerous
systematic review Systematic reviews are a type of review A review is an evaluation of a publication, service, or company such as a film, movie (a Film criticism, movie review), video game (video game review), musical composition (music criticism, music review ...
s of acupuncture are largely inconsistent with each other. 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. 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. A 2009 overview of
Cochrane reviews Cochrane (previously known as the Cochrane Collaboration) is a British international charitable organisation formed to organise medical research findings to facilitate evidence-based medicine, evidence-based choices about health interventions i ...
found acupuncture is not effective for a wide range of conditions. A 2014 systematic review suggests that the
nocebo effect A nocebo effect is said to occur when negative expectations of the patient regarding a treatment cause the treatment to have a more negative effect than it otherwise would have. For example, when a patient anticipates a side effect In medicine ...
of acupuncture is clinically relevant and that the rate of adverse events may be a gauge of the nocebo effect. A 2012
meta-analysis A meta-analysis is a statistical analysis that combines the results of multiple Randomized controlled trial, scientific studies. Meta-analyses can be performed when there are multiple scientific studies addressing the same question, with each i ...
conducted by the Acupuncture Trialists' Collaboration found "relatively modest" efficacy of acupuncture (in comparison to sham) for the treatment of four different types of
chronic pain Chronic pain is classified as pain that lasts longer than three to six months. In medicine, the distinction between Acute (medicine), acute and Chronic condition, chronic pain is sometimes determined by the amount of time since onset. Two commonly ...
(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. Commenting on this meta-analysis, both
Edzard Ernst Edzard Ernst (born 30 January 1948) is a retired academic physician and researcher specializing in the study of complementary and alternative medicine Alternative medicine is any practice that aims to achieve the healing effects of medicine ...

Edzard Ernst
and
David Colquhoun David Colquhoun (born 19 July 1936) is a British pharmacologist at University College London (UCL). He has contributed to the general theory of receptor and synaptic mechanisms, and in particular the theory and practice of single ion channel fu ...

David Colquhoun
said the results were of negligible clinical significance.
Edzard Ernst Edzard Ernst (born 30 January 1948) is a retired academic physician and researcher specializing in the study of complementary and alternative medicine Alternative medicine is any practice that aims to achieve the healing effects of medicine ...

Edzard 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." In 2017, the same research group updated their previous meta-analysis and again found acupuncture to be superior to sham acupuncture for non-specific musculoskeletal pain, osteoarthritis, chronic headache, and shoulder pain. They also found that the effects of acupuncture decreased by about 15% after one year. 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. A 2010 review found real acupuncture and sham acupuncture produce similar improvements, which can only be accepted as evidence against the efficacy of acupuncture. The same review found limited evidence that real acupuncture and sham acupuncture appear to produce biological differences despite similar effects. 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. The same review found that it remains unclear whether acupuncture reduces pain independent of a psychological impact of the needling ritual. A 2017 systematic review and meta-analysis found that ear acupuncture may be effective at reducing pain within 48 hours of its use, but the mean difference between the acupuncture and control groups was small.


Lower back pain

A 2013 systematic review found that acupuncture may be effective for nonspecific lower back pain, but the authors noted there were limitations in the studies examined, such as
heterogeneity Homogeneity and heterogeneity are concepts often used in the sciences Science (from the Latin Latin (, or , ) is a classical language belonging to the Italic languages, Italic branch of the Indo-European languages. Latin was originally ...
in study characteristics and low methodological quality in many studies. 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. 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." A 2010 review found that sham acupuncture was as effective as real acupuncture for chronic low back pain. The specific therapeutic effects of acupuncture were small, whereas its clinically relevant benefits were mostly due to contextual and psychosocial circumstances. 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. A 2005 Cochrane review found insufficient evidence to recommend for or against either acupuncture or dry needling for acute low back pain. The same review found low quality evidence for pain relief and improvement compared to no treatment or sham therapy for chronic low back pain only in the short term immediately after treatment. The same review also found that acupuncture is not more effective than conventional therapy and other alternative medicine treatments. A 2017 systematic review and meta-analysis concluded that, for neck pain, acupuncture was comparable in effectiveness to conventional treatment, while electroacupuncture was even more effective in reducing pain than was conventional acupuncture. The same review noted that "It is difficult to draw conclusion because the included studies have a high risk of bias and imprecision." A 2015 overview of systematic reviews of variable quality showed that acupuncture can provide short-term improvements to people with chronic Low Back Pain. The overview said this was true when acupuncture was used either in isolation or in addition to conventional therapy. A 2017 systematic review for an
American College of Physicians The American College of Physicians (ACP) is a national organization of internists, who specialize in the diagnosis, treatment, and care of adults.Sokanu "What is an Internist?" Retrieved 20 October 2014 With 154,000 members, ACP is the largest medi ...
clinical practice guideline found low to moderate evidence that acupuncture was effective for chronic low back pain, and limited evidence that it was effective for acute low back pain. The same review found that the strength of the evidence for both conditions was low to moderate. Another 2017 clinical practice guideline, this one produced by the Danish Health Authority, recommended against acupuncture for both recent-onset low back pain and lumbar radiculopathy.


Headaches and migraines

Two separate 2016 Cochrane reviews found that acupuncture could be useful in the prevention of tension-type headaches and episodic
migraine A migraine (, ) is a primary headache disorder characterized by recurrent headaches that are moderate to severe. Typically, episodes affect one side of the head, are pulsating in nature, and last from a few hours to three days. Associated sympt ...

migraine
s. The 2016 Cochrane 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. 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.


Arthritis pain

A 2014 review concluded that "current evidence supports the use of acupuncture as an alternative to traditional analgesics in osteoarthritis patients." , a meta-analysis showed that acupuncture may help
osteoarthritis Osteoarthritis (OA) is a type of degenerative joint disease An arthropathy is a disease of a joint. Signs and symptoms Arthralgia, Joint pain is a common but non-specific sign of joint disease. Signs will depend on the specific disease, and may ...

osteoarthritis
pain but it was noted that the effects were insignificant in comparison to sham needles. A 2012 review found "the potential beneficial action of acupuncture on osteoarthritis pain does not appear to be clinically relevant." A 2010 Cochrane review found that acupuncture shows
statistically significant Statistics is the discipline that concerns the collection, organization, analysis, interpretation, and presentation of data Data (; ) are individual facts, statistics, or items of information, often numeric. In a more technical sens ...
benefit over sham acupuncture in the treatment of peripheral joint osteoarthritis; however, these benefits were found to be so small that their
clinical significanceIn medicine and psychology, clinical significance is the practical importance of a treatment effect—whether it has a real genuine, palpable, noticeable effect on daily life. Types of significance Statistical significance Statistical significance ...
was doubtful, and "probably due at least partially to placebo effects from incomplete blinding". A 2013 Cochrane review found low to moderate evidence that acupuncture improves pain and stiffness in treating people with
fibromyalgia Fibromyalgia (FM) is a medical condition characterized by chronic widespread pain Pain is a distressing feeling often caused by intense or damaging stimuli. The defines pain as "an unpleasant sensory and emotional experience associated wi ...

fibromyalgia
compared with no treatment and standard care. A 2012 review found "there is insufficient evidence to recommend acupuncture for the treatment of fibromyalgia." 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. A 2012 review found that the effectiveness of acupuncture to treat
rheumatoid arthritis Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects synovial joint, joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and ...
is "sparse and inconclusive." A 2005 Cochrane review concluded that acupuncture use to treat rheumatoid arthritis "has no effect on ESR, , pain, patient's global assessment, number of swollen joints, number of tender joints, general health, disease activity and reduction of analgesics." 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. A 2018 systematic review found some evidence that acupuncture could be effective for the treatment of rheumatoid arthritis, but that the evidence was limited because of heterogeneity and methodological flaws in the included studies.


Other joint pain

A 2014 systematic review found that although manual acupuncture was effective at relieving short-term pain when used to treat
tennis elbow Tennis elbow, also known as lateral epicondylitis, is a condition in which the outer part of the elbow The elbow is the visible joint between the upper and lower parts of the arm. It includes prominent landmarks such as the olecranon, the ...

tennis elbow
, its long-term effect in relieving pain was "unremarkable". 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.


Post-operative pain and nausea

A 2014 overview of systematic reviews found insufficient evidence to suggest that acupuncture is an effective treatment for
postoperative nausea and vomiting Postoperative nausea and vomiting (PONV) is the phenomenon of nausea, vomiting, or retching experienced by a patient in the postanesthesia care unit (PACU) or within 24 hours following a surgical procedure. It is an unpleasant complication that affe ...
(PONV) in a clinical setting. A 2013 systematic review concluded that acupuncture might be beneficial in prevention and treatment of PONV. A 2015 Cochrane review found moderate-quality evidence of no difference between stimulation of the P6 acupoint on the wrist and
antiemetic An antiemetic is a drug Uncoated tablets, consisting of about 90% acetylsalicylic acid, along with a minor amount of inert fillers and binders. Aspirin is a pharmaceutical drug A medication (also referred to as medicine, pharmaceutic ...
drugs for preventing PONV. A new finding of the review was that further comparative trials are futile, based on the conclusions of a trial sequential analysis. Whether combining PC6 acupoint stimulation with antiemetics is effective was inconclusive. A 2014 overview of systematic reviews found insufficient evidence to suggest that acupuncture is effective for surgical or
post-operative Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical or dental specialty that uses operative manual and instrumental techniques on a person to investigate or tr ...
pain. For the use of acupuncture for post-operative pain, there was contradictory evidence. A 2014 systematic review found supportive but limited evidence for use of acupuncture for acute post-operative pain after back surgery. A 2014 systematic review found that while the evidence suggested acupuncture could be an effective treatment for postoperative
gastroparesis Gastroparesis (gastro- from Ancient Greek γαστήρ - gaster, "stomach"; and -paresis, πάρεσις - "partial paralysis"), also called delayed gastric emptying, is a medical disorder consisting of weak muscular contractions (peristalsis) of t ...
, a firm conclusion could not be reached because the trials examined were of low quality.


Pain and nausea associated with cancer and cancer treatment

A 2015 Cochrane review found that there is insufficient evidence to determine whether acupuncture is an effective treatment for cancer pain in adults. A 2014 systematic review published in the
Chinese Journal of Integrative Medicine The ''Chinese Journal of Integrative Medicine'' is a quarterly peer-reviewed medical journal covering integrative medicine, integrative and alternative medicine. It was established in 1995 as the ''Chinese Journal of Integrated Traditional and Weste ...
found that acupuncture may be effective as an adjunctive treatment to palliative care for cancer patients. A 2013 overview of reviews published in the Journal of Multinational Association for Supportive Care in Cancer found evidence that acupuncture could be beneficial for people with cancer-related symptoms, but also identified few rigorous trials and high heterogeneity between trials. A 2012 systematic review of randomised clinical trials published in the same journal found that the number and quality of RCTs for using acupuncture in the treatment of cancer pain was too low to draw definite conclusions. A 2014 systematic review reached inconclusive results with regard to the effectiveness of acupuncture for treating cancer-related fatigue. 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. A 2013 systematic review found that the quantity and quality of available RCTs for analysis were too low to draw valid conclusions for the effectiveness of acupuncture for cancer-related fatigue.


Sleep

Several meta-analytic and systematic reviews suggest that acupuncture alleviates sleep disturbance, particularly insomnia. However, reviewers caution that this evidence should be considered preliminary due to publication bias, problems with research methodology, small sample sizes, and heterogeneity.


Other conditions

For the following conditions, the Cochrane Collaboration or other reviews have concluded there is no strong evidence of benefit:


Moxibustion and cupping

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.


Safety


Adverse events

Acupuncture is generally safe when administered by an experienced, appropriately trained practitioner using clean-needle technique and sterile single-use needles. When improperly delivered it can cause adverse effects. Accidents and infections are associated with infractions of sterile technique or neglect on the part of the practitioner. To reduce the risk of serious adverse events after acupuncture, acupuncturists should be trained sufficiently. People with serious spinal disease, such as cancer or infection, are not good candidates for acupuncture. Contraindications to acupuncture (conditions that should not be treated with acupuncture) include coagulopathy disorders (e.g. hemophilia and advanced liver disease), warfarin use, severe psychiatric disorders (e.g. psychosis), and skin infections or skin trauma (e.g. burns). Further, electroacupuncture should be avoided at the spot of implanted electrical devices (such as pacemakers). A 2011 systematic review of systematic reviews (internationally and without language restrictions) found that serious complications following acupuncture continue to be reported. Between 2000 and 2009, ninety-five cases of serious adverse events, including five deaths, were reported. Many such events are not inherent to acupuncture but are due to Medical malpractice, malpractice of acupuncturists. This might be why such complications have not been reported in surveys of adequately trained acupuncturists. 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. Many serious adverse events were reported from developed countries. These included Australia, Austria, Canada, Croatia, France, Germany, Ireland, the Netherlands, New Zealand, Spain, Sweden, Switzerland, the UK, and the US. The number of adverse effects reported from the UK appears particularly unusual, which may indicate less under-reporting in the UK than other countries. Reports included 38 cases of infections and 42 cases of organ trauma. The most frequent adverse events included
pneumothorax A pneumothorax is an abnormal collection of air in the pleural space between the lung The lungs are the primary organs of the respiratory system in human Humans (''Homo sapiens'') are the most populous and widespread species of pri ...

pneumothorax
, and bacterial infection, bacterial and viral infections. A 2013 review found (without restrictions regarding publication date, study type or language) 295 cases of infections; mycobacterium was the pathogen in at least 96%. Likely sources of infection include towels, hot packs or boiling tank water, and reusing reprocessed needles. Possible sources of infection include contaminated needles, reusing personal needles, a person's skin containing mycobacterium, and reusing needles at various sites in the same person. Although acupuncture is generally considered a safe procedure, a 2013 review stated that the reports of infection transmission increased significantly in the prior decade, including those of mycobacterium. Although it is recommended that practitioners of acupuncture use disposable needles, the reuse of sterilized needles is still permitted. It is also recommended that thorough control practices for preventing infection be implemented and adapted.


English-language

A 2013 systematic review of the English-language case reports found that serious adverse events associated with acupuncture are rare, but that acupuncture is not without risk. Between 2000 and 2011 the English-language literature from 25 countries and regions reported 294 adverse events. The majority of the reported adverse events were relatively minor, and the incidences were low. For example, a prospective survey of 34,000 acupuncture treatments found no serious adverse events and 43 minor ones, a rate of 1.3 per 1000 interventions. Another survey found there were 7.1% minor adverse events, of which 5 were serious, amid 97,733 acupuncture patients. The most common adverse effect observed was infection (e.g. mycobacterium), and the majority of infections were bacterial in nature, caused by skin contact at the needling site. Infection has also resulted from skin contact with unsterilized equipment or with dirty towels in an unhygienic clinical setting. Other adverse complications included five reported cases of spinal cord injuries (e.g. migrating broken needles or needling too deeply), four brain injuries, four peripheral nerve injuries, five heart injuries, seven other organ and tissue injuries, bilateral hand edema, granuloma, epithelioid granuloma, pseudolymphoma, argyria, pustules, pancytopenia, and scarring due to hot-needle technique. Adverse reactions from acupuncture, which are unusual and uncommon in typical acupuncture practice, included syncope, galactorrhoea, bilateral nystagmus, pyoderma gangrenosum, hepatotoxicity, eruptive lichen planus, and spontaneous needle migration. A 2013 systematic review found 31 cases of vascular injuries caused by acupuncture, three resulting in death. Two died from pericardial tamponade and one was from an aortoduodenal fistula. The same review found vascular injuries were rare, bleeding and pseudoaneurysm were most prevalent. A 2011 systematic review (without restriction in time or language), aiming to summarize all reported case of cardiac tamponade after acupuncture, found 26 cases resulting in 14 deaths, with little doubt about causality in most fatal instances. The same review concluded cardiac tamponade was a serious, usually fatal, though theoretically avoidable complication following acupuncture, and urged training to minimize risk. A 2012 review found a number of adverse events were reported after acupuncture in the UK's National Health Service (England), National Health Service (NHS) but most (95%) were not severe, though miscategorization and under-reporting may alter the total figures. From January 2009 to December 2011, 468 safety incidents were recognized within the NHS organizations. The adverse events recorded included retained needles (31%), dizziness (30%), loss of consciousness/unresponsive (19%), falls (4%), bruising or soreness at needle site (2%), pneumothorax (1%) and other adverse side effects (12%). Acupuncture practitioners should know, and be prepared to be responsible for, any substantial harm from treatments. Some acupuncture proponents argue that the long history of acupuncture suggests it is safe. However, there is an increasing literature on adverse events (e.g. spinal-cord injury). Acupuncture seems to be safe in people getting anticoagulants, assuming needles are used at the correct location and depth. Studies are required to verify these findings. The evidence suggests that acupuncture might be a safe option for people with allergic rhinitis.


Chinese, Korean, and Japanese-language

A 2010 systematic review of the Chinese-language literature found numerous acupuncture-related adverse events, including pneumothorax, fainting, subarachnoid hemorrhage, and infection as the most frequent, and cardiovascular injuries, subarachnoid hemorrhage, pneumothorax, and recurrent cerebral hemorrhage as the most serious, most of which were due to improper technique. Between 1980 and 2009, the Chinese-language literature reported 479 adverse events. Prospective surveys show that mild, transient acupuncture-associated adverse events ranged from 6.71% to 15%. In a study with 190,924 patients, the prevalence of serious adverse events was roughly 0.024%. Another study showed a rate of adverse events requiring specific treatment of 2.2%, 4,963 Incidence (epidemiology), incidences among 229,230 patients. Infections, mainly hepatitis, after acupuncture are reported often in English-language research, though are rarely reported in Chinese-language research, making it plausible that acupuncture-associated infections have been underreported in China. Infections were mostly caused by poor sterilization of acupuncture needles. Other adverse events included spinal epidural hematoma (in the cervical, thoracic and lumbar spine), chylothorax, injuries of abdominal organs and tissues, injuries in the neck region, injuries to the eyes, including orbital hemorrhage, traumatic cataract, injury of the oculomotor nerve and retinal puncture, hemorrhage to the cheeks and the hypoglottis, peripheral motor-nerve injuries and subsequent motor dysfunction, local allergic reactions to metal needles, stroke, and cerebral hemorrhage after acupuncture. A causal link between acupuncture and the adverse events cardiac arrest, pyknolepsy, shock, fever, cough, thirst, aphonia, leg numbness, and sexual dysfunction remains uncertain. The same review concluded that acupuncture can be considered inherently safe when practiced by properly trained practitioners, but the review also stated there is a need to find effective strategies to minimize the health risks. Between 1999 and 2010, the Korean-language literature contained reports of 1104 adverse events. Between the 1980s and 2002, the Japanese-language literature contained reports of 150 adverse events.


Children and pregnancy

Although acupuncture has been practiced for thousands of years in China, its use in pediatrics in the United States did not become common until the early 2000s. In 2007, the National Health Interview Survey (NHIS) conducted by the National Center for Health Statistics, National Center For Health Statistics (NCHS) estimated that approximately 150,000 children had received acupuncture treatment for a variety of conditions. In 2008 a study determined that the use of acupuncture-needle treatment on children was "questionable" due to the possibility of adverse side-effects and the pain manifestation differences in children versus adults. The study also includes warnings against practicing acupuncture on infants, as well as on children who are over-fatigued, very weak, or have over-eaten. 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 pediatric acupuncture. The same review found 279 adverse events, 25 of them serious. The adverse events were mostly mild in nature (e.g. bruising or bleeding). The prevalence of mild adverse events ranged from 10.1% to 13.5%, an estimated 168 incidences among 1,422 patients. On rare occasions adverse events were serious (e.g. cardiac rupture or hemoptysis); many might have been a result of substandard practice. The incidence of serious adverse events was 5 per one million, which included children and adults. When used during pregnancy, the majority of adverse events caused by acupuncture were mild and transient, with few serious adverse events. The most frequent mild adverse event was needling or unspecified pain, followed by bleeding. Although two deaths (one stillbirth and one neonatal death) were reported, there was a lack of acupuncture-associated maternal mortality. 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. Although acupuncture is not contraindicated in pregnant women, some specific acupuncture points are particularly sensitive to needle insertion; these spots, as well as the abdomen, abdominal region, should be avoided during pregnancy.


Moxibustion and cupping

Four adverse events associated with moxibustion were bruising, burns and cellulitis, spinal epidural abscess, and large superficial basal cell carcinoma. Ten adverse events were associated with cupping. The minor ones were keloid scarring, burns, and bulla (dermatology), bullae; the serious ones were acquired hemophilia A, stroke following cupping on the back and neck, factitious panniculitis, reversible cardiac hypertrophy, and iron deficiency anemia.


Cost-effectiveness

A 2013 meta-analysis found that acupuncture for chronic low back pain was
cost-effective Cost-effectiveness analysis (CEA) is a form of economic analysis that compares the relative costs and outcomes (effects) of different courses of action. Cost-effectiveness analysis is distinct from cost–benefit analysis, which assigns a monetary ...
as a complement to standard care, but not as a substitute for standard care except in cases where comorbid depression presented. The same meta-analysis found there was no difference between sham and non-sham acupuncture. A 2011 systematic review found insufficient evidence for the cost-effectiveness of acupuncture in the treatment of chronic low back pain. A 2010 systematic review found that the cost-effectiveness of acupuncture could not be concluded. A 2012 review found that acupuncture seems to be cost-effective for some pain conditions.


Risk of forgoing conventional medical care

As with other alternative medicines, unethical or naïve practitioners may induce patients to exhaust financial resources by pursuing ineffective treatment. Professional ethics 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." 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".


Conceptual basis


Traditional

Acupuncture is a substantial part of
traditional Chinese medicine#REDIRECT Traditional Chinese medicine {{Redirect category shell, 1= {{R from other capitalisation ...
(TCM). Early acupuncture beliefs relied on concepts that are common in TCM, such as a life force energy called ''qi''. Aung & Chen ''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, through channels called meridians."(三)十二经脉 ...(四)奇经八脉 ..." [(3.) The Twelve Vessels ... (4.) The Extraordinary Eight Vessels ...] as seen at Acupuncture points where needles are inserted are mainly (but not always) found at locations along the meridians. Acupuncture points not found along a meridian are called extraordinary points and those with no designated site are called "A-shi" points. Aung & Chen, 2007, p
101
In TCM, disease is generally perceived as a disharmony or imbalance in energies such as Traditional Chinese medicine#Yin and yang, yin, yang, Traditional Chinese medicine#TCM model of the body, ''qi'', xuĕ, zàng-fǔ, meridians, and of the interaction between the body and the environment. Therapy is based on which "pattern of disharmony" can be identified. For example, some diseases are believed to be caused by meridians being invaded with an excess of wind, cold, and damp. In order to determine which Traditional chinese medicine#Patterns, pattern is at hand, practitioners examine things like the color 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. TCM and its concept of disease does not strongly differentiate between the cause and effect of symptoms.


Purported scientific basis

Scientific research has not supported the existence of ''qi'', meridians, or yin and yang. A ''Nature (journal), Nature'' editorial described TCM as "fraught with pseudoscience", with the majority of its treatments having no logical mechanism of action. Quackwatch states that "TCM 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. TCM practitioners disagree among themselves about how to diagnose patients and which treatments should go with which diagnoses. Even if they could agree, the TCM theories are so nebulous that no amount of scientific study will enable TCM to offer rational care." Some modern practitioners support the use of acupuncture to treat pain, but have abandoned the use of ''qi'', meridians, ''yin'', ''yang'' and other mystical energies as an explanatory frameworks. 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. Academic discussions of acupuncture still make reference to pseudoscientific concepts such as ''qi'' and meridians despite the lack of scientific evidence. Many within the scientific community consider attempts to rationalize acupuncture in science to be
quackery Quackery, often synonymous with health fraud, is the promotion of fraud In law, fraud is intentional deception Deception or falsehood is an act or statement which misleads, hides the truth, or promotes a belief, concept, or idea that is ...
and pseudoscience. Academics Massimo Pigliucci and Maarten Boudry describe it as a "borderlands science" lying between science and pseudoscience. 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. 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. Human tests to determine whether electrical continuity was significantly different near meridians than other places in the body have been inconclusive. Some studies suggest acupuncture causes a series of events within the central nervous system, and that it is possible to inhibit acupuncture's analgesic effects with the opioid antagonist naloxone. Mechanical deformation of the skin by acupuncture needles appears to result in the release of adenosine. The Nociception, anti-nociceptive effect of acupuncture may be mediated by the adenosine A1 receptor. A 2014 review in ''Nature Reviews Cancer'' found that since the key mouse studies that suggested acupuncture relieves pain via the local release of adenosine, which then triggered nearby A1 receptors "caused more tissue damage and inflammation relative to the size of the animal in mice than in humans, such studies unnecessarily muddled a finding that local inflammation can result in the local release of adenosine with analgesic effect." It has been proposed that acupuncture's effects in gastrointestinal disorders may relate to its effects on the parasympathetic nervous system, parasympathetic and sympathetic nervous system, which have been said to be the "Western medicine" equivalent of "yin and yang". Another mechanism whereby acupuncture may be effective for gastrointestinal dysfunction involves the promotion of gastric peristalsis in subjects with low initial gastric motility, and suppressing peristalsis in subjects with active initial motility. Acupuncture has also been found to exert anti-inflammatory effects, which may be mediated by the activation of the vagus nerve and deactivation of inflammatory macrophages. Neuroimaging studies suggest that acupuncture stimulation results in deactivation of the limbic brain areas and the default mode network.


History


Origins

Acupuncture, along with moxibustion, is one of the oldest practices of traditional Chinese medicine. Most historians believe the practice began in China, though there are some conflicting narratives on when it originated. Academics David Ramey and Paul Buell said the exact date acupuncture was founded depends on the extent to which dating of ancient texts can be trusted and the interpretation of what constitutes acupuncture. According to an article in ''Rheumatology'', the first documentation of an "organized system of diagnosis and treatment" for acupuncture was in ''The Yellow Emperor's Classic of Internal Medicine'' (
Huangdi Neijing ''Huangdi Neijing'' (), literally the ''Inner Canon of the Yellow Emperor'' or ''Esoteric Scripture of the Yellow Emperor'', is an ancient Chinese medical text that has been treated as the fundamental doctrinal source for Chinese medicine Tr ...
) from about 100 BC. Gold and silver needles found in the tomb of Liu Sheng, Prince of Zhongshan, Liu Sheng from around 100 BC are believed to be the earliest archaeological evidence of acupuncture, though it is unclear if that was their purpose. According to Plinio Prioreschi, the earliest known historical record of acupuncture is the Shiji ("Records of the Grand Historian"), written by a historian around 100 BC. It is believed that this text was documenting what was established practice at that time.


Alternate theories

The 5,000-year-old mummified body of Ötzi the Iceman was found with 15 groups of tattoos, many of which were located at points on the body where acupuncture needles are used for abdominal or lower back problems. Evidence from the body suggests Otzi suffered from these conditions. This has been cited as evidence that practices similar to acupuncture may have been practised elsewhere in Eurasia during the early Bronze Age; however, ''The Oxford Handbook of the History of Medicine'' calls this theory "speculative". It is considered unlikely that acupuncture was practised before 2000 BC. The Ötzi the Iceman's tattoo marks suggest to some experts that an acupuncture-like treatment was previously used in Europe 5 millennia ago. Acupuncture may have been practised during the Neolithic era, near the end of the Stone Age, using sharpened stones called Bian Stones, Bian shi. Many Chinese texts from later eras refer to sharp stones called "plen", which means "stone probe", that may have been used for acupuncture purposes. The ancient Chinese medical text, Huangdi Neijing, 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. However, it is more likely that stones were used for other medical purposes, such as puncturing a growth to drain its pus. The ''Mawangdui'' texts, which are believed to be from the 2nd century BC, mention the use of pointed stones to open abscesses, and moxibustion, but not for acupuncture. It is also speculated that these stones may have been used for bloodletting, due to the ancient Chinese belief that illnesses were caused by demons within the body that could be killed or released. It is likely bloodletting was an antecedent to acupuncture. According to historians Lu Gwei-djen and Joseph Needham, there is substantial evidence that acupuncture may have begun around 600 BC. Some hieroglyphs and Pictogram, pictographs from that era suggests acupuncture and moxibustion were practised. However, historians Lu and Needham said it was unlikely a needle could be made out of the materials available in China during this time period. It is possible that bronze was used for early acupuncture needles. Tin, copper, gold and silver are also possibilities, though they are considered less likely, or to have been used in fewer cases. If acupuncture was practised during the Shang dynasty (1766 to 1122 BC), organic materials like thorns, sharpened bones, or bamboo may have been used. 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. Lu and Needham noted that 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. An article in ''Rheumatology'' said that the absence of any mention of acupuncture in documents found in the tomb of Mawangdui from 198 BC suggest that acupuncture was not practised by that time.


Belief systems

Several different and sometimes conflicting belief systems emerged regarding acupuncture. This may have been the result of competing schools of thought. Some ancient texts referred to using acupuncture to cause bleeding, while others mixed the ideas of blood-letting and spiritual ch'i energy. Over time, the focus shifted from blood to the concept of puncturing specific points on the body, and eventually to balancing Yin and Yang energies as well. According to David Ramey, no single "method or theory" was ever predominantly adopted as the standard. 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. It is not certain when specific acupuncture points were introduced, but the autobiography of Bian Que from around 400–500 BC references inserting needles at designated areas. Bian Que believed there was a single acupuncture point at the top of one's skull that he called the point "of the hundred meetings." 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. Ramey and Buell said the "practice and theoretical underpinnings" of modern acupuncture were introduced in ''The Yellow Emperor's Classic'' (Huangdi Neijing) around 100 BC. It introduced the concept of using acupuncture to manipulate the flow of life energy (''qi'') in a network of meridian (channels) in the body. The network concept was made up of acu-tracts, such as a line down the arms, where it said acupoints were located. Some of the sites acupuncturists use needles at today still have the same names as those given to them by the ''Yellow Emperor's Classic''. Numerous additional documents were published over the centuries introducing new acupoints. By the 4th century AD, most of the acupuncture sites in use today had been named and identified.


Early development in China


Establishment and growth

In the first half of the 1st century AD, acupuncturists began promoting the belief that acupuncture's effectiveness was influenced by the time of day or night, the lunar cycle, and the season. The Science of the Yin-Yang Cycles (''Yün Chhi Hsüeh'') was a set of beliefs that curing diseases relied on the alignment of both heavenly (''tian'') and earthly (''di'') forces that were attuned to cycles like that of the sun and moon. There were several different belief systems that relied on a number of celestial and earthly bodies or elements that rotated and only became aligned at certain times. According to Needham and Lu, these "arbitrary predictions" were depicted by acupuncturists in complex charts and through a set of special terminology. Acupuncture needles during this period were much thicker than most modern ones and often resulted in infection. 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 needling in the wrong place, or at the wrong time. Later, many needles were heated in boiling water, or in a flame. Sometimes needles were used while they were still hot, creating a cauterizing effect at the injection site. Nine needles were recommended in the ''Chen Chiu Ta Chheng'' from 1601, which may have been because of an ancient Chinese belief that nine was a magic number. Other belief systems were based on the idea that the human body operated on a rhythm and acupuncture had to be applied at the right point in the rhythm to be effective. In some cases a lack of balance between Yin and Yang were believed to be the cause of disease. In the 1st century AD, many of the first books about acupuncture were published and recognized acupuncturist experts began to emerge. The ''Zhen Jiu Jia Yi Jing'', which was published in the mid-3rd century, became the oldest acupuncture book that is still in existence in the modern era. Other books like the ''Yu Kuei Chen Ching'', written by the Director of Medical Services for China, were also influential during this period, but were not preserved. In the mid 7th century, Sun Simiao 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. Acupuncture became more established in China as improvements in paper led to the publication of more acupuncture books. The Imperial Medical Service and the Imperial Medical College, which both supported acupuncture, became more established and created medical colleges in every province. The public was also exposed to stories about royal figures being cured of their diseases by prominent acupuncturists. 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.


Decline

By the end of the Song dynasty (1279 AD), acupuncture had lost much of its status in China.#Barnes2005, Barnes, 2005, p
25
It became rarer in the following centuries, and was associated with less prestigious professions like alchemy, shamanism, midwifery and moxibustion. Additionally, by the 18th century, scientific rationality was becoming more popular than traditional superstitious beliefs. By 1757 a book documenting the history of Chinese medicine called acupuncture a "lost art". Its decline was attributed in part to the popularity of prescriptions and medications, as well as its association with the lower classes. In 1822, the Chinese Emperor signed a decree excluding the practice of acupuncture from the Imperial Medical Institute. He said it was unfit for practice by gentlemen-scholars. In China acupuncture was increasingly associated with lower-class, illiterate practitioners. It was restored for a time, but banned again in 1929 in favor of science-based Western medicine. Although acupuncture declined in China during this time period, it was also growing in popularity in other countries.


International expansion

Korea is believed to be the first country in Asia that acupuncture spread to outside of China. Within Korea there is a legend that acupuncture was developed by emperor Dangun, though it is more likely to have been brought into Korea from a Chinese colonial prefecture in 514 AD. Acupuncture use was commonplace in Korea by the 6th century. It spread to Vietnam in the 8th and 9th centuries. As Vietnam began trading with Japan and China around the 9th century, it was influenced by their acupuncture practices as well. China and Korea sent "medical missionaries" that spread traditional Chinese medicine to Japan, starting around 219 AD. In 553, several Korean and Chinese citizens were appointed to re-organize medical education in Japan and they incorporated acupuncture as part of that system. Japan later sent students back to China and established acupuncture as one of five divisions of the Chinese State Medical Administration System. Acupuncture began to spread to Europe in the second half of the 17th century. 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. He published the first in-depth description of acupuncture for the European audience and created the term "acupuncture" in his 1683 work ''De Acupunctura''. 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. The French doctor Louis Berlioz (the father 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. By the 19th century, acupuncture had become commonplace in many areas of the world. Americans and Britons began showing interest in acupuncture in the early 19th century, although interest waned by mid-century. Western practitioners abandoned acupuncture's traditional beliefs in spiritual energy, pulse diagnosis, and the cycles of the moon, sun or the body's rhythm. Diagrams of the flow of spiritual energy, for example, conflicted with the West's own anatomical diagrams. It adopted a new set of ideas for acupuncture based on tapping needles into nerves. In Europe it was speculated that acupuncture may allow or prevent the flow of electricity in the body, as electrical pulses were found to make a frog's leg twitch after death. The West eventually created a belief system based on Travell trigger points that were believed to inhibit pain. They were in the same locations as China's spiritually identified acupuncture points, but under a different nomenclature. The first elaborate Western treatise on acupuncture was published in 1683 by Willem ten Rhijne.


Modern era

In China, the popularity of acupuncture rebounded in 1949 when Mao Zedong took power and sought to unite China behind traditional cultural values. It was also during this time that many Eastern medical practices were consolidated under the name traditional Chinese medicine (TCM). New practices were adopted in the 20th century, such as using a cluster of needles, electrified needles, or leaving needles inserted for up to a week. A lot of emphasis developed on using acupuncture on the ear. Acupuncture research organizations such as the International Society of Acupuncture were founded in the 1940s and 1950s and acupuncture services became available in modern hospitals. China, where acupuncture was believed to have originated, was increasingly influenced by Western medicine. Meanwhile, acupuncture grew in popularity in the US. The US Congress created the Office of Alternative Medicine in 1992 and the National Institutes of Health (NIH) declared support for acupuncture for some conditions in November 1997. In 1999, the National Center for Complementary and Integrative Health, National Center for Complementary and Alternative Medicine was created within the NIH. Acupuncture became the most popular alternative medicine in the US. Politicians from the Chinese Communist Party said acupuncture was superstitious and conflicted with the party's commitment to science. Communist Party Chairman Mao Zedong later reversed this position, arguing that the practice was based on scientific principles. 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. The US President 1972 Nixon visit to China, Richard Nixon visited China in 1972. During one part of the visit, the delegation was shown a patient undergoing major surgery while fully awake, ostensibly receiving acupuncture rather than anesthesia. Later it was found that the patients selected for the surgery had both a high pain tolerance and received heavy indoctrination before the operation; these demonstration cases were also frequently receiving morphine surreptitiously through an intravenous therapy, intravenous drip that observers were told contained only fluids and nutrients. 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 anesthetic into the wound. After the National Institute of Health expressed support for acupuncture for a limited number of conditions, adoption in the US grew further. In 1972 the first legal acupuncture center in the US was established in Washington DC and in 1973 the American Internal Revenue Service allowed acupuncture to be deducted as a medical expense. In 2006, a BBC documentary ''Alternative Medicine'' filmed a patient undergoing open heart surgery allegedly under acupuncture-induced anesthesia. It was later revealed that the patient had been given a cocktail of anesthetics. In 2010, UNESCO inscribed "acupuncture and
moxibustion 240px, First page of Shimetarō Hara: "Effects of Moxa on hemoglobin and RBC count". ''Iji Shinbun'', no. 1219, 10 Sept. 1927. (Summary in Esperanto) Moxibustion () is a traditional Chinese medicine therapy which consists of burning dried mug ...

moxibustion
of traditional Chinese medicine" on the UNESCO Intangible Cultural Heritage Lists, UNESCO Intangible Cultural Heritage List following China's nomination.


Adoption

Acupuncture is most heavily practiced in China and is popular in the US, Australia, and Europe. In Switzerland, acupuncture has become the most frequently used alternative medicine since 2004. In the United Kingdom, a total of 4 million acupuncture treatments were administered in 2009. Acupuncture is used in most pain clinics and hospices in the UK. An estimated 1 in 10 adults in Australia used acupuncture in 2004. In Japan, it is estimated that 25 percent of the population will try acupuncture at some point, though in most cases it is not covered by Health care system in Japan, public health insurance. Users of acupuncture in Japan are more likely to be elderly and to have a limited education. Approximately half of users surveyed indicated a likelihood to seek such remedies in the future, while 37% did not. Less than one percent of the US population reported having used acupuncture in the early 1990s. By the early 2010s, more than 14 million Americans reported having used acupuncture as part of their health care. In the US, acupuncture is increasingly () used at academic medical centers, and is usually offered through CAM centers or anesthesia and pain management services. Examples include those at Harvard University, Stanford University, Johns Hopkins University, and UCLA. The use of acupuncture in Germany increased by 20% in 2007, after the German acupuncture trials supported its efficacy for certain uses. In 2011, there were more than one million users, and insurance companies have estimated that two-thirds of German users are women. As a result of the trials, German Publicly funded health care, public health insurers began to cover acupuncture for chronic low back pain and osteoarthritis of the knee, but not tension headache or migraine. This decision was based in part on socio-political reasons. Some insurers in Germany chose to stop reimbursement of acupuncture because of the trials. For other conditions, insurers in Germany were not convinced that acupuncture had adequate benefits over usual care or sham treatments. Highlighting the results of the placebo group, researchers refused to accept a placebo therapy as efficient.


Regulation

There are various government and trade association regulatory bodies for acupuncture in the United Kingdom, the United States, Saudi Arabia, Australia, New Zealand, Japan, Canada, and in European countries and elsewhere. The World Health Organization recommends that before being licensed or certified, an acupuncturist receive 200 hours of specialized training if they are a physician and 2,500 hours for non-physicians; many governments have adopted similar standards. In China, the practice of acupuncture is regulated by the Chinese Medicine Council that was formed in 1999 by the Legislative Council. It includes a licensing exam and registration, as well as degree courses approved by the board. Canada has acupuncture licensing programs in the provinces of British Columbia, Ontario, Alberta and Quebec; standards set by the Chinese Medicine and Acupuncture Association of Canada are used in provinces without government regulation. Regulation in the US began in the 1970s in California, which was eventually followed by every state but Wyoming and Idaho. Licensing requirements vary greatly from state to state. The needles used in acupuncture are regulated in the US by the Food and Drug Administration. In some states acupuncture is regulated by a board of medical examiners, while in others by the board of licensing, health or education. In Japan, acupuncturists are licensed by the Ministry of Health, Labour, and Welfare, Minister of Health, Labour and Welfare after passing an examination and graduating from a technical school or university. In Australia, the Chinese Medicine Board of Australia regulates acupuncture, among other Chinese medical traditions, and restricts the use of titles like 'acupuncturist' to registered practitioners only. The practice of Acupuncture in New Zealand in 1990 acupuncture was included into the Governmental Accident Compensation Corporation (ACC) Act. This inclusion granted qualified and professionally registered acupuncturists to provide subsidised care and treatment to citizens, residents, and temporary visitors for work or sports related injuries that occurred within the country of New Zealand.The two bodies for the regulation of acupuncture and attainment of ACC treatment provider status in New Zealand are Acupuncture NZ, and The New Zealand Acupuncture Standards Authority. At least 28 countries in Europe have professional associations for acupuncturists. In France, the Académie Nationale de Médecine (National Academy of Medicine) has regulated acupuncture since 1955.


See also

*
Auriculotherapy Auriculotherapy (also auricular therapy, ear acupuncture, and auriculoacupuncture) is a form of alternative medicine based on the idea that the ear is a micro system, which reflects the entire body, represented on the Pinna (anatomy), auricle, the ...

Auriculotherapy
* Baunscheidtism * Colorpuncture * Dry needling * List of acupuncture points * List of ineffective cancer treatments – Includes
moxibustion 240px, First page of Shimetarō Hara: "Effects of Moxa on hemoglobin and RBC count". ''Iji Shinbun'', no. 1219, 10 Sept. 1927. (Summary in Esperanto) Moxibustion () is a traditional Chinese medicine therapy which consists of burning dried mug ...

moxibustion
* Moxibustion * Oriental Medicine * Pharmacopuncture * Pressure point * Regulation of acupuncture


Bibliography

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Notes


References


Further reading

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External links

* {{Authority control Acupuncture, Alternative medicine Chinese inventions Energy therapies Pain management Pseudoscience Traditional Chinese medicine