What Is Acupuncture

Acupuncture - Wikipedia https://en.wikipedia.
org/wiki/Acupuncture
Acupuncture
Acupuncture[a] is a form of alternative medicine[3] and a

Acupuncture
key component of traditional Chinese medicine (TCM) in
which thin needles are inserted into the body.[4]
Acupuncture is a pseudoscience,[5][6] the theories and
practices of TCM are not based on scientific knowledge,
and it has been characterized as quackery.[7] There is a
range of acupuncture variants which originated in
different philosophies,[8] and techniques vary depending
on the country in which it is performed.[9] It is most often
used to attempt pain relief,[10][11] 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.[12]
The conclusions of trials and systematic reviews of

acupuncture are inconsistent, which suggests that it is not
effective.[10][13][14] An overview of Cochrane reviews found
that acupuncture is not effective for a wide range of Needles being inserted into a person's arm
conditions.[13] A systematic review conducted by medical ICD-10-PCS 8E0H30Z (http://www.icd10
scientists at the Universities of Exeter and Plymouth data.com/ICD10PCS/Code
found little evidence of acupuncture's effectiveness in s/8/E/0/H//8E0H30Z)
treating pain.[10] Overall, the evidence suggests that short-
ICD-9 99.91 (http://icd9cm.chrisen
term treatment with acupuncture does not produce long-
dres.com/index.php?srchty
term benefits.[15] Some research results suggest that
acupuncture can alleviate some forms of pain, though the pe=procs&srchtext=99.91&
majority of research suggests that acupuncture's apparent Submit=Search&action=sea
effects are not caused by the treatment itself.[9] A rch)-99.92 (http://icd9cm.ch
systematic review concluded that the analgesic effect of risendres.com/index.php?sr
acupuncture seemed to lack clinical relevance and could chtype=procs&srchtext=99.
not be clearly distinguished from bias.[16] One meta- 92&Submit=Search&action
analysis found that acupuncture for chronic low back pain =search)
was cost-effective as an adjunct to standard care,[17] while MeSH D015670
a separate systematic review found insufficient evidence
for the cost-effectiveness of acupuncture in the treatment OPS-301 code 8-975 (http://ops.icd-code.d
of chronic low back pain.[18] e/ops/code/8-975.html).2
Acupuncture is generally safe when done by appropriately trained Acupuncture

practitioners using clean needle technique and single-use needles. Traditional Chinese 針灸[1]
[19][20] When properly delivered, it has a low rate of mostly minor
adverse effects.[4][19] Accidents and infections do occur, though, Simplified Chinese 针灸

and are associated with neglect on the part of the practitioner, Literal meaning "needling [and]
particularly in the application of sterile techniques.[10][20] A moxibustion"
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Acupuncture - Wikipedia https://en.wikipedia.org/wiki/Acupuncture
review conducted in 2013 stated that reports of infection Transcriptions

transmission increased significantly in the preceding decade.[21] Standard Mandarin
The most frequently reported adverse events were pneumothorax
and infections.[10] Since serious adverse events continue to be Hanyu Pinyin zhēnjiǔ
reported, it is recommended that acupuncturists be trained Wade–Giles chên1-chiu3
sufficiently to reduce the risk.[10] IPA [ʈʂə́n.tɕjòu]
Scientific investigation has not found any histological or Yue: Cantonese

physiological evidence for traditional Chinese concepts such as qi, Yale Romanization jām-gau
meridians, and acupuncture points,[n 1][25] and many modern Jyutping zam1-gau3
practitioners no longer support the existence of life force energy
IPA [tsɐ́m.kɐ̄u]
(qi) or meridians, which was a major part of early belief systems.
[8][26][27] Acupuncture is believed to have originated around Southern Min
100 BC in China, around the time The Yellow Emperor's Classic Hokkien POJ chiam-kù
of Internal Medicine (Huangdi Neijing) was published, [28]
though some experts suggest it could have been practiced earlier.[9] Over time, conflicting claims and
belief systems emerged about the effect of lunar, celestial and earthly cycles, yin and yang energies,
and a body's "rhythm" on the effectiveness of treatment.[29] Acupuncture fluctuated in popularity in
China due to changes in the country's political leadership and the preferential use of rationalism or
Western medicine.[28] Acupuncture spread first to Korea in the 6th century AD, then to Japan
through medical missionaries,[30] and then to Europe, beginning with France.[28] 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.[28][31][32]
Contents
Clinical practice
Needles
Needling technique
Related practices
Efficacy
Sham acupuncture and research
Publication bias
Specific conditions
Moxibustion and cupping
Safety
Adverse events
Cost-effectiveness
Risk of forgoing conventional medical care
Conceptual basis
Traditional
Purported scientific basis
History
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Origins
Early development in China
International expansion
Adoption
Regulation
See also
Bibliography
Notes
References
Further reading
External links
Clinical practice
Acupuncture is a form of alternative medicine.[3] It is used most
commonly for pain relief,[10][11] though it is also used to treat a
wide range of conditions. Acupuncture is generally only used in
combination with other forms of treatment.[12] For example, the
American Society of Anesthesiologists states it may be considered
in the treatment for nonspecific, noninflammatory low back pain
only in conjunction with conventional therapy.[33]
Acupuncture is the insertion of thin needles into the skin.[4] One type of acupuncture needle
According to the Mayo Foundation for Medical Education and
Research (Mayo Clinic), a typical session entails lying still while
approximately five to twenty needles are inserted; for the majority of cases, the needles will be left in
place for ten to twenty minutes.[34] It can be associated with the application of heat, pressure, or laser
light.[4] Classically, acupuncture is individualized and based on philosophy and intuition, and not on
scientific research.[35] There is also a non-invasive therapy developed in early 20th century Japan
using an elaborate set of instruments other than needles for the treatment of children (shōnishin or
shōnihari).[36][37]
Clinical practice varies depending on the country.[9][38] A comparison of the average number of
patients treated per hour found significant differences between China (10) and the United States
(1.2).[39] Chinese herbs are often used.[40] There is a diverse range of acupuncture approaches,
involving different philosophies.[8] Although various different techniques of acupuncture practice
have emerged, the method used in traditional Chinese medicine (TCM) seems to be the most widely
adopted in the US.[3] Traditional acupuncture involves needle insertion, moxibustion, and cupping
therapy,[19] and may be accompanied by other procedures such as feeling the pulse and other parts of
the body and examining the tongue.[3] Traditional acupuncture involves the belief that a "life force"
(qi) circulates within the body in lines called meridians.[41] The main methods practiced in the UK are
TCM and Western medical acupuncture.[42] The term Western medical acupuncture is used to
indicate an adaptation of TCM-based acupuncture which focuses less on TCM.[41][43] The Western
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medical acupuncture approach involves using acupuncture after a medical diagnosis.[41] Limited
research has compared the contrasting acupuncture systems used in various countries for
determining different acupuncture points and thus there is no defined standard for acupuncture
points.[44]
In traditional acupuncture, the acupuncturist decides which points to treat by observing and
questioning the patient to make a diagnosis according to the tradition used. 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.[45]
Auscultation and olfaction involve listening for particular sounds such as wheezing, and observing
body odor.[45] Inquiring involves focusing on the "seven inquiries": chills and fever; perspiration;
appetite, thirst and taste; defecation and urination; pain; sleep; and menses and leukorrhea.[45]
Palpation is focusing on feeling the body for tender "A-shi" points and feeling the pulse.[45]
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).[3]
Acupuncture needles are typically made of stainless steel, making
them flexible and preventing them from rusting or breaking.[46]
Needles are usually disposed of after each use to prevent
contamination.[46] Reusable needles when used should be
sterilized between applications.[46][47] In many areas, only sterile,
single-use acupuncture needles are allowed, including the State of
California, USA.[48] Needles vary in length between 13 to 130
millimetres (0.51 to 5.12 in), with shorter needles used near the
face and eyes, and longer needles in areas with thicker tissues; Acupuncture needles
needle diameters vary from 0.16 mm (0.006 in) to 0.46 mm
(0.018 in),[49] 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.[50]
Apart from the usual filiform needle, other needle types include
three-edged needles and the Nine Ancient Needles.[49] 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 Traditional and modern Japanese
China and the West). Korean acupuncture uses copper needles guiding tube needles
and has a greater focus on the hand.[38]
Needling technique
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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.[51] 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.[3] Acupuncture can be painful.[52]
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.[51]
De-qi sensation
De-qi (Chinese: 得气 ; pinyin: dé qì; "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, 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").[53]
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" (Chinese: 补 ; pinyin: bǔ) or "sedating"
(Chinese: 泄 ; pinyin: xiè) qi.[53] The former techniques are used in deficiency patterns, the latter in
excess patterns.[53] De qi is more important in Chinese acupuncture, while Western and Japanese
patients may not consider it a necessary part of the treatment.[38]
Related practices
Acupressure, a non-invasive form of bodywork, uses physical pressure applied to acupressure
points by the hand or elbow, or with various devices.[54]
Acupuncture is often accompanied by moxibustion, the burning of cone-shaped preparations of
moxa (made from dried mugwort) on or near the skin, often but not always near or on an
acupuncture point. Traditionally, acupuncture was used to treat acute conditions while
moxibustion was used for chronic diseases. 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).[55]
Cupping therapy is an ancient Chinese form of alternative medicine in which a local suction is
created on the skin; practitioners believe this mobilizes blood flow in order to promote healing.[56]
Tui na is a TCM method of attempting to stimulate the flow of qi by various bare-handed
techniques that do not involve needles.[57]
Electroacupuncture is a form of acupuncture in which acupuncture needles are attached to a
device that generates continuous electric pulses (this has been described as "essentially
transdermal electrical nerve stimulation [TENS] masquerading as acupuncture").[14]
Fire needle acupuncture also known as fire needling is a technique which involves quickly
inserting a flame-heated needle into areas on the body.[58]
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Sonopuncture is a stimulation of the body similar to acupuncture using sound instead of

needles.[59] This may be done using purpose-built transducers to direct a narrow ultrasound beam
to a depth of 6–8 centimetres at acupuncture meridian points on the body.[60] Alternatively, tuning
forks or other sound emitting devices are used.[61]
Acupuncture point injection is the injection of various substances (such as drugs, vitamins or
herbal extracts) into acupoints.[62] 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.[63]
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.[64] The modern approach was developed in France during the
early 1950s.[64] There is no scientific evidence that it can cure disease; the evidence of
effectiveness is negligible.[64]
Scalp acupuncture, developed in Japan, is based on reflexological considerations regarding the
scalp.
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.[65]
Cosmetic acupuncture is the use of acupuncture in an attempt to reduce wrinkles on the face.[66]
Bee venom acupuncture is a treatment approach of injecting purified, diluted bee venom into
acupoints.[67]
Veterinary acupuncture is the use of acupuncture on domesticated animals.[68] Rigorous evidence
for complementary and alternative techniques is lacking in veterinary medicine but evidence has
been growing.[69]
Acupressure being Sujichim, hand Japanese A woman receiving

applied to a hand. acupuncture moxibustion fire cupping in
China.
Efficacy
Acupuncture has been researched extensively; as of 2013, there were almost 1,500 randomized
controlled trials on PubMed with "acupuncture" in the title. The results of reviews of acupuncture's
efficacy, however, have been inconclusive.[70]
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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, Gorski said that its findings highlight the
conclusion that acupuncture is "a theatrical placebo whose real history has been retconned beyond
recognition." He also said this review "reveals the many weaknesses in the design of acupuncture
clinical trials".[71]
Sham acupuncture and research
It is difficult but not impossible to design rigorous research trials for acupuncture.[72][73] Due to
acupuncture's invasive nature, one of the major challenges in efficacy research is in the design of an
appropriate placebo control group.[74][75] 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.[72] Sham acupuncture uses non-penetrating needles or needling
at non-acupuncture points,[76] e.g. inserting needles on meridians not related to the specific condition
being studied, or in places not associated with meridians.[77] 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.[78][79]
A 2014 review in Nature Reviews Cancer 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."[80] 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.[81] 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.[81] 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.[78] 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).[3]
A response to "sham" acupuncture in osteoarthritis may be used in the elderly, but placebos have
usually been regarded as deception and thus unethical.[82] 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.[82] 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.[83]
Using the principles of evidence-based medicine to research acupuncture is controversial, and has
produced different results.[74] Some research suggests acupuncture can alleviate pain but the majority
of research suggests that acupuncture's effects are mainly due to placebo.[9] Evidence suggests that
any benefits of acupuncture are short-lasting.[15] There is insufficient evidence to support use of
acupuncture compared to mainstream medical treatments.[84] Acupuncture is not better than
mainstream treatment in the long term.[77]
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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.[80] Acupuncture has been called 'theatrical placebo',[14] and David Gorski argues that when
acupuncture proponents advocate 'harnessing of placebo effects' or work on developing 'meaningful
placebos', they essentially concede it is little more than that.[80]
Publication bias
Publication bias is cited as a concern in the reviews of randomized controlled trials of acupuncture.
[14][85][86] 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.[87] 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).[88] The study also found that
trials published in non-Chinese journals tended to be of higher quality.[88] Chinese authors use more
Chinese studies, which have been demonstrated to be uniformly positive.[89] A 2012 review of 88
systematic reviews of acupuncture published in Chinese journals found that less than half of these
reviews reported testing for publication bias, and that the majority of these reviews were published in
journals with impact factors of zero.[90] 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.[91]
Scientist and journalist 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.[92]
Specific conditions
Pain
The conclusions of many trials and numerous systematic reviews of acupuncture are largely
inconsistent with each other.[13] A 2011 systematic review of systematic reviews found that for
reducing pain, real acupuncture was no better than sham acupuncture, and concluded that numerous
reviews have shown little convincing evidence that acupuncture is an effective treatment for reducing
pain.[10] The same review found that neck pain was one of only four types of pain for which a positive
effect was suggested, but cautioned that the primary studies used carried a considerable risk of
bias.[10] A 2009 overview of Cochrane reviews found acupuncture is not effective for a wide range of
conditions.[13]
A 2014 systematic review suggests that the nocebo effect of acupuncture is clinically relevant and that
the rate of adverse events may be a gauge of the nocebo effect.[93] A 2012 meta-analysis 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 (back and neck pain,
knee osteoarthritis, chronic headache, and shoulder pain) and on that basis concluded that it "is more
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than a placebo" and a reasonable referral option.[94] Commenting on this meta-analysis, both Edzard
Ernst and David Colquhoun said the results were of negligible clinical significance.[95][96] 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."[97] 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.[98]
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.[99] A 2010 review found real acupuncture and sham
acupuncture produce similar improvements, which can only be accepted as evidence against the
efficacy of acupuncture.[100] The same review found limited evidence that real acupuncture and sham
acupuncture appear to produce biological differences despite similar effects.[100] 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.[16] The same review found that it
remains unclear whether acupuncture reduces pain independent of a psychological impact of the
needling ritual.[16] 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.[101]
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 in study
characteristics and low methodological quality in many studies.[102] A 2012 systematic review found
some supporting evidence that acupuncture was more effective than no treatment for chronic non-
specific low back pain; the evidence was conflicting comparing the effectiveness over other treatment
approaches.[12] A 2011 systematic review of systematic reviews found that "for chronic low back pain,
individualized acupuncture is not better in reducing symptoms than formula acupuncture or sham
acupuncture with a toothpick that does not penetrate the skin."[10] A 2010 review found that sham
acupuncture was as effective as real acupuncture for chronic low back pain.[3] The specific therapeutic
effects of acupuncture were small, whereas its clinically relevant benefits were mostly due to
contextual and psychosocial circumstances.[3] 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.[3] A 2005 Cochrane review found insufficient evidence to
recommend for or against either acupuncture or dry needling for acute low back pain.[103] 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.[103] The same
review also found that acupuncture is not more effective than conventional therapy and other
alternative medicine treatments.[103] 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 [sic] because the included studies have a
high risk of bias and imprecision."[104] A 2015 overview of systematic reviews of variable quality
showed that acupuncture can provide short-term improvements to people with chronic Low Back
Pain.[105] The overview said this was true when acupuncture was used either in isolation or in
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addition to conventional therapy.[105] A 2017 systematic review for an American College of Physicians
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.[106] 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.[107]
Headaches and migraines
Two separate 2016 Cochrane reviews found that acupuncture could be useful in the prevention of
tension-type headaches and episodic migraines.[108][109] 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.[109] 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.[110]
Arthritis pain
A 2014 review concluded that "current evidence supports the use of acupuncture as an alternative to
traditional analgesics in osteoarthritis patients."[111] As of 2014, a meta-analysis showed that
acupuncture may help osteoarthritis pain but it was noted that the effects were insignificant in
comparison to sham needles.[112] A 2012 review found "the potential beneficial action of acupuncture
on osteoarthritis pain does not appear to be clinically relevant."[77] A 2010 Cochrane review found
that acupuncture shows statistically significant benefit over sham acupuncture in the treatment of
peripheral joint osteoarthritis; however, these benefits were found to be so small that their clinical
significance was doubtful, and "probably due at least partially to placebo effects from incomplete
blinding".[113]
A 2013 Cochrane review found low to moderate evidence that acupuncture improves pain and
stiffness in treating people with fibromyalgia compared with no treatment and standard care.[114] A
2012 review found "there is insufficient evidence to recommend acupuncture for the treatment of
fibromyalgia."[77] 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.[115]
A 2012 review found that the effectiveness of acupuncture to treat rheumatoid arthritis is "sparse and
inconclusive."[77] A 2005 Cochrane review concluded that acupuncture use to treat rheumatoid
arthritis "has no effect on ESR, CRP, pain, patient's global assessment, number of swollen joints,
number of tender joints, general health, disease activity and reduction of analgesics."[116] 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.[117] 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.[118]
Other joint pain
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A 2014 systematic review found that although manual acupuncture was effective at relieving short-
term pain when used to treat tennis elbow, its long-term effect in relieving pain was
"unremarkable".[119] 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.[120]
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 (PONV) in a clinical setting.[121] A 2013
systematic review concluded that acupuncture might be beneficial in prevention and treatment of
PONV.[122] A 2015 Cochrane review found moderate-quality evidence of no difference between
stimulation of the P6 acupoint on the wrist and antiemetic drugs for preventing PONV.[123] A new
finding of the review was that further comparative trials are futile, based on the conclusions of a trial
sequential analysis.[124] 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 pain.[121] For the use of acupuncture for post-operative pain,
there was contradictory evidence.[121] A 2014 systematic review found supportive but limited evidence
for use of acupuncture for acute post-operative pain after back surgery.[125] A 2014 systematic review
found that while the evidence suggested acupuncture could be an effective treatment for postoperative
gastroparesis, a firm conclusion could not be reached because the trials examined were of low
quality.[126]
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.[127] A 2014 systematic review published in the
Chinese Journal of Integrative Medicine found that acupuncture may be effective as an adjunctive
treatment to palliative care for cancer patients.[128] 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.[129] 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.[130]
A 2014 systematic review reached inconclusive results with regard to the effectiveness of acupuncture
for treating cancer-related fatigue.[131] 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.[132] 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.[133]
Sleep
Several meta-analytic and systematic reviews suggest that acupuncture alleviates sleep disturbance,
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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.[134][135][136][137][138][139][140][141][142][143]
Other conditions
For the following conditions, the Cochrane Collaboration or other reviews have concluded there is no
strong evidence of benefit:
alcohol dependence,[144] epilepsy,[178] opioid addiction,[207][208]

allergy,[145][146][147] erectile dysfunction,[179] Parkinson's disease,[209]
Alzheimer's disease,[148] gastroparesis,[180] polycystic ovary syndrome,
[210][211]
angina pectoris,[149] glaucoma,[181]
ankle sprain,[150][151] gynaecological conditions posttraumatic stress
(except possibly fertility and disorder,[212]
asthma,[152][153]
nausea/vomiting),[182] premenstrual syndrome,[213]
attention deficit hyperactivity
disorder,[154][155] acute hordeolum,[183] preoperative anxiety,[214]
autism,[156][157] hot flashes,[184][185][186] restless legs syndrome,[215]
baby colic,[158] essential hypertension,[187] schizophrenia,[216]
Bell's palsy,[159][160] hypoxic ischemic sensorineural hearing
encephalopathy in newborn loss,[217]
cardiac arrhythmias,[161]
babies,[188] shoulder Pain,[218]
carpal tunnel syndrome,[162] in vitro fertilization (IVF), smoking cessation,[219]
cerebral hemorrhage,[163] [189][190]
stress urinary
chronic obstructive induction of labor,[191][192] incontinence,[220]
pulmonary disease,[164]
insomnia,[193][194][195] stroke,[221]
cocaine dependence,[165] irritable bowel acute stroke,[222]
constipation,[166] syndrome,[196]
stroke rehabilitation,[223]
depression,[167][168] labor pain[197][198]
temporomandibular joint
diabetic peripheral lumbar spinal stenosis,[199] dysfunction,[224][225]
neuropathy,[169] major depressive disorders tennis elbow,[226]
dysphagia after acute in pregnant women,[200]
stroke,[170] tinnitus,[227][228]
mumps in children,[201]
drug detoxification,[171][172] traumatic brain injury,[229]
musculoskeletal disorders of
dry eye,[173] uremic itching,[230]
the extremities,[202]
primary dysmenorrhoea,[174] uterine fibroids,[231]
myopia,[203]
dyspepsia,[175] vascular dementia,[232]
neuropathic pain,[204]
endometriosis,[176] whiplash,[233] and
obesity,[205]
enuresis,[177] xerostomia.[234]
obstetrical conditions,[206]
A 2010 overview of systematic reviews found that moxibustion was effective for several conditions but
12 of 55 28/12/2020, 4:00 am
the primary studies were of poor quality, so there persists ample uncertainty, which limits the
conclusiveness of their findings.[235]
Safety
Adverse events
Acupuncture is generally safe when administered by an experienced, appropriately trained

practitioner using clean-needle technique and sterile single-use needles.[20] When improperly
delivered it can cause adverse effects.[19] Accidents and infections are associated with infractions of
sterile technique or neglect on the part of the practitioner.[20] To reduce the risk of serious adverse
events after acupuncture, acupuncturists should be trained sufficiently.[10] People with serious spinal
disease, such as cancer or infection, are not good candidates for acupuncture.[3] 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).[3] Further, electroacupuncture should be
avoided at the spot of implanted electrical devices (such as pacemakers).[3]
A 2011 systematic review of systematic reviews (internationally and without language restrictions)
found that serious complications following acupuncture continue to be reported.[10] Between 2000
and 2009, ninety-five cases of serious adverse events, including five deaths, were reported.[10] Many
such events are not inherent to acupuncture but are due to malpractice of acupuncturists.[10] This
might be why such complications have not been reported in surveys of adequately trained
acupuncturists.[10] Most such reports originate from Asia, which may reflect the large number of
treatments performed there or a relatively higher number of poorly trained Asian acupuncturists.[10]
Many serious adverse events were reported from developed countries.[10] These included Australia,
Austria, Canada, Croatia, France, Germany, Ireland, the Netherlands, New Zealand, Spain, Sweden,
Switzerland, the UK, and the US.[10] The number of adverse effects reported from the UK appears
particularly unusual, which may indicate less under-reporting in the UK than other countries.[10]
Reports included 38 cases of infections and 42 cases of organ trauma.[10] The most frequent adverse
events included pneumothorax, and bacterial and viral infections.[10]
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%.[21] Likely sources of infection
include towels, hot packs or boiling tank water, and reusing reprocessed needles.[21] 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.[21] 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.[21] Although it is
recommended that practitioners of acupuncture use disposable needles, the reuse of sterilized needles
is still permitted.[21] It is also recommended that thorough control practices for preventing infection
be implemented and adapted.[21]
English-language
A 2013 systematic review of the English-language case reports found that serious adverse events
13 of 55 28/12/2020, 4:00 am
associated with acupuncture are rare, but that acupuncture is not without risk.[19] Between 2000 and
2011 the English-language literature from 25 countries and regions reported 294 adverse events.[19]
The majority of the reported adverse events were relatively minor, and the incidences were low.[19]
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.[19] Another survey found there were 7.1%
minor adverse events, of which 5 were serious, amid 97,733 acupuncture patients.[19] 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.[19] Infection has also resulted
from skin contact with unsterilized equipment or with dirty towels in an unhygienic clinical
setting.[19] 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, epithelioid granuloma,
pseudolymphoma, argyria, pustules, pancytopenia, and scarring due to hot-needle technique.[19]
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.[19]
A 2013 systematic review found 31 cases of vascular injuries caused by acupuncture, three resulting in
death.[236] Two died from pericardial tamponade and one was from an aortoduodenal fistula.[236] The
same review found vascular injuries were rare, bleeding and pseudoaneurysm were most
prevalent.[236] 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.[237] The same review concluded
cardiac tamponade was a serious, usually fatal, though theoretically avoidable complication following
acupuncture, and urged training to minimize risk.[237]
A 2012 review found a number of adverse events were reported after acupuncture in the UK's
National Health Service (NHS) but most (95%) were not severe,[42] though miscategorization and
under-reporting may alter the total figures.[42] From January 2009 to December 2011, 468 safety
incidents were recognized within the NHS organizations.[42] 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%).[42]
Acupuncture practitioners should know, and be prepared to be responsible for, any substantial harm
from treatments.[42] Some acupuncture proponents argue that the long history of acupuncture
suggests it is safe.[42] However, there is an increasing literature on adverse events (e.g. spinal-cord
injury).[42]
Acupuncture seems to be safe in people getting anticoagulants, assuming needles are used at the
correct location and depth.[238] Studies are required to verify these findings.[238] The evidence
suggests that acupuncture might be a safe option for people with allergic rhinitis.[145]
Chinese, South 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.[239]
Between 1980 and 2009, the Chinese-language literature reported 479 adverse events.[239]
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Prospective surveys show that mild, transient acupuncture-associated adverse events ranged from
6.71% to 15%.[239] In a study with 190,924 patients, the prevalence of serious adverse events was
roughly 0.024%.[239] Another study showed a rate of adverse events requiring specific treatment of
2.2%, 4,963 incidences among 229,230 patients.[239] 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.[239] Infections were mostly caused by poor sterilization of acupuncture needles.[239] 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.[239]
A causal link between acupuncture and the adverse events cardiac arrest, pyknolepsy, shock, fever,
cough, thirst, aphonia, leg numbness, and sexual dysfunction remains uncertain.[239] 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.[239] Between 1999 and 2010, the Republic of Korean-literature contained reports of
1104 adverse events.[240] Between the 1980s and 2002, the Japanese-language literature contained
reports of 150 adverse events.[241]
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 (NCHS) estimated that
approximately 150,000 children had received acupuncture treatment for a variety of conditions.[242]
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.[243]
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.[4] The same review found 279
adverse events, 25 of them serious.[4] The adverse events were mostly mild in nature (e.g. bruising or
bleeding).[4] The prevalence of mild adverse events ranged from 10.1% to 13.5%, an estimated 168
incidences among 1,422 patients.[4] On rare occasions adverse events were serious (e.g. cardiac
rupture or hemoptysis); many might have been a result of substandard practice.[4] The incidence of
serious adverse events was 5 per one million, which included children and adults.[4]
When used during pregnancy, the majority of adverse events caused by acupuncture were mild and
transient, with few serious adverse events.[244] The most frequent mild adverse event was needling or
unspecified pain, followed by bleeding.[244] Although two deaths (one stillbirth and one neonatal
death) were reported, there was a lack of acupuncture-associated maternal mortality.[244] Limiting
the evidence as certain, probable or possible in the causality evaluation, the estimated incidence of
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adverse events following acupuncture in pregnant women was 131 per 10,000.[244] Although
acupuncture is not contraindicated in pregnant women, some specific acupuncture points are
particularly sensitive to needle insertion; these spots, as well as the abdominal region, should be
avoided during pregnancy.[3]
Four adverse events associated with moxibustion were bruising, burns and cellulitis, spinal epidural
abscess, and large superficial basal cell carcinoma.[19] Ten adverse events were associated with
cupping.[19] The minor ones were keloid scarring, burns, and bullae;[19] the serious ones were
acquired hemophilia A, stroke following cupping on the back and neck, factitious panniculitis,
reversible cardiac hypertrophy, and iron deficiency anemia.[19]
Cost-effectiveness
A 2013 meta-analysis found that acupuncture for chronic low back pain was cost-effective as a
complement to standard care, but not as a substitute for standard care except in cases where
comorbid depression presented.[17] The same meta-analysis found there was no difference between
sham and non-sham acupuncture.[17] A 2011 systematic review found insufficient evidence for the
cost-effectiveness of acupuncture in the treatment of chronic low back pain.[18] A 2010 systematic
review found that the cost-effectiveness of acupuncture could not be concluded.[99] A 2012 review
found that acupuncture seems to be cost-effective for some pain conditions.[245]
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.[7][246] 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."[247] 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".[248]
Conceptual basis
Acupuncture
Traditional Simplified Chinese 针刺
Acupuncture is a substantial part of traditional Chinese medicine Transcriptions
(TCM). Early acupuncture beliefs relied on concepts that are Standard Mandarin
common in TCM, such as a life force energy called qi.[249] Qi was Hanyu Pinyin zhēncì
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.[250] Acupuncture points where needles are inserted are mainly (but not always)
found at locations along the meridians.[251] Acupuncture points not found along a meridian are called
extraordinary points and those with no designated site are called "A-shi" points.[251]
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In TCM, disease is generally perceived as a disharmony or

imbalance in energies such as yin, yang, qi, xuĕ, zàng-fǔ,
meridians, and of the interaction between the body and the
environment.[252] Therapy is based on which "pattern of
disharmony" can be identified.[253][254] For example, some
diseases are believed to be caused by meridians being invaded
with an excess of wind, cold, and damp.[255] In order to
determine which 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.[256][257] TCM and its concept of disease
does not strongly differentiate between the cause and effect of
symptoms.[258]
Purported scientific basis
Scientific research has not supported the existence of qi,

Old Chinese medical chart of
meridians, or yin and yang.[n 1][25][26] A Nature editorial
acupuncture meridians
described TCM as "fraught with pseudoscience", with the
majority of its treatments having no logical mechanism of
action.[259] 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."[7]
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.
[8][26][27] 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.[260] Academic discussions
of acupuncture still make reference to pseudoscientific concepts
such as qi and meridians despite the lack of scientific Modern acupuncture model
evidence.[260] Many within the scientific community consider
attempts to rationalize acupuncture in science to be quackery and
pseudoscience.[261][262] Academics Massimo Pigliucci and Maarten Boudry describe it as a
"borderlands science" lying between science and pseudoscience.[263]
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.[27][260] It is a generally held belief
within the acupuncture community that acupuncture points and meridians structures are special
conduits for electrical signals, but no research has established any consistent anatomical structure or
function for either acupuncture points or meridians.[n 1][25] Human tests to determine whether
electrical continuity was significantly different near meridians than other places in the body have
17 of 55 28/12/2020, 4:00 am
been inconclusive.[25]
Some studies suggest acupuncture causes a series of events within the central nervous system,[264]
and that it is possible to inhibit acupuncture's analgesic effects with the opioid antagonist
naloxone.[265] Mechanical deformation of the skin by acupuncture needles appears to result in the
release of adenosine.[3] The anti-nociceptive effect of acupuncture may be mediated by the adenosine
A1 receptor.[266] 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."[80]
It has been proposed that acupuncture's effects in gastrointestinal disorders may relate to its effects
on the parasympathetic and sympathetic nervous system, which have been said to be the "Western
medicine" equivalent of "yin and yang".[267] 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.[268]
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.[269] Neuroimaging
studies suggest that acupuncture stimulation results in deactivation of the limbic brain areas and the
default mode network.[270]
History
Origins
Acupuncture, along with moxibustion, is one of the oldest practices of traditional Chinese
medicine.[30] Most historians believe the practice began in China, though there are some conflicting
narratives on when it originated.[28][31] 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.[271]
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) from about 100 BC.[28] Gold and silver needles found in the tomb of 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.[271] 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.[29] It is believed that this text was documenting what was established practice at that
time.[28]
Alternate theories
The 5,000-year-old mummified body of Ötzi the Iceman was found with 15 groups of tattoos,[272]
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.[31] This
has been cited as evidence that practices similar to acupuncture may have been practised elsewhere in
18 of 55 28/12/2020, 4:00 am
Eurasia during the early Bronze Age;[272] however, The Oxford

Handbook of the History of Medicine calls this theory
"speculative".[32] It is considered unlikely that acupuncture was
practised before 2000 BC.[271] The Ötzi the Iceman's tattoo marks
suggest to some experts that an acupuncture-like treatment was
previously used in Europe 5 millennia ago.[9]
Acupuncture may have been practised during the Neolithic era,

near the end of the Stone Age, using sharpened stones called Bian
shi.[30]:70 Many Chinese texts from later eras refer to sharp
stones called "plen", which means "stone probe", that may have
been used for acupuncture purposes.[30]:70 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.[30]:71
However, it is more likely that stones were used for other medical
purposes, such as puncturing a growth to drain its pus.[28][31] 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.[29] 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
Acupuncture chart from the Ming
within the body that could be killed or released.[273] It is likely
dynasty (c. 1368–1644)
bloodletting was an antecedent to acupuncture.[31]
According to historians Lu Gwei-djen and Joseph Needham,

there is substantial evidence that acupuncture may have begun around 600 BC.[30] Some hieroglyphs
and pictographs from that era suggests acupuncture and moxibustion were practised.[274] 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.[30]:71–72 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.[30]:69 If acupuncture was practised during the Shang dynasty (1766 to
1122 BC), organic materials like thorns, sharpened bones, or bamboo may have been used.[30]:70 Once
methods for producing steel were discovered, it would replace all other materials, since it could be
used to create a very fine, but sturdy needles.[30]:74 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.[30] 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.[28]
Belief systems
Several different and sometimes conflicting belief systems emerged regarding acupuncture. This may
have been the result of competing schools of thought.[28] 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.[29] According to David Ramey, no single
"method or theory" was ever predominantly adopted as the standard.[275] At the time, scientific
19 of 55 28/12/2020, 4:00 am
knowledge of medicine was not yet developed, especially because in China dissection of the deceased
was forbidden, preventing the development of basic anatomical knowledge.[28]
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.[30] 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."[30]:83 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.[271]
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.[29][271] It introduced
the concept of using acupuncture to manipulate the flow of life energy (qi) in a network of meridian
(channels) in the body.[271][276] 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.[30]:93 Numerous
additional documents were published over the centuries introducing new acupoints.[30]:101 By the 4th
century AD, most of the acupuncture sites in use today had been named and identified.[30]:101
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.[30]:140–41 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.[30]:140–41 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.
[30]:140–41 According to Needham and Lu, these "arbitrary predictions" were depicted by
acupuncturists in complex charts and through a set of special terminology.[30]
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.[30]:102–03 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.[30]:104 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.[30]:102–03
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.[30]:140–41 In some cases
a lack of balance between Yin and Yang were believed to be the cause of disease.[30]:140–41
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.[30] 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.[30] In the mid 7th century, Sun Simiao
20 of 55 28/12/2020, 4:00 am
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.[30]
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.
[30]:129 The public was also exposed to stories about royal figures being cured of their diseases by
prominent acupuncturists.[30]:129–35 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.[28]
Decline
By the end of the Song dynasty (1279 AD), acupuncture had lost much of its status in China.[277] It
became rarer in the following centuries, and was associated with less prestigious professions like
alchemy, shamanism, midwifery and moxibustion.[278] Additionally, by the 18th century, scientific
rationality was becoming more popular than traditional superstitious beliefs.[28] By 1757 a book
documenting the history of Chinese medicine called acupuncture a "lost art".[30]:160 Its decline was
attributed in part to the popularity of prescriptions and medications, as well as its association with the
lower classes.[279]
In 1822, the Chinese Emperor signed a decree excluding the practice of acupuncture from the
Imperial Medical Institute.[28] He said it was unfit for practice by gentlemen-scholars.[280] In China
acupuncture was increasingly associated with lower-class, illiterate practitioners.[281] 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.[31]
International expansion
Korea is believed to be the first country in Asia that acupuncture spread to outside of China.[30]
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.[30]:262–63
Acupuncture use was commonplace in Korea by the 6th century. It spread to Vietnam in the 8th and
9th centuries.[31] As Vietnam began trading with Japan and China around the 9th century, it was
influenced by their acupuncture practices as well.[28] 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.[30]:264 Japan later sent students back to China and established
acupuncture as one of five divisions of the Chinese State Medical Administration System.[30]:264–65
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.[30]:264–65 He published the
first in-depth description of acupuncture for the European audience and created the term
"acupuncture" in his 1683 work De Acupunctura.[273] France was an early adopter among the West
21 of 55 28/12/2020, 4:00 am
due to the influence of Jesuit missionaries, who brought the

practice to French clinics in the 16th century.[28] 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.[280]
By the 19th century, acupuncture had become commonplace in

many areas of the world.[30]:295 Americans and Britons began
showing interest in acupuncture in the early 19th century,
although interest waned by mid-century.[28] 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.[28][31][32] In Europe it was speculated that Acupuncture chart from Shisi jing
acupuncture may allow or prevent the flow of electricity in the fahui (Expression of the Fourteen
body, as electrical pulses were found to make a frog's leg twitch Meridians) written by Hua Shou (fl.
after death.[273] 1340s, Ming dynasty). Japanese
reprint by Suharaya Heisuke (Edo,
The West eventually created a belief system based on Travell 1. year Kyōhō = 1716).
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.[28] The first elaborate Western treatise on acupuncture
was published in 1683 by Willem ten Rhijne.[282]
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).[31]
New practices were adopted in the 20th century, such as using a

cluster of needles,[30]:164 electrified needles, or leaving needles
inserted for up to a week.[30]:164 A lot of emphasis developed on
using acupuncture on the ear.[30]:164 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.[28][283] China, where
acupuncture was believed to have originated, was increasingly
influenced by Western medicine.[28] Meanwhile, acupuncture
grew in popularity in the US. The US Congress created the Office
An ancient Acupuncture statue at
of Alternative Medicine in 1992 and the National Institutes of the lobby of the Emperor's College
Health (NIH) declared support for acupuncture for some clinic, California
conditions in November 1997. In 1999, the National Center for
Complementary and Alternative Medicine was created within the
22 of 55 28/12/2020, 4:00 am
NIH. Acupuncture became the most popular alternative medicine in the US.[264]
Politicians from the Chinese Communist Party said acupuncture was superstitious and conflicted with
the party's commitment to science.[284] Communist Party Chairman Mao Zedong later reversed this
position,[284] arguing that the practice was based on scientific principles.[285]
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.[28] The US President Richard Nixon
visited China in 1972.[286] During one part of the visit, the delegation was shown a patient undergoing
major surgery while fully awake, ostensibly receiving acupuncture rather than anesthesia.[286] 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 drip that observers were told contained only fluids
and nutrients.[286] 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.[14] After the National Institute of Health expressed support for acupuncture for a
limited number of conditions, adoption in the US grew further.[28] In 1972 the first legal acupuncture
center in the US was established in Washington DC[287] and in 1973 the American Internal Revenue
Service allowed acupuncture to be deducted as a medical expense.[288]
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.[289][290]
In 2010, UNESCO inscribed "acupuncture and moxibustion of traditional Chinese medicine" on the
UNESCO Intangible Cultural Heritage List following China's nomination.[291]
Adoption
Acupuncture is most heavily practiced in China[239] and is popular in[239] the US,[19] Australia,[292]
and Europe.[293] In Switzerland, acupuncture has become the most frequently used alternative
medicine since 2004.[294] In the United Kingdom, a total of 4 million acupuncture treatments were
administered in 2009.[295] Acupuncture is used in most pain clinics and hospices in the UK.[41] An
estimated 1 in 10 adults in Australia used acupuncture in 2004.[292] In Japan, it is estimated that 25
percent of the population will try acupuncture at some point,[296] though in most cases it is not
covered by public health insurance.[296] Users of acupuncture in Japan are more likely to be elderly
and to have a limited education.[296] Approximately half of users surveyed indicated a likelihood to
seek such remedies in the future, while 37% did not.[296] Less than one percent of the US population
reported having used acupuncture in the early 1990s.[297] By the early 2010s, more than 14 million
Americans reported having used acupuncture as part of their health care.[297]
In the US, acupuncture is increasingly (as of 2014) used at academic medical centers,[80] 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.[298]
The use of acupuncture in Germany increased by 20% in 2007, after the German acupuncture trials
supported its efficacy for certain uses.[299] In 2011, there were more than one million users,[299] and
insurance companies have estimated that two-thirds of German users are women.[299] As a result of
23 of 55 28/12/2020, 4:00 am
the trials, German public health insurers began to cover acupuncture for chronic low back pain and
osteoarthritis of the knee, but not tension headache or migraine.[300] This decision was based in part
on socio-political reasons.[300] Some insurers in Germany chose to stop reimbursement of
acupuncture because of the trials.[301] For other conditions, insurers in Germany were not convinced
that acupuncture had adequate benefits over usual care or sham treatments.[302] Highlighting the
results of the placebo group, researchers refused to accept a placebo therapy as efficient.[303]
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.[304] 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.[293]
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.[305] 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 Minister of Health, Labour and Welfare after passing an
examination and graduating from a technical school or university.[306] 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.[307] 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[308], and The New Zealand Acupuncture Standards Authority[309] [310]. At least 28
countries in Europe have professional associations for acupuncturists.[306] In France, the Académie
Nationale de Médecine (National Academy of Medicine) has regulated acupuncture since 1955.[311]
See also
Auriculotherapy
Baunscheidtism
Colorpuncture
Dry needling
List of acupuncture points
List of ineffective cancer treatments – Includes moxibustion
24 of 55 28/12/2020, 4:00 am
Moxibustion
Oriental Medicine
Pharmacopuncture
Pressure point
Regulation of acupuncture
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Notes
a. From Latin, acus (needle) and punctura (to puncture)[2]
1. Singh & Ernst (2008) stated, "Scientists are still unable to find a shred of evidence to support the
existence of meridians or Ch'i",[22] "The traditional principles of acupuncture are deeply flawed, as
there is no evidence at all to demonstrate the existence of Ch'i or meridians"[23] and "As yin and
yang, acupuncture points and meridians are not a reality, but merely the product of an ancient
Chinese philosophy".[24]
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Further reading
Ulett GA (2002). "Acupuncture" (https://books.google.com/books?id=Gr4snwg7iaEC&pg=PA283).
In Shermer M (ed.). The Skeptic Encyclopedia of Pseudoscience. ABC-CLIO. pp. 283 ff.
ISBN 978-1-57607-653-8.
William FW, ed. (2013). "Acupuncture" (https://books.google.com/books?id=vH1EAgAAQBAJ&pg
=PT31). Encyclopedia of Pseudoscience: From Alien Abductions to Zone Therapy. Routledge.
pp. 3–4. ISBN 978-1-135-95522-9.
External links
Acupuncture (https://curlie.org/Health/Alternative/Acupuncture_and_Chinese_Medicine) at Curlie
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Acupuncture - Wikipedia https://en.wikipedia.

Acupuncture[a] is a form of alternative medicine[3] and a

The conclusions of trials and systematic reviews of

Acupuncture is generally safe when done by appropriately trained Acupuncture

adverse effects.[4][19] Accidents and infections do occur, though, Simplified Chinese 针灸

review conducted in 2013 stated that reports of infection Transcriptions

Scientific investigation has not found any histological or Yue: Cantonese

The most common mechanism of stimulation of acupuncture

Sonopuncture is a stimulation of the body similar to acupuncture using sound instead of

Acupressure being Sujichim, hand Japanese A woman receiving

Sham acupuncture and research

Lower back pain

Headaches and migraines

Other joint pain

Post-operative pain and nausea

Pain and nausea associated with cancer and cancer treatment

alcohol dependence,[144] epilepsy,[178] opioid addiction,[207][208]

Moxibustion and cupping

Acupuncture is generally safe when administered by an experienced, appropriately trained

Chinese, South Korean, and Japanese-language

A 2010 systematic review of the Chinese-language literature found numerous acupuncture-related

Children and pregnancy

Moxibustion and cupping

Risk of forgoing conventional medical care

In TCM, disease is generally perceived as a disharmony or

Purported scientific basis

Scientific research has not supported the existence of qi,

Some modern practitioners support the use of acupuncture to

According to an article in Rheumatology, the first documentation of an "organized system of

Eurasia during the early Bronze Age;[272] however, The Oxford

Acupuncture may have been practised during the Neolithic era,

According to historians Lu Gwei-djen and Joseph Needham,

Early development in China

Establishment and growth

acupuncturists in complex charts and through a set of special terminology.[30]

prominent acupuncturists.[30]:129–35 By time The Great Compendium of Acupuncture and

due to the influence of Jesuit missionaries, who brought the

By the 19th century, acupuncture had become commonplace in

In China, the popularity of acupuncture rebounded in 1949 when

New practices were adopted in the 20th century, such as using a

14. Colquhoun D, Novella SP (June 2013). "Acupuncture is theatrical placebo" (http://www.dcscience.

57. Farlex (2012). "Tui na" (http://medical-dictionary.thefreedictionary.com/tui+na). Farlex.

275. Ramey DW (December 2004). "Inaccurate acupuncture history" (https://doi.org/10.1093%2Frheu

Retrieved from "https://en.wikipedia.org/w/index.php?title=Acupuncture&oldid=996170040"

This page was last edited on 24 December 2020, at 22:55 (UTC).

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