View source for Acupuncture

{{Short description|Pseudoscientific needling treatment}}
{{pp|small=yes}}
{{Use dmy dates|date=July 2020}}
{{Infobox interventions
| name         = Acupuncture
| image        = Acupuncture1-1.jpg
| ICD10        = {{ICD10PCS|8E0H30Z|8/E/0/H/}}
| ICD9unlinked = {{ICD9proc|99.91}}-{{ICD9proc|99.92}}
| MeshID       = D015670
| OPS301       = {{OPS301|8-975}}.2
| other_codes  =
}}
{{Infobox Chinese
|s=针灸
|t=針灸{{efn|The word "needle" can be written with either of the two characters {{lang|zh|針}} or {{lang|zh|鍼}} in traditional contexts.}}
|l="needling [and] moxibustion"
|p=zhēnjiǔ
|w=chên<sup>1</sup>-chiu<sup>3</sup>
|mi={{IPAc-cmn|zh|en|1|.|j|iu|3}}
|j=zam<sup>1</sup>-gau<sup>3</sup>
|y=jāmgau
|ci={{IPAc-yue|z|am|1|.|g|au|3}}
|poj=chiam-kù
}}
{{Alternative medicine sidebar}}
'''Acupuncture'''{{efn|From the [[Latin language|Latin]] {{lang|la|acus}} (needle) and {{lang|la|punctura}} (to puncture).<ref>{{cite journal | vauthors = Pyne D, Shenker NG | title = Demystifying acupuncture | journal = Rheumatology | volume = 47 | issue = 8 | pages = 1132–36 | date = August 2008 | pmid = 18460551 | doi = 10.1093/rheumatology/ken161 | doi-access = free }}</ref>}} is a form of [[alternative medicine]]<ref name=Berman2010>{{cite journal | vauthors = Berman BM, Langevin HM, Witt CM, Dubner R | s2cid = 10129706 | title = Acupuncture for chronic low back pain | journal = The New England Journal of Medicine | volume = 363 | issue = 5 | pages = 454–61 | date = July 2010 | pmid = 20818865 | doi = 10.1056/NEJMct0806114 }}</ref> and a component of [[traditional Chinese medicine]] (TCM) in which thin needles are inserted into the body.<ref name="Adams 2011"/> Acupuncture is a [[pseudoscience]];<ref name=Baran2014>{{cite book |vauthors=Baran GR, Kiana MF, Samuel SP |title=Healthcare and Biomedical Technology in the 21st Century |chapter=Science, Pseudoscience, and Not Science: How do They Differ? |publisher=Springer |year=2014 |pages=19–57 |doi=10.1007/978-1-4614-8541-4_2 |isbn=978-1-4614-8540-7 |quote=various pseudosciences maintain their popularity in our society: acupuncture, astrology, homeopathy, etc.}}</ref><ref name=Khine2012>{{cite book |vauthors=Good R |veditors=Khine MS |title=Advances in Nature of Science Research: Concepts and Methodologies |chapter-url=https://books.google.com/books?id=4uOqSId2IjsC&pg=PA103 |year=2012 |publisher=Springer |isbn=978-94-007-2457-0 |page=103 |chapter=Chapter 5: Why the Study of Pseudoscience Should Be Included in Nature of Science Studies |quote=Believing in something like chiropractic or acupuncture really can help relieve pain to a small degree [...] but many related claims of medical cures by these pseudosciences are bogus. |access-date=3 August 2016 |archive-date=15 April 2023 |archive-url=https://web.archive.org/web/20230415011907/https://books.google.com/books?id=4uOqSId2IjsC&pg=PA103 |url-status=live }}</ref> the theories and practices of TCM are not based on [[Science|scientific knowledge]],<ref name="Barrett2007" /> and it has been characterized as [[quackery]].{{efn|name="quackery"}}
There is a range of acupuncture technological variants that originated in different philosophies,<ref name="Peñas2010" /> and techniques vary depending on the country in which it is performed. However, it can be divided into two main foundational philosophical applications and approaches; the first being the modern standardized form called [[eight principles]] TCM and the second being an older system that is based on the ancient [[Daoist]] ''[[Wuxing (Chinese philosophy)|wuxing]]'', better known as the five elements or phases in the West.<ref name="Ernst2006" /><ref>{{Cite journal|date=2009-12-01|title=A Study of the Sa-Ahm Five Element Acupuncture Theory|journal=Journal of Acupuncture and Meridian Studies|language=en|volume=2|issue=4|pages=309–320|doi=10.1016/S2005-2901(09)60074-1|issn=2005-2901|last1=Ahn|first1=Chang-Beohm|last2=Jang|first2=Kyung-Jun|last3=Yoon|first3=Hyun-Min|last4=Kim|first4=Cheol-Hong|last5=Min|first5=Young-Kwang|last6=Song|first6=Chun-Ho|last7=Lee|first7=Jang-Cheon|pmid=20633508|doi-access=free}}</ref><ref>{{Cite web |title=Syndrome differentiation according to the eight principles |url=http://www.shen-nong.com/eng/exam/diagnosis_eightprinciples.html |access-date=3 February 2021 |website=www.shen-nong.com |publisher=Shen-nong Limited |archive-date=10 August 2020 |archive-url=https://web.archive.org/web/20200810023753/http://www.shen-nong.com/eng/exam/diagnosis_eightprinciples.html |url-status=live }}</ref> Acupuncture is most often used to attempt pain relief,<ref name="Ernst 2011" /><ref name="NCCAM2010" /> though acupuncturists say that it can also be used for a wide range of other conditions. Acupuncture is typically used in combination with other forms of treatment.<ref name="Hutchinson2012">{{cite journal | vauthors = Hutchinson AJ, Ball S, Andrews JC, Jones GG | title = The effectiveness of acupuncture in treating chronic non-specific low back pain: a systematic review of the literature | journal = Journal of Orthopaedic Surgery and Research | volume = 7 | issue = 1 | pages = 36 | date = October 2012 | pmid = 23111099 | pmc = 3563482 | doi = 10.1186/1749-799X-7-36 | doi-access = free }}</ref>
The global acupuncture market was worth US$24.55 billion in 2017. The market was led by Europe with a 32.7% share, followed by Asia-Pacific with a 29.4% share and the Americas with a 25.3% share. It was estimated in 2021 that the industry would reach a market size of US$55 billion by 2023.<ref>{{Cite web|title=Acupuncture Market Share, Size Global Industry Revenue, Business Growth, Demand and Applications Market Research Report to 2023|url=https://www.marketwatch.com/press-release/acupuncture-market-share-size-global-industry-revenue-business-growth-demand-and-applications-market-research-report-to-2023-2021-08-30|access-date=2021-10-19|website=MarketWatch|language=EN-US|archive-date=20 October 2021|archive-url=https://web.archive.org/web/20211020235421/https://www.marketwatch.com/press-release/acupuncture-market-share-size-global-industry-revenue-business-growth-demand-and-applications-market-research-report-to-2023-2021-08-30|url-status=dead}}</ref>
<!-- Efficacy and safety -->
The conclusions of trials and [[systematic review]]s of acupuncture generally provide no good evidence of benefit, which suggests that it is not an effective method of healthcare.<ref name=sys0/><ref name=sys/> Acupuncture is generally safe when done by appropriately trained practitioners using clean needle techniques and single-use needles.<ref name="Xu S"/><ref name="nciacupuncture"/> When properly delivered, it has a low rate of mostly minor [[adverse effects]].<ref name="Adams 2011"/><ref name="Xu S"/> When accidents and infections do occur, they are associated with neglect on the part of the practitioner, particularly in the application of [[Asepsis|sterile techniques]].<ref name="Ernst 2011"/><ref name="nciacupuncture"/> A review conducted in 2013 stated that reports of infection transmission increased significantly in the preceding decade.<ref name="Gnatta2013"/> The most frequently reported adverse events were [[pneumothorax]] and infections.<ref name="Ernst 2011"/> Since serious adverse events continue to be reported, it is recommended that acupuncturists be trained sufficiently to reduce the risk.<ref name="Ernst 2011"/>
<!-- Mechanism, Epidemiology and History -->
Scientific investigation has not found any [[histology|histological]] or [[physiology|physiological]] evidence for traditional Chinese concepts such as ''[[qi]]'', [[meridian (Chinese medicine)|meridians]], and acupuncture points,{{efn |name=SinghErnst2008 |Singh & Ernst (2008) stated, "Scientists are still unable to find a shred of evidence to support the existence of meridians or Ch'i",<ref>{{harvnb|Singh & Ernst|2008|page= 72}}</ref> "The traditional principles of acupuncture are deeply flawed, as there is no evidence at all to demonstrate the existence of Ch'i or meridians"<ref>{{harvnb|Singh & Ernst|2008|page= 107}}</ref> and "As yin and yang, acupuncture points and meridians are not a reality, but merely the product of an ancient Chinese philosophy".<ref>{{harvnb|Singh & Ernst|2008|page= 387}}</ref>}}<ref name="Ahn2008"/> and many modern practitioners no longer support the existence of ''qi'' or meridians, which was a major part of early belief systems.<ref name="Peñas2010"/><ref name=Mann2000/><ref name=Williams2013/> Acupuncture is believed to have originated around 100&nbsp;BC in China, around the time ''The Inner Classic of Huang Di'' ([[Huangdi Neijing]]) was published,<ref name=White-Ernst/> though some experts suggest it could have been practiced earlier.<ref name="Ernst2006"/> 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.<ref name="Prioreschi2004"/> Acupuncture fluctuated in popularity in China due to changes in the country's political leadership and the preferential use of rationalism or scientific medicine.<ref name=White-Ernst/> Acupuncture spread first to Korea in the 6th century AD, then to Japan through medical missionaries,<ref name="abc"/> and then to Europe, beginning with France.<ref name=White-Ernst/> In the 20th century, as it spread to the United States and Western countries, spiritual elements of acupuncture that conflicted with scientific knowledge were sometimes abandoned in favor of simply tapping needles into acupuncture points.<ref name=White-Ernst/><ref name="Porter 2013 p. 403"/><ref name="Jackson 2011 p. 610"/>
{{TOC limit|3}}
== Clinical practice ==
[[File:Aiguille d acupuncture avec regle.dsc02265.untilted+cropped+WB.jpg|thumb|One type of acupuncture needle]]
Acupuncture is a form of alternative medicine.<ref name=Berman2010/> It is used most commonly for pain relief,<ref name="Ernst 2011"/><ref name=NCCAM2010>{{cite web|title=Acupuncture for Pain|url=http://nccih.nih.gov/health/acupuncture/acupuncture-for-pain.htm|work=NCCIH|access-date=9 May 2014|date=January 2008|archive-url=https://archive.today/20151011153254/https://nccih.nih.gov/health/acupuncture/introduction|archive-date=11 October 2015|url-status=dead}}</ref> though it is also used to treat a wide range of conditions. Acupuncture is generally only used in combination with other forms of treatment.<ref name=Hutchinson2012/> For example, the [[American Society of Anesthesiologists]] states it may be considered in the treatment of nonspecific, noninflammatory low back pain only in conjunction with conventional therapy.<ref>{{cite journal | vauthors = Benzon HT, Connis RT, De Leon-Casasola OA, Glass DD, Korevaar WC, Cynwyd B, Mekhail NA, Merrill DG, Nickinovich DG, Rathmell JP, Sang CN, Simon DL | title = Practice guidelines for chronic pain management: an updated report by the American Society of Anesthesiologists Task Force on Chronic Pain Management and the American Society of Regional Anesthesia and Pain Medicine | journal = Anesthesiology | volume = 112 | issue = 4 | pages = 810–33 | date = April 2010 | pmid = 20124882 | doi = 10.1097/ALN.0b013e3181c43103 | doi-access = free }}</ref>
Acupuncture is the insertion of thin needles into the skin.<ref name="Adams 2011"/> 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.<ref name=mayo2012>{{cite web|url=http://www.mayoclinic.org/tests-procedures/acupuncture/basics/what-you-can-expect/prc-20020778|work=Mayo Clinic Staff|publisher=[[Mayo Foundation for Medical Education and Research]]|title=What you can expect|date=January 2012|access-date=21 July 2014|archive-date=8 August 2014|archive-url=https://web.archive.org/web/20140808235324/http://www.mayoclinic.org/tests-procedures/acupuncture/basics/what-you-can-expect/prc-20020778|url-status=live}}</ref> It can be associated with the application of heat, pressure, or [[laser light]].<ref name="Adams 2011"/> Classically, acupuncture is individualized and based on philosophy and intuition, and not on scientific research.<ref>{{cite journal | last=Schwartz | first=L | url=http://medicalacupuncture.org/aama_marf/journal/vol12_1/evidence.html|archive-url=https://web.archive.org/web/20011121060240/http://medicalacupuncture.org/aama_marf/journal/vol12_1/evidence.html|archive-date=21 November 2001 |journal=Medical Acupuncture | pages=38–41 | year=2000 |volume=12 | issue=1 | title=Evidence-Based Medicine And Traditional Chinese Medicine: Not Mutually Exclusive}}</ref> There is also a [[invasiveness of surgical procedures#Non-invasive procedure|non-invasive]] therapy developed in early 20th-century Japan using an elaborate set of instruments other than needles for the treatment of children ({{Lang|ja-latn|shōnishin}} or {{Lang|ja-latn|shōnihari}}).<ref>{{cite book | first = Stephen | last = Birch | name-list-style = vanc |title=Japanese Pediatric Acupuncture|publisher=Thieme |year=2011 |isbn=978-3131500618}}</ref><ref>{{cite book | first = Thomas | last = Wernicke | name-list-style = vanc |title=The Art of Non-Invasive Paediatric Acupuncture|publisher=Jessica Kingsley Publishers |year=2014 |isbn=978-1848191600}}</ref>
Clinical practice varies depending on the country.<ref name=Ernst2006>{{cite journal | vauthors = Ernst E | title = Acupuncture – a critical analysis | journal = Journal of Internal Medicine | volume = 259 | issue = 2 | pages = 125–37 | date = February 2006 | pmid = 16420542 | doi = 10.1111/j.1365-2796.2005.01584.x | s2cid = 22052509 | doi-access = free }}</ref><ref name=Dummies/> A comparison of the average number of patients treated per hour found significant differences between China (10) and the United States (1.2).<ref>{{cite journal | vauthors = Napadow V, Kaptchuk TJ | s2cid = 2094918 | title = Patient characteristics for outpatient acupuncture in Beijing, China | journal = Journal of Alternative and Complementary Medicine | volume = 10 | issue = 3 | pages = 565–72 | date = June 2004 | pmid = 15253864 | doi = 10.1089/1075553041323849 }}</ref> [[Chinese herbs]] are often used.<ref name=Sherman>{{cite journal | vauthors = Sherman KJ, Cherkin DC, Eisenberg DM, Erro J, Hrbek A, Deyo RA | title = The practice of acupuncture: who are the providers and what do they do? | journal = Annals of Family Medicine | volume = 3 | issue = 2 | pages = 151–58 | year = 2005 | pmid = 15798042 | pmc = 1466855 | doi = 10.1370/afm.248 }}</ref> There is a diverse range of acupuncture approaches, involving different philosophies.<ref name="Peñas2010"/> 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.<ref name=Berman2010/> Traditional acupuncture involves needle insertion, [[moxibustion]], and [[cupping therapy]],<ref name="Xu S"/> and may be accompanied by other procedures such as feeling the [[Radial pulse|pulse]] and other parts of the body and examining the tongue.<ref name=Berman2010/> Traditional acupuncture involves the belief that a "life force" (''[[qi]]'') circulates within the body in lines called meridians.<ref name=NHS>{{cite web|url=http://www.nhs.uk/conditions/Acupuncture/Pages/Introduction.aspx|title=Acupuncture|publisher=NHSChoices|access-date=2 May 2015|archive-date=3 May 2015|archive-url=https://web.archive.org/web/20150503085352/http://www.nhs.uk/conditions/Acupuncture/Pages/Introduction.aspx|url-status=live}}</ref> The main methods practiced in the UK are TCM and Western medical acupuncture.<ref name=Wheway2012/> The term Western medical acupuncture is used to indicate an adaptation of TCM-based acupuncture which focuses less on TCM.<ref name=NHS/><ref name=WhiteCummings2008>{{cite book | first1 = Adrian | last1 = White | first2 = Mike | last2 = Cummings | first3 = Jacqueline | last3 = Filshie | name-list-style = vanc |title=An Introduction to Western Medical Acupuncture|chapter-url=https://books.google.com/books?id=Miw5AAAACAAJ|year=2008|publisher=Churchill Livingstone|isbn=978-0-443-07177-5|page=7|chapter=2}}</ref> The Western medical acupuncture approach involves using acupuncture after a medical diagnosis.<ref name=NHS/> 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.<ref name=Millers2014>{{cite book|title=Miller's Anesthesia|date=2014|publisher=Elsevier|isbn=978-0702052835|page=1235}}</ref>
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.<ref name=Cheng1987/> Auscultation and olfaction involve listening for particular sounds, such as wheezing, and observing body odor.<ref name=Cheng1987/> Inquiring involves focusing on the "seven inquiries": chills and fever; perspiration; appetite, thirst and taste; defecation and urination; pain; sleep; and [[menses]] and [[leukorrhea]].<ref name=Cheng1987/> Palpation is focusing on feeling the body for tender {{Lang|zh-latn|A-shi}} points and feeling the pulse.<ref name=Cheng1987>[[#Cheng1987|Cheng]], 1987, chapter 12.</ref>
=== Needles ===
[[File:Acupuncture Needles.jpg|thumb|right|Acupuncture needles]]
[[File:Japanese kudabari.jpg|thumb|right|Traditional and modern Japanese guiding tube 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).<ref name=Berman2010/> Acupuncture needles are typically made of stainless steel, making them flexible and preventing them from rusting or breaking.<ref name=Hicks2005/> Needles are usually disposed of after each use to prevent contamination.<ref name=Hicks2005/> Reusable needles when used should be sterilized between applications.<ref name=Hicks2005>{{cite book | first = Angela | last = Hicks | name-list-style = vanc |edition=1 |page=41 |title=The Acupuncture Handbook: How Acupuncture Works and How It Can Help You |publisher=[[Piatkus Books]] |year=2005 |isbn=978-0749924720}}</ref><ref>{{cite book |last=Collinge |first=William J. |name-list-style=vanc |title=The American Holistic Health Association Complete guide to alternative medicine |publisher=Warner Books |location=New York |year=1996 |isbn=978-0-446-67258-0 |url=https://archive.org/details/americanholistic00coll }}</ref> In many areas, only sterile, single-use acupuncture needles are allowed, including the State of California, USA.<ref>Department of Consumer Affairs, California Acupuncture Board. Title 16, Article 5. Standards of Practice, 1399.454. Single Use Needles. www.acupuncture.ca.gov/pubs_forms/laws_regs/art5.shtml 1-10-2020.</ref> Needles vary in length between {{convert|13|and|130|mm|in}}, with shorter needles used near the face and eyes, and longer needles in areas with thicker tissues; needle diameters vary from 0{{convert|.16|mm|3|abbr=on}} to 0{{convert|.46|mm|3|abbr=on}},<ref name=Aung116>[[#Aung2007|Aung & Chen]], 2007, p. [https://books.google.com/books?id=I6NclaeDWjgC&pg=PA116 116].</ref> 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.<ref name=FCA>{{cite book| pages =[https://books.google.com/books?id=bKoMiuhSb3YC&pg=PA2 2–3] | title=Fundamentals of Chinese Acupuncture | vauthors = Ellis A, Wiseman N, Boss K | isbn=978-0912111339 | publisher=Paradigm Publications | year=1991 }}</ref>
Apart from the usual filiform needle, other needle types include three-edged needles and the Nine Ancient Needles.<ref name=Aung116/> 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.<ref name=Dummies>{{cite book | pages=[https://books.google.com/books?id=b6_1FOwC_GYC&pg=PA126 126–28] | title=Complementary Medicine For Dummies | last=Young | first=J | publisher=[[John Wiley & Sons]] | year=2007 | isbn=978-0470519684}}</ref>
=== 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.<ref name=Aung2007>[[#Aung2007|Aung & Chen]], 2007, pp. [https://books.google.com/books?id=I6NclaeDWjgC&pg=PA113 113–14].</ref> 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.<ref name=Berman2010/> Acupuncture can be painful.<ref>{{cite journal | vauthors = Loyeung BY, Cobbin DM | title = Investigating the effects of three needling parameters (manipulation, retention time, and insertion site) on needling sensation and pain profiles: a study of eight deep needling interventions | journal = Evidence-Based Complementary and Alternative Medicine | volume = 2013 | pages = 1–12 | year = 2013 | pmid = 24159337 | pmc = 3789497 | doi = 10.1155/2013/136763 | doi-access = free }}</ref> The acupuncturist's skill level may influence the painfulness of the needle insertion; a sufficiently skilled practitioner may be able to insert the needles without causing any pain.<ref name=Aung2007/>
==== ''{{Lang|zh-latn|De-qi}}'' sensation ====
{{Lang|zh-latn|De-qi}} ({{zh|s=得气|p=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 {{Lang|zh-latn|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").<ref name="AungChen2007">{{cite book | first1 = Steven | last1 = Aung | first2 = William | last2 = Chen | name-list-style = vanc |title=Clinical Introduction to Medical Acupuncture|url=https://books.google.com/books?id=I6NclaeDWjgC|year=2007|publisher=Thieme|isbn=978-1588902214|page=116}}</ref>
Once ''{{Lang|zh-latn|de-qi}}'' is observed, techniques might be used which attempt to "influence" the ''{{Lang|zh-latn|de-qi}}''; for example, by certain manipulation the ''{{Lang|zh-latn|de-qi}}'' can allegedly be conducted from the needling site towards more distant sites of the body.<!---is this threading?---> Other techniques aim at "tonifying" ({{zh|s=补|p=bǔ}}) or "sedating" ({{zh|s=泄|p=xiè}}) ''qi''.<ref name="AungChen2007"/> The former techniques are used in [[Traditional Chinese medicine#Eight principles of diagnosis|deficiency]] patterns, the latter in excess patterns.<ref name="AungChen2007"/> ''De qi'' is more important in Chinese acupuncture, while Western and Japanese patients may not consider it a necessary part of the treatment.<ref name=Dummies/>
=== 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.<ref>{{cite journal | vauthors = Lee EJ, Frazier SK | title = The efficacy of acupressure for symptom management: a systematic review | journal = Journal of Pain and Symptom Management | volume = 42 | issue = 4 | pages = 589–603 | date = October 2011 | pmid = 21531533 | pmc = 3154967 | doi = 10.1016/j.jpainsymman.2011.01.007 }}</ref>
* 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 (medicine)|acute conditions]] while moxibustion was used for [[Chronic (medicine)|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).<ref>[[#Needham2002|Needham & Lu]], 2002, pp. [https://books.google.com/books?id=0-0tdqBr58cC&pg=PA170 170–73] {{Webarchive|url=https://web.archive.org/web/20230328220246/https://books.google.com/books?id=0-0tdqBr58cC&pg=PA170 |date=28 March 2023 }}.</ref>
* [[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.<ref>{{cite web | url=http://www.britishcuppingsociety.org/ | title=British Cupping Society | access-date=25 March 2014 | archive-date=27 December 2021 | archive-url=https://web.archive.org/web/20211227225757/https://www.britishcuppingsociety.org/ | url-status=live }}</ref>
* [[Tui na]] is a TCM method of attempting to stimulate the flow of ''qi'' by various bare-handed techniques that do not involve needles.<ref>{{cite web |url=http://medical-dictionary.thefreedictionary.com/tui+na |title=Tui na |author=Farlex |year=2012 |publisher=Farlex |access-date=25 March 2014 |archive-date=23 October 2013 |archive-url=https://web.archive.org/web/20131023061520/http://medical-dictionary.thefreedictionary.com/tui+na |url-status=live }}</ref>
* [[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 <nowiki>[</nowiki>[[Transcutaneous electrical nerve stimulation|TENS]]<nowiki>]</nowiki> masquerading as acupuncture").<ref name=Colquhoun2013>{{cite journal | vauthors = Colquhoun D, Novella SP | title = Acupuncture is theatrical placebo | journal = Anesthesia and Analgesia | volume = 116 | issue = 6 | pages = 1360–63 | date = June 2013 | pmid = 23709076 | doi = 10.1213/ANE.0b013e31828f2d5e | s2cid = 207135491 | url = http://www.dcscience.net/Colquhoun-Novella-A%26A-2013.pdf | author-link = David Colquhoun | access-date = 9 February 2014 | archive-date = 20 November 2018 | archive-url = https://web.archive.org/web/20181120055409/http://www.dcscience.net/Colquhoun-Novella-A%26A-2013.pdf | url-status = live }}</ref>
* [[Fire needle acupuncture]] also known as fire needling is a technique which involves quickly inserting a flame-heated needle into areas on the body.<ref name="Yan1997">{{cite book | first = Cui-lan | last = Yan | name-list-style = vanc | title = The Treatment of External Diseases with Acupuncture and Moxibustion|url=https://books.google.com/books?id=W0Ety2Hqug8C&pg=PA112|date=1997|publisher=Blue Poppy Enterprises, Inc.|isbn=978-0-936185-80-4|page=112}}</ref>
* Sonopuncture is a stimulation of the body similar to acupuncture using sound instead of needles.<ref>{{Cite book |title=Educational Opportunities in Integrative Medicine |chapter=Sonopuncture |page=[https://books.google.com/books?id=BNR1KGJXX9cC&pg=PA34 34] |publisher=The Hunter Press |year=2008 |isbn=978-0977655243}}</ref> 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.<ref>{{Cite book |title=Alternative Therapies |author=Bhagat |year=2004 |isbn=978-8180612206 |pages=[https://books.google.com/books?id=oKfvc8bvGwsC&pg=PA165 164–65]|publisher=Jaypee Brothers Medical Publishers }}</ref> Alternatively, [[tuning fork]]s or other sound emitting devices are used.<ref>{{Cite book |publisher=[[American Cancer Society]] |year=2000 |isbn=978-0944235249 |page=[https://archive.org/details/americancancerso00amer_0/page/158 158] |chapter=Sonopuncture |title=American Cancer Society's Guide to complementary and alternative cancer methods |chapter-url=https://archive.org/details/americancancerso00amer_0/page/158 }}</ref>
* Acupuncture point injection is the injection of various substances (such as drugs, [[vitamin]]s or [[herbal extract]]s) into acupoints.<ref>{{cite web | url=http://www.cancer.gov/dictionary?CdrID=467825 | title=Cancer Dictionary – Acupuncture point injection | access-date=4 April 2011 | publisher=[[National Cancer Institute]] | archive-url=https://web.archive.org/web/20110327191321/http://www.cancer.gov/dictionary?CdrID=467825| archive-date=27 March 2011| date=2 February 2011 }}</ref> 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.<ref>{{cite journal | vauthors = Sha T, Gao LL, Zhang CH, Zheng JG, Meng ZH | title = An update on acupuncture point injection | journal = QJM | volume = 109 | issue = 10 | pages = 639–41 | date = October 2016 | pmid = 27083985 | doi = 10.1093/qjmed/hcw055 | doi-access = free }}</ref>
* [[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]].<ref name=Barrett2008/> The modern approach was developed in France during the early 1950s.<ref name=Barrett2008/> There is no scientific evidence that it can cure disease; the evidence of effectiveness is negligible.<ref name=Barrett2008>{{cite web|last1=Barrett|first1=Stephen|title=Auriculotherapy: A Skeptical Look|url=http://www.acuwatch.org/reports/auriculotherapy.shtml|website=Acupuncture Watch|date=2 February 2008|access-date=31 August 2014|archive-date=28 May 2019|archive-url=https://web.archive.org/web/20190528151121/https://www.acuwatch.org/reports/auriculotherapy.shtml|url-status=live}}</ref>
* Scalp acupuncture, developed in Japan, is based on reflexological considerations regarding the [[scalp]].
* [[Koryo 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 (anatomy)|dermatome]] distribution) into acupuncture practice, and emphasizes a more formulaic approach to acupuncture point location.<ref name="AAMA list">{{cite journal | vauthors = Braverman S |title=Medical Acupuncture Review: Safety, Efficacy, And Treatment Practices |journal=Medical Acupuncture |volume=15 |issue=3 |year=2004 |url=http://www.medicalacupuncture.org/aama_marf/journal/vol15_3/article1.html|archive-url=https://web.archive.org/web/20050327073325/http://www.medicalacupuncture.org/aama_marf/journal/vol15_3/article1.html|archive-date=27 March 2005}}</ref>
* Cosmetic acupuncture is the use of acupuncture in an attempt to reduce wrinkles on the face.<ref name=NYT>{{cite news|work=The New York Times|title=Hold the Chemicals, Bring on the Needles|last=Isaacs|first=Nora|name-list-style=vanc|date=13 December 2007|access-date=23 November 2009|url=https://www.nytimes.com/2007/12/13/fashion/13SKIN.html|archive-date=28 August 2011|archive-url=https://web.archive.org/web/20110828113916/http://www.nytimes.com/2007/12/13/fashion/13SKIN.html|url-status=live}}</ref>
* Bee venom acupuncture is a treatment approach of injecting purified, diluted [[bee venom]] into acupoints.<ref>{{cite journal | vauthors = Lim SM, Lee SH | title = Effectiveness of bee venom acupuncture in alleviating post-stroke shoulder pain: a systematic review and meta-analysis | journal = Journal of Integrative Medicine | volume = 13 | issue = 4 | pages = 241–47 | date = July 2015 | pmid = 26165368 | doi = 10.1016/S2095-4964(15)60178-9 }}</ref>
* [[Veterinary acupuncture]] is the use of acupuncture on domesticated animals.<ref>{{cite journal | vauthors = Habacher G, Pittler MH, Ernst E | title = Effectiveness of acupuncture in veterinary medicine: systematic review | journal = Journal of Veterinary Internal Medicine | volume = 20 | issue = 3 | pages = 480–88 | year = 2006 | pmid = 16734078 | doi = 10.1111/j.1939-1676.2006.tb02885.x }}</ref>
{{gallery
|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]] in China}}
== Efficacy ==
{{as of|2021}}, many thousands of papers had been published on the efficacy of acupuncture for the treatment of various adult health conditions, but there was no robust evidence it was beneficial for anything, except shoulder pain and [[fibromyalgia]].<ref name=sys0>{{cite journal |vauthors=Allen J, Mak SS, Begashaw M, Larkin J, Miake-Lye I, Beroes-Severin J, Olson J, Shekelle PG |title=Use of Acupuncture for Adult Health Conditions, 2013 to 2021: A Systematic Review |journal=JAMA Netw Open |volume=5 |issue=11 |pages=e2243665 |date=November 2022 |pmid=36416820 |doi=10.1001/jamanetworkopen.2022.43665 |pmc=9685495 |type=Systematic review |quote=Despite the large literature on acupuncture, most reviews concluded that their confidence in the effect was limited. }}</ref> For ''[[Science-Based Medicine]]'', [[Steven Novella]] wrote that the overall pattern of evidence was reminiscent of that for [[homeopathy]], compatible with the hypothesis that most, if not all, benefits were due to the [[placebo effect]], and strongly suggestive that acupuncture had no beneficial therapeutic effects at all.<ref name=sys>{{cite web |publisher=[[Science-Based Medicine]] |vauthors=Novella S |title=Systematic Review of Systematic Reviews of Acupuncture |date=14 December 2022 |url=https://sciencebasedmedicine.org/systematic-review-of-systematic-reviews-of-acupuncture/ |access-date=15 December 2022 |archive-date=15 December 2022 |archive-url=https://web.archive.org/web/20221215073724/https://sciencebasedmedicine.org/systematic-review-of-systematic-reviews-of-acupuncture/ |url-status=live }}</ref>
== Research methodology and challenges ==
=== Sham acupuncture and research ===
It is difficult but not impossible to design rigorous research trials for acupuncture.<ref name=White2001/><ref>{{cite journal | vauthors = Witt CM, Aickin M, Baca T, Cherkin D, Haan MN, Hammerschlag R, Hao JJ, Kaplan GA, Lao L, McKay T, Pierce B, Riley D, Ritenbaugh C, Thorpe K, Tunis S, Weissberg J, Berman BM | title = Effectiveness Guidance Document (EGD) for acupuncture research – a consensus document for conducting trials | journal = BMC Complementary and Alternative Medicine | volume = 12 | issue = 1 | pages = 148 | date = September 2012 | pmid = 22953730 | pmc = 3495216 | doi = 10.1186/1472-6882-12-148 | doi-access = free }}</ref> Due to acupuncture's invasive nature, one of the major challenges in [[Efficacy#Medicine|efficacy]] research is in the design of an appropriate placebo [[control group]].<ref name=Ersnt-2007/><ref name=Johnson2006>{{cite journal | vauthors = Johnson MI | title = The clinical effectiveness of acupuncture for pain relief&nbsp;– you can be certain of uncertainty | journal = Acupuncture in Medicine | volume = 24 | issue = 2 | pages = 71–79 | date = June 2006 | pmid = 16783282 | doi = 10.1136/aim.24.2.71 | s2cid = 23222288 }}</ref> For efficacy studies to determine whether acupuncture has specific effects, "sham" forms of acupuncture where the patient, practitioner, and analyst are [[Blind experiment|blinded]] seem the most acceptable approach.<ref name=White2001>{{cite journal | vauthors = White AR, Filshie J, Cummings TM | title = Clinical trials of acupuncture: consensus recommendations for optimal treatment, sham controls and blinding | journal = Complementary Therapies in Medicine | volume = 9 | issue = 4 | pages = 237–45 | date = December 2001 | pmid = 12184353 | doi = 10.1054/ctim.2001.0489 | author4 = International Acupuncture Research Forum | s2cid = 4479335 }}</ref> Sham acupuncture uses non-penetrating needles or needling at non-acupuncture points,<ref>{{harvnb|Madsen|2009|page=a3115}}</ref> e.g. inserting needles on meridians not related to the specific condition being studied, or in places not associated with meridians.<ref name=Urruela2012>{{cite journal | vauthors = Amezaga Urruela M, Suarez-Almazor ME | title = Acupuncture in the treatment of rheumatic diseases | journal = Current Rheumatology Reports | volume = 14 | issue = 6 | pages = 589–97 | date = December 2012 | pmid = 23055010 | pmc = 3691014 | doi = 10.1007/s11926-012-0295-x }}</ref> 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.<ref name=Langevin2011/><ref>{{cite journal | vauthors = Paterson C, Dieppe P | title = Characteristic and incidental (placebo) effects in complex interventions such as acupuncture | journal = BMJ | volume = 330 | issue = 7501 | pages = 1202–05 | date = May 2005 | pmid = 15905259 | pmc = 558023 | doi = 10.1136/bmj.330.7501.1202 }}</ref>
A 2014 [[review article|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."<ref name=Gorski2014/> 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.<ref name=MacPherson2013/> 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.<ref name=MacPherson2013>{{cite journal | vauthors = MacPherson H, Maschino AC, Lewith G, Foster NE, Witt CM, Witt C, Vickers AJ | title = Characteristics of acupuncture treatment associated with outcome: an individual patient meta-analysis of 17,922 patients with chronic pain in randomised controlled trials | journal = PLOS ONE | volume = 8 | issue = 10 | pages = e77438 | year = 2013 | pmid = 24146995 | pmc = 3795671 | doi = 10.1371/journal.pone.0077438 | editor1-last = Eldabe | author7 = Acupuncture Trialists' Collaboration | editor1-first = Sam | bibcode = 2013PLoSO...877438M | doi-access = free }}</ref> 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.<ref name=Langevin2011>{{cite journal | vauthors = Langevin HM, Wayne PM, Macpherson H, Schnyer R, Milley RM, Napadow V, Lao L, Park J, Harris RE, Cohen M, Sherman KJ, Haramati A, Hammerschlag R | title = Paradoxes in acupuncture research: strategies for moving forward | journal = Evidence-Based Complementary and Alternative Medicine | volume = 2011 | pages = 1–11 | year = 2011 | pmid = 20976074 | pmc = 2957136 | doi = 10.1155/2011/180805 | doi-access = free }}</ref> 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).<ref name=Berman2010/>
A response to "sham" acupuncture in [[osteoarthritis]] may be used in the elderly, but placebos have usually been regarded as deception and thus unethical.<ref name=Cherniack2010/> 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.<ref name=Cherniack2010>{{cite journal | vauthors = Cherniack EP | title = Would the elderly be better off if they were given more placebos? | journal = Geriatrics & Gerontology International | volume = 10 | issue = 2 | pages = 131–37 | date = April 2010 | pmid = 20100289 | doi = 10.1111/j.1447-0594.2009.00580.x | s2cid = 36539535 | doi-access = free }}</ref> 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.<ref name=Posadzki2012>{{cite journal | vauthors = Posadzki P, Alotaibi A, Ernst E | title = Prevalence of use of complementary and alternative medicine (CAM) by physicians in the UK: a systematic review of surveys | journal = Clinical Medicine | volume = 12 | issue = 6 | pages = 505–12 | date = December 2012 | pmid = 23342401 | pmc = 5922587 | doi = 10.7861/clinmedicine.12-6-505 }}</ref>
Using the principles of [[evidence-based medicine]] to research acupuncture is controversial, and has produced different results.<ref name=Ersnt-2007>{{cite journal | vauthors = Ernst E, Pittler MH, Wider B, Boddy K | s2cid = 40080937 | title = Acupuncture: its evidence-base is changing | journal = The American Journal of Chinese Medicine | volume = 35 | issue = 1 | pages = 21–25 | year = 2007 | pmid = 17265547 | doi = 10.1142/S0192415X07004588 }}</ref> Some research suggests acupuncture can alleviate pain but the majority of research suggests that acupuncture's effects are mainly due to placebo.<ref name=Ernst2006/> Evidence suggests that any benefits of acupuncture are short-lasting.<ref name=Wang-2008>{{cite journal | vauthors = Wang SM, Kain ZN, White PF | s2cid = 24912939 | title = Acupuncture analgesia: II. Clinical considerations | journal = Anesthesia and Analgesia | volume = 106 | issue = 2 | pages = 611–21, table of contents | date = February 2008 | pmid = 18227323 | doi = 10.1213/ane.0b013e318160644d | doi-access = free }}</ref> There is insufficient evidence to support use of acupuncture compared to [[medicine|mainstream medical treatments]].<ref name=GoldmanSchafer2015>{{cite book| first1 = Lee | last1 = Goldman | first2 = Andrew I. | last2 = Schafer | name-list-style = vanc |title=Goldman-Cecil Medicine: Expert Consult – Online|url=https://books.google.com/books?id=40Z9CAAAQBAJ&pg=PA98-IA61|date=21 April 2015|publisher=Elsevier Health Sciences|isbn=978-0-323-32285-0|page=98}}</ref> Acupuncture is not better than mainstream treatment in the long term.<ref name=Urruela2012/>
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.<ref name=Gorski2014>{{cite journal | vauthors = Gorski DH | title = Integrative oncology: really the best of both worlds? | journal = Nature Reviews. Cancer | volume = 14 | issue = 10 | pages = 692–700 | date = October 2014 | pmid = 25230880 | doi = 10.1038/nrc3822 | s2cid = 33539406 }}</ref> Acupuncture has been called "theatrical placebo",<ref name=Colquhoun2013/> 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.<ref name=Gorski2014/>
=== Publication bias ===
[[Publication bias]] is cited as a concern in the reviews of [[randomized controlled trial]]s of acupuncture.<ref name=Colquhoun2013/><ref name=Lee2006>{{cite journal | vauthors = Lee A, Copas JB, Henmi M, Gin T, Chung RC | title = Publication bias affected the estimate of postoperative nausea in an acupoint stimulation systematic review | journal = Journal of Clinical Epidemiology | volume = 59 | issue = 9 | pages = 980–83 | date = September 2006 | pmid = 16895822 | doi = 10.1016/j.jclinepi.2006.02.003 }}</ref><ref name=Tang1999>{{cite journal | vauthors = Tang JL, Zhan SY, Ernst E | title = Review of randomised controlled trials of traditional Chinese medicine | journal = BMJ | volume = 319 | issue = 7203 | pages = 160–61 | date = July 1999 | pmid = 10406751 | pmc = 28166 | doi = 10.1136/bmj.319.7203.160 }}</ref> 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.<ref name=Vickers1998>{{cite journal | vauthors = Vickers A, Goyal N, Harland R, Rees R | title = Do certain countries produce only positive results? A systematic review of controlled trials | journal = Controlled Clinical Trials | volume = 19 | issue = 2 | pages = 159–66 | date = April 1998 | pmid = 9551280 | doi = 10.1016/S0197-2456(97)00150-5 | s2cid = 18860471 }}</ref> 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).<ref name=He-2011/> The study also found that trials published in non-Chinese journals tended to be of higher quality.<ref name=He-2011>{{cite journal | vauthors = He J, Du L, Liu G, Fu J, He X, Yu J, Shang L | title = Quality assessment of reporting of randomization, allocation concealment, and blinding in traditional Chinese medicine RCTs: a review of 3159 RCTs identified from 260 systematic reviews | journal = Trials | volume = 12 | issue = 1 | pages = 122 | date = May 2011 | pmid = 21569452 | pmc = 3114769 | doi = 10.1186/1745-6215-12-122 | doi-access = free }}</ref> Chinese authors use more Chinese studies, which have been demonstrated to be uniformly positive.<ref name=Ernst2012>{{cite journal | vauthors = Ernst E | title = Acupuncture: what does the most reliable evidence tell us? An update | journal = Journal of Pain and Symptom Management | volume = 43 | issue = 2 | pages = e11–13 | date = February 2012 | pmid = 22248792 | doi = 10.1016/j.jpainsymman.2011.11.001 | doi-access = free }}</ref> 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]]s of zero.<ref>{{cite journal | vauthors = Ma B, Qi GQ, Lin XT, Wang T, Chen ZM, Yang KH | title = Epidemiology, quality, and reporting characteristics of systematic reviews of acupuncture interventions published in Chinese journals | journal = Journal of Alternative and Complementary Medicine | volume = 18 | issue = 9 | pages = 813–17 | date = September 2012 | pmid = 22924413 | doi = 10.1089/acm.2011.0274 }}</ref> 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.<ref>{{cite journal | vauthors = Su CX, Han M, Ren J, Li WY, Yue SJ, Hao YF, Liu JP | title = Empirical evidence for outcome reporting bias in randomized clinical trials of acupuncture: comparison of registered records and subsequent publications | journal = Trials | volume = 16 | issue = 1 | pages = 28 | date = January 2015 | pmid = 25626862 | pmc = 4320495 | doi = 10.1186/s13063-014-0545-5 | doi-access = free }}</ref>
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]]''.<ref>{{cite web|url=https://www.forbes.com/sites/stevensalzberg/2017/01/03/fake-medical-journals-are-spreading-and-they-are-filled-with-bad-science/|title=Fake Medical Journals Are Spreading, And They Are Filled With Bad Science|first=Steven|last=Salzberg|website=[[Forbes]]|access-date=21 August 2017|archive-date=24 August 2017|archive-url=https://web.archive.org/web/20170824113043/https://www.forbes.com/sites/stevensalzberg/2017/01/03/fake-medical-journals-are-spreading-and-they-are-filled-with-bad-science/|url-status=live}}</ref>
== Safety ==
=== Adverse events ===
Acupuncture is generally safe when administered by an experienced, appropriately trained practitioner using clean-needle technique and sterile single-use needles.<ref name="nciacupuncture">{{cite web|title= Acupuncture&nbsp;– for health professionals (PDQ)|url= http://www.cancer.gov/about-cancer/treatment/cam/hp/acupuncture-pdq#section/_71|publisher= [[National Cancer Institute]]|date= 23 September 2005|access-date= 16 July 2015|archive-date= 17 July 2015|archive-url= https://web.archive.org/web/20150717182155/http://www.cancer.gov/about-cancer/treatment/cam/hp/acupuncture-pdq#section/_71|url-status= live}}</ref> When improperly delivered it can cause adverse effects.<ref name="Xu S"/> Accidents and infections are associated with infractions of sterile technique or neglect on the part of the practitioner.<ref name="nciacupuncture"/> To reduce the risk of serious adverse events after acupuncture, acupuncturists should be trained sufficiently.<ref name="Ernst 2011">{{cite journal | vauthors = Ernst E, Lee MS, Choi TY | title = Acupuncture: does it alleviate pain and are there serious risks? A review of reviews | journal = Pain | volume = 152 | issue = 4 | pages = 755–64 | date = April 2011 | pmid = 21440191 | doi = 10.1016/j.pain.2010.11.004 | s2cid = 20205666 | url = http://www.dcscience.net/Ernst-2011-AcupunctAlleviatePainRiskReview.pdf | access-date = 20 January 2017 | archive-date = 20 September 2017 | archive-url = https://web.archive.org/web/20170920124317/http://www.dcscience.net/Ernst-2011-AcupunctAlleviatePainRiskReview.pdf | url-status = live }}
*Comment in: {{cite journal | last=Hall | first=Harriet | title=Acupuncture's claims punctured: Not proven effective for pain, not harmless | journal=Pain | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=152 | issue=4 | year=2011 | issn=0304-3959 | doi=10.1016/j.pain.2011.01.039 | pages=711–712| pmid=21440190 | s2cid=4472996 }}</ref> A 2009 overview of [[Cochrane Collaboration|Cochrane reviews]] found acupuncture is not effective for a wide range of conditions.<ref name=Ernst2009>{{cite journal | vauthors = Ernst E | title = Acupuncture: what does the most reliable evidence tell us? | journal = Journal of Pain and Symptom Management | volume = 37 | issue = 4 | pages = 709–14 | date = April 2009 | pmid = 18789644 | doi = 10.1016/j.jpainsymman.2008.04.009 | doi-access = free }}</ref> People with serious spinal disease, such as cancer or infection, are not good candidates for acupuncture.<ref name=Berman2010/> [[Contraindication]]s 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).<ref name=Berman2010/> Further, electroacupuncture should be avoided at the spot of implanted electrical devices (such as pacemakers).<ref name=Berman2010/>
A 2011 systematic review of systematic reviews (internationally and without language restrictions) found that serious complications following acupuncture continue to be reported.<ref name="Ernst 2011"/> Between 2000 and 2009, ninety-five cases of [[serious adverse event]]s, including five [[deaths]], were reported.<ref name="Ernst 2011"/> Many such events are not inherent to acupuncture but are due to [[Medical malpractice|malpractice]] of acupuncturists.<ref name="Ernst 2011"/> This might be why such complications have not been reported in surveys of adequately trained acupuncturists.<ref name="Ernst 2011"/> 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.<ref name="Ernst 2011"/> Many serious adverse events were reported from developed countries.<ref name="Ernst 2011"/> These included Australia, Austria, Canada, Croatia, France, Germany, Ireland, the Netherlands, New Zealand, Spain, Sweden, Switzerland, the UK, and the US.<ref name="Ernst 2011"/> The number of adverse effects reported from the UK appears particularly unusual, which may indicate less under-reporting in the UK than other countries.<ref name="Ernst 2011"/> Reports included 38 cases of infections and 42 cases of organ trauma.<ref name="Ernst 2011"/> The most frequent adverse events included [[pneumothorax]], and [[bacterial infection|bacterial]] and [[viral infection]]s.<ref name="Ernst 2011"/>
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%.<ref name=Gnatta2013/> Likely sources of infection include towels, hot packs or boiling tank water, and reusing reprocessed needles.<ref name=Gnatta2013/> 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.<ref name=Gnatta2013/> 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.<ref name=Gnatta2013/> Although it is recommended that practitioners of acupuncture use disposable needles, the reuse of sterilized needles is still permitted.<ref name=Gnatta2013/> It is also recommended that thorough control practices for preventing infection be implemented and adapted.<ref name=Gnatta2013>{{cite journal | vauthors = Gnatta JR, Kurebayashi LF, Paes da Silva MJ | title = Atypical mycobacterias associated to acupuncuture: an integrative review | journal = Revista Latino-Americana de Enfermagem | volume = 21 | issue = 1 | pages = 450–58 | date = February 2013 | pmid = 23546331 | doi = 10.1590/s0104-11692013000100022 | doi-access = free }}</ref>
==== 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.<ref name="Xu S"/> Between 2000 and 2011 the English-language literature from 25 countries and regions reported 294 adverse events.<ref name="Xu S"/> The majority of the reported adverse events were relatively minor, and the incidences were low.<ref name="Xu S"/> 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.<ref name="Xu S"/> Another survey found there were 7.1% minor adverse events, of which 5 were serious, amid 97,733 acupuncture patients.<ref name="Xu S"/> 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.<ref name="Xu S"/> Infection has also resulted from skin contact with unsterilized equipment or with dirty towels in an unhygienic clinical setting.<ref name="Xu S"/> 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.<ref name="Xu S"/> 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.<ref name="Xu S">{{cite journal | vauthors = Xu S, Wang L, Cooper E, Zhang M, Manheimer E, Berman B, Shen X, Lao L | title = Adverse events of acupuncture: a systematic review of case reports | journal = Evidence-Based Complementary and Alternative Medicine | volume = 2013 | pages = 1–15 | year = 2013 | pmid = 23573135 | pmc = 3616356 | doi = 10.1155/2013/581203 | doi-access = free }}</ref>
A 2013 systematic review found 31 cases of vascular injuries caused by acupuncture, three causing death.<ref name=Bergqvist/> Two died from pericardial tamponade and one was from an aortoduodenal fistula.<ref name=Bergqvist>{{cite journal | vauthors = Bergqvist D | title = Vascular injuries caused by acupuncture. A systematic review | journal = International Angiology | volume = 32 | issue = 1 | pages = 1–8 | date = February 2013 | pmid = 23435388 | url = http://www.minervamedica.it/en/journals/international-angiology/article.php?cod=R34Y2013N01A0001 | access-date = 1 March 2014 | archive-date = 1 March 2014 | archive-url = https://web.archive.org/web/20140301091317/http://www.minervamedica.it/en/journals/international-angiology/article.php?cod=R34Y2013N01A0001 | url-status = live }}</ref> The same review found vascular injuries were rare, bleeding and pseudoaneurysm were most prevalent.<ref name=Bergqvist/> 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 cause in most fatal instances.<ref name=Ernst-Zhang/> The same review concluded that cardiac tamponade was a serious, usually fatal, though theoretically avoidable complication following acupuncture, and urged training to minimize risk.<ref name=Ernst-Zhang>{{cite journal | vauthors = Ernst E, Zhang J | title = Cardiac tamponade caused by acupuncture: a review of the literature | journal = International Journal of Cardiology | volume = 149 | issue = 3 | pages = 287–89 | date = June 2011 | pmid = 21093944 | doi = 10.1016/j.ijcard.2010.10.016 }}</ref>
A 2012 review found that a number of adverse events were reported after acupuncture in the UK's [[National Health Service (England)|National Health Service]] (NHS), 95% of which were not severe,<ref name=Wheway2012/> though miscategorization and under-reporting may alter the total figures.<ref name=Wheway2012/> From January 2009 to December 2011, 468 safety incidents were recognized within the NHS organizations.<ref name=Wheway2012/> 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%).<ref name=Wheway2012/> Acupuncture practitioners should know, and be prepared to be responsible for, any substantial harm from treatments.<ref name=Wheway2012/> Some acupuncture proponents argue that the long history of acupuncture suggests it is safe.<ref name=Wheway2012/> However, there is an increasing literature on adverse events (e.g. spinal-cord injury).<ref name=Wheway2012>{{cite journal | vauthors = Wheway J, Agbabiaka TB, Ernst E | title = Patient safety incidents from acupuncture treatments: a review of reports to the National Patient Safety Agency | journal = The International Journal of Risk & Safety in Medicine | volume = 24 | issue = 3 | pages = 163–69 | date = January 2012 | pmid = 22936058 | doi = 10.3233/JRS-2012-0569 }}</ref>
Acupuncture seems to be safe in people getting [[anticoagulant]]s, assuming needles are used at the correct location and depth,<ref name=Mcculloch2014/> but studies are required to verify these findings.<ref name="Mcculloch2014">{{cite journal | vauthors = Mcculloch M, Nachat A, Schwartz J, Casella-Gordon V, Cook J | title = Acupuncture safety in patients receiving anticoagulants: a systematic review | journal = The Permanente Journal | volume = 19 | issue = 1 | pages = 68–73 | year = 2014 | pmid = 25432001 | pmc = 4315381 | doi = 10.7812/TPP/14-057 }}</ref>
==== 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.<ref name=Zhang-2010/> Between 1980 and 2009, the Chinese-language literature reported 479 adverse events.<ref name=Zhang-2010/> [[Prospective survey]]s show that mild, transient acupuncture-associated adverse events ranged from 6.71% to 15%.<ref name=Zhang-2010/> In a study with 190,924 patients, the prevalence of serious adverse events was roughly 0.024%.<ref name=Zhang-2010/> Another study showed a rate of adverse events requiring specific treatment of 2.2%, 4,963 [[Incidence (epidemiology)|incidences]] among 229,230 patients.<ref name=Zhang-2010/> 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.<ref name=Zhang-2010/> Infections were mostly caused by poor sterilization of acupuncture needles.<ref name=Zhang-2010/> 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.<ref name=Zhang-2010/>
A causal link between acupuncture and the adverse events cardiac arrest, pyknolepsy, shock, fever, cough, thirst, aphonia, leg numbness, and sexual dysfunction remains uncertain.<ref name=Zhang-2010>{{cite journal | vauthors = Zhang J, Shang H, Gao X, Ernst E | title = Acupuncture-related adverse events: a systematic review of the Chinese literature | journal = Bulletin of the World Health Organization | volume = 88 | issue = 12 | pages = 915–21C | date = December 2010 | pmid = 21124716 | pmc = 2995190 | doi = 10.2471/BLT.10.076737 }}</ref> 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.<ref name=Zhang-2010/> Between 1999 and 2010, the Korean-language literature contained reports of 1104 adverse events.<ref>{{cite journal | vauthors = Shin HK, Jeong SJ, Lee MS, Ernst E | title = Adverse events attributed to traditional Korean medical practices: 1999–2010 | journal = Bulletin of the World Health Organization | volume = 91 | issue = 8 | pages = 569–75 | date = August 2013 | pmid = 23940404 | pmc = 3738306 | doi = 10.2471/BLT.12.111609 }}</ref> Between the 1980s and 2002, the Japanese-language literature contained reports of 150 adverse events.<ref>{{cite journal | vauthors = Yamashita H, Tsukayama H | title = Safety of acupuncture practice in Japan: patient reactions, therapist negligence and error reduction strategies | journal = Evidence-Based Complementary and Alternative Medicine | volume = 5 | issue = 4 | pages = 391–98 | date = December 2008 | pmid = 18955234 | pmc = 2586322 | doi = 10.1093/ecam/nem086 }}</ref>
==== 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.<ref>{{cite web |url = https://nccih.nih.gov/sites/nccam.nih.gov/files/news/nhsr12.pdf |title = Complementary and Alternative Medicine Use Among Adults and Children: United States, 2007 |date = 10 December 2008 |website = National Center for Complementary and Integrative Health |publisher = NCHS |last = Barnes |first = Patricia M. |access-date = 5 February 2016 |archive-date = 16 March 2016 |archive-url = https://web.archive.org/web/20160316075748/https://nccih.nih.gov/sites/nccam.nih.gov/files/news/nhsr12.pdf |url-status = live }}</ref>
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.<ref>{{cite journal | vauthors = Jindal V, Ge A, Mansky PJ | title = Safety and efficacy of acupuncture in children: a review of the evidence | journal = Journal of Pediatric Hematology/Oncology | volume = 30 | issue = 6 | pages = 431–42 | date = June 2008 | pmid = 18525459 | pmc = 2518962 | doi = 10.1097/MPH.0b013e318165b2cc }}</ref>
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.<ref name="Adams 2011"/> The same review found 279 adverse events, 25 of them serious.<ref name="Adams 2011"/> The adverse events were mostly mild in nature (e.g., bruising or bleeding).<ref name="Adams 2011"/> The prevalence of mild adverse events ranged from 10.1% to 13.5%, an estimated 168 incidences among 1,422 patients.<ref name="Adams 2011"/> On rare occasions adverse events were serious (e.g. [[cardiac rupture]] or [[hemoptysis]]); many might have been a result of substandard practice.<ref name="Adams 2011">{{cite journal | vauthors = Adams D, Cheng F, Jou H, Aung S, Yasui Y, Vohra S | s2cid = 46502395 | title = The safety of pediatric acupuncture: a systematic review | journal = Pediatrics | volume = 128 | issue = 6 | pages = e1575–87 | date = December 2011 | pmid = 22106073 | doi = 10.1542/peds.2011-1091 }}</ref> The incidence of serious adverse events was 5 per one million, which included children and adults.<ref name="Adams 2011"/>
When used during pregnancy, the majority of adverse events caused by acupuncture were mild and transient, with few serious adverse events.<ref name="Park-2014"/> The most frequent mild adverse event was needling or unspecified pain, followed by bleeding.<ref name="Park-2014"/> Although two deaths (one stillbirth and one neonatal death) were reported, there was a lack of acupuncture-associated maternal mortality.<ref name="Park-2014"/> 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.<ref name="Park-2014">
{{cite journal | vauthors = Park J, Sohn Y, White AR, Lee H | title = The safety of acupuncture during pregnancy: a systematic review | journal = Acupuncture in Medicine | volume = 32 | issue = 3 | pages = 257–66 | date = June 2014 | pmid = 24554789 | pmc = 4112450 | doi = 10.1136/acupmed-2013-010480 | type = Systematic review }}
</ref>
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.<ref name="Berman2010"/>
==== Moxibustion and cupping ====
<!-- Traditional acupuncture involves moxibustion and cupping. -->
Four adverse events associated with moxibustion were bruising, burns and cellulitis, spinal epidural abscess, and large superficial basal cell carcinoma.<ref name="Xu S"/> Ten adverse events were associated with cupping.<ref name="Xu S"/> The minor ones were [[keloid]] scarring, burns, and [[bulla (dermatology)|bullae]];<ref name="Xu S"/> the serious ones were acquired hemophilia A, stroke following cupping on the back and neck, factitious [[panniculitis]], reversible cardiac hypertrophy, and [[iron deficiency anemia]].<ref name="Xu S"/>
=== 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.<ref name=Barrett2007>{{cite web|last=Barrett|first=S|title=Be Wary of Acupuncture, Qigong, and "Chinese Medicine"|url=http://www.quackwatch.org/01QuackeryRelatedTopics/acu.html|publisher=[[Quackwatch]]|access-date=4 May 2015|date=30 December 2007|author-link=Stephen Barrett|archive-date=2 June 2018|archive-url=https://web.archive.org/web/20180602104856/https://www.quackwatch.org/01QuackeryRelatedTopics/acu.html|url-status=live}}</ref><ref>{{cite web| title= Final Report, Report into Traditional Chinese Medicine| url= http://www.parliament.nsw.gov.au/prod/parlment/committee.nsf/0/ca78e168ce1b6fa2ca2570b400200a34/$FILE/reportversion2.pdf| archive-url= https://web.archive.org/web/20110628190713/http://www.parliament.nsw.gov.au/prod/parlment/committee.nsf/0/ca78e168ce1b6fa2ca2570b400200a34/$FILE/reportversion2.pdf| archive-date= 28 June 2011| publisher= [[Parliament of New South Wales]]| access-date= 3 November 2010| date= 9 November 2005| url-status= dead}}</ref> 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."<ref name=NCCAOMethics>{{cite web |url = http://www.nccaom.org/about/pdfdocs/Code_of_Ethics.pdf | publisher = National Certification Commission for Acupuncture and Oriental Medicine | title= NCCAOM Code of Ethics | access-date= 3 November 2010 | archive-url= https://web.archive.org/web/20101127060246/http://nccaom.org/about/pdfdocs/Code_of_Ethics.pdf| archive-date= 27 November 2010}}</ref> [[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".<ref name=HumberAlmeder2013>{{cite book | last = Barrett | first = Stephen | editor1-last = Humber | editor1-first = James M. | editor2-last = Almeder | editor2-first = Robert F. | name-list-style = vanc |chapter='Alternative' Medicine: More Hype Than Hope |title=Alternative Medicine and Ethics |chapter-url=https://books.google.com/books?id=ehWzBwAAQBAJ&pg=PA10 |year=2013 |publisher=Springer Science & Business Media |isbn=978-1-4757-2774-6 |page=10}}</ref>
== Conceptual basis ==
{{Infobox Chinese|s=针刺|hp=zhēncì}}
===Traditional===
{{Main|Qi|Traditional Chinese medicine|Meridian (Chinese medicine)|List of acupuncture points}}
[[File:ChineseMedecine.JPG|thumb|right|Old Chinese medical chart of acupuncture meridians]]
Acupuncture is a substantial part of [[traditional Chinese medicine]] (TCM). Early acupuncture beliefs relied on concepts that are common in TCM, such as a life force energy called ''qi''.<ref name=Aung11>[[#Aung2007|Aung & Chen]] {{cite book| first1 = Steven K. H. | last1 = Aung| first2 = William Pai-Dei | last2 = Chen | name-list-style = vanc |title=Clinical Introduction to Medical Acupuncture|url=https://books.google.com/books?id=I6NclaeDWjgC&pg=PR1|year=2007|publisher=Thieme|isbn=978-1-58890-221-4|pages=11–12}}</ref> ''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.<ref name=meridian-theory>"（三）十二经脉 ...（四）奇经八脉 ..." [(3.) The Twelve Vessels ... (4.) The Extraordinary Eight Vessels ...] as seen at {{cite web |url= http://www.pharmnet.com.cn/tcm/knowledge/detail/100044.html |archive-url= https://web.archive.org/web/20161110121328/http://www.pharmnet.com.cn/tcm/knowledge/detail/100044.html |archive-date= 10 November 2016 |script-title=zh:经络学 |access-date=22 February 2011 |language=zh |trans-title=Meridian theory}}</ref> Acupuncture points where needles are inserted are mainly (but not always) found at locations along the meridians.<ref name=Aung101/> Acupuncture points not found along a meridian are called extraordinary points and those with no designated site are called {{Lang|zh-latn|A-shi}} points.<ref name=Aung101>[[#Aung2007|Aung & Chen]], 2007, p. [https://books.google.com/books?id=I6NclaeDWjgC&pg=PA101 101].</ref>
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#Model of the body|''qi'', xuĕ, zàng-fǔ, meridians]], and of the interaction between the body and the environment.<ref>{{harvnb|Wiseman & Ellis|1996|page=77}}</ref> Therapy is based on which "pattern of disharmony" can be identified.<ref>{{Cite book | vauthors = Ergil MC, Ergil KV | page = [https://books.google.com/books?id=kdZ1rFKW&pg=PA19 19], [https://books.google.com/books?id=kdZ1rFKW&pg=PA148 148] | title = Pocket Atlas of Chinese Medicine | year = 2009 | publisher = Thieme | location = Stuttgart | isbn = 978-3131416117}}</ref><ref>{{cite book | vauthors = Flaws B, Finney D | year = 2007 | title = A handbook of TCM patterns & their treatments | edition = 6th | publisher = Blue Poppy Press | isbn = 978-0936185705 | pages = [https://books.google.com/books?id=iJT3mz20yHoC&pg=PA1 1] }}</ref> For example, some diseases are believed to be caused by meridians being invaded with an excess of wind, cold, and damp.<ref>{{cite book | vauthors = Flaws B, Finney D | title = A handbook of TCM patterns & their treatments | publisher = Blue Poppy Press | year = 1996 | edition = 6 (2007) |isbn = 978-0936185705 | pages = [https://books.google.com/books?id=iJT3mz20yHoC&pg=PA169 169–73] }}</ref> 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.<ref name=Tongue>{{cite book | title = Tongue Diagnosis in Chinese Medicine | last = Maciocia | first = G | publisher = Eastland Press | year = 1995 | isbn = 978-0939616190 }}</ref><ref name=Maciocia>{{Cite book | first = G | last = Maciocia | title = The Foundations of Chinese Medicine | publisher = Churchill Livingstone | year = 2005 | isbn = 978-0443074899 }}</ref> TCM and its concept of disease does not strongly differentiate between the cause and effect of symptoms.<ref>{{cite book| page=[https://books.google.com/books?id=t23zKB1FSVYC&pg=PA26 26]| last=Ross |first=J|title=Zang Fu, the organ systems of traditional Chinese medicine| publisher=Elsevier |year=1984 | isbn=978-0443034824 }}</ref>
===Purported scientific basis===
[[File:Archie McPhee acupuncture.jpg|thumb|right|Modern acupuncture model]]
Many within the [[scientific community]] consider acupuncture to be [[quackery]]{{efn|name="quackery"|Attributed to multiple sources: <ref name="Wang2013" /><ref name="rank" /><ref name=crappy/><ref name=Jarvis>{{cite journal|url=https://pubmed.ncbi.nlm.nih.gov/1643742/|title=Quackery: a national scandal|first=W.T.|last=Jarvis|journal=Clinical Chemistry|date=August 1992|volume=38|issue=8B part 2|pages=1574–86|pmid=1643742}}</ref><ref name=Naudet>{{cite journal|url=https://hal.science/hal-01138648|title=Has evidence-based medicine left quackery behind?|first1=Florian|last1=Naudet|first2=Bruno|last2=Falissard|author2-link= Bruno Falissard |first3=Rémy|last3=Boussageon|first4=David|last4=Healy|journal=Internal and Emergency Medicine|volume=10|issue=5|pages=631–4|date=2015|doi=10.1007/s11739-015-1227-3|pmid=25828467|s2cid=20697592 }}</ref>}} and pseudoscience, having no effect other than as "theatrical placebo".<ref name=Wang2013>{{cite journal | vauthors = Wang SM, Harris RE, Lin YC, Gan TJ | title = Acupuncture in 21st century anesthesia: is there a needle in the haystack? | journal = Anesthesia and Analgesia | volume = 116 | issue = 6 | pages = 1356–59 | date = June 2013 | pmid = 23709075 | doi = 10.1213/ANE.0b013e31828f5efa | s2cid = 1106695 | url = http://www.dcscience.net/Wang-acupunc-A%26A-2013.pdf | access-date = 22 March 2015 | archive-date = 23 September 2015 | archive-url = https://web.archive.org/web/20150923213155/http://www.dcscience.net/Wang-acupunc-A%26A-2013.pdf | url-status = live }}</ref><ref name=rank>{{cite web |author=Gorski D |author-link=David Gorski |website=[[Science-Based Medicine]] |date=23 June 2014 |title=Ketogenic diet does not 'beat chemo for almost all cancers' |url=https://sciencebasedmedicine.org/ketogenic-diets-for-cancer-hype-versus-science/ |quote=it is quite obvious that modalities such as homeopathy, acupuncture, reflexology, craniosacral therapy, Hulda Clark's "zapper," the Gerson therapy and Gonzalez protocol for cancer, and reiki (not to mention every other "energy healing" therapy) are the rankest quackery |access-date=6 August 2019 |archive-date=27 September 2019 |archive-url=https://web.archive.org/web/20190927214952/https://sciencebasedmedicine.org/ketogenic-diets-for-cancer-hype-versus-science/ |url-status=live }}</ref> [[David Gorski]] has argued that of all forms of quackery, acupuncture has perhaps gained most acceptance among physicians and institutions.<ref name=crappy>{{cite web |author=Gorski D |author-link=David Gorski |website=[[Science-Based Medicine]] |date=7 May 2018 |title=PLOS ONE, peer review, and a 'crappy' acupuncture study |url=https://sciencebasedmedicine.org/plos-one-peer-review-and-a-crappy-acupuncture-study/}}</ref> Academics [[Massimo Pigliucci]] and [[Maarten Boudry]] describe acupuncture as a "borderlands science" lying between science and pseudoscience.<ref name=Massimo2013>{{cite book | url=https://books.google.com/books?id=Pc4OAAAAQBAJ | title=Philosophy of Pseudoscience: Reconsidering the Demarcation Problem | publisher=University of Chicago Press | last=Pigliucci | first=Massimo | name-list-style=vanc | year=2013 | page=206 | isbn=978-0226051826 | access-date=3 June 2020 | archive-date=15 April 2023 | archive-url=https://web.archive.org/web/20230415011850/https://books.google.com/books?id=Pc4OAAAAQBAJ | url-status=live }}</ref>
====Rationalizations of traditional medicine====
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.{{efn|name=SinghErnst2008}}<ref name="Ahn2008">{{cite journal | vauthors = Ahn AC, Colbert AP, Anderson BJ, Martinsen OG, Hammerschlag R, Cina S, Wayne PM, Langevin HM | title = Electrical properties of acupuncture points and meridians: a systematic review | journal = Bioelectromagnetics | volume = 29 | issue = 4 | pages = 245–56 | date = May 2008 | pmid = 18240287 | doi = 10.1002/bem.20403 | s2cid = 7001749 | url = https://mn.uio.no/fysikk/english/research/projects/bioimpedance/publications/papers/meridian_rev.pdf | access-date = 2 March 2012 | archive-date = 18 May 2021 | archive-url = https://web.archive.org/web/20210518004121/https://www.mn.uio.no/fysikk/english/research/projects/bioimpedance/publications/papers/meridian_rev.pdf | url-status = live }}</ref> Human tests to determine whether electrical continuity was significantly different near meridians than other places in the body have been inconclusive.<ref name="Ahn2008"/> Scientific research has not supported the existence of ''qi'', meridians, or yin and yang.{{efn|name=SinghErnst2008}}<ref name="Ahn2008"/><ref name=Mann2000>{{cite book | last = Mann | first = F | author-link = Felix Mann | isbn = 978-0750648578 | publisher = [[Elsevier Health Sciences|Elsevier]] | year = 2000 | title = Reinventing Acupuncture: A New Concept of Ancient Medicine}}</ref> A ''[[Nature (journal)|Nature]]'' editorial described TCM as "fraught with pseudoscience", with the majority of its treatments having no logical [[mechanism of action]].<ref name=swallow>{{cite journal | title = Hard to swallow | journal = Nature | volume = 448 | issue = 7150 | pages = 105–06 | date = July 2007 | pmid = 17625521 | doi = 10.1038/448106a | bibcode = 2007Natur.448S.105. | doi-access = free }}</ref> [[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."<ref name=Barrett2007/> Academic discussions of acupuncture still make reference to pseudoscientific concepts such as ''qi'' and meridians despite the lack of scientific evidence.<ref name=Ulett2002/>
====Release of endorphins or adenosine====
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.<ref name="Peñas2010">{{cite book |last1=de las Peñas |first1=César Fernández |last2=Arendt-Nielsen |first2=Lars |last3=Gerwin |first3=Robert D |name-list-style=vanc |title=Tension-type and cervicogenic headache: pathophysiology, diagnosis, and management |publisher=[[Jones & Bartlett Learning]] |year=2010 |isbn=978-0763752835 |pages=251–54 |url=https://books.google.com/books?id=HpRwMB-cNCoC&pg=PA251 |access-date=27 January 2016 |archive-date=4 February 2023 |archive-url=https://web.archive.org/web/20230204181953/https://books.google.com/books?id=HpRwMB-cNCoC&pg=PA251 |url-status=live }}</ref><ref name=Mann2000/><ref name=Williams2013/> 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.<ref name=Ulett2002/>
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.<ref name=Williams2013>{{cite encyclopedia | last = Williams | first = WF | title = Encyclopedia of Pseudoscience: From Alien Abductions to Zone Therapy | isbn = 978-1135955229 | encyclopedia = [[Encyclopedia of Pseudoscience: From Alien Abductions to Zone Therapy|Encyclopedia of Pseudoscience]] | publisher = [[Routledge]] | year = 2013 | pages = 3–4 | url = https://books.google.com/books?id=vH1EAgAAQBAJ }}</ref><ref name=Ulett2002>{{cite book | last = Ulett | first = GA | title = The Skeptic: Encyclopedia of Pseudoscience | publisher = [[ABC-CLIO]] | editor = [[Michael Shermer|Shermer, M]] | isbn = 978-1576076538 | chapter-url = https://books.google.com/books?id=Gr4snwg7iaEC&pg=PA283 | pages = 283–91 | chapter = Acupuncture | year = 2002 }}</ref> Some studies suggest acupuncture causes a series of events within the [[central nervous system]],<ref name=Wang2008>{{cite journal | vauthors = Wang SM, Kain ZN, White P | title = Acupuncture analgesia: I. The scientific basis | journal = Anesthesia and Analgesia | volume = 106 | issue = 2 | pages = 602–10 | date = February 2008 | pmid = 18227322 | doi = 10.1213/01.ane.0000277493.42335.7b | s2cid = 29330113 | doi-access = free }}</ref> and that it is possible to inhibit acupuncture's analgesic effects with the opioid antagonist [[naloxone]].<ref>{{cite journal | vauthors = Staud R, Price DD | title = Mechanisms of acupuncture analgesia for clinical and experimental pain | journal = Expert Review of Neurotherapeutics | volume = 6 | issue = 5 | pages = 661–67 | date = May 2006 | pmid = 16734514 | doi = 10.1586/14737175.6.5.661 | s2cid = 2647845 }}</ref> Mechanical deformation of the skin by acupuncture needles appears to result in the release of [[adenosine]].<ref name=Berman2010/> The [[Nociception|anti-nociceptive]] effect of acupuncture may be mediated by the [[adenosine A1 receptor]].<ref>{{cite journal | vauthors = Langevin HM | title = Acupuncture, connective tissue, and peripheral sensory modulation | journal = Critical Reviews in Eukaryotic Gene Expression | volume = 24 | issue = 3 | pages = 249–53 | year = 2014 | pmid = 25072149 | doi = 10.1615/CritRevEukaryotGeneExpr.2014008284 }}</ref> A 2014 review in ''Nature Reviews Cancer'' analyzed mouse studies that suggested acupuncture relieves pain via the local release of adenosine, which then triggered nearby A1 receptors. The review found that in those studies, because acupuncture "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."<ref name=Gorski2014/>
== History ==
=== Origins ===
[[File:Acupuncture chart 300px.jpg|thumb|right|Acupuncture chart from the [[Ming dynasty]] ({{circa|1368|1644}})]]
Acupuncture, along with [[moxibustion]], is one of the oldest practices of traditional Chinese medicine.<ref name="abc">{{cite book| first1 = Gwei-Djen | last1 = Lu | first2 = Joseph | last2 = Needham | name-list-style = vanc |title=Celestial Lancets: A History and Rationale of Acupuncture and Moxa|isbn=978-0700714582 |date=2002| publisher = Psychology Press }}</ref> Most historians believe the practice began in China, though there are some conflicting narratives on when it originated.<ref name=White-Ernst>{{cite journal | vauthors = White A, Ernst E | title = A brief history of acupuncture | journal = Rheumatology | volume = 43 | issue = 5 | pages = 662–63 | date = May 2004 | pmid = 15103027 | doi = 10.1093/rheumatology/keg005 | doi-access = free }}</ref><ref name="Porter 2013 p. 403">{{cite book |editor=Porter, Stuart B|chapter=18:Acupuncture in Physiotherapy|last=Bannan| first=Andrew | title=Tidy's Physiotherapy15: Tidy's Physiotherapy | publisher=Elsevier | series=Churchill Livingstone | year=2013 | isbn=978-0-7020-4344-4 | chapter-url=https://books.google.com/books?id=RUlRPxA6O9YC&pg=PA403| page=403}}</ref> 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.<ref name=Ramey/>
Acupressure therapy was prevalent in India. Once [[Chinese Buddhism#Han Dynasty (206 BCE–220 CE)|Buddhism spread to China]], the acupressure therapy was also integrated into common medical practice in China and it came to be known as acupuncture. The major points of Indian acupressure and Chinese acupuncture are similar to each other.<ref>{{cite book|url=https://books.google.com/books?id=wGQUBAAAQBAJ&pg=PA27|page=27|author=Joseph S. Alter|title=Asian Medicine and Globalization|publisher=[[University of Pennsylvania Press]]|year=2013|isbn=9780812205251|access-date=13 February 2022|archive-date=15 April 2023|archive-url=https://web.archive.org/web/20230415012411/https://books.google.com/books?id=wGQUBAAAQBAJ&pg=PA27|url-status=live}}</ref>
According to an article in ''Rheumatology'', the first documentation of an "organized system of diagnosis and treatment" for acupuncture was in ''Inner Classic of Huang Di'' ([[Huangdi Neijing]]) from about 100&nbsp;BC.<ref name=White-Ernst/> Gold and silver needles found in the tomb of [[Liu Sheng, Prince of Zhongshan|Liu Sheng]] from around 100&nbsp;BC are believed to be the earliest archaeological evidence of acupuncture, though it is unclear if that was their purpose.<ref name=Ramey>{{cite journal | vauthors = Ramey D, Buell D | year = 2004 | title = A true history of acupuncture | url = http://onlinelibrary.wiley.com/doi/10.1211/fact.2004.00244/full | doi = 10.1211/fact.2004.00244 | volume = 9 | issue = 4 | journal = Focus on Alternative and Complementary Therapies | pages = 269–73 | s2cid = 71106490 | trans-title = 2017-01-01 | access-date = 21 March 2014 | archive-date = 24 May 2014 | archive-url = https://web.archive.org/web/20140524190347/http://onlinelibrary.wiley.com/doi/10.1211/fact.2004.00244/full | url-status = live }}</ref> 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&nbsp;BC.<ref name="Prioreschi2004"/> It is believed that this text was documenting what was established practice at that time.<ref name=White-Ernst/>
====Alternative theories====
The 5,000-year-old mummified body of [[Ötzi the Iceman]] was found with 15 groups of tattoos,<ref name=Dorfer-1999/> 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 Ötzi had these conditions.<ref name="Porter 2013 p. 403"/> This has been cited as evidence that practices similar to acupuncture may have been practised elsewhere in [[Eurasia]] during the early [[Bronze Age]];<ref name=Dorfer-1999>{{cite journal | vauthors = Dorfer L, Moser M, Bahr F, Spindler K, Egarter-Vigl E, Giullén S, Dohr G, Kenner T | title = A medical report from the Stone Age? | journal = Lancet | volume = 354 | issue = 9183 | pages = 1023–25 | date = September 1999 | pmid = 10501382 | doi = 10.1016/S0140-6736(98)12242-0 | s2cid = 29084491 | url = http://www.utexas.edu/courses/classicalarch/readings/Iceman_Tattoos.pdf | archive-url = https://web.archive.org/web/20100922184626/http://www.utexas.edu/courses/classicalarch/readings/Iceman_Tattoos.pdf | url-status = dead | archive-date = 22 September 2010 }}</ref> however, ''The Oxford Handbook of the History of Medicine'' calls this theory "speculative".<ref name="Jackson 2011 p. 610">{{cite book | last=Jackson | first=M. | title=The Oxford Handbook of the History of Medicine | publisher=OUP Oxford | series=Oxford Handbooks in History | year=2011 | isbn=978-0-19-954649-7 | url=https://books.google.com/books?id=cpjgoazGIC4C&pg=PT610| page=610}}</ref> It is considered unlikely that acupuncture was practised before 2000&nbsp;BC.<ref name=Ramey/>
Acupuncture may have been practised during the [[Neolithic]] era, near the end of the [[Stone Age]], using sharpened stones called [[Bian Stones|Bian shi]].<ref name="abc"/>{{RP|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.<ref name="abc"/>{{RP|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.<ref name="abc"/>{{RP|71}} However, it is more likely that stones were used for other medical purposes, such as puncturing a growth to drain its [[pus]].<ref name=White-Ernst/><ref name="Porter 2013 p. 403"/> The ''[[Mawangdui]]'' texts, which are believed to be from the 2nd century BC, mention the use of pointed stones to open [[abscess]]es, and moxibustion, but not for acupuncture.<ref name="Prioreschi2004"/> 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.<ref name="Singh Ernst 2008 p. 42">{{cite book | vauthors=Singh S, Ernst E | title=Trick Or Treatment: The Undeniable Facts about Alternative Medicine | publisher=W. W. Norton | series=Norton paperback | year=2008 | isbn=978-0-393-06661-6 | url=https://books.google.com/books?id=5m6CKTEr3I0C&pg=PA42 | page=42 | access-date=27 January 2016 | archive-date=4 February 2023 | archive-url=https://web.archive.org/web/20230204181954/https://books.google.com/books?id=5m6CKTEr3I0C&pg=PA42 | url-status=live }}</ref> It is likely bloodletting was an antecedent to acupuncture.<ref name="Porter 2013 p. 403"/>
According to historians [[Lu Gwei-djen]] and [[Joseph Needham]], there is substantial evidence that acupuncture may have begun around 600&nbsp;BC.<ref name="abc"/> Some hieroglyphs and [[Pictogram|pictographs]] from that era suggests acupuncture and moxibustion were practised.<ref name="Robson">{{cite book | last = Robson | first = T | title = An Introduction to Complementary Medicine | isbn = 978-1741140545 | year = 2004 | publisher = [[Allen & Unwin]] | url=https://books.google.com/books?id=E6oa37ZyTxEC&pg=PA90 | page = 90 }}</ref> 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.<ref name="abc"/>{{RP|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.<ref name="abc"/>{{RP|69}} If acupuncture was practised during the [[Shang dynasty]] (1766 to 1122&nbsp;BC), organic materials like thorns, sharpened bones, or bamboo may have been used.<ref name="abc"/>{{RP|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 needle.<ref name="abc"/>{{RP|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.<ref name="abc"/> An article in ''Rheumatology'' said that the absence of any mention of acupuncture in documents found in the tomb of [[Mawangdui]] from 198&nbsp;BC suggest that acupuncture was not practised by that time.<ref name=White-Ernst/>
====Belief systems====
Several different and sometimes conflicting belief systems emerged regarding acupuncture. This may have been the result of competing schools of thought.<ref name=White-Ernst/> 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.<ref name="Prioreschi2004"/> According to David Ramey, no single "method or theory" was ever predominantly adopted as the standard.<ref>{{cite journal | vauthors = Ramey DW | title = Inaccurate acupuncture history | journal = Rheumatology | volume = 43 | issue = 12 | pages = 1593; author reply 1593–94 | date = December 2004 | pmid = 15564643 | doi = 10.1093/rheumatology/keh363 | doi-access = free }}</ref> 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.<ref name=White-Ernst/>
It is not certain when specific acupuncture points were introduced, but the autobiography of [[Bian Que]] from around 400–500&nbsp;BC references inserting needles at designated areas.<ref name="abc"/> 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."<ref name="abc"/>{{RP|83}} Texts dated to be from 156 to 186&nbsp;BC document early beliefs in channels of life force energy called meridians that would later be an element in early acupuncture beliefs.<ref name=Ramey/>
Ramey and Buell said the "practice and theoretical underpinnings" of modern acupuncture were introduced in ''The Yellow Emperor's Classic'' (Huangdi Neijing) around 100&nbsp;BC.<ref name=Prioreschi2004>{{cite book | last = Prioreschi | first = P | pages = [https://books.google.com/books?id=MJUMhEYGOKsC&pg=PA147 147–48] | year = 2004 | isbn = 978-1888456011 | publisher = Horatius Press | title = A history of Medicine, Volume 2 }}</ref><ref name=Ramey/> It introduced the concept of using acupuncture to manipulate the flow of life energy (''qi'') in a network of meridian (channels) in the body.<ref name=Ramey/><ref name="Epler">{{cite journal | vauthors = Epler DC | title = Bloodletting in early Chinese medicine and its relation to the origin of acupuncture | journal = Bulletin of the History of Medicine | volume = 54 | issue = 3 | pages = 337–67 | year = 1980 | pmid = 6998524 }}</ref> 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''.<ref name="abc"/>{{RP|93}} Numerous additional documents were published over the centuries introducing new acupoints.<ref name="abc"/>{{RP|101}} By the 4th century AD, most of the acupuncture sites in use today had been named and identified.<ref name="abc"/>{{RP|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.<ref name="abc"/>{{RP|140–41}} The 'science of the yin-yang cycles' ({{lang|zh|運氣學}} {{transliteration|zh|yùn qì xué}}{{efn|A reference to the five movements and six ''qi'' ({{lang|zh|五運六氣}} {{transliteration|zh|wǔ yùn liù qì}}).}}) was a set of beliefs that curing diseases relied on the alignment of both heavenly ({{Lang|zh-latn|tian}}) and earthly ({{Lang|zh-latn|di}}) forces that were attuned to cycles like that of the sun and moon.<ref name="abc"/>{{RP|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.<ref name="abc"/>{{RP|140–41}} According to Needham and Lu, these "arbitrary predictions" were depicted by acupuncturists in complex charts and through a set of special terminology.<ref name="abc"/>
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.<ref name="abc"/>{{RP|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.<ref name="abc"/>{{RP|104}} Nine needles were recommended in the ''Great Compendium of Acupuncture and Moxibustion''{{efn|{{zh|t=針灸大成|s=针灸大成|p=Zhēn jiǔ dà chéng|w=Chen Chiu Ta Chʻeng}}.}} from 1601, which may have been because of an ancient Chinese belief that nine was a magic number.<ref name="abc"/>{{RP|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.<ref name="abc"/>{{RP|140–41}} In some cases a lack of balance between Yin and Yang were believed to be the cause of disease.<ref name="abc"/>{{RP|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'',{{efn|{{zh|t=針灸甲乙經|s=针灸甲乙经|p=Zhēn jiǔ jiǎ yǐ jīng}}.}} which was published in the mid-3rd century, became the oldest acupuncture book that is still in existence in the modern era.<ref name="abc"/> Other books like the ''Yu Gui Zhen Jing'',{{efn|{{zh|t=玉匱鍼經|s=玉匮针经|p=Yù guì zhēn jīng|w=Yü Kuei Chen Ching}}.}} written by the Director of Medical Services for China, were also influential during this period, but were not preserved.<ref name="abc"/> 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.<ref name="abc"/>
Acupuncture became more established in China as improvements in paper led to the publication of more acupuncture books.<ref>{{Cite web |date=2022-10-20 |title=Some Sepsis Stuff {{!}} Science-Based Medicine |url=https://sciencebasedmedicine.org/some-sepsis-stuff/ |access-date=2022-11-04 |website=sciencebasedmedicine.org |language=en-US |archive-date=4 November 2022 |archive-url=https://web.archive.org/web/20221104115738/https://sciencebasedmedicine.org/some-sepsis-stuff/ |url-status=live }}</ref> The Imperial Medical Service and the Imperial Medical College, which both supported acupuncture, became more established and created medical colleges in every province.<ref name="abc"/>{{rp|129}} The public was also exposed to stories about royal figures being cured of their diseases by prominent acupuncturists.<ref name="abc"/>{{rp|129–35}} By time the ''Great Compendium of Acupuncture and Moxibustion'' was published during the [[Ming dynasty]] (1368–1644&nbsp;AD), most of the acupuncture practices used in the modern era had been established.<ref name=White-Ernst/>
====Decline====
By the end of the Song dynasty (1279&nbsp;AD), acupuncture had lost much of its status in China.<ref name=Barnes2005>{{cite book | last = Barnes | first = Linda L | title = Needles, Herbs, Gods, and Ghosts: China, Healing, and the West to 1848 | year = 2005 | publisher = [[Harvard University Press]] | isbn = 978-0674018723}}</ref>{{rp|25}} It became rarer in the following centuries, and was associated with less prestigious professions like [[alchemy]], [[shamanism]], [[midwifery]] and moxibustion.<ref name=Barnes2005/>{{rp|25}} Additionally, by the 18th century, scientific rationality was becoming more popular than traditional superstitious beliefs.<ref name=White-Ernst/> By 1757 a book documenting the history of Chinese medicine called acupuncture a "lost art".<ref name="abc"/>{{RP|160}} Its decline was attributed in part to the popularity of prescriptions and medications, as well as its association with the lower classes.<ref name=Barnes2005/>{{rp|188}}
In 1822, the Chinese Emperor signed a decree excluding the practice of acupuncture from the Imperial Medical Institute.<ref name=White-Ernst/> He said it was unfit for practice by gentlemen-scholars.<ref name=Barnes2005/>{{rp|308}} In China acupuncture was increasingly associated with lower-class, illiterate practitioners.<ref name=Barnes2005/>{{rp|58}} It was restored for a time, but banned again in 1929 in favor of science-based medicine. Although acupuncture declined in China during this time period, it was also growing in popularity in other countries.<ref name="Porter 2013 p. 403"/>
===International expansion===
[[File:hua t08.jpg|thumb|Acupuncture chart from ''Shisi jing fahui'' (Expression of the Fourteen Meridians) written by Hua Shou ({{floruit|1340s}}, [[Ming dynasty]]). Japanese reprint by Suharaya Heisuke (Edo, 1. year Kyōhō = 1716).]]
Korea is believed to be the first country in Asia that acupuncture spread to outside of China.<ref name="abc"/> 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&nbsp;AD.<ref name="abc"/>{{RP|262–63}} Acupuncture use was commonplace in Korea by the 6th century. It spread to Vietnam in the 8th and 9th centuries.<ref name="Porter 2013 p. 403"/> As Vietnam began trading with Japan and China around the 9th century, it was influenced by their acupuncture practices as well.<ref name=White-Ernst/> China and Korea sent "medical missionaries" that spread traditional Chinese medicine to Japan, starting around 219&nbsp;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.<ref name="abc"/>{{RP|264}} Japan later sent students back to China and established acupuncture as one of five divisions of the Chinese State Medical Administration System.<ref name="abc"/>{{RP|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.<ref name="abc"/>{{RP|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''.<ref name="Singh Ernst 2008 p. 42"/> 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.<ref name=White-Ernst/> 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.<ref name=Barnes2005/>{{rp|308}}
By the 19th century, acupuncture had become commonplace in many areas of the world.<ref name=abc/>{{RP|295}} Americans and Britons began showing interest in acupuncture in the early 19th century, although interest waned by mid-century.<ref name=White-Ernst/> 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.<ref name=White-Ernst/><ref name="Porter 2013 p. 403"/><ref name="Jackson 2011 p. 610"/> 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.<ref name="Singh Ernst 2008 p. 42"/>
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.<ref name=White-Ernst/> The first elaborate Western treatise on acupuncture was published in 1683 by [[Willem ten Rhijne]].<ref name=Barnes2005/>{{rp|75}}
==== Modern era ====
[[File:An ancient acupuncture statue.jpg|thumb| An ancient Acupuncture statue at the lobby of the [[Emperor's College|Emperor's College clinic]], California]]
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).<ref name="Porter 2013 p. 403"/>
New practices were adopted in the 20th century, such as using a cluster of needles,<ref name=abc/>{{RP|164}} electrified needles, or leaving needles inserted for up to a week.<ref name=abc/>{{RP|164}} A lot of emphasis developed on using [[Auriculotherapy|acupuncture on the ear]].<ref name=abc/>{{RP|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.<ref name=White-Ernst/><ref>{{Cite journal|last1=Lu|first1=Dominic P.|last2=Lu|first2=Gabriel P.|date=October 2013|title=An Historical Review and Perspective on the Impact of Acupuncture on U.S. Medicine and Society|journal=Medical Acupuncture|volume=25|issue=5|pages=311–16|doi=10.1089/acu.2012.0921|issn=1933-6586|pmc=3796320|pmid=24761180}}</ref> China, where acupuncture was believed to have originated, was increasingly influenced by Western medicine.<ref name=White-Ernst/> 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.<ref name=Wang2008/>
Politicians from the [[Chinese Communist Party]] said acupuncture was superstitious and conflicted with the party's commitment to science.<ref name=Crozier1968/> Communist Party Chairman Mao Zedong later reversed this position,<ref name=Crozier1968>{{cite book | vauthors = Crozier RC |title= Traditional medicine in modern China: science, nationalism, and the tensions of cultural change |edition=1 |publisher= [[Harvard University Press]] |location= Cambridge |year=1968 |isbn=978-0674901056|pages=101–205}}</ref> arguing that the practice was based on scientific principles.<ref name=Taylor2011>{{cite book | last=Taylor | first=K | title=Chinese Medicine in Early Communist China, 1945–63: a Medicine of Revolution | year=2005 | isbn=978-0415345125 | publisher=RoutledgeCurzon |page=109}}</ref> During the [[Cultural Revolution]], disbelief in acupuncture anesthesia was subjected to ruthless [[political repression]].<ref>{{cite book | last=Unschuld | first=Paul Ulrich | title=Medicine in China: A History of Ideas | publisher=University of California Press | series=Comparative Studies of Health Systems and Medical Care | year=2010 | isbn=978-0-520-26613-1 | url=https://books.google.com/books?id=4agwDwAAQBAJ&pg=PA364 | access-date=8 July 2024 | page=364}}</ref>
In 1971, ''New York Times'' reporter [[James Reston]] published an article on his acupuncture experiences in China, which led to more investigation of and support for acupuncture.<ref name=White-Ernst/> The US President [[1972 Nixon visit to China|Richard Nixon visited China in 1972]].<ref name="CSICOP"/> During one part of the visit, the delegation was shown a patient undergoing major surgery while fully awake, ostensibly receiving acupuncture rather than [[anesthesia]].<ref name="CSICOP"/> 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.<ref name="CSICOP">{{cite journal|url=http://www.csicop.org/si/show/china_conference_1/ |title=Traditional Medicine and Pseudoscience in China: A Report of the Second CSICOP Delegation (Part 1) | vauthors = Beyerstein BL, Sampson W |volume=20 |issue=4 |year=1996 |journal=[[Skeptical Inquirer]] |publisher=[[Committee for Skeptical Inquiry]] |url-status=dead |archive-url=https://web.archive.org/web/20091004020227/http://www.csicop.org/si/show/china_conference_1/ |archive-date=4 October 2009 }}</ref> 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.<ref name=Colquhoun2013/> After the [[National Institute of Health]] expressed support for acupuncture for a limited number of conditions, adoption in the US grew further.<ref name=White-Ernst/> In 1972 the first legal acupuncture center in the US was established in Washington DC<ref name="JCIM_Lee">{{cite journal|url=http://www.jcimjournal.com/en/index.aspx/ |title=The first acupuncture center in the United States: an interview with Yao Wu Lee, Washington Acupuncture Center |first=AY |last=Fan |volume=20 |issue=5 |year=2012 |journal=[[Journal of Integrative Medicine]] |publisher=Committee for Journal of Chinese Integrative Medicine |url-status=dead |archive-url=https://web.archive.org/web/20120727004846/http://www.jcimjournal.com/en/index.aspx |archive-date=27 July 2012 }}</ref> and in 1973 the American [[Internal Revenue Service]] allowed acupuncture to be deducted as a medical expense.<ref name="'70s 133">{{cite book|title= How We Got Here: The '70s|last= Frum|first= David|author-link= David Frum|year= 2000|publisher= Basic Books|location= New York City|isbn= 978-0465041954|page= [https://archive.org/details/howwegothere70sd00frum/page/133 133]|url= https://archive.org/details/howwegothere70sd00frum/page/133}}</ref>
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.<ref name=SinghGuardian>{{cite news | title = A groundbreaking experiment ... or a sensationalized TV stunt? | first = Simon | last = Singh | name-list-style = vanc | work = The Guardian | date = 26 March 2006 | url = https://www.theguardian.com/media/2006/mar/25/science.broadcasting | access-date = 13 December 2016 | archive-date = 2 February 2017 | archive-url = https://web.archive.org/web/20170202092852/https://www.theguardian.com/media/2006/mar/25/science.broadcasting | url-status = live }}</ref><ref name=SinghTelegraph>{{cite news|title=Did we really witness the 'amazing power' of acupuncture?|work=The Daily Telegraph|date=14 February 2006 | first = Simon | last = Singh | name-list-style =vanc |url=https://www.telegraph.co.uk/news/science/science-news/3344833/Did-we-really-witness-the-amazing-power-of-acupuncture.html |archive-url=https://ghostarchive.org/archive/20220111/https://www.telegraph.co.uk/news/science/science-news/3344833/Did-we-really-witness-the-amazing-power-of-acupuncture.html |archive-date=11 January 2022 |url-access=subscription |url-status=live}}{{cbignore}}</ref>
In 2010, [[UNESCO]] inscribed "acupuncture and [[moxibustion]] of traditional Chinese medicine" on the [[UNESCO Intangible Cultural Heritage Lists|UNESCO Intangible Cultural Heritage List]] following China's nomination.<ref name="unes_Acup">{{cite web | title = Acupuncture and moxibustion of traditional Chinese medicine – intangible heritage | work = unesco.org – Culture Sector – UNESCO | access-date = 17 January 2017 | url = http://www.unesco.org/culture/ich/en/RL/acupuncture-and-moxibustion-of-traditional-chinese-medicine-00425 | archive-date = 29 January 2016 | archive-url = https://web.archive.org/web/20160129043402/http://www.unesco.org/culture/ich/en/RL/acupuncture-and-moxibustion-of-traditional-chinese-medicine-00425 | url-status = live }}</ref>
== Adoption ==
Acupuncture is most heavily practiced in China<ref name=Zhang-2010/> and is popular in<ref name=Zhang-2010/> the US,<ref name="Xu S"/> Australia,<ref name="dahfdfaDF"/> and Europe.<ref name="Ramsay2009"/> In Switzerland, acupuncture has become the most frequently used alternative medicine since 2004.<ref>{{cite journal | vauthors = Carruzzo P, Graz B, Rodondi PY, Michaud PA | title = Offer and use of complementary and alternative medicine in hospitals of the French-speaking part of Switzerland | journal = [[Swiss Medical Weekly]] | volume = 143 | pages = w13756 | date = September 2013 | pmid = 24018633 | doi = 10.4414/smw.2013.13756 | doi-access = free }}</ref> In the United Kingdom, a total of 4 million acupuncture treatments were administered in 2009.<ref>{{cite journal | vauthors = Hopton AK, Curnoe S, Kanaan M, Macpherson H | title = Acupuncture in practice: mapping the providers, the patients and the settings in a national cross-sectional survey | journal = BMJ Open | volume = 2 | issue = 1 | pages = e000456 | year = 2012 | pmid = 22240649 | pmc = 3278493 | doi = 10.1136/bmjopen-2011-000456 | publisher = bmj.com }}</ref> Acupuncture is used in most pain clinics and hospices in the UK.<ref name=NHS/> An estimated 1 in 10 adults in Australia used acupuncture in 2004.<ref name="dahfdfaDF">{{cite journal | vauthors = Xue CC, Zhang AL, Lin V, Myers R, Polus B, Story DF | title = Acupuncture, chiropractic and osteopathy use in Australia: a national population survey | journal = BMC Public Health | volume = 8 | issue = 1 | pages = 105 | date = April 2008 | pmid = 18377663 | pmc = 2322980 | doi = 10.1186/1471-2458-8-105 | display-authors = 1 | doi-access = free }}</ref> In Japan, it is estimated that 25 percent of the population will try acupuncture at some point,<ref name=Ishizaki2010/> though in most cases it is not covered by [[Health care system in Japan|public health insurance]].<ref name=Ishizaki2010/> Users of acupuncture in Japan are more likely to be elderly and to have a limited education.<ref name=Ishizaki2010/> Approximately half of users surveyed indicated a likelihood to seek such remedies in the future, while 37% did not.<ref name=Ishizaki2010>{{cite journal | vauthors = Ishizaki N, Yano T, Kawakita K | title = Public status and prevalence of acupuncture in Japan | journal = Evidence-Based Complementary and Alternative Medicine | volume = 7 | issue = 4 | pages = 493–500 | date = December 2010 | pmid = 18955345 | pmc = 2892353 | doi = 10.1093/ecam/nen037 }}</ref> Less than one percent of the US population reported having used acupuncture in the early 1990s.<ref name=Samadi2012>{{cite web|title=More Americans using acupuncture for common ailments|first=David B.|last=Samadi|name-list-style=vanc|url=https://www.foxnews.com/health/more-americans-using-acupuncture-for-common-ailments/|publisher=[[Fox News Channel]]|access-date=25 May 2013|archive-date=28 July 2013|archive-url=https://web.archive.org/web/20130728054400/http://www.foxnews.com/health/2012/05/15/more-americans-using-acupuncture-for-common-ailments/|url-status=live}}</ref> By the early 2010s, more than 14 million Americans reported having used acupuncture as part of their health care.<ref name=Samadi2012/>
In the US, acupuncture is increasingly ({{As of|2014|lc=y}}) used at [[academic medical centers]],<ref name=Gorski2014/> 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]].<ref>{{cite journal | vauthors = Highfield ES, Kaptchuk TJ, Ott MJ, Barnes L, Kemper KJ | title = Availability of acupuncture in the hospitals of a major academic medical center: a pilot study | journal = Complementary Therapies in Medicine | volume = 11 | issue = 3 | pages = 177–83 | date = September 2003 | pmid = 14659382 | doi = 10.1016/S0965-2299(03)00069-4 | url = http://www.complementarytherapiesinmedicine.com/article/S0965-2299%2803%2900069-4/abstract | publisher = Elsevier }}</ref> CDC [[clinical practice guideline]]s from 2022 list acupuncture among the types of complementary and alternative medicines physicians should consider in preference to [[opioid]] prescription for certain kinds of pain.<ref>{{cite journal |pages=1–95 |publisher=CDC |date=4 November 2022 |title=CDC Clinical Practice Guideline for Prescribing Opioids for Pain |url=https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm |vauthors=Dowell D, Ragan KR, Jones CN, Baldwin GT, Chou R |volume=71 |issue=3 |journal=Morbidity and Mortality Weekly Report |access-date=23 December 2022 |archive-date=23 December 2022 |archive-url=https://web.archive.org/web/20221223102004/https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm |url-status=live }}</ref>
The use of acupuncture in Germany increased by 20% in 2007, after the [[German acupuncture trials]] supported its efficacy for certain uses.<ref name="accupuncture-rponline"/> In 2011, there were more than one million users,<ref name="accupuncture-rponline">{{cite web|title=Frauen häufiger mit Akupunktur behandelt|url=http://www.rp-online.de/gesundheit/medizin-und-vorsorge/frauen-haeufiger-mit-akupunktur-behandelt-1.2973239|work=[[Rheinische Post]]|date=30 August 2012|access-date=25 May 2013|language=de|archive-date=4 December 2012|archive-url=https://web.archive.org/web/20121204125847/http://www.rp-online.de/gesundheit/medizin-und-vorsorge/frauen-haeufiger-mit-akupunktur-behandelt-1.2973239|url-status=live}}</ref> and insurance companies have estimated that two-thirds of German users are women.<ref name="accupuncture-rponline"/> 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.<ref name=Birch2007/> This decision was based in part on [[socio-political]] reasons.<ref name=Birch2007>{{cite journal |url=http://www.paradigm-pubs.com/sites/www.paradigm-pubs.com/files/files/Birch-german-studies.pdf |journal=Journal of Chinese Medicine |title=Reflections on the German Acupuncture studies |vauthors=Birch S |issue=83 |year=2007 |pages=12–17 |access-date=20 January 2014 |archive-date=16 January 2014 |archive-url=https://web.archive.org/web/20140116140150/http://www.paradigm-pubs.com/sites/www.paradigm-pubs.com/files/files/Birch-german-studies.pdf |url-status=dead }}</ref> Some insurers in Germany chose to stop reimbursement of acupuncture because of the trials.<ref name=He2013>{{cite journal | vauthors = He W, Tong Y, Zhao Y, Zhang L, Ben H, Qin Q, Huang F, Rong P | title = Review of controlled clinical trials on acupuncture versus sham acupuncture in Germany | journal = Journal of Traditional Chinese Medicine | volume = 33 | issue = 3 | pages = 403–07 | date = June 2013 | pmid = 24024341 | doi = 10.1016/s0254-6272(13)60187-9 | display-authors = 4 | doi-access = free }}</ref> For other conditions, insurers in Germany were not convinced that acupuncture had adequate benefits over usual care or sham treatments.<ref name=Porter2013>{{cite book | first = Stuart B. | last = Porter | name-list-style = vanc |page=408 |title=Tidy's Physiotherapy |edition=15 |editor=Stuart B. Porter |publisher=[[Churchill Livingstone]] |year=2013 |isbn=978-0702043444}}</ref> Highlighting the results of the placebo group, researchers refused to accept a placebo therapy as efficient.<ref name="Hinrichs">{{cite book | first1 = TJ | last1 = Hinrichs | first2 = Linda L. | last2 = Barnes | name-list-style = vanc |page=314 |title=Chinese Medicine and Healing: An Illustrated History |edition=1 | editor1-first = TJ | editor1-last = Hinrichs | editor2-first = Linda L. | editor2-last = Barnes |publisher=[[Belknap Press]] |year=2013 |isbn=978-0674047372}}</ref>
==Regulation==
{{Main|Regulation of acupuncture}}
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 an acupuncturist receive 200 hours of specialized training if they are a physician and 2,500 hours for non-physicians before being licensed or certified; many governments have adopted similar standards.
In Hong Kong, the practice of acupuncture is regulated by the Chinese Medicine Council, which was formed in 1999 by the Legislative Council. It includes a licensing exam, registration, and degree courses approved by the board.<ref>{{cite news|title=Hong Kong's traditional Chinese medicine laws 'putting public at risk'|date=23 July 2007|first=Mark|last=O'Neill|url=http://www.scmp.com/article/601500/hong-kongs-traditional-chinese-medicine-laws-putting-public-risk|newspaper=South China Morning Post|access-date=14 May 2015|archive-date=19 May 2015|archive-url=https://web.archive.org/web/20150519083803/http://www.scmp.com/article/601500/hong-kongs-traditional-chinese-medicine-laws-putting-public-risk|url-status=live}}</ref> 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.<ref name="Ramsay2009">{{cite book|first=Cynthia|last=Ramsay|name-list-style=vanc|title=Unnatural Regulation: Complementary and Alternative Medicine Policy in Canada|url=https://books.google.com/books?id=4Y5oPvK4QVwC&pg=PA43|year=2009|publisher=The Fraser Institute|page=43|id=GGKEY:0KK0XUSQASK|access-date=27 January 2016|archive-date=15 April 2023|archive-url=https://web.archive.org/web/20230415012412/https://books.google.com/books?id=4Y5oPvK4QVwC&pg=PA43|url-status=live}}</ref> 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]].<ref name="ChanLee2001">{{cite book | first1 = Kevin | last1 = Chan | first2 = Henry | last2 = Lee | name-list-style = vanc |title=The Way Forward for Chinese Medicine|url=https://books.google.com/books?id=x5EIubrfg6wC&pg=PA349|year= 2001|publisher=CRC Press|isbn=978-1-4200-2423-4|page=349}}</ref> 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.<ref name=":0">{{Cite book|title = WHO Global Atlas of Traditional, Complementary and Alternative Medicine|publisher = World Health Organization|year = 2005|isbn = 978-92-4-156286-7|page = 195|url = https://books.google.com/books?id=VO8K9h9GvaoC&pg=PA195}}</ref> 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.<ref>{{Cite web|url=https://www.chinesemedicineboard.gov.au/Codes-Guidelines/FAQ/Registration.aspx|title=Chinese Medicine Board of Australia – Registration and how to apply|website=www.chinesemedicineboard.gov.au|language=en|access-date=2020-02-07|archive-date=26 February 2020|archive-url=https://web.archive.org/web/20200226065209/https://www.chinesemedicineboard.gov.au/Codes-Guidelines/FAQ/Registration.aspx|url-status=live}}</ref>  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 the ability 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,<ref>{{Cite web|title=Home|url=https://www.acupuncture.org.nz/|access-date=2020-11-13|website=Acupuncture NZ|archive-date=19 January 2021|archive-url=https://web.archive.org/web/20210119203419/https://www.acupuncture.org.nz/|url-status=live}}</ref> and The New Zealand Acupuncture Standards Authority.<ref>{{Cite web|title=NZASA - Home|url=https://nzasa.org/|access-date=2020-12-24|website=nzasa.org|archive-date=14 April 2021|archive-url=https://web.archive.org/web/20210414013230/https://nzasa.org/|url-status=live}}</ref><ref>{{Cite web|url=https://www.legislation.govt.nz/act/public/2001/0049/latest/DLM99494.html|title=Accident Compensation Act 2001 No 49 (As at 30 March 2021), Public Act Contents – New Zealand Legislation|access-date=24 December 2020|archive-date=23 January 2021|archive-url=https://web.archive.org/web/20210123043453/https://www.legislation.govt.nz/act/public/2001/0049/latest/DLM99494.html|url-status=live}}</ref> At least 28 countries in Europe have professional associations for acupuncturists.<ref name=":0"/> In France, the [[Académie Nationale de Médecine]] (National Academy of Medicine) has regulated acupuncture since 1955.<ref>{{cite journal|last=Bossy|first=Jean|title=Acupuncture in France|journal=Acupuncture in Medicine|publisher=Sage Journals|date=January 1, 1988|volume=5|pages=6–8|doi=10.1136/aim.5.1.6|s2cid=70372649|quote=Since 1955, the French Academy of Medicine accepted and included Acupuncture as a part of medicine because it includes both diagnosis and therapeutic treatment|doi-access=free}}</ref>
== See also ==
<!-- Please keep entries in alphabetical order per [[WP:SEEALSO]] -->
{{Columnslist|colwidth=30em|
* [[Auriculotherapy]]
* [[Baunscheidtism]]
* [[Colorpuncture]]
* [[Dry needling]]
* [[List of acupuncture points]]
* [[List of ineffective cancer treatments]]&nbsp;– Includes [[moxibustion]]
* [[Moxibustion]]
* [[Pharmacopuncture]]
* [[Pressure point]]
* [[Regulation of acupuncture]]
}}
<!-- please keep entries in alphabetical order -->
== Notes ==
{{Notelist}}
{{Reflist|group=n}}
== References ==
{{Reflist}}
=== Bibliography ===
{{Refbegin}}
<!-- The short citations in the References section are interlinked with the full citations here. -->
* {{cite book | ref=Aung2007 | last1 = Aung | first1 = SKH | last2 = Chen | first2 = WPD | name-list-style = vanc | year = 2007 | title = Clinical Introduction to Medical Acupuncture | publisher = Thieme Medical Publishers | isbn = 978-1588902214 }}
* {{cite book | ref=Cheng1987 | last =Cheng | first = X | title = Chinese Acupuncture and Moxibustion |edition =1st | year = 1987 | publisher = Foreign Languages Press | isbn = 978-7119003788}} <!--revisit and verify cites against 3rd ed-->
* {{cite book | vauthors = Singh S, Ernst E |author-link1= Simon Singh |author-link2= Edzard Ernst |title= Trick or Treatment: Alternative Medicine on Trial |location= London |publisher= Bantam |year= 2008 |isbn= 978-0593061299 |ref= {{harvid|Singh & Ernst|2008}}}}
* {{cite journal | vauthors = Madsen MV, Gøtzsche PC, Hróbjartsson A | title = Acupuncture treatment for pain: systematic review of randomised clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups | journal = BMJ | volume = 338 | pages = a3115 | date = January 2009 | pmid = 19174438 | pmc = 2769056 | doi = 10.1136/bmj.a3115 | ref = {{harvid|Madsen|2009}} }}
* {{cite book | vauthors = Wiseman N, Ellis A | year = 1996 | title = Fundamentals of Chinese medicine | publisher = Paradigm Publications | isbn = 978-0912111445 |ref={{harvid|Wiseman & Ellis|1996}}}}
{{Refend}}
== Further reading ==
* {{cite book |last = Brown |first= Brandon P |year = 2011 |title = "Acupuncture." ''Magill's Medical Guide'', 6th ed., vol. 1 |publisher = Salem Press |isbn = 978-1-63700-107-3}}
* {{cite encyclopedia|encyclopedia=The Skeptic Encyclopedia of Pseudoscience|url=https://books.google.com/books?id=Gr4snwg7iaEC&pg=PA283|publisher=ABC-CLIO|isbn=978-1-57607-653-8|pages=283 ff | vauthors = Ulett GA | veditors = Shermer M|title=Acupuncture |year=2002 |ref=none}}
* {{cite encyclopedia | veditors = William FW|encyclopedia=Encyclopedia of Pseudoscience: From Alien Abductions to Zone Therapy |url=https://books.google.com/books?id=vH1EAgAAQBAJ&pg=PT31|year=2013|publisher=Routledge|isbn=978-1-135-95522-9|pages=3–4 |title=Acupuncture |ref=none}}
* {{cite book |last = Bivins |first= Roberta E. |translator = |year = 2000 |title = Acupuncture, Expertise, and Cross-Cultural Medicine |publisher = Palgrave| location = New York |isbn = 0333918932}}
* FRONTLINE: The Alternative Fix - "[https://www.pbs.org/wgbh/pages/frontline/shows/altmed/themes/acupuncture.html What is acupuncture?]" (04 November 2003). PBS Video.
{{Acupuncture}}
{{Alternative medicine |state=collapsed}}
{{Traditional Chinese medicine}}
{{Pseudoscience}}
{{Sister bar|auto=yes|wikt=acupuncture|q=Traditional Chinese medicine}}
{{Authority control}}
[[Category:Acupuncture| ]]<!-- Please leave the empty space as standard. -->
[[Category:Alternative medicine]]
[[Category:Chinese inventions]]
[[Category:Energy therapies]]
[[Category:Pain management]]
[[Category:Pseudoscience]]
[[Category:Traditional Chinese medicine]]