Tin,.opper, gold and silver are also possibilities, though they are considered less likely, or to have been used in fewer cases. 29 :69 If acupuncture was practice during the Cang dynasty 1766 to 1122 BC, organic materials like thorns, sharpened bones, or bamboo may have been used. 29 :70 Once methods for producing steel were discovered, it would replace all other materials, since it could be used to create a very fine, but sturdy needles. 29 :74 Gwei-djen and Needham noted that skin is sterilized and needles are inserted, frequently with a plastic guide tube. It.s difficult but not impossible to design rigorous research trials for acupuncture. 69 70 Due to acupuncture's invasive nature, one of the major challenges in efficacy research is in the design of an appropriate placebo control group . 71 72 For efficacy studies to determine whether acupuncture has specific effects, “sham” forms of acupuncture where the patient, practitioner, and analyst are blinded seem the most acceptable approach. 69 Sham acupuncture uses non-penetrating needles or needling at non-acupuncture points, 73 e.g. inserting needles on meridians not related to the specific condition being studied, or a very weak constitution of the patient can be considered, all of which are thought to decrease the likelihood of successful treatment. Sometimes needles were used while they were still hot, creating a cauterizing effect at the injection site. 29 :104 Nine needles were recommended in the Ben chi Ta Ceng from 1601, which may have been because of an ancient Chinese belief that nine was a magic number. 29 :102-103 Other belief systems were based on the idea that the human body operated are still unable to find a shred of evidence to support the existence of meridians or Ch'i”, 21 “The traditional principles of acupuncture are deeply flawed, as there is no evidence at all to demonstrate the existence of Ch'i or meridians” 22 and “As yin and yang, acupuncture points and meridians are not a reality, but merely the product of an ancient Chinese philosophy”. 23 Tyne, D.; Shenker, N.
.>Diagrams.f.he.low.f.piritual.nergy,.or example, many governments have adopted similar standards. 299 In China, the practiced of acupuncture is regulated by the Chinese Medicine Council that was formed in 1999 by the Legislative Council. Thinner needles may be flexible Texts dated to be from 156–186 BC document early beliefs in Phannels of life force energy called meridians that would later be an element in early acupuncture beliefs. 267 Ramey and quell said the “practice and theoretical underpinnings” of modern acupuncture were introduced in the Yellow Emperor's Classic Huangdi Beijing around 100 BC. 28 267 It introduced the concept of using acupuncture to manipulate the flow of life energy qi in a network of meridian channels in the body. 267 272 The network concept was made up of acu-tracts, such as a line down the arms, where it said acupoints were located. Acupuncture.Tote..s. form of alternative medicine 2 in which thin needles are inserted into the body. 3 It is a key component of traditional Chinese medicine ACM. 4 ACM theory and practice are not based upon scientific knowledge, 5 and acupuncture is a pseudo-science . 6 7 There is a diverse range of acupuncture theories based on different philosophies, 8 and techniques vary depending on the country. 9 The method used in ACM is likely the most widespread in the US. 2 It is most often used for pain relief, 10 11 though it is also used for a wide range of oether conditions. 4 Acupuncture is generally used only in combination with other forms of treatment. 12 The conclusions of many trials and numerous systematic reviews of acupuncture are largely inconsistent. 10 13 An overview of Cochran reviews found that acupuncture is not effective for a wide range of conditions, and it suggests acupuncture may be effective only for chemotherapy-induced nausea/vomiting, postoperative nausea/vomiting, and idiopathic headache. 13 A systematic review of systematic reviews found little evidence of acupuncture's effectiveness in treating pain. 10 The evidence suggests that short-term treatment with acupuncture does not produce long-term benefits. 14 Some research results suggest acupuncture can alleviate pain, though the majority of research suggests that acupuncture's effects are mainly due to placebo . 9 A systematic review concluded that the analgesic effect of acupuncture seemed to lack clinical relevance and could not be clearly distinguished from bias. 15 Acupuncture is generally safe when done by an appropriately trained practitioner using clean needle technique and single-use needles. 16 17 When properly delivered, it has a low rate of mostly minor adverse effects . 3 16 Accidents and infections are associated with infractions of sterile technique or neglect of the practitioner. 17 A review stated that the reports of infection transmission increased significantly in the prior decade. 18 The most frequently reported adverse events were pneumothorax and infections. 10 Since serious adverse events continue to be reported, it is recommended that acupuncturists be trained sufficiently to reduce the risk. 10 A meta-analysis found that acupuncture for chronic low back pain was cost-effective as an adjunct to standard care, 19 while a systematic review found insufficient evidence for the cost-effectiveness of acupuncture in the treatment of chronic low back pain. 20 Scientific investigation has not found any histological or physiological evidence for traditional Chinese concepts such as qi, meridians, and acupuncture points, n 1 24 and many modern practitioners no longer support the existence of life force energy qi flowing through meridians, which was a major part of early belief systems. 8 25 26 Acupuncture is believed to have originated around 100 BC in China, around the time The Yellow Emperor's Classic of Internal Medicine Huangdi Beijing was published, 27 though some experts suggest it could have been practice earlier. 9 Over time, conflicting claims and belief systems emerged about the effect of lunar, celestial and earthly cycles, yin and yang energies, and a body's “rhythm” on the effectiveness of treatment. 28 Acupuncture grew and diminished in popularity 51 The skill level of the acupuncturist may influence how painful the needle insertion is, and a sufficiently skilled practitioner may be able to insert the needles without causing any pain. 50 De-qi Chinese : 得气; pin yin : d q; “arrival of qi” refers to a sensation of numbness, distension, or electrical tingling at the needling site which might radiate along the corresponding meridian . Some of the sites acupuncturists use needles at today still have the same names as this given to them by the Yellow empower's Classic. 29 :93 Numerous additional documents were published over the centuries introducing new acupoints. 29 :101 By the 4th century AD, most of the acupuncture sites in use today had been named and identified. 29 :101 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. 29 :140-141 The Science of the Yin-Yang Cycles yen chi Hsüeh was a set of beliefs 238 Acupuncture can potentially improve a number of common paediatric issues, including gastrointestinal issues, reflux, colic, asthma, allergies, add, and headaches, 239 however, its safety has been debated. Over time, the focus shifted from blood to the concept of puncturing specific points on or a very weak constitution of the patient can be considered, all of which are thought to decrease the likelihood of successful treatment. Traditionally, acupuncture was used to treat acute conditions that time. 27 The 5,000-year-old mummified body of Ötzi the Iceman was found with 15 groups of tattoos, 268 many of which were located at points on the body where acupuncture needles are used for abdominal or lower back problems. Korea is believed to be the first country in Asia that acupuncture spread to outside of China. 29 Within Korea there is a legend that acupuncture was developed by emperor Dan gun, techniques might be utilized which aim to “influence” the de-qi; for example, by certain manipulation the de-qi sensation allegedly can be conducted from the needling site towards more distant sites of the body. In.ther.Ards, 'sham' or 'placebo' acupuncture generally produces the same effects as 'real' acupuncture and, in some cases, does better.” 77 A 2013 meta-analysis found little evidence that the effectiveness of acupuncture on pain compared to sham was modified by the location of the needles, the number of needles used, the experience or technique of the practitioner, or by the circumstances of the sessions. 78 The same analysis also suggested that the number of needles and sessions is important, as greater numbers improved the outcomes of acupuncture compared to non-acupuncture controls. 78 There has been little systematic investigation of which components of an acupuncture session may be important for any therapeutic effect, including needle placement and depth, type and intensity of stimulation, and number of needles used. 75 The research seems to suggest that needles do not need to stimulate the traditionally specified acupuncture points or penetrate the skin to attain an anticipated effect e.g. psychosocial factors. 2 A response to “sham” acupuncture in osteoarthritis may be used in the elderly, but placebos have usually been regarded as deception and thus unethical. 79 However, some physicians and ethicists have suggested circumstances for applicable uses for placebos such as it might present a theoretical advantage of an inexpensive treatment without adverse reactions or interactions with drugs or other medications. 79 As the evidence for most types of alternative medicine such as acupuncture is far from strong, the use of alternative medicine in regular healthcare can present an ethical question. 80 Using the principles of evidence-based medicine to research acupuncture is controversial, and has produced different results. 71 Some research suggests acupuncture can alleviate pain but the majority of research suggests that acupuncture's effects are mainly due to placebo. 9 Evidence suggests that any benefits of acupuncture are short-listing. 14 There is insufficient evidence to support use of acupuncture compared to mainstream medical treatments . 81 Acupuncture is not better than mainstream treatment in the long term. 74 Publication bias is cited as a concern in the reviews of randomized controlled trials CRTs of acupuncture. 57 82 83 A 1998 review of studies on acupuncture found that trials originating in China, Japan, Hong Kong, and Taiwan were uniformly favourable to acupuncture, as were ten out of eleven studies conducted in Russia. 84 A 2011 assessment of the quality of CRTs on ACM, including acupuncture, concluded that the methodological quality of most such trials including randomization, experimental control, and blinding was generally poor, particularly for trials published in Chinese journals though the quality of acupuncture trials was better than the trials testing ACM remedies. 85 The study also found that trials published in non-Chinese journals tended to be of higher quality. 85 Chinese authors use more Chinese studies, which have been demonstrated to be uniformly positive. 86 A 2012 review of 88 systematic reviews of acupuncture published in Chinese journals found that less than half of these reviews reported testing for publication bias, and that the majority of these reviews were published in journals with impact factors of zero. 87 Scientist and journalist Steven Salzburg identifies acupuncture and Chinese medicine generally as a focus for “fake medical journals” such as the Journal of Acupuncture and Meridian Studies and Acupuncture in Medicine . 88 The conclusions of many trials and numerous systematic reviews of acupuncture are largely inconsistent with each other. 13 A 2011 systematic review of systematic reviews found that for reducing pain, real acupuncture was no better than sham acupuncture, and concluded that numerous reviews have shown little convincing evidence that acupuncture is an effective treatment for reducing pain. 10 The same review found that neck pain was one of only four types of pain for which a positive effect was suggested, but cautioned that the primary studies used carried a considerable risk of bias. 10 A 2009 overview of Cochran reviews found acupuncture is not effective for a wide range of conditions, and suggested that it may be effective for only chemotherapy-induced nausea/vomiting, postoperative nausea/vomiting, and idiopathic headache. 13 A 2014 systematic review suggests that the nocebo effect of acupuncture is clinically relevant and that the rate of adverse events may be a gauge of the nocebo effect. 89 According to the 2014 Miller's anaesthesia book, “when compared with placebo, acupuncture treatment has proven efficacy for relieving pain”. 44 A 2012 meta-analysis conducted by the Acupuncture Trialists' Collaboration found “relatively modest” efficiency of acupuncture in comparison to sham for the treatment of four different types of chronic pain back and neck pain, knee osteoarthritis, chronic headache, and shoulder pain and on that basis concluded that it “is more than a placebo” and a reasonable referral option. 90 Commenting on this meta-analysis, both Eduard Ernst and David Colquhoun said the results were of negligible clinical significance. 91 92 Eduard Ernst later stated that “I fear that, once we manage to eliminate this bias that operators are not blind … we might find that the effects of acupuncture exclusively are a placebo response.” 93 A 2010 systematic review suggested that acupuncture is more than a placebo for commonly occurring chronic pain conditions, but the authors acknowledged that it is still unknown if the overall benefit is clinically meaningful or cost-effective. 94 A 2010 review found real acupuncture and sham acupuncture produce similar improvements, which can only be accepted as evidence against the efficacy of acupuncture. 95 The same review found limited evidence that real acupuncture and sham acupuncture appear to produce biological differences despite similar effects. 95 A 2009 systematic review and meta-analysis found that acupuncture had a small analgesic effect, which appeared to lack any clinical importance and could not be discerned from bias. 15 The same review found that it remains unclear whether acupuncture reduces pain independent of a psychological impact of the needling ritual. 15 A 2016 Cochran review found moderate quality evidence that real acupuncture was more effective than sham acupuncture or inactive for short-term relief of neck pain measured either upon completion of treatment or at short-term follow-up. 96 A 2013 meta-analysis found that acupuncture was better than no treatment for reducing lower back pain, but not better than sham acupuncture, and concluded that the effect of acupuncture “is likely to be produced by the non-specific effects of manipulation”. 97 A 2013 systematic review found supportive evidence that real acupuncture may be more effective than sham acupuncture with respect to relieving lower back pain, but there were Acupuncture methodological limitations with the studies. 98 A 2013 systematic review found that acupuncture may be effective for non-specific lower back pain, but the authors noted there were limitations in the studies examined, such as heterogeneity in study characteristics and low methodological quality in many studies. 99 A 2012 systematic review found some supporting evidence that acupuncture was more effective than no treatment for chronic non-specific low back pain; the evidence was conflicting comparing the effectiveness over other treatment approaches. 12 A 2011 systematic review of systematic reviews found that “for chronic low back pain, individualized acupuncture is not better in reducing symptoms than formula acupuncture or sham acupuncture with a toothpick that does not penetrate the skin.” 10 A 2010 review found that sham acupuncture was as effective as real acupuncture for chronic low back pain. 2 The specific therapeutic effects of acupuncture were small, whereas its clinically relevant benefits were mostly due to contextual and psychosocial circumstances. 2 Brain imaging studies have shown that traditional acupuncture and sham acupuncture differ in their effect on limbic structures, while at the same time showed equivalent analgesic effects. 2 A 2005 Cochran review found insufficient evidence to recommend for or against either acupuncture or dry needling for acute low back pain. 100 The same review found low quality evidence for pain relief and improvement compared acupuncture to cause bleeding, while others mixed the ideas of blood-letting and spiritual ch'i energy. The tip of the needle should not be made too sharp to prevent breakage, although blunt needles cause more pain. 49 Apart from the usual filiform needle, other needle types include three-edged needles and the Nine Ancient 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. 276 By the 19th century, acupuncture had become commonplace in many areas of the world. 29 :295 Americans and Britons began showing interest in acupuncture in the early 19th century but interest waned by mid century. 27 Western practitioners abandoned acupuncture's traditional beliefs in spiritual energy, pulse diagnosis, and the cycles of the moon, sun or the body's rhythm. In ACM, the four diagnostic methods are: inspection, on a rhythm and acupuncture had to be applied at the right point in the rhythm to be effective. 29 :140-141 In some cases a lack of balance between Yin and Yang were believed to be the cause of disease. 29 :140-141 In the 1st century AD, many of the first books about acupuncture were published and recognized acupuncturist experts began to emerge. Hand acupuncture, developed in Korea, canters all the ancient materials that could have been used for acupuncture and which often produce archaeological evidence, such as sharpened bones, bamboo or stones, were also used for other purposes. 29 An article in Rheumatology said that the absence of any mention of acupuncture in documents found in the tomb of Ma-Wang-Dui from 198 BC suggest that acupuncture was not practice by that time. 27 Several and sometimes conflicting belief systems emerged regarding acupuncture. “Demystifying Ed, 1. year Kyōhō = 1716. Medical acupuncture attempts to integrate reflexological concepts, the trigger point model, and anatomical insights such as dermatome distribution into acupuncture practice, and emphasizes a more formulaic approach to acupuncture point location. 64 Cosmetic acupuncture is the use of acupuncture in an attempt to reduce wrinkles on the face. 65 Bee venom acupuncture is a treatment approach 292 293 This usage has been criticized owing to there being little scientific evidence for explicit effects, or the mechanisms for its supposed effectiveness, for any condition that is discernible from placebo. 77 Acupuncture has been called 'theatrical placebo', 57 and David Gorski argues that when acupuncture proponents advocate 'harnessing of placebo effects' or work on developing 'meaningful placebos', they essentially concede it is little more than that. 77 The use of acupuncture in Germany increased by 20% in 2007, after the German acupuncture trials supported its efficacy for certain uses. 294 In 2011, there were more than one million users, 294 and insurance companies have estimated that two-thirds of German users are women. 294 As a result of the trials, German public health insurers began to cover acupuncture for chronic low back pain and osteoarthritis of the knee, but not tension headache or migraine. 295 This decision was based in part on socio-political reasons. 295 Some insurers in Germany chose to stop reimbursement of acupuncture because of the trials. 296 For other conditions, insurers in Germany were not convinced that acupuncture had adequate benefits over usual care or sham treatments. 297 Highlighting the results of the placebo group, researchers refused to accept a placebo therapy as efficient. 298 Main article: Regulation of acupuncture There are various governments and trade association regulatory bodies for acupuncture in the United Kingdom, the United States, Saudi Arabia, Australia, Japan, Canada, and in European countries and elsewhere. It.evolves inserting needles to stimulate points on the outer ear . 63 The modern approach was developed in France during the early 1950s. 63 There is no scientific evidence cupping in China. The US Congress created the Office of Alternative Medicine in 1992 and the National Institutes transdermal electrical nerve stimulation TENS masquerading as acupuncture”. 57 Fire needle acupuncture also known as fire needling is a technique which involves quickly inserting a flame-heated needle into areas on the body. 58 Sonopuncture is a stimulation of the body similar to acupuncture using sound instead of needles. 59 This may be done using purpose-built transducers to direct a narrow ultrasound beam to a depth of 6–8 centimetres at acupuncture meridian points on the body. 60 Alternatively, tuning forks or other sound emitting devices are used. 61 Acupuncture point injection is the injection of various substances such as drugs, vitamins or herbal extracts into acupoints. 62 Auriculotherapy, commonly known as ear acupuncture, auricular acupuncture, or auriculoacupuncture, is considered to date back to ancient China.