Acupuncture
Overview
Acupuncture is a type of alternative medicine
Alternative medicine
Alternative medicine is any healing practice, "that does not fall within the realm of conventional medicine." It is based on historical or cultural traditions, rather than on scientific evidence....

 that treats patients by insertion and manipulation of solid, generally thin needles in the body.

Through its origins, acupuncture has been embedded in the concepts of Traditional Chinese medicine
Traditional Chinese medicine
Traditional Chinese Medicine refers to a broad range of medicine practices sharing common theoretical concepts which have been developed in China and are based on a tradition of more than 2,000 years, including various forms of herbal medicine, acupuncture, massage , exercise , and dietary therapy...

 (TCM). Its general theory is based on the premise that bodily functions are regulated by the flow of an energy-like entity called qi
Qi
In traditional Chinese culture, qì is an active principle forming part of any living thing. Qi is frequently translated as life energy, lifeforce, or energy flow. Qi is the central underlying principle in traditional Chinese medicine and martial arts...

. Acupuncture aims to correct imbalances in the flow of qi by stimulation of anatomical locations on or under the skin called acupuncture points, most of which are connected by channels known as meridians
Meridian (Chinese medicine)
The meridian is a path through which the life-energy known as "qi" is believed to flow, in traditional Chinese medicine. There is no physically verifiable anatomical or histological basis for the existence of acupuncture points or meridians.- Main concepts :...

.
Encyclopedia
Acupuncture is a type of alternative medicine
Alternative medicine
Alternative medicine is any healing practice, "that does not fall within the realm of conventional medicine." It is based on historical or cultural traditions, rather than on scientific evidence....

 that treats patients by insertion and manipulation of solid, generally thin needles in the body.

Through its origins, acupuncture has been embedded in the concepts of Traditional Chinese medicine
Traditional Chinese medicine
Traditional Chinese Medicine refers to a broad range of medicine practices sharing common theoretical concepts which have been developed in China and are based on a tradition of more than 2,000 years, including various forms of herbal medicine, acupuncture, massage , exercise , and dietary therapy...

 (TCM). Its general theory is based on the premise that bodily functions are regulated by the flow of an energy-like entity called qi
Qi
In traditional Chinese culture, qì is an active principle forming part of any living thing. Qi is frequently translated as life energy, lifeforce, or energy flow. Qi is the central underlying principle in traditional Chinese medicine and martial arts...

. Acupuncture aims to correct imbalances in the flow of qi by stimulation of anatomical locations on or under the skin called acupuncture points, most of which are connected by channels known as meridians
Meridian (Chinese medicine)
The meridian is a path through which the life-energy known as "qi" is believed to flow, in traditional Chinese medicine. There is no physically verifiable anatomical or histological basis for the existence of acupuncture points or meridians.- Main concepts :...

. Scientific research has not found any physical or biological correlate of qi, meridians and acupuncture points, and some contemporary practitioners needle the body without using a theoretical framework, instead selecting points based on their tenderness to pressure.

The earliest written record of acupuncture is found in the Huangdi Neijing (黄帝内经; translated as The Yellow Emperor's Inner Canon), dated approximately 200 BCE. The practice of acupuncture expanded out of China into the areas now part of Japan
Japan
Japan is an island nation in East Asia. Located in the Pacific Ocean, it lies to the east of the Sea of Japan, China, North Korea, South Korea and Russia, stretching from the Sea of Okhotsk in the north to the East China Sea and Taiwan in the south...

, Korea
Korea
Korea ) is an East Asian geographic region that is currently divided into two separate sovereign states — North Korea and South Korea. Located on the Korean Peninsula, Korea is bordered by the People's Republic of China to the northwest, Russia to the northeast, and is separated from Japan to the...

 and Taiwan
Taiwan
Taiwan , also known, especially in the past, as Formosa , is the largest island of the same-named island group of East Asia in the western Pacific Ocean and located off the southeastern coast of mainland China. The island forms over 99% of the current territory of the Republic of China following...

, diverging from the narrower theory and practice of mainland TCM in the process. A large number of contemporary practitioners outside of China follow these non-TCM practices, particularly in Europe.

Proponents of acupuncture believe that it promotes general health
Health
Health is the level of functional or metabolic efficiency of a living being. In humans, it is the general condition of a person's mind, body and spirit, usually meaning to be free from illness, injury or pain...

, relieves pain
Pain
Pain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...

, treats infertility
Infertility
Infertility primarily refers to the biological inability of a person to contribute to conception. Infertility may also refer to the state of a woman who is unable to carry a pregnancy to full term...

, treats and prevents disease
Disease
A disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune...

. Scientific research has not found it effective for anything but the relief of some types of pain and nausea. Systemic reviews have found conflicting results regarding the prevention of postoperative nausea and vomiting
Postoperative nausea and vomiting
Postoperative nausea and vomiting is an unpleasant complication affecting about a third of the 10% of the population undergoing general anaesthesia each year. This equates to about two million people in the United Kingdom annually.-Impact:...

 though a 2009 Cochrane review
Cochrane Collaboration
The Cochrane Collaboration is a group of over 28,000 volunteers in more than 100 countries who review the effects of health care interventions tested in biomedical randomized controlled trials. A few more recent reviews have also studied the results of non-randomized, observational studies...

 concluded stimulation of the P6 acupuncture point was as effective as antiemetic
Antiemetic
An antiemetic is a drug that is effective against vomiting and nausea. Antiemetics are typically used to treat motion sickness and the side effects of opioid analgesics, general anaesthetics, and chemotherapy directed against cancer....

 medications. Acupuncture also appears to have a small effect in the short-term management of some types of pain
Pain
Pain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...

 though a 2011 review of review articles concluded that acupuncture was of doubtful efficacy in treating pain other than neck pain
Neck pain
Neck pain is a common problem, with two-thirds of the population having neck pain at some point in their lives.Neck pain, although felt in the neck, can be caused by numerous other spinal problems. Neck pain may arise due to muscular tightness in both the neck and upper back, or pinching of the...

. It has been suggested that the positive results reported for acupuncture can be explained by placebo
Placebo
A placebo is a simulated or otherwise medically ineffectual treatment for a disease or other medical condition intended to deceive the recipient...

 effects and publication bias
Publication bias
Publication bias is the tendency of researchers, editors, and pharmaceutical companies to handle the reporting of experimental results that are positive differently from results that are negative or inconclusive, leading to bias in the overall published literature...

 and researchers have pointed out the difficulty in designing an adequate scientific control
Scientific control
Scientific control allows for comparisons of concepts. It is a part of the scientific method. Scientific control is often used in discussion of natural experiments. For instance, during drug testing, scientists will try to control two groups to keep them as identical and normal as possible, then...

 for any placebo effect acupuncture might have due to its invasiveness. The development and inclusion of retracting needles as a form of placebo control has resulted in a much larger number of studies concluding acupuncture's effects are due to placebo.

There is general agreement that acupuncture is safe when administered by well-trained practitioners using sterile needles but does carry small but serious risks and adverse effects including death. Accompanied by calls for more research, the use of acupuncture for certain conditions has been tentatively endorsed by the United States National Institutes of Health
National Institutes of Health
The National Institutes of Health are an agency of the United States Department of Health and Human Services and are the primary agency of the United States government responsible for biomedical and health-related research. Its science and engineering counterpart is the National Science Foundation...

 and National Center for Complementary and Alternative Medicine, the National Health Service
National Health Service
The National Health Service is the shared name of three of the four publicly funded healthcare systems in the United Kingdom. They provide a comprehensive range of health services, the vast majority of which are free at the point of use to residents of the United Kingdom...

 of the United Kingdom
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...

, and the World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...

, though most of these endorsements have been criticized and it has been questioned whether research on acupuncture is a good use of limited research funding.

History

Antiquity

In China
China
Chinese civilization may refer to:* China for more general discussion of the country.* Chinese culture* Greater China, the transnational community of ethnic Chinese.* History of China* Sinosphere, the area historically affected by Chinese culture...

, the earliest examples of metal needles were found in a tomb dated to c. 113 BCE, are believed to be used for medicinal purposes though not necessarily acupuncture. The earliest example of the unseen meridians
Meridian (Chinese medicine)
The meridian is a path through which the life-energy known as "qi" is believed to flow, in traditional Chinese medicine. There is no physically verifiable anatomical or histological basis for the existence of acupuncture points or meridians.- Main concepts :...

 used for diagnosis and treatment are dated to the second century BCE but these records do not mention needling, while the earliest reference to therapeutic needling occurs in the historical Shiji text (史記, English: Records of the Grand Historian
Records of the Grand Historian
The Records of the Grand Historian, also known in English by the Chinese name Shiji , written from 109 BC to 91 BC, was the Magnum opus of Sima Qian, in which he recounted Chinese history from the time of the Yellow Emperor until his own time...

) but does not mention the meridians and may be a reference to lancing rather than acupuncture. The 2nd century BCE medical text Huangdi Neijing (黃帝內經, English: Yellow Emperor's Inner Canon) combines acupuncture with moxibustion
Moxibustion
Moxibustion is a traditional Chinese medicine therapy using moxa, or mugwort herb. It plays an important role in the traditional medical systems of China, Japan, Korea, Vietnam, Tibet, and Mongolia. Suppliers usually age the mugwort and grind it up to a fluff; practitioners burn the fluff or...

 and may refer to the use of needles to drain water from joints or lance abscess
Abscess
An abscess is a collection of pus that has accumulated in a cavity formed by the tissue in which the pus resides due to an infectious process or other foreign materials...

es (though the Huangdi Neijing has been revised several times since its original publication in, and the oldest version currently available dates to the 11 century of the Common Era
Common Era
Common Era ,abbreviated as CE, is an alternative designation for the calendar era originally introduced by Dionysius Exiguus in the 6th century, traditionally identified with Anno Domini .Dates before the year 1 CE are indicated by the usage of BCE, short for Before the Common Era Common Era...

).

Acupuncture's origins in China are uncertain. One explanation is that some soldiers wounded in battle by arrow
Arrow
An arrow is a shafted projectile that is shot with a bow. It predates recorded history and is common to most cultures.An arrow usually consists of a shaft with an arrowhead attached to the front end, with fletchings and a nock at the other.- History:...

s were believed to have been cured of chronic afflictions that were otherwise untreated, and there are variations on this idea. Sharpened stones known as Bian shi have been found in China
China
Chinese civilization may refer to:* China for more general discussion of the country.* Chinese culture* Greater China, the transnational community of ethnic Chinese.* History of China* Sinosphere, the area historically affected by Chinese culture...

, suggesting the practice may date to the Neolithic
Neolithic
The Neolithic Age, Era, or Period, or New Stone Age, was a period in the development of human technology, beginning about 9500 BC in some parts of the Middle East, and later in other parts of the world. It is traditionally considered as the last part of the Stone Age...

 or possibly even earlier in the Stone Age
Stone Age
The Stone Age is a broad prehistoric period, lasting about 2.5 million years , during which humans and their predecessor species in the genus Homo, as well as the earlier partly contemporary genera Australopithecus and Paranthropus, widely used exclusively stone as their hard material in the...

. Hieroglyphs and pictographs
Pictogram
A pictograph, also called pictogram or pictogramme is an ideogram that conveys its meaning through its pictorial resemblance to a physical object. Pictographs are often used in writing and graphic systems in which the characters are to considerable extent pictorial in appearance.Pictography is a...

 have been found dating from the Shang Dynasty
Shang Dynasty
The Shang Dynasty or Yin Dynasty was, according to traditional sources, the second Chinese dynasty, after the Xia. They ruled in the northeastern regions of the area known as "China proper" in the Yellow River valley...

 (1600–1100 BCE) which suggest that acupuncture was practiced along with moxibustion
Moxibustion
Moxibustion is a traditional Chinese medicine therapy using moxa, or mugwort herb. It plays an important role in the traditional medical systems of China, Japan, Korea, Vietnam, Tibet, and Mongolia. Suppliers usually age the mugwort and grind it up to a fluff; practitioners burn the fluff or...

. It has also been suggested that acupuncture has its origins in bloodletting
Bloodletting
Bloodletting is the withdrawal of often little quantities of blood from a patient to cure or prevent illness and disease. Bloodletting was based on an ancient system of medicine in which blood and other bodily fluid were considered to be "humors" the proper balance of which maintained health...

 or demonology.

Despite improvements in metallurgy
Metallurgy
Metallurgy is a domain of materials science that studies the physical and chemical behavior of metallic elements, their intermetallic compounds, and their mixtures, which are called alloys. It is also the technology of metals: the way in which science is applied to their practical use...

 over centuries, it was not until the 2nd century BCE during the Han Dynasty
Han Dynasty
The Han Dynasty was the second imperial dynasty of China, preceded by the Qin Dynasty and succeeded by the Three Kingdoms . It was founded by the rebel leader Liu Bang, known posthumously as Emperor Gaozu of Han. It was briefly interrupted by the Xin Dynasty of the former regent Wang Mang...

 that stone and bone needles were replaced with metal. The earliest records of acupuncture is in the Shiji (史記, in English, Records of the Grand Historian
Records of the Grand Historian
The Records of the Grand Historian, also known in English by the Chinese name Shiji , written from 109 BC to 91 BC, was the Magnum opus of Sima Qian, in which he recounted Chinese history from the time of the Yellow Emperor until his own time...

) with references in later medical texts that are equivocal, but could be interpreted as discussing acupuncture. The earliest Chinese medical text to describe acupuncture is the Huangdi Neijing, the legendary Yellow Emperor
Yellow Emperor
The Yellow Emperor or Huangdi1 is a legendary Chinese sovereign and culture hero, included among the Three Sovereigns and Five Emperors. Tradition holds that he reigned from 2697–2597 or 2696–2598 BC...

's Classic of Internal Medicine (History of Acupuncture) which was compiled around 305–204 BCE.

The Huangdi Neijing does not distinguish between acupuncture and moxibustion and gives the same indication for both treatments. The Mawangdui texts, which also date from the 2nd century BCE (though antedating both the Shiji and Huangdi Neijing), mention the use of pointed stones to open abscess
Abscess
An abscess is a collection of pus that has accumulated in a cavity formed by the tissue in which the pus resides due to an infectious process or other foreign materials...

es, and moxibustion but not acupuncture. However, by the 2nd century BCE, acupuncture replaced moxibustion as the primary treatment of systemic conditions.

In Europe, examinations of the 5,000-year-old mummified body of Ötzi the Iceman
Ötzi the Iceman
Ötzi the Iceman , Similaun Man, and Man from Hauslabjoch are modern names for a well-preserved natural mummy of a man who lived about 5,300 years ago. The mummy was found in September 1991 in the Ötztal Alps, near Hauslabjoch on the border between Austria and Italy. The nickname comes from the...

 have identified 15 groups of tattoo
Tattoo
A tattoo is made by inserting indelible ink into the dermis layer of the skin to change the pigment. Tattoos on humans are a type of body modification, and tattoos on other animals are most commonly used for identification purposes...

s on his body, some of which are located on what are now seen as contemporary acupuncture points. This has been cited as evidence that practices similar to acupuncture may have been practiced elsewhere in Eurasia
Eurasia
Eurasia is a continent or supercontinent comprising the traditional continents of Europe and Asia ; covering about 52,990,000 km2 or about 10.6% of the Earth's surface located primarily in the eastern and northern hemispheres...

 during the early Bronze Age
Bronze Age
The Bronze Age is a period characterized by the use of copper and its alloy bronze as the chief hard materials in the manufacture of some implements and weapons. Chronologically, it stands between the Stone Age and Iron Age...

.

Middle history

Korea is believed to be the first country acupuncture spread to outside of China. Within Korea there is a legend that acupuncture was developed by the legendary emperor Dangun
Dangun
Dangun Wanggeom was the legendary founder of Gojoseon, the first Korean kingdom, around present-day Liaoning, Manchuria, and the Korean Peninsula. He is said to be the "grandson of heaven", and to have founded the kingdom in 2333 BC...

 though it is more likely brought into Korea from a Chinese colonial prefecture.

Around ninety works on acupuncture were written in China between the Han Dynasty
Han Dynasty
The Han Dynasty was the second imperial dynasty of China, preceded by the Qin Dynasty and succeeded by the Three Kingdoms . It was founded by the rebel leader Liu Bang, known posthumously as Emperor Gaozu of Han. It was briefly interrupted by the Xin Dynasty of the former regent Wang Mang...

 and the Song Dynasty
Song Dynasty
The Song Dynasty was a ruling dynasty in China between 960 and 1279; it succeeded the Five Dynasties and Ten Kingdoms Period, and was followed by the Yuan Dynasty. It was the first government in world history to issue banknotes or paper money, and the first Chinese government to establish a...

, and the Emperor Renzong of Song
Emperor Renzong of Song
Emperor Renzong was the fourth emperor of the Song Dynasty of China. His personal name was Zhao Zhen . He reigned from 1022 to 1063. Renzong was the son of Emperor Zhenzong of Song. Despite his long reign of over 40 years, Renzong is not widely known...

, in 1023, ordered the production of a bronze statuette depicting the meridians and acupuncture points then in use. However, after the end of the Song Dynasty, acupuncture lost status, and started to be seen as a technical profession, in comparison to the more scholarly profession of herbalism. It became rarer in the following centuries, and was associated with less prestigious practices like alchemy
Alchemy
Alchemy is an influential philosophical tradition whose early practitioners’ claims to profound powers were known from antiquity. The defining objectives of alchemy are varied; these include the creation of the fabled philosopher's stone possessing powers including the capability of turning base...

, shamanism
Shamanism
Shamanism is an anthropological term referencing a range of beliefs and practices regarding communication with the spiritual world. To quote Eliade: "A first definition of this complex phenomenon, and perhaps the least hazardous, will be: shamanism = technique of ecstasy." Shamanism encompasses the...

, midwifery
Midwifery
Midwifery is a health care profession in which providers offer care to childbearing women during pregnancy, labour and birth, and during the postpartum period. They also help care for the newborn and assist the mother with breastfeeding....

 and moxibustion
Moxibustion
Moxibustion is a traditional Chinese medicine therapy using moxa, or mugwort herb. It plays an important role in the traditional medical systems of China, Japan, Korea, Vietnam, Tibet, and Mongolia. Suppliers usually age the mugwort and grind it up to a fluff; practitioners burn the fluff or...

.

Portuguese
Portuguese Empire
The Portuguese Empire , also known as the Portuguese Overseas Empire or the Portuguese Colonial Empire , was the first global empire in history...

 missionaries in the 16th century were among the first to bring reports of acupuncture to the West. Jacob de Bondt, a Dutch surgeon
Surgeon
In medicine, a surgeon is a specialist in surgery. Surgery is a broad category of invasive medical treatment that involves the cutting of a body, whether human or animal, for a specific reason such as the removal of diseased tissue or to repair a tear or breakage...

 traveling in Asia, described the practice in both Japan
Japan
Japan is an island nation in East Asia. Located in the Pacific Ocean, it lies to the east of the Sea of Japan, China, North Korea, South Korea and Russia, stretching from the Sea of Okhotsk in the north to the East China Sea and Taiwan in the south...

 and Java
Java
Java is an island of Indonesia. With a population of 135 million , it is the world's most populous island, and one of the most densely populated regions in the world. It is home to 60% of Indonesia's population. The Indonesian capital city, Jakarta, is in west Java...

. However, in China itself the practice was increasingly associated with the lower-classes and illiterate practitioners.

In 1674, Hermann Buschoff, a Dutch priest in Batavia, published the first book on moxibustion (from Japanese mogusa) for the cure of arthritis. The first elaborate Western treatise on acupuncture was published in 1683 by Willem ten Rhijne, a Dutch physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...

 who had worked at the Dutch trading post Dejima
Dejima
was a small fan-shaped artificial island built in the bay of Nagasaki in 1634. This island, which was formed by digging a canal through a small peninsula, remained as the single place of direct trade and exchange between Japan and the outside world during the Edo period. Dejima was built to...

 in Nagasaki
Nagasaki
is the capital and the largest city of Nagasaki Prefecture on the island of Kyushu in Japan. Nagasaki was founded by the Portuguese in the second half of the 16th century on the site of a small fishing village, formerly part of Nishisonogi District...

 for two years. In 1757 the physician Xu Daqun described the further decline of acupuncture, saying it was a lost art, with few experts to instruct; its decline was attributed in part to the popularity of prescriptions and medications, as well as its association with the lower classes.

In 1822, an edict from the Chinese Emperor banned the practice and teaching of acupuncture within the Imperial Academy of Medicine outright, as unfit for practice by gentlemen-scholars. At this point, acupuncture was still cited in Europe with both skepticism and praise, with little study and only a small amount of experimentation.

Modern era

In the early years after the Chinese Civil War
Chinese Civil War
The Chinese Civil War was a civil war fought between the Kuomintang , the governing party of the Republic of China, and the Communist Party of China , for the control of China which eventually led to China's division into two Chinas, Republic of China and People's Republic of...

, Chinese Communist Party
Communist Party of China
The Communist Party of China , also known as the Chinese Communist Party , is the founding and ruling political party of the People's Republic of China...

 leaders ridiculed traditional Chinese medicine, including acupuncture, as superstitious, irrational and backward, claiming that it conflicted with the Party's dedication to science
Science
Science is a systematic enterprise that builds and organizes knowledge in the form of testable explanations and predictions about the universe...

 as the way of progress. Communist Party Chairman Mao Zedong
Mao Zedong
Mao Zedong, also transliterated as Mao Tse-tung , and commonly referred to as Chairman Mao , was a Chinese Communist revolutionary, guerrilla warfare strategist, Marxist political philosopher, and leader of the Chinese Revolution...

 later reversed this position, saying that "Chinese medicine and pharmacology are a great treasure house and efforts should be made to explore them and raise them to a higher level." Under Mao's leadership, in response to the lack of modern medical practitioners, acupuncture was revived and its theory rewritten to adhere to the political, economic and logistic necessities of providing for the medical needs of China's population. Despite Mao proclaiming the practice of Chinese medicine to be "scientific", the practice was based more on the materialist
Materialism
In philosophy, the theory of materialism holds that the only thing that exists is matter; that all things are composed of material and all phenomena are the result of material interactions. In other words, matter is the only substance...

 assumptions of Marxism
Marxism
Marxism is an economic and sociopolitical worldview and method of socioeconomic inquiry that centers upon a materialist interpretation of history, a dialectical view of social change, and an analysis and critique of the development of capitalism. Marxism was pioneered in the early to mid 19th...

 in opposition to superstition rather than the Western
Western culture
Western culture, sometimes equated with Western civilization or European civilization, refers to cultures of European origin and is used very broadly to refer to a heritage of social norms, ethical values, traditional customs, religious beliefs, political systems, and specific artifacts and...

 practice of empirical investigation of nature. Later the 1950s TCM's theory was again rewritten at Mao's insistence as a political response to the lack of unity between scientific and traditional Chinese medicine, and to correct the supposed "bourgeois thought of Western doctors of medicine" (p. 109).

Acupuncture gained attention in the United States when President Richard Nixon
Richard Nixon
Richard Milhous Nixon was the 37th President of the United States, serving from 1969 to 1974. The only president to resign the office, Nixon had previously served as a US representative and senator from California and as the 36th Vice President of the United States from 1953 to 1961 under...

 visited China in 1972. During one part of the visit, the delegation was shown a patient undergoing major surgery while fully awake, ostensibly receiving acupuncture rather than anesthesia
Anesthesia
Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...

. Later it was found that the patients selected for the surgery had both a high pain tolerance
Pain tolerance
Pain tolerance is the maximum level of pain that a person is able to tolerate. Pain tolerance is distinct from pain threshold .-Factors affecting pain tolerance:...

 and received heavy indoctrination before the operation; these demonstration cases were also frequently receiving morphine
Morphine
Morphine is a potent opiate analgesic medication and is considered to be the prototypical opioid. It was first isolated in 1804 by Friedrich Sertürner, first distributed by same in 1817, and first commercially sold by Merck in 1827, which at the time was a single small chemists' shop. It was more...

 surreptitiously through an intravenous drip
Intravenous therapy
Intravenous therapy or IV therapy is the infusion of liquid substances directly into a vein. The word intravenous simply means "within a vein". Therapies administered intravenously are often called specialty pharmaceuticals...

 that observers were told contained only fluids and nutrients.

The greatest exposure in the West came when New York Times reporter James Reston
James Reston
James Barrett Reston , nicknamed "Scotty," was an American journalist whose career spanned the mid 1930s to the early 1990s. He was associated for many years with the New York Times.-Life:...

, who accompanied Nixon during the visit, received acupuncture in China for post-operative pain after undergoing an emergency appendectomy under standard anesthesia. Reston experienced pain relief from the acupuncture and wrote it in The New York Times. In 1973 the American Internal Revenue Service
Internal Revenue Service
The Internal Revenue Service is the revenue service of the United States federal government. The agency is a bureau of the Department of the Treasury, and is under the immediate direction of the Commissioner of Internal Revenue...

 allowed acupuncture to be deducted as a medical expense.

In 2006, a BBC
BBC
The British Broadcasting Corporation is a British public service broadcaster. Its headquarters is at Broadcasting House in the City of Westminster, London. It is the largest broadcaster in the world, with about 23,000 staff...

 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 weak anesthetics that in combination could have a much more powerful effect. The program was also criticized for its fanciful interpretation of the results of a brain scanning experiment.

The use of acupuncture as anesthesia for surgery has fallen out of favor with scientifically trained surgeons in China. A delegation of the Committee for Skeptical Inquiry reported in 1995: We were not shown acupuncture anesthesia for surgery, this apparently having fallen out of favor with scientifically trained surgeons. Dr. Han, for instance, had been emphatic that he and his colleagues see acupuncture only as an analgesic (pain reducer), not an anesthetic (an agent that blocks all conscious sensations).

Theory

The general theory of acupuncture is based on the premise that bodily functions are regulated by an energy called qi
Qi
In traditional Chinese culture, qì is an active principle forming part of any living thing. Qi is frequently translated as life energy, lifeforce, or energy flow. Qi is the central underlying principle in traditional Chinese medicine and martial arts...

 which flows through the body; disruptions of this flow are believed to be responsible for disease. Acupuncture describes a family of procedures aiming to correct imbalances in the flow of qi by stimulation of anatomical locations on or under the skin (usually called acupuncture points or acupoints), by a variety of techniques. The most common mechanism of stimulation of acupuncture points employs penetration of the skin by thin metal needles, which are manipulated manually or by electrical stimulation.

Qi, meridians and acupuncture points

Traditional Chinese medicine
Traditional Chinese medicine
Traditional Chinese Medicine refers to a broad range of medicine practices sharing common theoretical concepts which have been developed in China and are based on a tradition of more than 2,000 years, including various forms of herbal medicine, acupuncture, massage , exercise , and dietary therapy...

 distinguishes not only one but several different kinds of qi
Qi
In traditional Chinese culture, qì is an active principle forming part of any living thing. Qi is frequently translated as life energy, lifeforce, or energy flow. Qi is the central underlying principle in traditional Chinese medicine and martial arts...

 (氣). In a general sense, qi is something that is defined by five "cardinal functions":
  1. Actuation (推動, tuīdòng) - of all physical processes in the body, especially the circulation of all body fluids such as blood in their vessels. This includes actuation of the functions of the zang-fu organs and meridians
    Meridian (Chinese medicine)
    The meridian is a path through which the life-energy known as "qi" is believed to flow, in traditional Chinese medicine. There is no physically verifiable anatomical or histological basis for the existence of acupuncture points or meridians.- Main concepts :...

    .
  2. Warming (溫煦) - the body, especially the limbs.
  3. Defense (防御) - against Exogenous Pathogenic Factors
  4. Containment (固攝) - of body fluids, i.e. keeping blood, sweat, urine, semen etc. from leakage or excessive emission.
  5. Transformation (氣化) - of food, drink, and breath into qi, xue (blood), and jinye (“fluids”), and/or transformation of all of the latter into each other.


To fulfill its functions, qi has to steadily flow from the inside of the body (where the zang-fu organs are located) to the "superficial" body tissues of the skin, muscles, tendons, bones, and joints. It is assisted in its flow by "channels" referred to as meridians
Meridian (Chinese medicine)
The meridian is a path through which the life-energy known as "qi" is believed to flow, in traditional Chinese medicine. There is no physically verifiable anatomical or histological basis for the existence of acupuncture points or meridians.- Main concepts :...

 (经络). TCM identifies 12 "regular" and 8 "extraordinary" meridians; the Chinese terms being 十二经脉 and 奇经八脉 respectively. There's also a number of less customary channels branching off from the "regular" meridians. No contemporary research has supported the existence of qi or meridians. The meridians are believed to connect to the bodily organs
Organ (anatomy)
In biology, an organ is a collection of tissues joined in structural unit to serve a common function. Usually there is a main tissue and sporadic tissues . The main tissue is the one that is unique for the specific organ. For example, main tissue in the heart is the myocardium, while sporadic are...

, of which those considered hollow organs (such as the stomach and intestines) were also considered yang while those considered solid (such as the liver and lungs) were considered yin. They were also symbolically linked to the rivers found in ancient China, such as the Yangtze
Yangtze River
The Yangtze, Yangzi or Cháng Jiāng is the longest river in Asia, and the third-longest in the world. It flows for from the glaciers on the Tibetan Plateau in Qinghai eastward across southwest, central and eastern China before emptying into the East China Sea at Shanghai. It is also one of the...

, Wei
Wei River
The Wei River is a major river in west-central China's Gansu and Shaanxi provinces. It is the largest tributary of the Yellow River and very important in the early development of Chinese civilization....

and Yellow River
Yellow River
The Yellow River or Huang He, formerly known as the Hwang Ho, is the second-longest river in China and the sixth-longest in the world at the estimated length of . Originating in the Bayan Har Mountains in Qinghai Province in western China, it flows through nine provinces of China and empties into...

s.

Acupuncture points are mainly (but not always) found at specified locations along the meridians. There also is a number of acupuncture points with specified locations outside of the meridians; these are called "extraordinary" points and often credited with special therapeutic properties. A third category of acupuncture points called "A-shi" points have no fixed location but represent tender or reflexive points appearing in the course of pain syndromes. The actual number of points have varied considerably over time, initially they were considered to number 365, symbolically aligning with the number of days in the year (and in Han
Han Dynasty
The Han Dynasty was the second imperial dynasty of China, preceded by the Qin Dynasty and succeeded by the Three Kingdoms . It was founded by the rebel leader Liu Bang, known posthumously as Emperor Gaozu of Han. It was briefly interrupted by the Xin Dynasty of the former regent Wang Mang...

 times, the number of bones thought to be in the body). The Huangdi Neijing mentioned only 160 and a further 135 could be deduced giving a total of 295. The modern total was once considered 670 but subsequently expanded due to more recent interest in auricular (ear) acupuncture and the treatment of further conditions. In addition, it is considered likely that some points used historically have since ceased being used.

TCM concept of disease

In TCM, disease is generally perceived as a disharmony (or imbalance) in the functions or interactions of yin, yang, qi, xuĕ, zàng-fǔ, meridians etc. and/or of the interaction between the human body and the environment. Therapy is based on which "pattern of disharmony" can be identified. In the case of the meridians, typical disease patterns are invasions with wind, cold and damp Excesses.

In order to determine which pattern is at hand, practitioners will examine things like the color and shape of the tongue, the relative strength of pulse-points, the smell of the breath, the quality of breathing or the sound of the voice.

TCM and its concept of disease do not strongly differentiate between cause and effect. In theory, however, endogenous, exogenous and miscellaneous causes of disease are recognized.

Traditional diagnosis

The acupuncturist decides which points to treat by observing and questioning the patient in order to make a diagnosis according to the tradition which he or she utilizes. In TCM, there are four diagnostic methods: inspection, auscultation and olfaction, inquiring, and palpation.
  • Inspection focuses on the face and particularly on the tongue, including analysis of the tongue size, shape, tension, color and coating, and the absence or presence of teeth marks around the edge.
  • Auscultation and olfaction refer, respectively, to listening for particular sounds (such as wheezing) and attending to body odor.
  • Inquiring focuses on the "seven inquiries", which are: chills and fever; perspiration; appetite, thirst and taste; defecation and urination; pain; sleep; and menses and leukorrhea
    Leukorrhea
    Leukorrhea or leucorrhoea is a medical term that denotes a thick, whitish or yellowish vaginal discharge.There are many causes of leukorrhea, the usual one being estrogen imbalance...

    .
  • Palpation includes feeling the body for tender A-shi points, and palpation of the left and right radial pulses at two levels of pressure (superficial and deep) and three positions Cun, Guan, Chi (immediately proximal to the wrist crease, and one and two fingers' breadth proximally, usually palpated with the index, middle and ring fingers).

Tongue and pulse

Examination of the tongue and the pulse are among the principal diagnostic methods in traditional Chinese medicine. The surface of the tongue is believed to contain a map of the entire body, and is used to determine acupuncture points to manipulate. For example, teeth marks on one part of the tongue might indicate a problem with the heart, while teeth marks on another part of the tongue might indicate a problem with the liver. TCM diagnosis also involves measuring for three superficial and three deep pulse
Pulse
In medicine, one's pulse represents the tactile arterial palpation of the heartbeat by trained fingertips. The pulse may be palpated in any place that allows an artery to be compressed against a bone, such as at the neck , at the wrist , behind the knee , on the inside of the elbow , and near the...

s at different locations on the radial artery
Radial artery
In human anatomy, the radial artery is the main blood vessel, with oxygenated blood, of the lateral aspect of the forearm.-Course:The radial artery arises from the bifurcation of the brachial artery in the cubital fossa. It runs distally on the anterior part of the forearm...

 of each arm, for a total of twelve pulses that are thought to correspond to twelve internal organs. The pulse is examined for several characteristics including rhythm, strength and volume, and described with terms like "floating, slippery, bolstering-like, feeble, thready and quick", which are used to ascribe a specific imbalance in the body. Learning TCM pulse diagnosis can take several years.

Clinical practice

In a modern acupuncture session, an initial consultation is followed by taking the pulse on both arms, and an inspection of the tongue. Classically, in clinical practice, acupuncture is highly individualized and based on philosophy and intuition, and not on controlled scientific research. In the United States, acupuncture typically lasts from 10 to 60 minutes, with diagnosis
Diagnosis
Diagnosis is the identification of the nature and cause of anything. Diagnosis is used in many different disciplines with variations in the use of logics, analytics, and experience to determine the cause and effect relationships...

 and treatment for a single session ranging from $25 to $80 in 2011. Sometimes needles are left in the ear for up to 3 days.

Clinical practice varies depending on the country. A comparison of the average number of patients treated per hour found significant differences between China (10) and the United States (1.2). Aucpuncture is used to treat various type of pain, neurological problems and stroke
Stroke
A stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...

 rehabilitation. Studies conducted in China and Brazil found that the majority of patients were female, though in one study the majority of Chinese patients using acupuncture for stroke rehabilitation were male.

Needles

Acupuncture needles are typically made of stainless steel wire. They are usually disposable, but reusable needles are sometimes used as well, though they must be sterilized between uses. Needles vary in length between 13 to 130 mm (0.511811023622047 to 5.1 in), with shorter needles used near the face and eyes, and longer needles in more fleshy areas; needle diameters vary from 00.16 mm (0.0062992125984252 in) to 00.46 mm (0.0181102362204724 in), with thicker needles used on more robust patients. Thinner needles may be flexible and require tubes for insertion. The tip of the needle should not be made too sharp to prevent breakage, although blunt needles cause more pain.

Apart from the usual filiform needle, there also other needle types which can be utilized, such as three-edged needles and the Nine Ancient Needles. Japanese acupuncturists use extremely thin needles that are used superficially, sometimes without penetrating the skin, and surrounded by a guide tube (a technique adopted in China and the West). Korea
Korea
Korea ) is an East Asian geographic region that is currently divided into two separate sovereign states — North Korea and South Korea. Located on the Korean Peninsula, Korea is bordered by the People's Republic of China to the northwest, Russia to the northeast, and is separated from Japan to the...

n acupuncture uses copper
Copper
Copper is a chemical element with the symbol Cu and atomic number 29. It is a ductile metal with very high thermal and electrical conductivity. Pure copper is soft and malleable; an exposed surface has a reddish-orange tarnish...

 needles and has a greater focus on the hand.

Insertion

Since most pain is felt in the superficial layers of the skin, a quick insertion of the needle is recommended. If skilled enough, a practitioner purportedly can insert the needles without causing any pain.

Both peer-reviewed medical journals, and acupuncture journals reviewed by acupuncturists, have published on the painfulness of acupuncture treatments, in some cases within the context of reporting studies testing acupuncture’s effectiveness. A peer-reviewed medical journal on pain published an article stating that "acupuncture is a painful and unpleasant treatment". There are other cases in which patients have found the insertion of needles in acupuncture too painful to endure. An acupuncture journal, peer-reviewed by acupuncturists, published an article describing insertion of needles in TCM acupuncture and random needling acupuncture as “painful stimulation”. In a peer-reviewed medical journal, one medical scientist published that Japanese acupuncture is “far less painful” than Chinese acupuncture, and that Japanese acupuncture needles are smaller than Chinese acupuncture needles.

De-qi sensation

De-qi refers to a sensation of numbness, distension, or electrical tingling at the needling site which might radiate along the corresponding meridian. If it can not be generated, inaccurate location of the acupoint, improper depth of needle insertion, inadequate manipulation, or a very weak constitution of the patient have to be considered, all of which decrease the likelihood of successful treatment. If de-qi sensation doesn't immediately occur upon needle insertion, various manipulation techniques can be applied to promote it (such as "plucking", "shaking" or "trembling"). Once it is achieved, further 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. Other techniques aim at "tonifying" or "sedating" qi. The former techniques are used in vacuity patterns, the latter in repletion patterns.

De qi is more important in Chinese acupuncture, while Western and Japanese patients may not consider it a necessary part of the treatment.

Related practices

  • Moxibustion
    Moxibustion
    Moxibustion is a traditional Chinese medicine therapy using moxa, or mugwort herb. It plays an important role in the traditional medical systems of China, Japan, Korea, Vietnam, Tibet, and Mongolia. Suppliers usually age the mugwort and grind it up to a fluff; practitioners burn the fluff or...

    – Acupuncture is often accompanied by moxibustion, the burning of cone-shaped preparations of Artemisia vulgaris
    Artemisia vulgaris
    Artemisia vulgaris is one of several species in the genus Artemisia which have common names that include the word mugwort. This species is also occasionally known as Felon Herb, Chrysanthemum Weed, Wild Wormwood, Old uncle Henry, Sailor's Tobacco, Naughty Man, Old Man or St...

    (mugwort) on or near the skin, often but not always near or on an acupuncture point. Traditionally acupuncture was used to treat acute conditions
    Acute (medicine)
    In medicine, an acute disease is a disease with either or both of:# a rapid onset, as in acute infection# a short course ....

     while moxibustion was used for chronic diseases
    Chronic (medicine)
    A chronic disease is a disease or other human health condition that is persistent or long-lasting in nature. The term chronic is usually applied when the course of the disease lasts for more than three months. Common chronic diseases include asthma, cancer, diabetes and HIV/AIDS.In medicine, the...

    . 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 mugwort was placed on a slice of garlic, ginger or other vegetable, or a cylinder of mugwort was held above the skin, close enough to either warm or burn it).
  • Fire cupping
    Fire cupping
    Cupping therapy is an ancient 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. Suction is created using heat or mechanical devices...

  • Tuina (also known as acupressure) is a TCM method of attempting to stimulate the flow of qi by various bare handed techniques.
  • Electroacupuncture
    Electroacupuncture
    Electroacupuncture is a form of acupuncture where a small electric current is passed between pairs of acupuncture needles. Another term is Percutaneous Electrical Nerve Stimulation ....

    is a form of acupuncture in which acupuncture needles are attached to a device that generates continuous electric pulses. Another term is percutaneous electrical nerve stimulation.
  • Sonopuncture or acutonics is a stimulation of the body similar to acupuncture, but using sound instead of needles. This may be done using purpose-built transducers to direct a narrow ultrasound
    Ultrasound
    Ultrasound is cyclic sound pressure with a frequency greater than the upper limit of human hearing. Ultrasound is thus not separated from "normal" sound based on differences in physical properties, only the fact that humans cannot hear it. Although this limit varies from person to person, it is...

     beam to a depth of 6–8 centimetres at acupuncture meridian
    Meridian (Chinese medicine)
    The meridian is a path through which the life-energy known as "qi" is believed to flow, in traditional Chinese medicine. There is no physically verifiable anatomical or histological basis for the existence of acupuncture points or meridians.- Main concepts :...

     points on the body. Alternatively, tuning fork
    Tuning fork
    A tuning fork is an acoustic resonator in the form of a two-pronged fork with the prongs formed from a U-shaped bar of elastic metal . It resonates at a specific constant pitch when set vibrating by striking it against a surface or with an object, and emits a pure musical tone after waiting a...

    s or other sound emitting devices are used.
  • Acupuncture point injection is the injection of various substances (such as drugs, vitamin
    Vitamin
    A vitamin is an organic compound required as a nutrient in tiny amounts by an organism. In other words, an organic chemical compound is called a vitamin when it cannot be synthesized in sufficient quantities by an organism, and must be obtained from the diet. Thus, the term is conditional both on...

    s or herbal extract
    Herbal extract
    Tincture is a liquid solution of herbs and a fluid menstruum, usually ethanol. The dried or fresh herbs are combined with alcohol, then the solid matter is removed leaving only the oils of the herbs mixed with the alcohol...

    s into acupuncture point
    Acupuncture point
    Acupuncture points are locations on the body that are the focus of acupuncture, acupressure, sonopuncture and laser acupuncture treatment. Several hundred acupuncture points are considered to be located along meridians...

    .
  • Ear acupuncture
    Auriculotherapy
    Auriculotherapy, or auricular therapy, or ear acupuncture, or auriculoacupuncture is a form of alternative medicine based on the idea that the ear is a microsystem of the entire body represented on the auricle, the outer portion of the ear. Ailments of the entire body are assumed to be treatable...

    is a form of acupuncture developed in France which is based on the assumption of reflexological
    Reflexology
    Reflexology, or zone therapy, is an alternative medicine involving the physical act of applying pressure to the feet, hands, or ears with specific thumb, finger, and hand techniques without the use of oil or lotion...

     representation of the entire body in the outer ear
    Outer ear
    The outer ear is the external portion of the ear, which consists of the pinna, concha, and external auditory meatus. It gathers sound energy and focuses it on the eardrum . One consequence of the configuration of the external ear is to selectively boost the sound pressure 30- to 100-fold for...

    .
  • Scalp acupuncture is likewise based on reflexological
    Reflexology
    Reflexology, or zone therapy, is an alternative medicine involving the physical act of applying pressure to the feet, hands, or ears with specific thumb, finger, and hand techniques without the use of oil or lotion...

     considerations regarding the scalp
    Scalp
    The scalp is the anatomical area bordered by the face anteriorly and the neck to the sides and posteriorly.-Layers:It is usually described as having five layers, which can conveniently be remembered as a mnemonic:...

     area; it has been developed in Japan.
  • Hand acupuncture similarly centers around assumed reflex zones
    Reflexology
    Reflexology, or zone therapy, is an alternative medicine involving the physical act of applying pressure to the feet, hands, or ears with specific thumb, finger, and hand techniques without the use of oil or lotion...

     of the hand; it has been developed in Korea.
  • Medical acupuncture tries to integrate reflexological concepts, the trigger point
    Trigger point
    Trigger points, also known as trigger sites or muscle knots, are described as hyperirritable spots in skeletal muscle that are associated with palpable nodules in taut bands of muscle fibers. Trigger point practitioners believe that palpable nodules are small contraction knots and a common cause of...

     model, and anatomical insights (such as dermatome distribution) into acupuncture practice, and emphasizes a more formulaic approach to acupuncture point location.
  • Cosmetic acupuncture is the use of acupuncture in an attempt to reduce wrinkles on the face.

Effectiveness for specific conditions

Professor of Complementary and Alternative Medicine Edzard Ernst
Edzard Ernst
Edzard Ernst is the first Professor of Complementary Medicine in the world, at the University of Exeter, England....

 and his colleagues have produced regular systematic review
Systematic review
A systematic review is a literature review focused on a research question that tries to identify, appraise, select and synthesize all high quality research evidence relevant to that question. Systematic reviews of high-quality randomized controlled trials are crucial to evidence-based medicine...

s of the acupuncture literature. In 2007, they concluded that "the emerging clinical evidence seems to imply that acupuncture is effective for some but not all conditions." Several review article
Review article
Review articles are an attempt to summarize the current state of understanding on a topic. They analyze or discuss research previously published by others, rather than reporting new experimental results....

s discussing the effectiveness of acupuncture have concluded that its effects may be due to placebo
Placebo
A placebo is a simulated or otherwise medically ineffectual treatment for a disease or other medical condition intended to deceive the recipient...

. Evidence for the treatment of psychological conditions other than pain is equivocal. Acupuncture's greatest effectiveness appears to be in symptom
Symptom
A symptom is a departure from normal function or feeling which is noticed by a patient, indicating the presence of disease or abnormality...

atic control of pain
Pain
Pain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...

 and nausea
Nausea
Nausea , is a sensation of unease and discomfort in the upper stomach with an involuntary urge to vomit. It often, but not always, precedes vomiting...

.

Pain

A 2009 review of the highest quality clinical trials of acupuncture in the treatment of pain, published in the British Medical Journal
British Medical Journal
BMJ is a partially open-access peer-reviewed medical journal. Originally called the British Medical Journal, the title was officially shortened to BMJ in 1988. The journal is published by the BMJ Group, a wholly owned subsidiary of the British Medical Association...

, reported a "small analgesic effect of acupuncture was found, which seems to lack clinical relevance and cannot be clearly distinguished from bias. Whether needling at acupuncture points, or at any site, reduces pain independently of the psychological impact of the treatment ritual is unclear." A 2011 review of fifty seven systematic reviews of the topic, published in the journal of the International Association for the Study of Pain
International Association for the Study of Pain
The International Association for the Study of Pain is an international professional organization promoting research, education and policies for the knowledge and management of pain. The IASP was founded in 1973, following the Seattle-Issaquah conference, under the leadership of John Bonica. Its...

 found there is "little truly convincing evidence that acupuncture is effective in reducing pain." A review of Cochrane Collaboration
Cochrane Collaboration
The Cochrane Collaboration is a group of over 28,000 volunteers in more than 100 countries who review the effects of health care interventions tested in biomedical randomized controlled trials. A few more recent reviews have also studied the results of non-randomized, observational studies...

 articles on pain concluded that "Their results suggest that acupuncture is effective for some but not all types of pain" and singled out migraines, neck disorders, tension headaches, and peripheral joint osteoarthritis as having evidence supporting acupuncture's use, while results were inconclusive for shoulder pain, lateral elbow pain, and low back pain and negative for rheumatoid arthritis. Medical acupuncturist Steven E. Braverman, who separates the "needling" of acupuncture from its theoretical basis within traditional Chinese medicine, stated in 2004 that he believed needling has been successful in treating some pain and recommended acupuncture be considered a complementary therapy for various conditions. Braverman and other medical acupuncturists also stated that definitive conclusions based on research findings were rare because the state of acupuncture research is poor, but that it is improving.

For acute low back pain
Low back pain
Low back pain or lumbago is a common musculoskeletal disorder affecting 80% of people at some point in their lives. In the United States it is the most common cause of job-related disability, a leading contributor to missed work, and the second most common neurological ailment — only headache is...

, there is insufficient evidence to recommend for or against either acupuncture or dry needling
Dry needling
Dry needling is the use of solid filiform needles for therapy of muscle pain, sometimes also known as intramuscular stimulation. The needles are similar to acupuncture needles. Dry needling contrasts with the use of a hollow hypodermic needle to inject substances such as saline solution, botox or...

, though for chronic low back pain, acupuncture is more effective than other CAM treatments, but no more effective than conventional and alternative treatments for short-term pain relief and improving function. However, when combined with other conventional therapies, the combination is slightly better than conventional therapy alone. A review for the American Pain Society/American College of Physicians found fair evidence that acupuncture is effective for chronic low back pain. Conducting research on low back pain is unusually problematic since most patients have experienced "conventional care" – which is itself relatively ineffective – and have low expectations for it. As such, conventional care groups may not be an adequate scientific control
Scientific control
Scientific control allows for comparisons of concepts. It is a part of the scientific method. Scientific control is often used in discussion of natural experiments. For instance, during drug testing, scientists will try to control two groups to keep them as identical and normal as possible, then...

 and may even lead to nocebo
Nocebo
In medicine, a nocebo reaction or response refers to harmful, unpleasant, or undesirable effects a subject manifests after receiving an inert dummy drug or placebo...

 effects that can further inflate of the apparent effectiveness of acupuncture.

There is moderate evidence that for neck pain, acupuncture is more likely to be effective than other CAM treatments and offers short-term improvement compared to those on a waiting list. This is tentatively supported by a recent review.

There is evidence to support the use of acupuncture to treat headache
Headache
A headache or cephalalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck. The brain tissue itself is not sensitive to pain because it lacks pain receptors. Rather, the pain is caused by disturbance of the...

s that are idiopathic
Idiopathic
Idiopathic is an adjective used primarily in medicine meaning arising spontaneously or from an obscure or unknown cause. From Greek ἴδιος, idios + πάθος, pathos , it means approximately "a disease of its own kind". It is technically a term from nosology, the classification of disease...

, though the evidence is not conclusive and more studies need to be conducted. Several trials have indicated that migraine patients benefit from acupuncture, although the correct placement of needles seems to be less relevant than is usually thought by acupuncturists. Overall in these trials acupuncture was associated with slightly better outcomes and fewer adverse effects than prophylactic drug treatment.

There is conflicting evidence that acupuncture may be useful for osteoarthritis
Osteoarthritis
Osteoarthritis also known as degenerative arthritis or degenerative joint disease, is a group of mechanical abnormalities involving degradation of joints, including articular cartilage and subchondral bone. Symptoms may include joint pain, tenderness, stiffness, locking, and sometimes an effusion...

 of the knee, with both positive and negative results. The Osteoarthritis Research Society International released a set of consensus
Consensus (medical)
Medical consensus is a public statement on a particular aspect of medical knowledge available at the time it was written, and that is generally agreed upon as the evidence-based, state-of-the-art knowledge by a representative group of experts in that area...

 recommendations in 2008 that concluded acupuncture may be useful for treating the symptoms of osteoarthritis of the knee. Results for osteoarthritis in other joints suggest insignificant effects in short-term pain relief, which may be due to placebo or expectation effects.

Nausea and vomiting

Stimulation of a particular acupuncture point (P6, located on the underside of the forearm, several finger-widths from the wrist) is traditionally thought to relieve nausea
Nausea
Nausea , is a sensation of unease and discomfort in the upper stomach with an involuntary urge to vomit. It often, but not always, precedes vomiting...

. A 2004 Cochrane Review initially concluded that acupuncture appeared to be more effective than antiemetic
Antiemetic
An antiemetic is a drug that is effective against vomiting and nausea. Antiemetics are typically used to treat motion sickness and the side effects of opioid analgesics, general anaesthetics, and chemotherapy directed against cancer....

 drugs in treating postoperative nausea and vomiting
Postoperative nausea and vomiting
Postoperative nausea and vomiting is an unpleasant complication affecting about a third of the 10% of the population undergoing general anaesthesia each year. This equates to about two million people in the United Kingdom annually.-Impact:...

, but the authors subsequently retracted this conclusion due to a publication bias
Publication bias
Publication bias is the tendency of researchers, editors, and pharmaceutical companies to handle the reporting of experimental results that are positive differently from results that are negative or inconclusive, leading to bias in the overall published literature...

 in Asian countries that had skewed their results. An updated Cochrane Review published in 2009 concluded that both penetrative and non-penetrative stimulation of the P6 acupuncture point was approximately equal to, but not better than, preventive antiemetic drugs for postoperative nausea and vomiting though only 10% of the studies had adequate information on patient blinding regarding receiving standard or nonstandard acupuncture. A 2011 Cochrane Review on the treatment of vomiting after the start of chemotherapy
Chemotherapy
Chemotherapy is the treatment of cancer with an antineoplastic drug or with a combination of such drugs into a standardized treatment regimen....

 concluded that acupuncture point stimulation with needles and electroacupuncture reduced the number times subjects vomited on the day of treatment, but were no help regarding immediate or delayed nausea. Acupressure was found to reduce the short-term severity of nausea, but was no help over the long term and did not influence vomiting. All of the experiments reviewed also used medication to control vomiting, though trials involving electroacupuncture did not use the newest drugs available.

A 2008 review examined randomized controlled trial
Randomized controlled trial
A randomized controlled trial is a type of scientific experiment - a form of clinical trial - most commonly used in testing the safety and efficacy or effectiveness of healthcare services or health technologies A randomized controlled trial (RCT) is a type of scientific experiment - a form of...

s on the effects of the P6 point, as well as points thought to rely on the same meridian, at preventing PONV within the first 24 hours of surgery. Three of the ten studies found statistically significant
Statistical significance
In statistics, a result is called statistically significant if it is unlikely to have occurred by chance. The phrase test of significance was coined by Ronald Fisher....

 evidence that acupuncture could prevent PONV though comparison of the studies is difficult due to the use of varied methodologies (different patient groups, different ways of stimulating the P6 point such as a needle versus finger pressure versus a special bracelet, timing and length of application of pressure, the use of one versus both arms, whether a general anaesthetic
General anaesthetic
A general anaesthetic is a drug that brings about a reversible loss of consciousness. These drugs are generally administered by an anaesthesia provider to induce or maintain general anaesthesia to facilitate surgery...

 was used, and the mixture of men and women in the studies). The reviewer ultimately concluded that "due to the lack of robust studies, [this review] found that neither acupressure nor acupuncture was effective in preventing or managing PONV in adults" and suggested further research to clarify issues such as the length and type of stimulation applied, training of those applying stimulation and gathering data, risk factors for PONV, inclusion of proper placebos, and the analysis of specific population. The author also suggested disagreement with previous systemic reviews were due to their inclusion of older studies with poorer methodologies, while the more recent, better quality studies included in the review offered more negative results.

Fertility and childbirth

Proponents believe acupuncture can assist with fertility
Fertility
Fertility is the natural capability of producing offsprings. As a measure, "fertility rate" is the number of children born per couple, person or population. Fertility differs from fecundity, which is defined as the potential for reproduction...

, pregnancy
Pregnancy
Pregnancy refers to the fertilization and development of one or more offspring, known as a fetus or embryo, in a woman's uterus. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets...

 and childbirth
Childbirth
Childbirth is the culmination of a human pregnancy or gestation period with the birth of one or more newborn infants from a woman's uterus...

, attributing various conditions of health and difficulty with the flow of qi through various meridians.

A 2008 Cochrane review
Cochrane Collaboration
The Cochrane Collaboration is a group of over 28,000 volunteers in more than 100 countries who review the effects of health care interventions tested in biomedical randomized controlled trials. A few more recent reviews have also studied the results of non-randomized, observational studies...

 of randomized controlled trials of in vitro fertilisation
In vitro fertilisation
In vitro fertilisation is a process by which egg cells are fertilised by sperm outside the body: in vitro. IVF is a major treatment in infertility when other methods of assisted reproductive technology have failed...

 and acupuncture suggests that acupuncture performed on the day the embryo is transferred to the uterus may increase the live birth rate, although this effect could be due to the placebo effect and the small number of women included in acceptable trials. There was no evidence of benefit when the egg
Oocyte
An oocyte, ovocyte, or rarely ocyte, is a female gametocyte or germ cell involved in reproduction. In other words, it is an immature ovum, or egg cell. An oocyte is produced in the ovary during female gametogenesis. The female germ cells produce a primordial germ cell which undergoes a mitotic...

 was initially removed and the review did not recommend the routine use of acupuncture during the luteal phase
Luteal phase
The luteal phase is the latter phase of the menstrual cycle or the estrous cycle . It begins with the formation of the corpus luteum and ends in either pregnancy or luteolysis...

 until better trials were available. A different review article published in 2010 found that there was no evidence acupuncture improved pregnancy rates irrespective of when it was performed and recommended against its use during in vitro fertilization either during egg retrieval or implantation.

Lack of effectiveness for other conditions

The Danish
Denmark
Denmark is a Scandinavian country in Northern Europe. The countries of Denmark and Greenland, as well as the Faroe Islands, constitute the Kingdom of Denmark . It is the southernmost of the Nordic countries, southwest of Sweden and south of Norway, and bordered to the south by Germany. Denmark...

 Knowledge and Research Center for Alternative Medicines has a fully updated list of all the Cochrane Collaboration regarding acupuncture and the overall conclusion is:

...the majority of the Cochrane reviews about acupuncture, acupressure, electroacupuncture and moxibustion [concluded] there exists no solid evidence to determine the effectiveness of the treatments. The reviews point out that many of the studies suffer from methodological defects and shortcomings. Furthermore, the number of trial subjects has been limited. Thus most of the overall conclusions are uncertain.


For the following conditions, the Cochrane Collaboration or other review articles have concluded there is insufficient evidence to determine whether acupuncture is beneficial, often because of the paucity and poor quality of the research, and that further research is needed:
  • Chronic asthma
    Asthma
    Asthma is the common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm. Symptoms include wheezing, coughing, chest tightness, and shortness of breath...

  • Bell's palsy
    Bell's palsy
    Bell's palsy is a form of facial paralysis resulting from a dysfunction of the cranial nerve VII that results in the inability to control facial muscles on the affected side. Several conditions can cause facial paralysis, e.g., brain tumor, stroke, and Lyme disease. However, if no specific cause...

  • Cocaine dependence
    Cocaine dependence
    Cocaine dependence is a psychological desire to regularly use cocaine. It can result in cardiovascular and brain damage such as constricting blood vessels in the brain, causing strokes and constricting arteries in the heart, causing heart attacks specifically in the central nervous system.The use...

  • depression
    Clinical depression
    Major depressive disorder is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities...

  • Drug detoxification
  • Primary dysmenorrhoea (incorporating TENS
    Transcutaneous electrical nerve stimulation
    Transcutaneous electrical nerve stimulation is the use of electric current produced by a device to stimulate the nerves for therapeutic purposes...

    )
  • Epilepsy
    Epilepsy
    Epilepsy is a common chronic neurological disorder characterized by seizures. These seizures are transient signs and/or symptoms of abnormal, excessive or hypersynchronous neuronal activity in the brain.About 50 million people worldwide have epilepsy, and nearly two out of every three new cases...

  • Fibromyalgia
    Fibromyalgia
    Fibromyalgia is a medical disorder characterized by chronic widespread pain and allodynia, a heightened and painful response to pressure. It is an example of a diagnosis of exclusion...

  • Glaucoma
    Glaucoma
    Glaucoma is an eye disorder in which the optic nerve suffers damage, permanently damaging vision in the affected eye and progressing to complete blindness if untreated. It is often, but not always, associated with increased pressure of the fluid in the eye...

    ,
  • Insomnia
    Insomnia
    Insomnia is most often defined by an individual's report of sleeping difficulties. While the term is sometimes used in sleep literature to describe a disorder demonstrated by polysomnographic evidence of disturbed sleep, insomnia is often defined as a positive response to either of two questions:...

  • Irritable bowel syndrome
    Irritable bowel syndrome
    Irritable bowel syndrome is a diagnosis of exclusion. It is a functional bowel disorder characterized by chronic abdominal pain, discomfort, bloating, and alteration of bowel habits in the absence of any detectable organic cause. In some cases, the symptoms are relieved by bowel movements...

  • Induction of childbirth
    Childbirth
    Childbirth is the culmination of a human pregnancy or gestation period with the birth of one or more newborn infants from a woman's uterus...

  • Rheumatoid arthritis
    Rheumatoid arthritis
    Rheumatoid arthritis is a chronic, systemic inflammatory disorder that may affect many tissues and organs, but principally attacks synovial joints. The process produces an inflammatory response of the synovium secondary to hyperplasia of synovial cells, excess synovial fluid, and the development...

  • Shoulder pain
  • Schizophrenia
    Schizophrenia
    Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...

  • Smoking cessation
    Smoking cessation
    Smoking cessation is the process of discontinuing the practice of inhaling a smoked substance. This article focuses exclusively on cessation of tobacco smoking; however, the methods described may apply to cessation of smoking other substances that can be difficult to stop using due to the...

  • Acute stroke
    Stroke
    A stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...

     and stroke rehabilitation
    Stroke rehabilitation
    The primary goals of stroke management are to reduce brain injury and promote maximum patient recovery. Rapid detection and appropriate emergency medical care are essential for optimizing health outcomes. When available, patients are admitted to an acute stroke unit for treatment. These units...

  • Tennis elbow
    Tennis elbow
    Lateral epicondylitis or lateral epicondylalgia, also known as tennis elbow, shooter's elbow and archer's elbow, is a condition where the outer part of the elbow becomes sore and tender...

  • Vascular dementia

Scientific basis

Acupuncture has been the subject of active scientific research
Scientific method
Scientific method refers to a body of techniques for investigating phenomena, acquiring new knowledge, or correcting and integrating previous knowledge. To be termed scientific, a method of inquiry must be based on gathering empirical and measurable evidence subject to specific principles of...

 both in regard to its basis and therapeutic effectiveness since the late 20th century, but it remains controversial among medical researchers and clinicians. Research on acupuncture point
Acupuncture point
Acupuncture points are locations on the body that are the focus of acupuncture, acupressure, sonopuncture and laser acupuncture treatment. Several hundred acupuncture points are considered to be located along meridians...

s and meridians
Meridian (Chinese medicine)
The meridian is a path through which the life-energy known as "qi" is believed to flow, in traditional Chinese medicine. There is no physically verifiable anatomical or histological basis for the existence of acupuncture points or meridians.- Main concepts :...

 has not demonstrated their existence or properties. Clinical assessment of acupuncture treatments, due to its invasive and easily detected nature, makes it difficult to use proper scientific control
Scientific control
Scientific control allows for comparisons of concepts. It is a part of the scientific method. Scientific control is often used in discussion of natural experiments. For instance, during drug testing, scientists will try to control two groups to keep them as identical and normal as possible, then...

s for placebo effect
Placebo effect
Placebo effect may refer to:* Placebo effect, the tendency of any medication or treatment, even an inert or ineffective one, to exhibit results simply because the recipient believes that it will work...

s. Positive results from some studies on the efficacy of acupuncture may be as a result of poorly designed studies or publication bias. Edzard Ernst
Edzard Ernst
Edzard Ernst is the first Professor of Complementary Medicine in the world, at the University of Exeter, England....

 and Simon Singh
Simon Singh
Simon Lehna Singh, MBE is a British author who has specialised in writing about mathematical and scientific topics in an accessible manner....

 state that (as the quality of experimental tests of acupuncture have increased over the course of several decades through better blinding, the use of sham needling as a form of placebo control, etc.) the "more that researchers eliminate bias from their trials, the greater the tendency for results to indicate that acupuncture is little more than a placebo." Also complicating reseach on acupuncture is the possibility of a strong publication bias
Publication bias
Publication bias is the tendency of researchers, editors, and pharmaceutical companies to handle the reporting of experimental results that are positive differently from results that are negative or inconclusive, leading to bias in the overall published literature...

 from certain countries; a 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 11 studies conducted in Russia
Russia
Russia or , officially known as both Russia and the Russian Federation , is a country in northern Eurasia. It is a federal semi-presidential republic, comprising 83 federal subjects...

.

Different types of comparison are made in the scientific literature and terminology can vary, therefore care is needed when assessing research. “Acupuncture” may refer only to insertion of needles in traditionally determined acupuncture points; in which case, it is contrasted with randomly inserting needles, which is called a sham treatment, placebo
Placebo
A placebo is a simulated or otherwise medically ineffectual treatment for a disease or other medical condition intended to deceive the recipient...

, needling or medical acupuncture if the points are determined by anatomy and not by TCM. In some sources "acupuncture" refers to random needling with needle insertion, and this is compared to pressing telescoping needles against the skin at the same points but not puncturing the skin, which is called a "sham treatment" or "placebo".

The World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...

 and the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...

' National Institutes of Health
National Institutes of Health
The National Institutes of Health are an agency of the United States Department of Health and Human Services and are the primary agency of the United States government responsible for biomedical and health-related research. Its science and engineering counterpart is the National Science Foundation...

 (NIH) have stated that acupuncture can be effective in the treatment of neurological conditions and pain, though these statements have been criticized for bias and a reliance on studies that used poor methodology. Reports from the USA's National Center for Complementary and Alternative Medicine (NCCAM), the American Medical Association
American Medical Association
The American Medical Association , founded in 1847 and incorporated in 1897, is the largest association of medical doctors and medical students in the United States.-Scope and operations:...

 (AMA) and various USA government reports have studied and commented on the efficacy of acupuncture. There is general agreement that acupuncture is safe when administered by well-trained practitioners using sterile needles, but not on its efficacy as a medical procedure.

Many research studies conclude that "further research is needed", but opinion is divided as to whether this is a good place to spend limited research funds.

Criticism

The National Council Against Health Fraud stated in 1990 that acupuncture’s “theory and practice are based on primitive and fanciful concepts of health and disease that bear no relationship to present scientific knowledge.” In 1993 neurologist Arthur Taub called acupuncture “nonsense with needles.” The website Quackwatch
Quackwatch
Quackwatch is an American non-profit organization founded by Stephen Barrett with the stated aim being to "combat health-related frauds, myths, fads, fallacies, and misconduct" and with a primary focus on providing "quackery-related information that is difficult or impossible to get elsewhere."...

 criticizes TCM as having unproven efficacy and an unsound scientific basis. Physicist John P. Jackson, Steven Salzberg
Steven Salzberg
Steven Salzberg is an American Biologist and Computer Scientist who since 2011 has been a Professor of Medicine and Biostatistics in the Institute of Genetic Medicine at Johns Hopkins School of Medicine...

, director of the Center for Bioinformatics and Computational Biology
Center for Bioinformatics and Computational Biology
The Center for Bioinformatics and Computational Biology is a University of Maryland, College Park multidisciplinary center dedicated to research on questions arising from the genome revolution....

 and professor at the University of Maryland
University of Maryland
When the term "University of Maryland" is used without any qualification, it generally refers to the University of Maryland, College Park.University of Maryland may refer to the following:...

, Yale University professor of neurology, and founder and executive editor of the blog
Blog
A blog is a type of website or part of a website supposed to be updated with new content from time to time. Blogs are usually maintained by an individual with regular entries of commentary, descriptions of events, or other material such as graphics or video. Entries are commonly displayed in...

 Science Based Medicine, Steven Novella
Steven Novella
Steven P. Novella is an American clinical neurologist, assistant professor and Director of General Neurology at Yale University School of Medicine...

, and Wallace Sampson, clinical professor emeritus of medicine at Stanford University
Stanford University
The Leland Stanford Junior University, commonly referred to as Stanford University or Stanford, is a private research university on an campus located near Palo Alto, California. It is situated in the northwestern Santa Clara Valley on the San Francisco Peninsula, approximately northwest of San...

 and editor-in-chief at the Scientific Review of Alternative Medicine
Scientific Review of Alternative Medicine
Scientific Review of Alternative Medicine and Aberrant Medical Practices is a scientific journal published by the Commission for Scientific Medicine and Mental Health...

,
have all characterized acupuncture as pseudoscience or pseudomedical.

According to the 1997 NIH
National Institutes of Health
The National Institutes of Health are an agency of the United States Department of Health and Human Services and are the primary agency of the United States government responsible for biomedical and health-related research. Its science and engineering counterpart is the National Science Foundation...

 consensus statement on acupuncture:

Qi, acupuncture points and meridians

In some early texts, 365 acupuncture points were identified, corresponding to the days of the year. No research has established any consistent anatomical structure or function for either acupuncture points or meridians. The nervous system
Nervous system
The nervous system is an organ system containing a network of specialized cells called neurons that coordinate the actions of an animal and transmit signals between different parts of its body. In most animals the nervous system consists of two parts, central and peripheral. The central nervous...

 has been evaluated for a relationship to acupuncture points, but no structures have been clearly linked to them. Controversial studies using nuclear imaging
Nuclear medicine
In nuclear medicine procedures, elemental radionuclides are combined with other elements to form chemical compounds, or else combined with existing pharmaceutical compounds, to form radiopharmaceuticals. These radiopharmaceuticals, once administered to the patient, can localize to specific organs...

 have suggested that tracers may be used to follow meridians and are not related to veins or lymphatic tissues, but the interpretation of these results is unclear. The electrical resistance
Electrical resistance
The electrical resistance of an electrical element is the opposition to the passage of an electric current through that element; the inverse quantity is electrical conductance, the ease at which an electric current passes. Electrical resistance shares some conceptual parallels with the mechanical...

 of acupuncture points and meridians have also been studied, with conflicting results.

The meridians are part of the controversy in the efforts to reconcile acupuncture with conventional medicine. The National Institutes of Health
National Institutes of Health
The National Institutes of Health are an agency of the United States Department of Health and Human Services and are the primary agency of the United States government responsible for biomedical and health-related research. Its science and engineering counterpart is the National Science Foundation...

 1997 consensus development statement on acupuncture stated that acupuncture points, Qi, the meridian system and related theories play an important role in the use of acupuncture, but are difficult to relate to a contemporary understanding of the body. Chinese medicine forbade dissection, and as a result the understanding of how the body functioned was based on a system that related to the world around the body rather than its internal structures. The 365 "divisions" of the body were based on the number of days in a year, and the 12 meridians proposed in the TCM system are thought to be based on the 12 major rivers that run through China.

The ancient traditions of qi, yin, yang and meridians have no counterpart in modern studies of chemistry
Chemistry
Chemistry is the science of matter, especially its chemical reactions, but also its composition, structure and properties. Chemistry is concerned with atoms and their interactions with other atoms, and particularly with the properties of chemical bonds....

, biology
Biology
Biology is a natural science concerned with the study of life and living organisms, including their structure, function, growth, origin, evolution, distribution, and taxonomy. Biology is a vast subject containing many subdivisions, topics, and disciplines...

, physics
Physics
Physics is a natural science that involves the study of matter and its motion through spacetime, along with related concepts such as energy and force. More broadly, it is the general analysis of nature, conducted in order to understand how the universe behaves.Physics is one of the oldest academic...

, or human physiology
Human physiology
Human physiology is the science of the mechanical, physical, bioelectrical, and biochemical functions of humans in good health, their organs, and the cells of which they are composed. Physiology focuses principally at the level of organs and systems...

 and to date scientists have been unable to find evidence that supports their existence. Support for the existence of qi is often looked for in scientific fields such as bioelectricity but this research is rarely verified and the connection with qi may be spurious.

Research on the electrical activity of acupuncture points lacks a standardized methodology and reporting protocols, and is generally of poor quality.

Acupuncturist Felix Mann
Felix Mann
Felix Mann is a German-born acupuncturist. He devised the system known as Scientific Acupuncture and is the founder and past-president of the Medical Acupuncture Society...

, who was the author of the first comprehensive English language acupuncture textbook Acupuncture: The Ancient Chinese Art of Healing, has stated that "The traditional acupuncture points are no more real than the black spots a drunkard sees in front of his eyes" and compared the meridians to the meridians
Meridian (geography)
A meridian is an imaginary line on the Earth's surface from the North Pole to the South Pole that connects all locations along it with a given longitude. The position of a point along the meridian is given by its latitude. Each meridian is perpendicular to all circles of latitude...

 of longitude used in geography – an imaginary human construct. Mann attempted to join up his medical knowledge with that of Chinese theory. In spite of his protestations about the theory, he was fascinated by it and trained many people in the west with the parts of it he borrowed. He also wrote many books on this subject. His legacy is that there is now a college in London and a system of needling that is known as "Medical Acupuncture". Today this college trains doctors and western medical professionals only. Reviewers Leonid Kalichman and Simon Vulfsons have described the use of dry needling
Dry needling
Dry needling is the use of solid filiform needles for therapy of muscle pain, sometimes also known as intramuscular stimulation. The needles are similar to acupuncture needles. Dry needling contrasts with the use of a hollow hypodermic needle to inject substances such as saline solution, botox or...

 of myofascial trigger point
Trigger point
Trigger points, also known as trigger sites or muscle knots, are described as hyperirritable spots in skeletal muscle that are associated with palpable nodules in taut bands of muscle fibers. Trigger point practitioners believe that palpable nodules are small contraction knots and a common cause of...

s as an effective and low risk treatment modality. A systematic review
Systematic review
A systematic review is a literature review focused on a research question that tries to identify, appraise, select and synthesize all high quality research evidence relevant to that question. Systematic reviews of high-quality randomized controlled trials are crucial to evidence-based medicine...

 of acupuncture for pain found that there was no difference between inserting needles into "true" acupuncture on traditional acupuncture points versus "placebo" points not associated with any TCM acupuncture points or meridians. The review concluded that "A small analgesic effect of acupuncture was found, which seems to lack clinical relevance and cannot be clearly distinguished from bias. Whether needling at acupuncture points, or at any site, reduces pain independently of the psychological impact of the treatment ritual is unclear."

A history of medical science article published in the journal Biocommunications states that "the Chinese drew mystical numerical associations, called the Da shu, or “great numbers.” It was no coincidence to the ancient Chinese, for example, that our four limbs matched the number of seasons and directions, and that in the one record of a human dissection on the body of the rebel Wangsun Qing, the hired butchers of his captor, Wang Mang, reported finding five zang (liver, gall bladder, heart, spleen, kidneys) corresponding to the five planets; 12 vessels circulating blood and air corresponding to the 12 rivers flowing toward the Central Kingdom; and 365 parts of the body, one for each day of the year (Lingshu 13/311 ), and the Ling shu cited says “There are 365 days in the year, while humans have 365 joints (or acupoints)... There are 12 channel rivers across the land, while humans have 12 channel” – Ling Shu

A report for CSICOP on pseudoscience
Pseudoscience
Pseudoscience is a claim, belief, or practice which is presented as scientific, but which does not adhere to a valid scientific method, lacks supporting evidence or plausibility, cannot be reliably tested, or otherwise lacks scientific status...

 in China written by Wallace Sampson and Barry Beyerstein
Barry Beyerstein
Barry L Beyerstein, Ph.D. was a noted scientific skeptic and professor of psychology at Simon Fraser University in Burnaby, British Columbia...

 said:

Possible mechanisms

Evidence supports that stimulation of one acupuncture point reduces post-operative nausea and vomiting, although insertion of needles at that point does not increase the reduction over nonpenetrating stimulation, and pain
Pain
Pain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...

, but evidence for the treatment of other conditions is equivocal, and several review articles
Review journal
A review journal in academic publishing is a periodical or series that is devoted to the publication of review articles that summarize the progress in some particular area or topic during a preceding period.-Types:Review journals can be divided by...

 discussing the effectiveness of acupuncture have concluded it is possible to explain through the placebo effect
Placebo effect
Placebo effect may refer to:* Placebo effect, the tendency of any medication or treatment, even an inert or ineffective one, to exhibit results simply because the recipient believes that it will work...

. Despite consistently failing to find a difference between real and sham acupuncture, much of the literature on the topic has consistently failed to consider placebo effect as an explanation for apparent effectiveness. Endorphin release, stimulation of the peripheral nervous system, and pain mediation through the effects of other neuropeptides are thought to be the most likely explanations for the effects of the insertion of needles. Publication bias is a significant concern when evaluating the literature. Other claims of efficacy have not been tested. Reports from the US National Center for Complementary and Alternative Medicine (NCCAM), the American Medical Association
American Medical Association
The American Medical Association , founded in 1847 and incorporated in 1897, is the largest association of medical doctors and medical students in the United States.-Scope and operations:...

 (AMA) and various US government reports have studied and commented on the efficacy (or lack thereof) of acupuncture. There is general agreement that acupuncture is safe when administered by well-trained practitioners using sterile needles. The neural mechanisms underlying minute pain relief from insertion of needles are unknown, but it has been suggested that it may involve recruitment of the body's own pain reduction system, and an increased release of endorphin
Endorphin
Endorphins are endogenous opioid peptides that function as neurotransmitters. They are produced by the pituitary gland and the hypothalamus in vertebrates during exercise, excitement, pain, consumption of spicy food, love and orgasm, and they resemble the opiates in their abilities to produce...

s, serotonin
Serotonin
Serotonin or 5-hydroxytryptamine is a monoamine neurotransmitter. Biochemically derived from tryptophan, serotonin is primarily found in the gastrointestinal tract, platelets, and in the central nervous system of animals including humans...

, norepinephrine
Norepinephrine
Norepinephrine is the US name for noradrenaline , a catecholamine with multiple roles including as a hormone and a neurotransmitter...

, or gamma-Aminobutyric acid
Gamma-aminobutyric acid
γ-Aminobutyric acid is the chief inhibitory neurotransmitter in the mammalian central nervous system. It plays a role in regulating neuronal excitability throughout the nervous system...

.

Efficacy study design

One of the major challenges in acupuncture research is in the design of an appropriate placebo
Placebo
A placebo is a simulated or otherwise medically ineffectual treatment for a disease or other medical condition intended to deceive the recipient...

 control group. In trials of new drugs, double blinding is the accepted standard, but since acupuncture is a procedure rather than a pill, it is difficult to design studies in which both the acupuncturist and patient are blinded as to the treatment being given. The same problem arises in double-blinding procedures used in biomedicine, including virtually all surgical procedures, dentistry, physical therapy, etc. As the Institute of Medicine
Institute of Medicine
The Institute of Medicine is a not-for-profit, non-governmental American organization founded in 1970, under the congressional charter of the National Academy of Sciences...

 states: "Controlled trials of surgical procedures have been done less frequently than studies of medications because it is much more difficult to standardize the process of surgery. Surgery depends to some degree on the skills and training of the surgeon and the specific environment and support team available to the surgeon. A surgical procedure in the hands of a highly skilled, experienced surgeon is different from the same procedure in the hands of an inexperienced and unskilled surgeon... For many CAM
Alternative medicine
Alternative medicine is any healing practice, "that does not fall within the realm of conventional medicine." It is based on historical or cultural traditions, rather than on scientific evidence....

 modalities, it is similarly difficult to separate the effectiveness of the treatment from the effectiveness of the person providing the treatment." Acupuncture itself is also a very strong placebo, and can provoke extremely high expectations from patients and test subjects; this is particularly problematic for health problems like chronic low back pain, where conventional treatment is often relatively ineffective and may have been unsuccessfully used in the past. In situations like these, it may be inappropriate to consider "conventional care" a proper control intervention for acupuncture since patient expectations for conventional care are quite low.

Blinding of the practitioner in acupuncture remains challenging. One proposed solution to blinding patients has been the development of "sham acupuncture", i.e., needling performed superficially or at non-acupuncture sites. Controversy remains over whether, and under what conditions, sham acupuncture may function as a true placebo, particularly in studies on pain
Pain
Pain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...

, in which insertion of needles anywhere near painful regions may elicit a beneficial response. A review in 2007 noted several issues confounding sham acupuncture: "Weak physiologic activity of superficial or sham needle penetration is suggested by several lines of research, including RCT
Randomized controlled trial
A randomized controlled trial is a type of scientific experiment - a form of clinical trial - most commonly used in testing the safety and efficacy or effectiveness of healthcare services or health technologies A randomized controlled trial (RCT) is a type of scientific experiment - a form of...

s showing larger effects of a superficial needle penetrating acupuncture than those of a nonpenetrating sham control, positron emission tomography research indicating that sham acupuncture can stimulate regions of the brain associated with natural opiate production, and animal studies showing that sham needle insertion can have nonspecific analgesic effects through a postulated mechanism of “diffuse noxious inhibitory control”. Indeed, superficial needle penetration is a common technique in many authentic traditional Japanese acupuncture styles." When "placebo needles" (in which the needle retracts into a handle rather than penetrating the skin) were introduced to the study of acupuncture, the majority of studies conducted using these needles concluded the effects of acupuncture were due to placebo.

An analysis of 13 studies of pain treatment with acupuncture, published in January 2009 in the journal BMJ, concluded there was little difference in the effect of real, sham and no acupuncture.

Medical organizations

In 1997, the American Medical Association Council on Scientific Affairs stated:
Also in 1997, the United States National Institutes of Health
National Institutes of Health
The National Institutes of Health are an agency of the United States Department of Health and Human Services and are the primary agency of the United States government responsible for biomedical and health-related research. Its science and engineering counterpart is the National Science Foundation...

 (NIH) issued a consensus statement on acupuncture that concluded that despite research on acupuncture being difficult to conduct, there was sufficient evidence to encourage further study and expand its use. The consensus statement and conference that produced it were criticized by Wallace Sampson, founder of the Scientific Review of Alternative Medicine
Scientific Review of Alternative Medicine
Scientific Review of Alternative Medicine and Aberrant Medical Practices is a scientific journal published by the Commission for Scientific Medicine and Mental Health...

, writing for an affiliated publication of Quackwatch
Quackwatch
Quackwatch is an American non-profit organization founded by Stephen Barrett with the stated aim being to "combat health-related frauds, myths, fads, fallacies, and misconduct" and with a primary focus on providing "quackery-related information that is difficult or impossible to get elsewhere."...

 who stated the meeting was chaired by a strong proponent of acupuncture and failed to include speakers who had obtained negative results on studies of acupuncture. Sampson also stated he believed the report showed evidence of pseudoscientific
Pseudoscience
Pseudoscience is a claim, belief, or practice which is presented as scientific, but which does not adhere to a valid scientific method, lacks supporting evidence or plausibility, cannot be reliably tested, or otherwise lacks scientific status...

 reasoning. In 2006 the NIH's National Center for Complementary and Alternative Medicine stated that it continued to abide by the recommendations of the 1997 NIH consensus statement, even if research is still unable to explain its mechanism.

In 2003 the World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...

's Department of Essential Drugs and Medicine Policy produced a report on acupuncture. The report was drafted, revised and updated by Zhu-Fan Xie, the Director for the Institute of Integrated Medicines of Beijing Medical University
Peking University Health Science Center
Peking University Health Science Center is a respected medical school in China attached to Peking University, and is affiliated to 14 other hospitals in the Beijing Metropolitan Area. It enjoys a reputation as the best medical school in the country...

. It contained, based on research results available in early 1999, a list of diseases, symptoms or conditions for which it was believed acupuncture had been demonstrated as an effective treatment, as well as a second list of conditions that were possibly able to be treated with acupuncture. Noting the difficulties of conducting controlled research and the debate on how to best conduct research on acupuncture, the report described itself as "...intended to facilitate research on and the evaluation and application of acupuncture. It is hoped that it will provide a useful resource for researchers, health care providers, national health authorities and the general public." The coordinator for the team that produced the report, Xiaorui Zhang, stated that the report was designed to facilitate research on acupuncture, not recommend treatment for specific diseases. The report was controversial; critics assailed it as being problematic since, in spite of the disclaimer, supporters used it to claim that the WHO endorsed acupuncture and other alternative medicine practices that were either pseudoscientific or lacking sufficient evidence-basis. Medical scientists expressed concern that the evidence supporting acupuncture outlined in the report was weak, and Willem Betz of SKEPP (Studie Kring voor Kritische Evaluatie van Pseudowetenschap en het Paranormale, the Study Circle for the Critical Evaluation of Pseudoscience and the Paranormal) said that the report was evidence that the "WHO has been infiltrated by missionaries for alternative medicine
Alternative medicine
Alternative medicine is any healing practice, "that does not fall within the realm of conventional medicine." It is based on historical or cultural traditions, rather than on scientific evidence....

". The WHO 2005 report was also criticized in the 2008 book Trick or Treatment
Trick or Treatment
Trick or Treatment? Alternative Medicine on Trial is a 2008 book about alternative medicine by Simon Singh and Edzard Ernst. Singh is a physicist and the writer of several popular science books...

for, in addition to being produced by a panel that included no critics of acupuncture at all, containing two major errors – including too many results from low-quality clinical trial
Clinical trial
Clinical trials are a set of procedures in medical research and drug development that are conducted to allow safety and efficacy data to be collected for health interventions...

s, and including a large number of trials originating in China
China
Chinese civilization may refer to:* China for more general discussion of the country.* Chinese culture* Greater China, the transnational community of ethnic Chinese.* History of China* Sinosphere, the area historically affected by Chinese culture...

 where, probably due to publication bias, no negative trials have ever been produced. In contrast, studies originating in the West
Western culture
Western culture, sometimes equated with Western civilization or European civilization, refers to cultures of European origin and is used very broadly to refer to a heritage of social norms, ethical values, traditional customs, religious beliefs, political systems, and specific artifacts and...

 include a mixture of positive, negative and neutral results. Ernst and Singh, the authors of the book, described the report as "highly misleading", a "shoddy piece of work that was never rigorously scrutinized" and stated that the results of high-quality clinical trials do not support the use of acupuncture to treat anything but pain and nausea. Ernst also described the statement in a 2006 peer reviewed article as "Perhaps the most obviously over-optimistic overview [of acupuncture]", noting that of the 35 conditions that the WHO stated acupuncture was effective for, 27 of the systematic reviews that the WHO report was based on found that acupuncture was not effective for treating the specified condition.

The National Health Service
National Health Service
The National Health Service is the shared name of three of the four publicly funded healthcare systems in the United Kingdom. They provide a comprehensive range of health services, the vast majority of which are free at the point of use to residents of the United Kingdom...

 of the United Kingdom
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...

 states that there is "reasonably good evidence that acupuncture is an effective treatment" for nausea, vomiting, osteoarthritis of the knee and several types of pain but "because of disagreements over the way acupuncture trials should be carried out and over what their results mean, this evidence does not allow us to draw definite conclusions". The NHS states there is evidence against acupuncture being useful for rheumatoid arthritis, smoking cessation and weight loss, and inadequate evidence for most other conditions that acupuncture is used for.

Safety

Because acupuncture needles penetrate the skin, many forms of acupuncture are invasive procedures, and therefore not without risk. Injuries are rare among patients treated by trained practitioners in some countries. Sometimes, needles are required by law to be sterile
Asepsis
Asepsis is the state of being free from disease-causing contaminants or, preventing contact with microorganisms. The term asepsis often refers to those practices used to promote or induce asepsis in an operative field in surgery or medicine to prevent infection...

, disposable and used only once; in some places, needles may be reused if they are first resterilized, e.g. in an autoclave
Autoclave
An autoclave is an instrument used to sterilize equipment and supplies by subjecting them to high pressure saturated steam at 121 °C for around 15–20 minutes depending on the size of the load and the contents. It was invented by Charles Chamberland in 1879, although a precursor known as the...

. When needles are contaminated, risk of bacterial or other blood-borne infection increases, as with re-use of any type of needle.

Adverse events

Estimates of adverse effects due to acupuncture range from 671 to 1,137 per 10,000 treatments. The majority of adverse effects reported are minor, mainly slight haemorrhage (2.9%), haematoma (2.2%), and dizziness (1%). A 2010 systematic review found that acupuncture has been associated with a possible total of up to 86 deaths over the years surveyed, most commonly due to pneumothorax
Pneumothorax
Pneumothorax is a collection of air or gas in the pleural cavity of the chest between the lung and the chest wall. It may occur spontaneously in people without chronic lung conditions as well as in those with lung disease , and many pneumothoraces occur after physical trauma to the chest, blast...

. Some reported adverse effects include 50 cases of bacterial infections, and more than 80 cases of hepatitis B since 1970. A 2011 review that included many case reports
Case study
A case study is an intensive analysis of an individual unit stressing developmental factors in relation to context. The case study is common in social sciences and life sciences. Case studies may be descriptive or explanatory. The latter type is used to explore causation in order to find...

 of injuries stated that "ninety-five cases of severe adverse effects including 5 fatalities" were evident in the literature reviewed. "Pneumothorax and infections were the most frequently reported adverse effects."

Other injury

Other risks of injury include: nerve
Nerve
A peripheral nerve, or simply nerve, is an enclosed, cable-like bundle of peripheral axons . A nerve provides a common pathway for the electrochemical nerve impulses that are transmitted along each of the axons. Nerves are found only in the peripheral nervous system...

 injury, resulting from the accidental puncture of any nerve, brain damage
Brain damage
"Brain damage" or "brain injury" is the destruction or degeneration of brain cells. Brain injuries occur due to a wide range of internal and external factors...

 or stroke
Stroke
A stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...

, which is possible with very deep needling at the base of the skull, kidney
Kidney
The kidneys, organs with several functions, serve essential regulatory roles in most animals, including vertebrates and some invertebrates. They are essential in the urinary system and also serve homeostatic functions such as the regulation of electrolytes, maintenance of acid–base balance, and...

 damage from deep needling in the low back. Haemopericardium, or puncture of the protective membrane surrounding the heart
Human heart
The human heart is a muscular organ that provides a continuous blood circulation through the cardiac cycle and is one of the most vital organs in the human body...

, which may occur with needling over a sternal foramen
Foramen
In anatomy, a foramen is any opening. Foramina inside the body of humans and other animals typically allow muscles, nerves, arteries, veins, or other structures to connect one part of the body with another.-Skull:...

.

Omitting modern medical care

Receiving alternative medicine
Alternative medicine
Alternative medicine is any healing practice, "that does not fall within the realm of conventional medicine." It is based on historical or cultural traditions, rather than on scientific evidence....

 as a replacement for standard modern medical care could result in inadequate diagnosis or treatment of conditions for which modern medicine has a better treatment record.

As with other alternative medicines, unethical or naïve practitioners may also induce patients to exhaust financial resources by pursuing ineffective treatment. Profession ethical codes set by accrediting organizations such as the National Certification Commission for Acupuncture and Oriental Medicine
National Certification Commission for Acupuncture and Oriental Medicine
The National Certification Commission for Acupuncture and Oriental Medicine is a non-profit organization in the United States that aims to "establish, assess, and promote recognized standards of competence and safety in acupuncture and Oriental medicine for the protection and benefit of the...

 require practitioners to make "timely referrals to other health care professionals as may be appropriate." In Canada
Canada
Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...

, public health departments in the provinces of Ontario
Ontario
Ontario is a province of Canada, located in east-central Canada. It is Canada's most populous province and second largest in total area. It is home to the nation's most populous city, Toronto, and the nation's capital, Ottawa....

 and British Columbia
British Columbia
British Columbia is the westernmost of Canada's provinces and is known for its natural beauty, as reflected in its Latin motto, Splendor sine occasu . Its name was chosen by Queen Victoria in 1858...

 regulate acupuncture.

United States

Those who specialize in Acupuncture and Oriental Medicine are usually referred to as "licensed acupuncturists", or L.Ac.'s. The abbreviation "Dipl. Ac." stands for "Diplomate of Acupuncture" and signifies that the holder is board-certified by the NCCAOM. Twenty-three states require certification, according to that body.

A poll of American doctors in 2005 showed that 59% believe acupuncture was at least somewhat effective for treatment of pain. In 1996, the United States Food and Drug Administration changed the status of acupuncture needles from Class III to Class II medical device
Medical device
A medical device is a product which is used for medical purposes in patients, in diagnosis, therapy or surgery . Whereas medicinal products achieve their principal action by pharmacological, metabolic or immunological means. Medical devices act by other means like physical, mechanical, thermal,...

s, meaning that needles are regarded as safe and effective when used appropriately by licensed practitioners. As of 2004, nearly 50% of Americans who were enrolled in employer health insurance plans were covered for acupuncture treatments.

Canada

In Ontario
Ontario
Ontario is a province of Canada, located in east-central Canada. It is Canada's most populous province and second largest in total area. It is home to the nation's most populous city, Toronto, and the nation's capital, Ottawa....

, the practice of acupuncture is now regulated by the Traditional Chinese Medicine Act, 2006, S.O. 2006, chapter 27. The government is in the process of establishing a college whose mandate will be to oversee the implementation of policies and regulations relating to the profession.

United Kingdom

Acupuncturists are not a regulated profession. The principal body for professional standards in traditional/lay acupuncture is the British Acupuncture Council, The British Medical Acupuncture Society is an inter-disciplinary professional body for regulated health professional using acupuncture as a modality and there is the Acupuncture Association of Chartered Physiotherapists.

Australia

Traditional/lay acupuncture is not a regulated health profession; traditional/lay acupuncture or Chinese Medicine was not included in the National Health Regulation Law. Acupuncture will not be recognized as a profession in Australia but as a modality, either within Chinese Medicine / traditional Asian healing systems or within the scope of practice of regulated health professions. The practice of acupuncture is governed by a range of state / territory laws relating to consumer protection and infection control. Victoria is the only state of Australia with an operational registration board. Currently acupuncturists in New South Wales are bound by the guidelines in the Public Health (Skin Penetration) Regulation 2000, which is enforced at local council level. Other states of Australia have their own skin penetration acts.

New Zealand

Traditional/lay acupuncture is not a regulated health profession. Osteopaths have a scope of practice for Western Medical Acupuncture and Related Needling Techniques. The state-owned Accident Compensation Corporation
Accident Compensation Corporation
The Accident Compensation Corporation is a New Zealand Crown entity responsible for administering the Accident Compensation Act 2001. The Act provides support to citizens, residents, and temporary visitors who have suffered personal injuries....

 reimburses for acupuncture treatment by registered health care practitioners and some traditional/lay acupuncturists that belong to voluntary professional associations.

See also

  • Chinese herbology
    Chinese herbology
    Chinese Herbology is the theory of Traditional Chinese herbal therapy, which accounts for the majority of treatments in Traditional Chinese medicine ....

  • Auriculotherapy
    Auriculotherapy
    Auriculotherapy, or auricular therapy, or ear acupuncture, or auriculoacupuncture is a form of alternative medicine based on the idea that the ear is a microsystem of the entire body represented on the auricle, the outer portion of the ear. Ailments of the entire body are assumed to be treatable...

  • Colorpuncture
    Colorpuncture
    Colorpuncture, or color light acupuncture, is an alternative medicine practice asserting that colored lights can be used to stimulate acupuncture points to promote healing and better health. It is a form of color therapy. There is no known anatomical or histological basis for the existence of...

  • Pressure point
    Pressure point
    A pressure point in the field of martial arts refers to an area on the human body that may produce significant pain or other effects when manipulated in a specific manner...

  • Susuk
    Susuk
    In Malayan culture, susuk, or charm needles, are needles made of gold or other precious metals, which are inserted into the soft tissues of the body to act as talismans. Susuk has various supposed purposes, ranging from the purely aesthetic to the treatment of joint pains and other minor ailments....

  • German Acupuncture Trials

External links

The source of this article is wikipedia, the free encyclopedia.  The text of this article is licensed under the GFDL.
 
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