Acupuncture
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/* Criticism of TCM theory */ rm tag - please justify on [[Talk:Acupuncture]]; minor misc
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! colspan="2" align="center" bgcolor="#ffcc99" | Acupuncture
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| [[Medicine]]: || [[Terms and concepts in alternative medicine#CAM|CAM]]
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| [[Terms and concepts in alternative medicine#NCCAM Classifications|NCCAM]]: || [[Terms and concepts in alternative medicine#Terms_and_concepts_in_alternative_medicine#Alternative_medical_systems|Alternative Medical Systems]]<ref>[http://nccam.nih.gov/health/backgrounds/wholemed.htm Whole Medical Systems: An Overview [NCCAM Backgrounder]<!-- Bot generated title -->]</ref>
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| [[Terms and concepts in alternative medicine#NCCAM Classifications|NCCAM]]: || [[Terms and concepts in alternative medicine#Energy_therapies|Energy Medicine]]<ref>[http://nccam.nih.gov/health/backgrounds/energymed.htm Energy Medicine: An Overview [NCCAM Backgrounder]<!-- Bot generated title -->]</ref>
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| [[Terms and concepts in alternative medicine#Modality Classifications|Modality]]: || [[Terms and concepts in alternative medicine#Professionalized Modalities|Professionalized]]
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| [[Culture]]: || [[Chinese culture|East]]/[[Western culture|West]]
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[[Image:hua t08.jpg|thumb|right|250px|Acupuncture chart from Hua Shou (fl. 1340s, [[Ming Dynasty]]). This image from ''Shi si jing fa hui (Expression of the Fourteen Meridians).'' ([[Tokyo]] : Suharaya Heisuke kanko, Kyoho gan 1716).]]
'''Acupuncture''' (from Lat. ''acus,'' "needle", and ''pungere,'' "prick") or in [[Standard Mandarin]], 針 砭 (zhēn biān) (a related word, 針灸 (zhēn jiǔ), refers to acupuncture together with [[moxibustion]])<ref>ABC Chinese-English Comprehensive Dictionary edited by John DeFrancis, as used in [http://www.wenlin.com/ Wenlin] version 3.4.1</ref> is a technique of inserting and manipulating fine [[wikt:filiform|filiform]] needles into specific points on the body with the aim of relieving [[pain]] and for therapeutic purposes.<ref name ="Dorlands">'''Acupuncture''': the Chinese practice of piercing specific areas of the body along peripheral nerves with fine needles to relieve pain, induce surgical anesthesia, and for therapeutic purposes. ''Dorland's Pocket Medical Dictionary'', 25th ed. W. B. Saunders Co., 1995. ISBN 0-7216-5738-9</ref> According to acupuncture theory, these [[acupuncture points]] lie along [[Channel (Chinese medicine)|meridians]] along which [[qi]], a kind of [[vital energy]], is said to flow. There is no generally-accepted [[anatomical]] or [[histological]] basis for these concepts,<ref name="NIH-1997consensus"/> and modern acupuncturists tend to view them in functional rather than structural terms, (''viz''. as a useful metaphor in guiding evaluation and care of patients).<ref>Kaptchuk, ''The Web That Has No Weaver'', 1983, pp. 34-35</ref><ref>"Despite considerable efforts to understand the anatomy and physiology of the "acupuncture points", the definition and characterization of these points remains controversial. Even more elusive is the basis of some of the key traditional Eastern medical concepts such as the circulation of [[Qi]], the meridian system, and the five phases theory, which are difficult to reconcile with contemporary biomedical information but continue to play an important role in the evaluation of patients and the formulation of treatment in acupuncture."{{cite web |author=NIH Consensus Development Program |title=Acupuncture --Consensus Development Conference Statement |url=http://consensus.nih.gov/1997/1997Acupuncture107html.htm |date=November 3-5, 1997 |publisher=National Institutes of Health |accessdate=2007-07-17}}</ref> Acupuncture is thought to have originated in [[China]] and is most commonly associated with [[Traditional Chinese Medicine]] (TCM). Different types of acupuncture (Classical Chinese, Japanese, Tibetan, Vietnamese and Korean acupuncture) are practiced and taught throughout the world.
While acupuncture has been a subject of active scientific research since the late 20th century, its effects are not well-understood, and it remains controversial among researchers and clinicians.<ref name='Ernst_2006-02'> {{cite journal |title=Acupuncture - a critical analysis |journal=Journal of Internal Medicine |date=2006-02 |first=Edzard |last=Ernst |volume=259 |issue=2 |pages=125–137 |pmid=16420542 |url=http://www.ncbi.nlm.nih.gov/pubmed/16420542?dopt=Abstract |accessdate=2008-04-08 |doi=10.1111/j.1365-2796.2005.01584.x }}</ref> The body of evidence remains inconclusive but is active and growing, and a 2007 review by [[Edzard Ernst]] and colleagues finds that the "emerging clinical evidence seems to imply that acupuncture is effective for some but not all conditions".<ref name ="pmid17265547" />
The [[WHO]], the [[National Center for Complementary and Alternative Medicine]] (NCCAM) of the [[National Institutes of Health]] (NIH), the [[American Medical Association]] (AMA) and various government reports have all studied and commented on the efficacy (or lack therof) of acupuncture. There is general agreement that acupuncture is safe when administered by well-trained practitioners using sterile needles, and that further research is warranted.<ref name="NIH-1997consensus">{{cite web |author=NIH Consensus Development Program |title=Acupuncture --Consensus Development Conference Statement |url=http://consensus.nih.gov/1997/1997Acupuncture107html.htm |date=November 3-5, 1997 |publisher=National Institutes of Health |accessdate=2007-07-17}}</ref><ref name="NCCAM2006-Acupuncture">{{cite web |title=Get the Facts, Acupuncture |url=http://nccam.nih.gov/health/acupuncture/ |publisher=National Institute of Health |date=2006 |accessdate=2006-03-02}}</ref><ref name="pmid12801494">{{cite journal |author=Ernst G, Strzyz H, Hagmeister H |title=Incidence of adverse effects during acupuncture therapy-a multicentre survey |journal=Complementary therapies in medicine |volume=11 |issue=2 |pages=93–7 |year=2003 |pmid=12801494 |doi=}}</ref>
==History==
===Antiquity===
In [[China]], the practice of acupuncture can perhaps be traced as far back as the stone age, with the ''Bian shi'', or sharpened stones.
Stone acupuncture needles dating back to 3000 B.C. have been found by archeologists in Inner Mongolia. <ref>[http://www.moondragon.org/health/therapy/acupuncture.html MoonDragon's Health & Wellness Therapy: Acupuncture<!-- Bot generated title -->]</ref><ref>[http://www.paralumun.com/acupuncture.htm Acupuncture<!-- Bot generated title -->]</ref> Clearer evidence exists from the [[1st millennium BCE|1<sup>st</sup> millennium BCE]], and archeological evidence has been identified with the period of the [[Han dynasty]] (202 [[Anno Domini|BC]]–220 [[Anno Domini|AD]]).
Recent examinations of [[Ötzi]], a 5,000-year-old [[mummy]] found in the [[Alps]], have identified over 50 [[tattoo]]s on his body, some of which are located on acupuncture points that would today be used to treat ailments Ötzi suffered from. Some scientists believe that this is evidence that practices similar to acupuncture were practiced elsewhere in [[Eurasia]] during the early [[bronze age]]. According to an article published in [[The Lancet]] by Dorfer ''et al.'', "We hypothesised that there might have been a medical system similar to acupuncture (Chinese Zhenjiu: needling and burning) that was practiced in Central Europe 5,200 years ago... A treatment modality similar to acupuncture thus appears to have been in use long before its previously known period of use in the medical tradition of ancient China. This raises the possibility of acupuncture having originated in the Eurasian continent at least 2000 years earlier than previously recognised."<ref>http://www.ogka.at/a_p_oetzi.asp?nav_reihenfolge=9</ref>, <ref>http://www.thelancet.com/journals/lancet/article/PIIS0140673698122420/fulltext</ref>.
Acupuncture's origins in China are uncertain. The earliest Chinese medical text that first describes acupuncture is the Yellow Emperor’s ''Classic of Internal Medicine (History of Acupuncture)'' [[Huangdi Neijing]], which was compiled around 305–204 B.C. However, the Chinese medical texts (Ma-wang-tui graves, 68 BC) do not mention acupuncture. Some hieroglyphics have been found dating back to 1000 B.C. that may indicate an early use of acupuncture. Bian stones, sharp pointed rocks used to treat diseases in ancient times, have also been discovered in ruins; some scholars believe that the bloodletting for which these stones were likely used presages certain acupuncture techniques.<ref>http://www.redwingbooks.com/html/catalog/index.cfm/action_search/type_detail/InventoryKey_UndAcu/file_Chapter</ref>
According to one legend,<ref>http://www.medicalacupuncturist.co.uk/hoa.html</ref>, acupuncture started in China when some soldiers who were wounded by arrows in battle experienced a relief of pain in other parts of the body, and consequently people started experimenting with arrows (and later needles) as therapy.
===Middle history===
Acupuncture spread from China to [[Japan]], [[Korea]], [[Vietnam]] and elsewhere in East Asia. [[Portuguese Empire|Portuguese]] missionaries in the 16th century were among the first to bring reports of acupuncture to the West.<ref>Unschuld, Paul. Chinese Medicine, p. 94. 1998, Paradigm Publications</ref>
===Modern era===
R.C. Crozier in the book ''Traditional medicine in modern China'' (Harvard University Press, Cambridge, 1968) says the early Chinese Communist Party expressed considerable antipathy towards classical forms of Chinese medicine, ridiculing it as superstitious, irrational and backward, and claiming that it conflicted with the Party’s dedication to science as the way of progress. Acupuncture was included in this criticism. Reversing this position, Communist Party Chairman [[Mao Zedong|Mao]] later said 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."<ref>http://www.healthy.net/scr/article.asp?ID=1708</ref>
Representatives were sent out across China to collect information about the theories and practices of Chinese medicine. Traditional Chinese Medicine is the formalized system of Chinese medicine that was created out of this effort. TCM combines the use of acupuncture, Chinese herbal medicine, ''[[tui na]]'', and other modalities. After the [[Cultural Revolution]], TCM instruction was incorporated into university medical curricula under the "Three Roads" policy, wherein TCM, biomedicine, and a synthesis of the two would all be encouraged and permitted to develop. After this time, forms of classical Chinese medicine other than TCM were outlawed, and some practitioners left China.{{Fact|date=June 2008}}
The first forms of acupuncture to reach the United States were brought by non-TCM practitioners - such as Chinese rail road workers - many employing styles that had been handed down in family lineages, or from master to apprentice (collectively known as "Classical Chinese Acupuncture").
In Vietnam, Dr. Van Nghi and colleagues used the classical Chinese medical texts and applied them in clinical conditions without reference to political screening. They rewrote the modern version: ''Trung E Hoc''.{{clarifyme}}<!-- modern version of what? --> Van Nghi was made the first President of the First World Congress of Chinese Medicine at Bejing in 1988 in recognition of his work.
In the 1970s, acupuncture became popular in America after American visitors to China brought back firsthand reports of patients undergoing major surgery using acupuncture as their sole form of anesthesia. The National Acupuncture Association (NAA), the first national association of acupuncture in the US, introduced acupuncture to the West through seminars and research presentations. The NAA created and staffed the UCLA Acupuncture Pain clinic in 1972. This was the first legal clinic in a medical school setting in the US.
==Traditional theory==
===Traditional Chinese medicine===
{{Main|Traditional Chinese medicine}}
[[Chinese medicine]] is based on a pre-scientific [[paradigm]] of medicine that developed over several thousand years. Its theory holds the following explanation of acupuncture:
Health is a condition of balance of [[yin and yang]] within the body. Particularly important in acupuncture is the free flow of [[Qi]], a difficult-to-translate concept that pervades Chinese philosophy and is commonly translated as "[[vitalism|vital]] energy"). ''Qi'' is immaterial and hence ''yang''; its ''yin'', material counterpart is Blood (capitalized to distinguish it from physiological [[blood]], and very roughly equivalent to it). Acupuncture treatment regulates the flow of Qi and Blood, tonifying where there is deficiency, draining where there is excess, and promoting free flow where there is stagnation. An axiom of the medical literature of acupuncture is "no pain, no blockage; no blockage, no pain."
Many patients claim to experience the sensations of stimulus known in Chinese as ''de qi'' ("obtaining the Qi" or "arrival of the Qi"). This kind of sensation was historically considered to be evidence of effectively locating the desired point. (There are some electronic devices now available which will make a noise when what they have been programmed to describe as the "correct" acupuncture point is pressed).
TCM treats the human body as a whole that involves several "systems of function" generally named after anatomical [[organs]] but not directly associated with them. The Chinese term for these systems is [[Zang Fu]], where ''zang'' is translated as "viscera" or solid organs and ''fu'' is translated as "bowels" or hollow organs. In order to distinguish systems of function from physical organs, ''Zang Fu'' are capitalized in English, thus Lung, Heart, Kidney, ''etc.'' Disease is understood as a loss of balance of Yin, Yang, Qi and Blood (which bears some resemblance to [[homeostasis]]). Treatment of disease is attempted by modifying the activity of one or more systems of function through the activity of needles, pressure, heat, ''etc.'' on sensitive parts of the body of small volume traditionally called "acupuncture points" in English, or "xue" (穴, cavities) in Chinese. This is referred to in TCM as treating "patterns of disharmony."
===Acupuncture points and meridians===
{{See also|Acupuncture points|Channel (Chinese medicine)}}
[[Image:Acupuncture1-1.jpg|thumb|Needles being inserted into a patient's skin.]]
Most of the main acupuncture points are found on the "twelve main meridians" and two of the "eight extra meridians" (Du Mai and Ren Mai) a total of "fourteen channels", which are described in classical and traditional Chinese medical texts, as pathways through which [[Qi]] and "Blood" flow. There also exist "extra points" not belonging to any channel. Other tender points (known as "ashi points") may also be needled as they are believed to be where stagnation has gathered.
Treatment of acupuncture points may be performed along several layers of pathways, most commonly the twelve primary [[Channel (Chinese medicine)|channels]], or ''mai'', located throughout the body. The first twelve channels correspond to systems of function: Lung, Large Intestine, Stomach, Spleen, Heart, Small Intestine, Bladder, Kidney, Pericardium, [[San Jiao]] (an intangible, also known as Triple Burner), Gall Bladder, and Liver. Other pathways include the Eight Extraordinary Pathways (''Qi Jing Ba Mai''), the Luo Vessels, the Divergents and the Sinew Channels. ''Ashi'' (tender) points are generally used for treatment of local pain.
Of the eight extraordinary pathways, only two have acupuncture points of their own: the ''Ren Mai'' and ''Du Mai'', which are situated on the midline of the anterior and posterior aspects of the trunk and head respectively. The other six meridians are "activated" by using a master and couple point technique which involves needling the acupuncture points located on the twelve main meridians that correspond to the particular extraordinary pathway.
The twelve primary pathways run vertically, bilaterally, and symmetrically and every channel corresponds to and connects internally with one of the twelve [[Zang Fu]] ("organs"). This means that there are six [[Yin and yang|yin]] and six [[Yin and yang|yang]] channels. There are three yin and three yang channels on each arm, and three yin and three yang on each leg.
* The three yin channels of the hand (Lung, Pericardium, and Heart) begin on the chest and travel along the inner surface (mostly the anterior portion) of the arm to the hand.
* The three yang channels of the hand (Large intestine, [[San Jiao]], and Small intestine) begin on the hand and travel along the outer surface (mostly the posterior portion) of the arm to the head.
* The three yin channels of the foot (Spleen, Liver, and Kidney) begin on the foot and travel along the inner surface (mostly posterior and medial portion) of the leg to the chest or flank.
* The three yang channels of the foot (Stomach, Gallbladder, and Urinary Bladder) begin on the face, in the region of the eye, and travel down the body and along the outer surface (mostly the anterior and lateral portion) of the leg to the foot.
The movement of Qi through each of the twelve channels comprises an internal and an external pathway. The external pathway is what is normally shown on an acupuncture chart and is relatively superficial. All of the acupuncture points of a channel lie on its external pathway. The internal pathways are the deep course of the channel where it enters the body cavities and related Zang Fu organs. The superficial pathways of the twelve channels describe three complete circuits of the body, chest to hands, hands to head, head to feet, feet to chest, ''etc.''
The distribution of Qi through the pathways is said to be as follows (the based on the demarcations in TCM's Chinese Clock):
Lung channel of hand ''taiyin'' to Large Intestine channel of hand ''yangming'' to Stomach channel of foot ''yangming'' to Spleen channel of foot ''taiyin'' to Heart channel of hand ''shaoyin'' to Small Intestine channel of hand ''taiyang'' to Bladder channel of foot ''taiyang'' to Kidney channel of foot ''shaoyin'' to Pericardium channel of hand ''jueyin'' to ''San Jiao'' channel of hand ''shaoyang'' to Gallbladder channel of foot ''shaoyang'' to Liver channel of foot ''jueyin'' then back to the Lung channel of hand ''taiyin''. According to the "Chinese clock", each channel occupies two hours, beginning with the Lung, 3AM-5AM, and coming full circle with the Liver 1AM-3AM.
===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 (Cheng, 1987, ch. 12).
* 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]].
* Palpation includes feeling the body for tender "ashi" 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).
Other forms of acupuncture employ additional diagnosic techniques. In many forms of classical Chinese acupuncture, as well as Japanese acupuncture, palpation of the muscles and the ''hara'' (abdomen) are central to diagnosis.
===TCM perspective on treatment of disease===
Although TCM is based on the treatment of "patterns of disharmony" rather than biomedical diagnoses, practitioners familiar with both systems have commented on relationships between the two. A given TCM pattern of disharmony may be reflected in a certain range of biomedical diagnoses: thus, the pattern called Deficiency of Spleen Qi could manifest as chronic fatigue, diarrhea or uterine prolapse. Likewise, a population of patients with a given biomedical diagnosis may have varying TCM patterns. These observations are encapsulated in the TCM aphorism "One disease, many patterns; one pattern, many diseases". (Kaptchuk, 1982)
Classically, in clinical practice, acupuncture treatment is typically highly individualized and based on philosophical constructs as well as subjective and intuitive impressions, and not on controlled scientific research.<ref>[http://www.medicalacupuncture.org/aama_marf/journal/vol12_1/evidence.html Medical Acupuncture - Spring / Summer 2000- Volume 12 / Number 1]</ref>
===Criticism of TCM theory===
{{Anchor|Criticism of TCM theory}}
TCM theory predates use of the [[scientific method]] and has received various criticisms based on scientific [[reductionist]] thinking, since there is no physically verifiable [[anatomical]] or [[histological]] basis for the existence of [[acupuncture points]] or [[meridian (Chinese medicine)|meridians]].
[[Felix Mann]], founder and past-president of the Medical Acupuncture Society (1959–1980), the first president of the [http://www.medical-acupuncture.co.uk/ British Medical Acupuncture Society] (1980), and the author of the first comprehensive English language acupuncture textbook ''Acupuncture: The Ancient Chinese Art of Healing''' first published in 1962, has stated in his book ''Reinventing Acupuncture: A New Concept of Ancient Medicine'':
<blockquote>The traditional acupuncture points are no more real than the black spots a drunkard sees in front of his eyes. (p. 14)</blockquote>
and…
<blockquote>The meridians of acupuncture are no more real than the meridians of geography. If someone were to get a spade and tried to dig up the Greenwich meridian, he might end up in a lunatic asylum. Perhaps the same fate should await those doctors who believe in [acupuncture] meridians. (p. 31)<ref name="Mann F.">[[Felix Mann]], quoted by Matthew Bauer in ''[http://www.chinesemedicinetimes.com/section.php?xSec=122 Chinese Medicine Times]'', vol 1 issue 4, Aug. 2006, "The Final Days of Traditional Beliefs? - Part One"</ref></blockquote>
<blockquote>A report for [[CSICOP]] on [[pseudoscience]] in China written by Wallace Sampson and [[Barry Beyerstein]] said:
A few Chinese scientists we met maintained that although Qi is merely a metaphor, it is still a useful physiological abstraction (''e.g.'', that the related concepts of [[Yin and Yang]] parallel modern scientific notions of endocrinologic and metabolic feedback mechanisms). They see this as a useful way to unite Eastern and Western medicine. Their more hard-nosed colleagues quietly dismissed Qi as only a philosophy, bearing no tangible relationship to modern physiology and medicine.<ref>{{cite journal
| last = Sampson
| first = Wallace Sampson
| coauthors = Barry L. Beyerstein
| year = 1996
| month = September/October
| title = Traditional Medicine and Pseudoscience in China: A Report of the Second CSICOP Delegation (Part 2)
| journal = Skeptical Inquirer
| volume = 20
| issue = 5
| url = http://www.csicop.org/si/9609/china.html
| accessdate = 2007-01-06
}}
</ref></blockquote>
George A. Ulett, MD, PhD, Clinical Professor of Psychiatry, University of Missouri School of Medicine states: "Devoid of metaphysical thinking, acupuncture becomes a rather simple technique that can be useful as a nondrug method of pain control." He believes that the traditional Chinese variety is primarily a placebo treatment, but electrical stimulation of about 80 acupuncture points has been proven useful for pain control.<ref>Ulett GA, Acupuncture update 1984, Southern Medical Journal 78:233234, 1985. Comment found at [http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=9853722&dopt=AbstractPlus NCBI - Traditional and evidence-based acupuncture: history, mechanisms, and present status. Ulett GA, Han J, Han S.]</ref>
Ted J. Kaptchuk, author of ''The Web That Has No Weaver'', refers to acupuncture as "prescientific." Regarding TCM theory, Kaptchuk states:
<blockquote>These ideas are cultural and speculative constructs that provide orientation and direction for the practical patient situation. There are few secrets of Oriental wisdom buried here. When presented outside the context of Chinese civilization, or of practical diagnosis and therapeutics, these ideas are fragmented and without great significance. The "truth" of these ideas lies in the way the physician can use them to treat real people with real complaints. (1983, pp. 34-35)</blockquote>
According to the 1997 [[NIH]] consensus statement on acupuncture:
<blockquote>Despite considerable efforts to understand the anatomy and physiology of the "acupuncture points", the definition and characterization of these points remains controversial. Even more elusive is the basis of some of the key traditional Eastern medical concepts such as the circulation of [[Qi]], the meridian system, and the five phases theory, which are difficult to reconcile with contemporary biomedical information but continue to play an important role in the evaluation of patients and the formulation of treatment in acupuncture.<ref name="NIH-1997consensus">{{cite web |author=NIH Consensus Development Program |title=Acupuncture --Consensus Development Conference Statement |url=http://consensus.nih.gov/1997/1997Acupuncture107html.htm |date=November 3-5, 1997 |publisher=National Institutes of Health |accessdate=2007-07-17}}</ref></blockquote>
==Clinical practice==
[[Image:Aiguille d acupuncture avec regle.dsc02265.untilted+cropped+WB.jpg|thumb|Acupuncture needle]]
Most modern acupuncturists use disposable [[stainless steel]] needles of fine [[diameter]] (0.007" to 0.020", 0.18 mm to 0.51 mm), sterilized with [[ethylene oxide]] or by [[autoclave]]. These needles are far smaller in diameter (and therefore less painful) than the needles used to give shots, since they do not have to be hollow for purposes of injection. The upper third of these needles is wound with a thicker wire (typically bronze), or covered in plastic, to stiffen the needle and provide a handle for the acupuncturist to grasp while inserting. The size and type of needle used, and the depth of insertion, depend on the acupuncture style being practised.
Warming an acupuncture point, typically by [[moxibustion]] (the burning of a combination of herbs, primarily [[mugwort]]), is a different treatment than acupuncture itself and is often, but not exclusively, used as a supplemental treatment. The Chinese term zhēn jǐu (針灸), commonly used to refer to acupuncture, comes from ''zhen'' meaning "needle", and ''jiu'' meaning "moxibustion". Moxibustion is used to varying degrees among current schools of oriental medicine. For example, one well-known technique is to insert the needle at the desired acupuncture point, attach dried ''moxa'' to the external end of an acupuncture needle, and then ignite it. The moxa will then smolder for several minutes (depending on the amount adhered to the needle) and conduct heat through the needle to the tissue surrounding the needle in the patient's body. Another common technique is to hold a large glowing stick of moxa over the needles. Moxa is also sometimes burned at the skin surface, usually by applying an ointment to the skin to protect from burns, though burning of the skin is general practice in China.
===An example of acupuncture treatment===
In Western medicine, vascular headaches (the kind that are accompanied by throbbing veins in the temples) are typically treated with analgesics such as aspirin and/or by the use of agents such as niacin that dilate the affected blood vessels in the scalp, but in acupuncture a common treatment for such headaches is to stimulate the sensitive points that are located roughly in the center of the webs between the thumbs and the palms of the patient, the ''hé gǔ'' points. These points are described by acupuncture theory as "targeting the face and head" and are considered to be the most important point when treating disorders affecting the face and head. The patient reclines, and the points on each hand are first sterilized with alcohol, and then thin, disposable needles are inserted to a depth of approximately 3-5 mm until a characteristic "twinge" is felt by the patient, often accompanied by a slight twitching of the area between the thumb and hand. Most patients report a pleasurable "tingling" sensation and feeling of relaxation while the needles are in place. The needles are retained for 15-20 minutes while the patient rests, and then are removed.
In the clinical practice of acupuncturists, patients frequently report one or more of certain kinds of sensation that are associated with this treatment, sensations that are stronger than those that would be felt by a patient not suffering from a vascular headache:
# Extreme sensitivity to pain at the points in the webs of the thumbs.
# In bad headaches, a feeling of nausea that persists for roughly the same period as the stimulation being administered to the webs of the thumbs.
# Simultaneous relief of the headache. (See ''Zhen Jiu Xue'', p. 177f et passim.)
===Indications according to acupuncturists in the West===
According to the American Academy of [[Medical acupuncture|Medical Acupuncture]] (2004), acupuncture may be considered as a [[complementary medicine|complementary]] therapy for the conditions in the list below.<ref>{{cite journal |author=Braverman S |title=Medical Acupuncture Review: Safety, Efficacy, And Treatment Practices |journal=Medical Acupuncture |volume=15 |issue=3 |year=2004 |url=http://www.medicalacupuncture.org/aama_marf/journal/vol15_3/article1.html}}</ref> The conditions labeled with * are also included in the World Health Organization list of acupuncture indications.<ref name=WHO>[http://www.aaaomonline.org/default.asp?pagenumber=47494 The World Health Organization Viewpoint On Acupuncture]</ref>.
These cases are based on clinical experience and are not necessarily substantiated by controlled clinical research. The inclusion of specific diseases is not meant to indicate the extent of acupuncture's efficacy in treating them.<ref name=WHO/>
*Abdominal distention/flatulence*
*Acute and chronic pain control*
*Allergic sinusitis *
*Anesthesia for high-risk patients or patients with previous adverse responses to anesthetics
*Anorexia
*Anxiety, fright, panic*
*Arthritis/arthrosis *
*Atypical chest pain (negative workup)
*Bursitis, tendinitis, carpal tunnel syndrome*
*Certain functional gastrointestinal disorders (nausea and vomiting, esophageal spasm, hyperacidity, irritable bowel) *
*Cervical and lumbar spine syndromes*
*Constipation, diarrhea *
*Cough with contraindications for narcotics
*Drug detoxification *
*Dysmenorrhea, pelvic pain *
*Frozen shoulder *
*Headache (migraine and tension-type), vertigo (Meniere disease), tinnitus *
*Idiopathic palpitations, sinus tachycardia
*In fractures, assisting in pain control, edema, and enhancing healing process
*Muscle spasms, tremors, tics, contractures*
*Neuralgias (trigeminal, herpes zoster, postherpetic pain, other)
*Paresthesias *
*Persistent hiccups*
*Phantom pain
*Plantar fasciitis*
*Post-traumatic and post-operative ileus *
*Premenstrual syndrome<ref name="pmid11869624">{{cite journal |author=Proctor ML, Smith CA, Farquhar CM, Stones RW |title=Transcutaneous electrical nerve stimulation and acupuncture for primary dysmenorrhoea |journal=Cochrane Database Syst Rev |volume= |issue=1 |pages=CD002123 |year=2002 |pmid=11869624 |doi= |url=http://www.cochrane.org/reviews/en/ab002123.html}}</ref>
*Selected dermatoses (urticaria, pruritus, eczema, psoriasis)
*Sequelae of stroke syndrome (aphasia, hemiplegia) *
*Seventh nerve palsy
*Severe hyperthermia
*Sleep disorders<ref name="pmid18035236">{{cite journal |author=Gooneratne NS |title=Complementary and alternative medicine for sleep disturbances in older adults |journal=Clin. Geriatr. Med. |volume=24 |issue=1 |pages=121–38, viii |year=2008 |pmid=18035236 |doi=10.1016/j.cger.2007.08.002}}</ref>
*Sprains and contusions
*Temporo-mandibular joint derangement, bruxism *
*Urinary incontinence, retention (neurogenic, spastic, adverse drug effect) *
*Weight Loss <ref>[http://www.acufinder.com/Acupuncture+Information/Detail/The+Acupuncture+Weight+Loss+Solution The Acupuncture Weight Loss Solution<!-- Bot generated title -->]</ref>
==Scientific theories and mechanisms of action==
{{main|Scientific theories regarding acupuncture}}
Many hypotheses have been proposed to address the physiological mechanisms of action of acupuncture. To date, more than 10,000 scientific research studies have been published on acupuncture as cataloged by the [[National Library of Medicine]] database.<ref>[http://www.nlm.nih.gov/medlineplus/acupuncture.html MedlinePlus: Acupuncture<!-- Bot generated title -->]</ref>
===Neurohormonal theory===
[[Image:Archie McPhee acupuncture.jpg|thumb|Modern acupuncture model.]]
Pain transmission can also be modulated at many other levels in the brain along the pain pathways, including the [[periaqueductal gray]], [[thalamus]], and the feedback pathways from the [[cerebral cortex]] back to the thalamus. Pain blockade at these brain locations is often mediated by [[neurohormone]]s, especially those that bind to the [[opioid]] receptors (pain-blockade site).
Some studies suggest that the [[analgesic]] (pain-killing) action of acupuncture is associated with the release of natural endorphins in the brain. This effect can be inferred by blocking the action of endorphins (or morphine) using a drug called [[naloxone]]. When naloxone is administered to the patient, the analgesic effects of morphine can be reversed, causing the patient to feel pain again. When naloxone is administered to an acupunctured patient, the analgesic effect of acupuncture can also be reversed, causing the patient to report an increased level of pain.<ref name="pmid187888">{{cite journal |author=Pomeranz B, Chiu D |title=Naloxone blockade of acupuncture analgesia: endorphin implicated |journal=Life Sci. |volume=19 |issue=11 |pages=1757–62 |year=1976 |pmid=187888 |doi=}}</ref><ref name="pmid832169">
{{cite journal |author=Mayer DJ, Price DD, Rafii A |title=Antagonism of acupuncture analgesia in man by the narcotic antagonist naloxone |journal=Brain Res. |volume=121 |issue=2 |pages=368–72 |year=1977 |pmid=832169 |doi=}}</ref><ref name="pmid1654741">{{cite journal |author=Eriksson SV, Lundeberg T, Lundeberg S |title=Interaction of diazepam and naloxone on acupuncture induced pain relief |journal=Am. J. Chin. Med. |volume=19 |issue=1 |pages=1–7 |year=1991 |pmid=1654741 |doi=}}</ref><ref>[http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=6243184&dopt=AbstractPlus Bishop B. - Pain: its physiology and rationale for management. Part III. Consequences of current concepts of pain mechanisms related to pain management. Phys Ther. 1980, 60:24-37.]</ref> It should be noted, however, that studies using similar procedures, including the administration of naloxone, have suggested a role of endogenous opioids in the placebo response, demonstrating that this response is not unique to acupuncture.<ref>{{cite journal |author=Amanzio, M., Pollo, A., Maggi, G., Benedetti, F. |title=Response Variability to Analgesics: a Role for Non-specific Activation of Endogenous Opioids |journal= Pain |volume=90 |issue=3 |pages=205–215 |year=2001 |pmid= |doi=}}</ref>
One study performed on monkeys by recording the neural activity directly in the [[thalamus]] of the brain indicated that acupuncture's analgesic effect lasted more than an hour.<ref name="pmid417686">{{cite journal |author=Sandrew BB, Yang RC, Wang SC |title=Electro-acupuncture analgesia in monkeys: a behavioral and neurophysiological assessment |journal=Archives internationales de pharmacodynamie et de thérapie |volume=231 |issue=2 |pages=274–84 |year=1978 |pmid=417686 |doi=}}</ref> Furthermore, there is a large overlap between the nervous system and acupuncture trigger points (points of maximum tenderness) in myofascial pain syndrome.<ref name="pmid69288">{{cite journal |author=Melzack R, Stillwell DM, Fox EJ |title=Trigger points and acupuncture points for pain: correlations and implications |journal=Pain |volume=3 |issue=1 |pages=3–23 |year=1977 |pmid=69288 |doi=}}</ref>
Evidence suggests that the sites of action of [[analgesia]] associated with acupuncture include the [[thalamus]] using fMRI ([[functional magnetic resonance imaging]])<ref name="pmid16970531">{{cite journal |author=Li K, Shan B, Xu J, ''et al.'' |title=Changes in FMRI in the human brain related to different durations of manual acupuncture needling |journal=[[Journal of alternative and complementary medicine]] (New York, N.Y.) |volume=12 |issue=7 |pages=615–23 |year=2006 |pmid=16970531 |doi=10.1089/acm.2006.12.615}}</ref> and PET ([[positron emission tomography]])<ref name="pmid15850733">{{cite journal |author=Pariente J, White P, Frackowiak RS, Lewith G |title=Expectancy and belief modulate the neuronal substrates of pain treated by acupuncture |journal=Neuroimage |volume=25 |issue=4 |pages=1161–7 |year=2005 |pmid=15850733 |doi=10.1016/j.neuroimage.2005.01.016}}</ref> [[brain imaging]] techniques,<ref name="pmid11822627">{{cite journal |author=Shen J |title=Research on the neurophysiological mechanisms of acupuncture: review of selected studies and methodological issues |journal=Journal of alternative and complementary medicine (New York, N.Y.) |volume=7 Suppl 1 |issue= |pages=S121–7 |year=2001 |pmid=11822627 |doi=10.1089/107555301753393896}}</ref> and via the feedback pathway from the [[cerebral cortex]] using [[electrophysiological recording]] of the nerve impulses of neurons directly in the cortex, which shows inhibitory action when acupuncture stimulus is applied.<ref name="pmid2242217">{{cite journal |author=Liu JL, Han XW, Su SN |title=The role of frontal neurons in pain and acupuncture analgesia |journal=Sci. China, Ser. B, Chem. Life Sci. Earth Sci. |volume=33 |issue=8 |pages=938–45 |year=1990 |pmid=2242217 |doi=}}</ref> Similar effects have been observed in association with the placebo response. One study using fMRI found that placebo analgesia was associated with decreased activity in the thalamus, insula and anterior cingulate cortex.<ref>{{cite journal |author=Wagner, T.D., Rilling, J.K., Smith, E.E., Sokolik, A., Casey, K.L. ''et al.'' |title=Placebo-Induced Changes in fMRI in the Anticipation and Experience of Pain |journal=Science |volume=303 |issue=5661 |pages=1162–1167. |year=2007|pmid= |doi=}}</ref>
Recently, acupuncture has been shown to increase the [[nitric oxide]] levels in treated regions, resulting in increased local blood circulation.<ref name="pmid17242084">{{cite journal |author=Tsuchiya M, Sato EF, Inoue M, Asada A |title=Acupuncture enhances generation of nitric oxide and increases local circulation |journal=Anesth. Analg. |volume=104 |issue=2 |pages=301–7 |year=2007 |pmid=17242084 |doi=10.1213/01.ane.0000230622.16367.fb}}</ref><ref name="pmid10412476">{{cite journal |author=Blom M, Lundeberg T, Dawidson I, Angmar-Månsson B |title=Effects on local blood flux of acupuncture stimulation used to treat xerostomia in patients suffering from Sjögren's syndrome |journal=Journal of oral rehabilitation |volume=20 |issue=5 |pages=541–8 |year=1993 |pmid=10412476 |doi=}}</ref> Effects on local inflammation and ischemia have also been reported.<ref name="pmid8122077">{{cite journal |author=Lundeberg T |title=Peripheral effects of sensory nerve stimulation (acupuncture) in inflammation and ischemia |journal=Scandinavian journal of rehabilitation medicine. Supplement |volume=29 |issue= |pages=61–86 |year=1993 |pmid=8122077 |doi=}}</ref>
===Issues in study design===
One of the major challenges in acupuncture research is in the design of an appropriate [[placebo]] [[control group]].<ref name="pmid12184353">{{cite journal |author=White AR, Filshie J, Cummings TM |title=Clinical trials of acupuncture: consensus recommendations for optimal treatment, sham controls and blinding|journal=Complement Ther Med. |volume=9 |issue=4 |pages=237–245 |year=2001 |pmid=12184353 |doi=}}</ref> 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.''
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]], in which insertion of needles anywhere near painful regions may elicit a beneficial response.<ref name="pmid16783282">{{cite journal |author=Johnson MI |title=The clinical effectiveness of acupuncture for pain relief--you can be certain of uncertainty.|journal= Acupunct Med. |volume=24 |issue=2 |pages=71–9 |year=2006 |pmid=16783282 |doi=}}</ref><ref name="NIH-1997consensus">{{cite web |author=NIH Consensus Development Program |title=Acupuncture --Consensus Development Conference Statement |url=http://consensus.nih.gov/1997/1997Acupuncture107html.htm |date=November 3-5, 1997 |publisher=National Institutes of Health |accessdate=2007-07-17}}</ref> A review in 2007 noted several issues confounding sham acupuncture:{{Quotation|Weak physiologic activity of superficial or sham needle penetration is suggested by several lines of research, including [[Randomized controlled trial|RCT]]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.<ref name="Annals_2007_Knee" />}}
A study by [[Ted Kaptchuk]] et. al. showed that sham acupuncture exerted a stronger effect on pain than an inert pill did, and concluded: "Placebo effects seem to be malleable and depend on the behaviours embedded in medical rituals."<ref>[http://www.bmj.com/cgi/content/full/332/7538/391 Kaptchuk et. al., BMJ 2006;332:391-397]</ref>
==Scientific research into efficacy==
{{Cleanup-section|date=May 2008}}
===Evidence-based medicine===
There is scientific agreement that an [[evidence-based medicine]] (EBM) framework should be used to assess health outcomes and that systematic reviews with strict protocols are essential. Organisations such as the [[Cochrane Collaboration]] and [[Bandolier (journal)|Bandolier]] publish such reviews. In practice, EBM is "about integrating individual clinical expertise and the best external evidence" and thus does not demand that doctors ignore research outside its "top-tier" criteria <ref>[http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=32159 Message to
complementary and alternative medicine: evidence is a better friend than power. Andrew J Vickers]</ref>.
The development of the evidence base for acupuncture was summarized in a review by researcher [[Edzard Ernst]] and colleagues in 2007. They compared systematic reviews conducted (with similar methodology) in 2000 and 2005:
:The effectiveness of acupuncture remains a controversial issue. ... The results indicate that the evidence base has increased for 13 of the 26 conditions included in this comparison. For 7 indications it has become more positive (''i.e.'' favoring acupuncture) and for 6 it had changed in the opposite direction. It is concluded, that acupuncture research is active. The emerging clinical evidence seems to imply that acupuncture is effective for some but not all conditions.<ref name ="pmid17265547">{{cite journal |author=Ernst E, Pittler MH, Wider B, Boddy K. |title=Acupuncture: its evidence-base is changing |journal=Am J Chin Med. |volume=35|issue=1 |pages=21–5 |year=2007 |pmid=17265547 |doi=10.1142/S0192415X07004588}}</ref>
For [[low back pain]], a Cochrane review (2005) stated:
:Thirty-five RCTs covering 2861 patients were included in this systematic review. There is insufficient evidence to make any recommendations about acupuncture or [[dry needling|dry-needling]] for acute low-back pain. For chronic low-back pain, results show that acupuncture is more effective for pain relief than no treatment or sham treatment, in measurements taken up to three months. The results also show that for chronic low-back pain, acupuncture is more effective for improving function than no treatment, in the short-term. Acupuncture is not more effective than other conventional and "alternative" treatments. When acupuncture is added to other conventional therapies, it relieves pain and improves function better than the conventional therapies alone. However, effects are only small. Dry-needling appears to be a useful adjunct to other therapies for chronic low-back pain.<ref>{{cite journal |author=Furlan AD, van Tulder MW, Cherkin DC, ''et al.'' |title=Acupuncture and dry-needling for low back pain |journal=Cochrane database of systematic reviews (Online) |volume= |issue=1 |pages=CD001351 |year=2005 |pmid=15674876 |doi=10.1002/14651858.CD001351.pub2 |url=http://www.cochrane.org/reviews/en/ab001351.html}}</ref>
A 2008 study suggest that combining acupuncture with conventional infertility treatments such as IVF greatly improves the success rates of such medical interventions.<ref name="pmid18258932">{{cite journal |author=Manheimer E, Zhang G, Udoff L, Haramati A, Langenberg P, Berman BM, Bouter LM |title=Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis |journal=BMJ |volume=336 |issue=7643 |pages=545–9 |year=2008 |pmid=18258932 |doi=}}</ref>
A review by Manheimer ''et al.'' in ''Annals of Internal Medicine'' (2005) reached conclusions similar to Cochrane's review on low back pain.<ref>{{cite journal |author=Manheimer E, White A, Berman B, Forys K, Ernst E |title=Meta-analysis: acupuncture for low back pain |journal=Ann. Intern. Med. |volume=142 |issue=8 |pages=651–63 |year=2005 |pmid=15838072 |doi= |url=http://www.annals.org/cgi/reprint/142/8/651.pdf |format=PDF}}</ref> A review for the American Pain Society/American College of Physicians found fair evidence that acupuncture is effective for chronic low back pain.<ref name="pmid17909210">{{cite journal |author=Chou R, Huffman LH |title=Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline|journal=Ann Intern Med.|volume=147 |issue=7 |pages=492–504 |year=2007 |pmid=17909210}}</ref>
For [[nausea]]<ref name="pmid17723973">{{cite journal |author=Dibble SL, Luce J, Cooper BA, Israel J, Cohen M, Nussey B, Rugo H |title=Acupressure for chemotherapy-induced nausea and vomiting: a randomized clinical trial |journal=Oncol Nurs Forum |volume=34 |issue=4 |pages=813–20 |year=2007 |pmid=17723973 |doi=10.1188/07.ONF.xxx-xxx}}</ref> and [[vomiting]]: The Cochrane review (Lee and Done, 2006) on the use of the P6 acupoint for the reduction of post-operative nausea and vomiting concluded that the use of P6 acupoint stimulation can reduce the risk of postoperative nausea and vomiting with minimal side effects, albeit with efficacy less than or equal to [[prophylactic]] (''i.e.'', preventative) treatment with [[antiemetic]] drugs.<ref name="pmid15266478">{{cite journal |author=Lee A, Done ML |title=Stimulation of the wrist acupuncture point P6 for preventing postoperative nausea and vomiting |journal=Cochrane database of systematic reviews (Online) |volume= |issue=3 |pages=CD003281 |year=2004 |pmid=15266478 |doi=10.1002/14651858.CD003281.pub2 |url=http://www.cochrane.org/reviews/en/ab003281.html}}</ref><ref>For nausea, acupuncture at first appeared to be more effective than [[antiemetic]] drugs, per Lee and Done (2006); however, the authors later retracted this conclusion, finding that [[publication bias]] (in Asian countries) had skewed their results, and that acupuncture's efficacy in treating nausea did not exceed (but approximately equalled) that of [[antiemetic]] [[prophylaxis]]. {{cite journal |author=Lee A, Copas JB, Henmi M, Gin T, Chung RC |title=Publication bias affected the estimate of postoperative nausea in an acupoint stimulation systematic review |journal=J Clin Epidemiol. |volume=59 |issue=9 |pages=980–3 |year=2006 |pmid=16895822 |doi=10.1016/j.jclinepi.2006.02.003}}</ref> Cochrane also stated: "Electroacupuncture is effective for first day vomiting after chemotherapy, but trials considering modern antivomiting drugs are needed."<ref>{{cite journal |author=Ezzo JM, Richardson MA, Vickers A, ''et al.'' |title=Acupuncture-point stimulation for chemotherapy-induced nausea or vomiting |journal=Cochrane database of systematic reviews (Online) |volume= |issue=2 |pages=CD002285 |year=2006 |pmid=16625560 |doi=10.1002/14651858.CD002285.pub2 |url=http://www.cochrane.org/reviews/en/ab002285.html}}</ref>
A 2007 Cochrane Review for the use of acupuncture for [[neck]] pain stated:
:There is moderate evidence that acupuncture relieves pain better than some sham treatments, measured at the end of the treatment. There is moderate evidence that those who received acupuncture reported less pain at short term follow-up than those on a waiting list. There is also moderate evidence that acupuncture is more effective than inactive treatments for relieving pain post-treatment and this is maintained at short-term follow-up.<ref name="Trinh K">{{cite journal |author=Trinh K, Graham N, Gross A, Goldsmith C, Wang E, Cameron I, Kay T |title=Acupuncture for neck disorders |journal=Spine |volume=32 |issue=2 |pages=236–43 |year=2007 |pmid=17224820 |doi=10.1097/01.brs.0000252100.61002.d4}}[http://www.cochrane.org/reviews/en/ab004870.html Cochrane review of Acupuncture for neck disorders]</ref>
For [[headache]], Cochrane concluded (2006) that "(o)verall, the existing evidence supports the value of acupuncture for the treatment of [[idiopathic]] headaches. However, the quality and amount of evidence are not fully convincing. There is an urgent need for well-planned, large-scale studies to assess the effectiveness and cost-effectiveness of acupuncture under real-life conditions." <ref>[http://www.cochrane.org/reviews/en/ab001218.html Acupuncture for idiopathic headache<!-- Bot generated title -->]</ref>.
For [[osteoarthritis]], reviews since 2006 show acupuncture to be more effective than no treatment at all, but approximately as effective as sham acupuncture (wherein needles are inserted in points that, according to acupuncture theory, should not be effective).<ref>[http://www.jr2.ox.ac.uk/bandolier/booth/alternat/acuosteo.html Acupuncture for osteoarthritis<!-- Bot generated title -->]</ref><ref name="Annals_2007_Knee">[http://lib.bioinfo.pl/pmid:17577006 Meta-analysis: acupuncture for osteoarthritis of the knee]. Eric Manheimer, Klaus Linde, Lixing Lao, Lex M Bouter, Brian M Berman. Ann Intern Med. 2007 Jun 19;146 (12):868-77. [http://www.annals.org/cgi/reprint/146/12/868.pdf Full text (PDF)]</ref>
For [[fibromyalgia]], a systematic review of the best 5 [[randomized controlled trials]] available found mixed results.<ref name="pmid17189243">{{cite journal |author=Mayhew E, Ernst E |title=Acupuncture for fibromyalgia--a systematic review of randomized clinical trials |journal=Rheumatology (Oxford, England) |volume=46 |issue=5 |pages=801–4 |year=2007 |pmid=17189243 |doi=10.1093/rheumatology/kel406}}</ref> Three positive studies, all using electro-acupuncture, found short term benefits. The methodological quality of the 5 trials was mixed and frequently low.
For the following conditions, the [[Cochrane Collaboration]] has 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]]<ref name='Cochrane_asthma'>
{{cite journal|
title=Acupuncture for chronic asthma|
journal=Cochrane Database of Systematic Reviews|
date=2003|
first=RW|last=McCarney|coauthors=B Brinkhaus, TJ Lasserson, K Linde|
volume=2003|issue=3|pages=CD000008|
doi= 10.1002/14651858.CD000008.pub2|
url=http://www.cochrane.org/reviews/en/ab000008.html|accessdate=2008-05-02 }}</ref>
* [[Bell's palsy]]<ref name='Cochrane_BP'>
{{cite journal|
title=Acupuncture for Bell's palsy|
journal=Cochrane Database of Systematic Reviews|
date=2004|
first=L|last=He|coauthors=D Zhou MK, Zhou, B Wu, N Li, SY Kong, DP Zhang, QF Li, J Yang, X Zhang|
volume=2007|issue=4|pages=CD002914|
doi= 10.1002/14651858.CD002914.pub3|
url=http://www.cochrane.org/reviews/en/ab002914.html|accessdate=2008-05-02 }}</ref>
* [[Cocaine dependence]] (auricular acupuncture)<ref name='Cochrane_cocaine'>
{{cite journal|
title=Auricular acupuncture for cocaine dependence|
journal=Cochrane Database of Systematic Reviews|
date=2006|
first=S|last=Gates|coauthors=LA Smith, DR Foxcroft|
volume=2006|issue=1|pages=CD005192|
doi= 10.1002/14651858.CD005192.pub2|
url=http://www.cochrane.org/reviews/en/ab005192.html|accessdate=2008-05-02 }}</ref>
* [[Clinical depression|Depression]]<ref name='acupuncture_Cochrane'>
{{cite journal|
title=Acupuncture for depression|
journal=Cochrane Database of Systematic Reviews|
date=2004-03-17|
first=CA|last=Smith|coauthors=PPJ Hay|
volume=2004|issue=3|pages=CD004046|
doi= 10.1002/14651858.CD004046.pub2|
url=http://www.cochrane.org/reviews/en/ab004046.html|accessdate=2008-05-02 }}</ref>
* Primary [[dysmenorrhoea]] (acupuncture plus transcutaneous electrical nerve stimulation)<ref name='Cochrane_dysmenorrhoea'>
{{cite journal|
title=Transcutaneous electrical nerve stimulation and acupuncture for primary dysmenorrhoea|
journal=Cochrane Database of Systematic Reviews|
date=2002
|first=ML|last=Proctor|coauthors=CA Smith, CM Farquhar, RW Stones|
volume=2002|issue=1|pages=CD002123|
doi= 10.1002/14651858.CD002123|
url=http://www.cochrane.org/reviews/en/ab002123.html|accessdate=2008-05-02 }}</ref>
* [[Epilepsy]]<ref name='Cochrane_epilepsy'>
{{cite journal|
title=Acupuncture for epilepsy|
journal=Cochrane Database of Systematic Reviews|
date=2006|
first=DKL|last=Cheuk|coauthors=V Wong|
volume=2006|issue=2|pages=CD005062|
doi= 10.1002/14651858.CD005062.pub2|
url=http://www.cochrane.org/reviews/en/ab005062.html|accessdate=2008-05-02 }}</ref>
* [[Glaucoma]]<ref name='Cochrane_glaucoma'>
{{cite journal|
title=Acupuncture for glaucoma|
journal=Cochrane Database of Systematic Reviews|
date=2007|
first=SK|last=Law|coauthors=T Li|
volume=2007|issue=4|pages=CD006030|
doi= 10.1002/14651858.CD006030.pub2|
url=http://www.cochrane.org/reviews/en/ab006030.html|accessdate=2008-05-02 }}</ref>
* [[Insomnia]]<ref name='Cochrane_insomnia'> {{cite journal|
title=Acupuncture for insomnia|
journal=Cochrane Database of Systematic Reviews|
date=2007|
first=DKL|last=Cheuk|coauthors=WF Yeung, KF Chung, V Wong|
volume=2007|issue=3|pages=CD005472|
doi= 10.1002/14651858.CD005472.pub2|
url=http://www.cochrane.org/reviews/en/ab005472.html|accessdate=2008-05-02 }}</ref>
* [[Irritable bowel syndrome]] <ref name='Cochrane_IBS'> {{cite journal|
title=Acupuncture for treatment of irritable bowel syndrome|
journal=Cochrane Database of Systematic Reviews|
date=2006|
first=B|last=Lim|coauthors=Manheimer E, Lao L, Ziea E, Wisniewski J, Liu J, Berman B|
volume=2006|issue=4|pages=CD005111|
doi= 10.1002/14651858.CD005111.pub2|
url=http://www.cochrane.org/reviews/en/ab005111.html|accessdate=2008-05-06 }}</ref>
* Induction of [[childbirth]] <ref name='Cochrane_labour'> {{cite journal|
title=Acupuncture for induction of labour|
journal=Cochrane Database of Systematic Reviews|
date=2004|
first=CA|last=Smith|coauthors=Crowther CA|
volume=2004|issue=1|pages=CD002962|
doi= 10.1002/14651858.CD002962.pub2|
url=http://www.cochrane.org/reviews/en/ab002962.html|accessdate=2008-05-06 }}</ref>
* [[Rheumatoid arthritis]] <ref name='Cochrane_rheum'> {{cite journal|
title=Acupuncture and electroacupuncture for the treatment of rheumatoid arthritis|
journal=Cochrane Database of Systematic Reviews|
date=2005|
first=L|last=Casimiro|coauthors=Barnsley L, Brosseau L, Milne S, Robinson VA, Tugwell P, Wells G|
volume=2005|issue=4|pages=CD003788|
doi= 10.1002/14651858.CD003788.pub2|
url=http://www.cochrane.org/reviews/en/ab003788.html|accessdate=2008-05-06 }}</ref>
* [[Shoulder pain]] <ref name='Cochrane_shoulder'> {{cite journal|
title=Acupuncture for shoulder pain|
journal=Cochrane Database of Systematic Reviews|
date=2005|
first=S|last=Green|coauthors=Buchbinder R, Hetrick S|
volume=2005|issue=2|pages=CD005319|
doi= 10.1002/14651858.CD005319|
url=http://www.cochrane.org/reviews/en/ab005319.html|accessdate=2008-05-06 }}</ref>
* [[Schizophrenia]] <ref name='Cochrane_schiz'> {{cite journal|
title=Acupuncture for schizophrenia|
journal=Cochrane Database of Systematic Reviews|
date=2005|
first=J|last=Rathbone|coauthors=Xia J|
volume=2005|issue=4|pages=CD005475|
doi= 10.1002/14651858.CD005475|
url=http://www.cochrane.org/reviews/en/ab005475.html|accessdate=2008-05-06 }}</ref>
* [[Smoking cessation]] <ref name='Cochrane_smoking'> {{cite journal|
title=Acupuncture and related interventions for smoking cessation|
journal=Cochrane Database of Systematic Reviews|
date=2006|
first=AR|last=White|coauthors=Rampes H, Campbell JL|
volume=2006|issue=1|pages=CD000009|
doi= 10.1002/14651858.CD000009.pub2|
url=http://www.cochrane.org/reviews/en/ab000009.html|accessdate=2008-05-06 }}</ref>
* Acute [[stroke]] <ref name='Cochrane_stroke_acute'> {{cite journal|
title=Acupuncture for acute stroke|
journal=Cochrane Database of Systematic Reviews|
date=2005|
first=SH|last=Zhang|coauthors=Liu M, Asplund K, Li L|
volume=2005|issue=2|pages=CD003317|
doi= 10.1002/14651858.CD003317.pub2|
url=http://www.cochrane.org/reviews/en/ab003317.html|accessdate=2008-05-06 }}</ref>
* [[Stroke rehabilitation]] <ref name='Cochrane_stroke_rehab'> {{cite journal|
title=Acupuncture for stroke rehabilitation|
journal=Cochrane Database of Systematic Reviews|
date=2006|
first=HM|last=Wu|coauthors=JL Tang, XP Lin, J Lau, PC Leung, J Woo, YP Li|
volume=2006|issue=3|pages=CD004131|
doi= 10.1002/14651858.CD004131.pub2|
url=http://www.cochrane.org/reviews/en/ab004131.html|accessdate=2008-05-06 }}</ref>
* [[Tennis elbow]] (lateral elbow pain) <ref name='Cochrane_lat_elbow'> {{cite journal|
title=Acupuncture for lateral elbow pain|
journal=Cochrane Database of Systematic Reviews|
date=2002|
first=S|last=Green|coauthors=Buchbinder R, Barnsley L, Hall S, White M, Smidt N, Assendelft W.|
volume=2002|issue=1|pages=CD003527|
doi= 10.1002/14651858.CD003527|
url=http://www.cochrane.org/reviews/en/ab003527.html|accessdate=2008-05-06 }}</ref>
* [[Vascular dementia]] <ref name='Cochrane_vasc_dement'> {{cite journal|
title=Acupuncture for vascular dementia|
journal=Cochrane Database of Systematic Reviews|
date=2008|
first=WN|last=Peng|coauthors=Zhao H, Liu ZS, Wang S|
volume=2007|issue=2|pages=CD004987|
doi= 10.1002/14651858.CD004987.pub2|
url=http://www.cochrane.org/reviews/en/ab004987.html|accessdate=2008-05-06 }}</ref>
Positive results from some studies on the efficacy of acupuncture may be as a result of poorly designed studies or publication bias.<ref>{{cite journal
|author=Tang JL, Zhan SY, Ernst E
|title=Review of randomised controlled trials of traditional Chinese medicine
|journal=BMJ
|volume=319
|issue=7203
|pages=160–1
|year=1999
|month=July
|pmid=10406751
|doi=
|url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=10406751
|accessdate=2008-05-13
}}</ref><ref>{{cite journal
|author=Vickers A, Goyal N, Harland R, Rees R
|title=Do certain countries produce only positive results? A systematic review of controlled trials
|journal=Control Clin Trials
|volume=19
|issue=2
|pages=159–66
|year=1998
|month=April
|pmid=9551280
|doi=
|url=http://linkinghub.elsevier.com/retrieve/pii/S0197-2456(97)00150-5
}}</ref>
===Evidence from neuroimaging studies===
Acupuncture appears to have effects on cortical activity, as demonstrated by MRI ([[magnetic resonance imaging]]) and PET ([[positron emission tomography]]). Researchers from the University of Southampton, UK and Purpan Hospital of Toulouse, France, summarize the literature:
*''Investigating Acupuncture Using Brain Imaging Techniques: The Current State of Play'': George T. Lewith, Peter J. White and Jeremie Pariente. "We have systematically researched and reviewed the literature looking at the effect of acupuncture on brain activation as measured by functional magnetic resonance imaging and positron emission tomography. These studies show that specific and largely predictable areas of brain activation and deactivation occur when considering the traditional Chinese functions attributable to certain specific acupuncture points. For example, points associated with hearing and vision stimulates the visual and auditory cerebral areas respectively. Pain, however, is a complex matrix that is intimately intertwined with expectation. Acupuncture clearly affects this matrix in both specific and non-specific manner that is consistent with its specific clinical effects, as well as the effects of expectation on pain relief. ... It is quite possible that specific acupuncture points for non-painful conditions, such as PC6 in the treatment of nausea, may activate or inhibit very specific neuronal substrates. This may support ... the assumptions inherent within traditional Chinese medicine. The effects of acupuncture in pain and possibly also in addiction may be far less point-specific as has been previously suggested from the available clinical evidence."<ref name="pmid16136210">{{cite journal |author=Lewith GT, White PJ, Pariente J |title=Investigating acupuncture using brain imaging techniques: the current state of play |journal=Evidence-based complementary and alternative medicine : eCAM |volume=2 |issue=3 |pages=315–9 |year=2005 |month=Sep |pmid=16136210 |doi=10.1093/ecam/neh110 |url=http://ecam.oxfordjournals.org/cgi/content/full/2/3/315 |accessdate=2007-03-06}}</ref>
===NIH consensus statement===
In 1997, the [[National Institutes of Health]] (NIH) issued a [[Consensus (medical)|consensus statement]] on acupuncture that concluded that
:''there is sufficient evidence of acupuncture's value to expand its use into conventional medicine and to encourage further studies of its physiology and clinical value.''<ref name="NIH-1997consensus" />
The statement was not a policy statement of the NIH but is the considered assessment of a panel convened by the NIH.
The NIH consensus statement said that
:''the data in support of acupuncture are as strong as those for many accepted Western medical therapies''
and added that
: ''there is clear evidence that needle acupuncture is efficacious for adult postoperative and [[chemotherapy]] nausea and vomiting and probably for the nausea of pregnancy... There is reasonable evidence of efficacy for postoperative dental pain... reasonable studies (although sometimes only single studies) showing relief of pain with acupuncture on diverse pain conditions such as menstrual cramps, tennis elbow, and fibromyalgia...''
The NIH consensus statement summarized and made a prediction:
:''Acupuncture as a therapeutic intervention is widely practiced in the United States. While there have been many studies of its potential usefulness, many of these studies provide equivocal results because of design, sample size, and other factors. The issue is further complicated by inherent difficulties in the use of appropriate controls, such as placebos and sham acupuncture groups. However, promising results have emerged, for example, showing efficacy of acupuncture in adult postoperative and chemotherapy nausea and vomiting and in postoperative dental pain. There are other situations such as addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma, in which acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program. Further research is likely to uncover additional areas where acupuncture interventions will be useful.''
The NIH's [[U.S. National Center for Complementary and Alternative Medicine|National Center for Complementary and Alternative Medicine]] continues to abide by the recommendations of the NIH Consensus Statement, stating that:
:''Preclinical studies have documented acupuncture's effects, but they have not been able to fully explain how acupuncture works within the framework of the Western system of medicine that is commonly practiced in the United States.''<ref name="NCCAM2006-Acupuncture">{{cite web |title=Get the Facts, Acupuncture |url=http://nccam.nih.gov/health/acupuncture/ |publisher=National Institute of Health |date=2006 |accessdate=2006-03-02}}</ref>
===American Medical Association statement===
In 1997, the following statement was adopted as policy of the [[American Medical Association]] (AMA),
an association of medical doctors and medical students, after a report on a number of alternative therapies including acupuncture:<ref>{{cite web| title=Report 12 of the Council on Scientific Affairs (A-97) -- Alternative Medicine |url=http://www.ama-assn.org/ama/pub/category/13638.html |publisher=American Medical Association |date=1997}}</ref>
''<blockquote>"There is little evidence to confirm the safety or efficacy of most alternative therapies. Much of the information currently known about these therapies makes it clear that many have not been shown to be efficacious. Well-designed, stringently controlled research should be done to evaluate the efficacy of alternative therapies."</blockquote>''
===German study===
A German study published in the September 2007 issue of the [[Archives of Internal Medicine]] found that nearly half of patients treated with acupuncture or a sham treatment felt relief from chronic [[low back pain]] over a period of months compared to just nearly a quarter of those receiving a variety of more conventional treatments (drugs, heat, massage, ''etc.'')<ref name="pmid17893311">{{cite journal |author=Haake M, Müller HH, Schade-Brittinger C, ''et al.'' |title=German Acupuncture Trials (GERAC) for Chronic Low Back Pain: Randomized, Multicenter, Blinded, Parallel-Group Trial With 3 Groups |journal=Arch. Intern. Med. |volume=167 |issue=17 |pages=1892–8 |year=2007 |pmid=17893311 |doi=10.1001/archinte.167.17.1892}}</ref><ref>[http://news.bbc.co.uk/1/hi/health/7011738.stm BBC NEWS, Acupuncture 'best for back pain']</ref> The greater benefit of the real and sham treatments were not significantly different.
===Nonacupuncture points===
A controlled study of 300 migraine patients found that both sham and real acupuncture resulted in improvements compared with patients on a waiting list, with no significant difference in benefit between the sham and active treatment groups. The sham treatment involved actual needles piercing the skin, but at nonacupuncture points.<ref>{{cite journal|author=Linde K, Streng A, Jürgens S, Hoppe A, Brinkhaus B, Witt C, Wagenpfeil S, Pfaffenrath V, Hammes MG, Weidenhammer W, Willich SN, Melchart D|title=Acupuncture for patients with migraine: a randomized controlled trial|journal=JAMA|volume=293|issue=17|pages=2118–25|year=2005|pmid=15870415|doi=10.1001/jama.293.17.2118}}</ref>
Some researchers have questioned the use of sham acupuncture as a control in this study<ref>[http://www.annals.org/cgi/eletters/145/1/12#3500 Ann Intern Med - Rapid Responses for Scharf ''et al.'', 145 (1) 12-20<!-- Bot generated title -->]</ref> and others, arguing that sham acupuncture may be too similar to real acupuncture to be a valid control, thereby skewing results toward showing a relative lack of efficacy.
==Safety and risks==
Because acupuncture needles penetrate the skin, many forms of acupuncture are [[Invasive (medical)|invasive]] procedures, and therefore not without risk. Injuries are rare among patients treated by trained practitioners.<ref name="pmid12564354">{{cite journal |author=Lao L, Hamilton GR, Fu J, Berman BM |title=Is acupuncture safe? A systematic review of case reports |journal=Alternative therapies in health and medicine |volume=9 |issue=1 |pages=72–83 |year=2003 |pmid=12564354 |doi=}}</ref><ref name="pmid9395661">{{cite journal |author=Norheim AJ |title=Adverse effects of acupuncture: a study of the literature for the years 1981-1994 |journal=Journal of alternative and complementary medicine (New York, N.Y.) |volume=2 |issue=2 |pages=291–7 |year=1996 |pmid=9395661 |doi=}}</ref> In most jurisdictions, needles are required by law to be [[sterile]], disposable and used only once; in some places, needles may be reused if they are first resterilized, ''e.g.'' in an [[autoclave]].
Several styles of Japanese acupuncture use ''non-inserted needling'', making for an entirely [[Non-invasive (medical)|non-invasive]] procedure. In non-inserted needling the needle is brought to the skin, but never penetrates it, and various other acupuncture tools are used to tap or stroke along the meridians. Notable examples of these styles are ''Tōyōhari'' and the pediatric acupuncture style ''Shōnishin''.
===Common, minor adverse events===
A survey by Ernst ''et al.'' of over 400 patients receiving over 3500 acupuncture treatments found that the most common adverse effects from acupuncture were:<ref name="pmid12801494">{{cite journal |author=Ernst G, Strzyz H, Hagmeister H |title=Incidence of adverse effects during acupuncture therapy-a multicentre survey |journal=Complementary therapies in medicine |volume=11 |issue=2 |pages=93–7 |year=2003 |pmid=12801494 |doi=}}</ref>
*Minor [[bleeding]] after removal of the needles, seen in roughly 3% of patients. (Holding a cotton ball for about one minute over the site of puncture is usually sufficient to stop the bleeding.)
*[[Hematoma]], seen in about 2% of patients, which manifests as bruises. These usually go away after a few days.
*[[Dizziness]], seen in about 1% of patients. Some patients have a conscious or unconscious fear of needles which can produce dizziness and other symptoms of anxiety. Patients are usually treated lying down in order to reduce likelihood of fainting.
The survey concluded: ''"Acupuncture has adverse effects, like any therapeutic approach. If it is used according to established safety rules and carefully at appropriate anatomic regions, it is a safe treatment method."''<ref name="pmid12801494">{{cite journal |author=Ernst G, Strzyz H, Hagmeister H |title=Incidence of adverse effects during acupuncture therapy-a multicentre survey |journal=Complementary therapies in medicine |volume=11 |issue=2 |pages=93–7 |year=2003 |pmid=12801494 |doi=}}</ref>
===Other injury===
Other risks of injury from the insertion of acupuncture needles include:
*[[Nerve]] injury, resulting from the accidental puncture of any nerve.
*[[Brain damage]] or [[stroke]], which is possible with very deep needling at the base of the skull.
*[[Pneumothorax]] from deep needling into the [[lung]].<ref>{{cite journal |author=Leow TK |title=Pneumothorax Using Bladder 14 |journal=Medical Acupuncture |year=2001 |volume=16 |issue=2 |pages= | url=http://www.medicalacupuncture.org/aama_marf/journal/vol16_2/case_2.html}}</ref>
*[[Kidney]] damage from deep needling in the low back.
*Haemopericardium, or puncture of the protective membrane surrounding the [[heart]], which may occur with needling over a sternal foramen (a hole in the breastbone that occurs as the result of a congenital defect.) <ref> {{cite journal|title=Frequency of Sternal Variations and Anomalies Evaluated by MDCT|journal=American Journal of Roentgenology|date=|first=Ensar|last=Yekeler|coauthors=Mehtap Tunaci, Atadan Tunaci, ''et al.''|volume=|issue=|pages=|doi= 10.2214|url=http://www.ajronline.org/cgi/content/full/186/4/956|accessdate=2007-11-24|pmid=16554563|doi_brokendate=2008-06-24 }}</ref>
*Risk of terminating pregnancy with the use of certain acupuncture points that have been shown to stimulate the production of adrenocorticotropic hormone ([[ACTH]]) and [[oxytocin]].
The chance of these is very small; the risk can be further reduced through proper training of acupuncturists. Graduates of medical schools and (in the US) accredited acupuncture schools receive thorough instruction in proper technique so as to avoid these events. (Cf. Cheng, 1987)
===Risks from omitting orthodox medical care===
Receiving any form of [[alternative medicine|alternative medical]] care without also receiving orthodox Western [[medicine|medical]] care can be inherently risky, since undiagnosed disease may go untreated and could worsen. For this reason many acupuncturists and doctors prefer to consider acupuncture a [[complementary medicine|complementary]] therapy rather than an alternative therapy.
Critics also express concern that unethical or naive practitioners may induce patients to exhaust financial resources by pursuing ineffective treatment.<ref>http://www.quackwatch.org/01QuackeryRelatedTopics/acu.html</ref><ref>http://www.parliament.nsw.gov.au/prod/parlment/committee.nsf/0/CA78E168CE1B6FA2CA2570B400200A34</ref> Some public health departments regulate acupuncture.<ref>http://ogov.newswire.ca/ontario/GPOE/2005/12/07/c4319.html?lmatch=&lang=_e.html</ref><ref>http://www.e-laws.gov.on.ca/DBLaws/Statutes/English/06t27_e.htm</ref><ref>http://www.ctcma.bc.ca/index.asp</ref>
===Safety compared with other treatments===
Commenting on the relative safety of acupuncture compared with other treatments, the NIH consensus panel stated that "(a)dverse side effects of acupuncture are extremely low and often lower than conventional treatments." They also stated:
:''"the incidence of adverse effects is substantially lower than that of many [[medication|drugs]] or other accepted medical procedures used for the same condition. For example, [[musculoskeletal]] conditions, such as [[fibromyalgia]], [[Myofascial Pain Syndrome|myofascial pain]], and [[tennis elbow]]... are conditions for which acupuncture may be beneficial. These painful conditions are often treated with, among other things, [[NSAIDS|anti-inflammatory medications]] (aspirin, ibuprofen, ''etc.'') or with [[steroid]] injections. Both medical interventions have a potential for deleterious side effects but are still widely used and are considered acceptable treatments."''
In a Japanese survey of 55,291 acupuncture treatments given over five years by 73 acupuncturists, 99.8% of them were performed with no significant minor adverse effects and zero major adverse incidents (Hitoshi Yamashita, Bac, Hiroshi Tsukayama, BA, Yasuo Tanno, MD, PhD. Kazushi Nishijo, PhD, JAMA). Two combined studies in the UK of 66,229 acupuncture treatments yielded only 134 minor adverse events. (British Medical Journal 2001 Sep 1). The total of 121,520 treatments with acupuncture therapy were given with no major adverse incidents (for comparison, a single such event would have indicated a 0.0008% incidence).
==Legal and political status==
{{Main|Regulation of acupuncture}}
Acupuncturists may also practice [[herbal medicine]] or [[tui na]], or may be medical acupuncturists, who, as well as being qualified physicians, also practice acupuncture in a simplified form. In most states, medical doctors are not required to have any formal training to perform acupuncture. Over 20 states allow chiropractors to perform acupuncture with less than 200 hours training. The typical amount of hours of medical training by licenesed acupuncturists is over 3,000 hours. License is regulated by the [[state (non-sovereign)|state]] or [[province]] in many countries, and often requires passage of a [[board exam]].
In the US, acupuncture is practiced by a variety of healthcare providers. 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<ref>[http://nccaom.org/about/about.html NCCAOM<!-- Bot generated title -->]</ref>. Professional degrees are usually at the level of a [[Master's degree]].
A poll of American doctors in 2005 showed that 59% believe acupuncture was at least somewhat effective.<ref>"More than half of the physicians (59%) believed that acupuncture can be effective to some extent." ''Physicians Divided on Impact of CAM on U.S. Health Care; Aromatherapy Fares Poorly; Acupuncture Touted''. HCD Research, 9 Sept. 2005. convenience link: [http://findarticles.com/p/articles/mi_m0EIN/is_2005_Sept_9/ai_n15378095/pg_1 Business Wire, 2005]. Link to [[internet archive]] version: [http://web.archive.org/web/20060110033955/http://publish.hcdhealth.com/P1007/CumulativeReport.htm Cumulative Report]</ref> In 1996, the [[Food and Drug Administration]] changed the status of acupuncture needles from [[Medical devices#Classifications|Class III]] to [[Medical devices#Classifications|Class II]] [[medical device]]s, meaning that needles are regarded as safe and effective when used appropriately by licensed practitioners.<ref>[http://www.fda.gov/fdac/departs/596_upd.html Updates-June 1996 FDA Consumer<!-- Bot generated title -->]</ref><ref>[http://www.fda.gov/cdrh/pmapage.html US FDA/CDRH: Premarket Approvals<!-- Bot generated title -->]</ref>
Canadian acupuncturists have been licensed in [[British Columbia]] since 2003. In [[Ontario]], the practice of acupuncture is now regulated by the Traditional Chinese Medicine Act, 2006, S.o. 2006, chapter 27.<ref>[http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_06t27_e.htm Traditional Chinese Medicine Act, 2006, S.O. 2006, c. 27<!-- Bot generated title -->]</ref> 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.
In the United Kingdom, acupuncturists are not yet regulated by the government.
In Australia, the legalities of practicing acupuncture also vary by state. Victoria is the only state of Australia with an operational registration board.<ref>[http://www.cmrb.vic.gov.au Welcome to the Chinese Medicine Registration Board of Victoria<!-- Bot generated title -->]</ref> Currently acupuncturists in New South Wales are bound by the guidelines in the Public Health (Skin Penetration) Regulation 2000,<ref>{{cite web|url=http://www.health.nsw.gov.au/public-health/ehb/general/skinpen/skin_pen_reg_2000.pdf|title=Health NSW}}</ref> which is enforced at local council level. Other states of Australia have their own skin penetration acts.
Many other countries do not license acupuncturists or require them be trained.
==See also==
{{Wikiquote|Traditional Chinese medicine}}
{{commons|Acupuncture}}
* [[Acupoint therapy]]
* [[Acupressure]]
* [[Acupuncture detoxification]]
* [[Auriculotherapy]]
* [[Chin na]]
* [[Complementary and Alternative Medicine]]
* [[Dry needling]]
* [[Electroacupuncture]]
* [[Medical acupuncture]]
* [[Pressure Points]]
* [[Qi]]
* [[Qigong]]
* [[Seitai]]
* [[Susuk]]
* [[T'ai Chi Ch'uan]]
* [[Traditional Chinese medicine]]
* [[Trigger point]]
* [[Veterinary acupuncture]]
==Bibliography==
* {{cite journal |author=Vincent CA, Richardson PH |title=The evaluation of therapeutic acupuncture: concepts and methods |journal=Pain |volume=24 |issue=1 |pages=1–13 |year=1986 |pmid=3513094 |doi=}}
* {{cite journal | author=Richardson PH, Vincent CA | title=Acupuncture for the treatment of pain | journal=Pain | year=1986 | volume=24 | issue= | pages=1540 | doi=10.1016/0304-3959(86)90023-0 }}
* {{cite journal | author=Ter Riet G ''et al.'' | title=The effectiveness of acupuncture | journal=Huisarts Wet | year=1989 | volume=32 | issue= | pages=170–175, 176–181, 308–312 }}
* {{cite journal |author=Brinkhaus B, Hummelsberger J, Kohnen R, ''et al.'' |title=Acupuncture and Chinese herbal medicine in the treatment of patients with seasonal allergic rhinitis: a randomized-controlled clinical trial |journal=Allergy |volume=59 |issue=9 |pages=953–60 |year=2004 |pmid=15291903 |doi=10.1111/j.1398-9995.2004.00540.x}}
* G. Maciocia. The Foundations of Chinese Medicine: A Comprehensive Text for Acupuncturists and Herbalists. Second Edition. Churchill Livingstone. 1989
* P. Deadman, K. Baker, M. Al-Khafaji. A Manual of Acupuncture. Eastland Press
* {{cite journal |author=Witt C, Brinkhaus B, Jena S, ''et al.'' |title=Acupuncture in patients with osteoarthritis of the knee: a randomised trial |journal=Lancet |volume=366 |issue=9480 |pages=136–43 |year=2005 |pmid=16005336 |doi=10.1016/S0140-6736(05)66871-7}}
* Edwards, J. Acupuncture and Heart Health. Access, February 2002
* {{cite web |author=Wolfe HL |title=Chronic Fatigue Syndrome, Acupuncture and its related modalities. |url=http://findarticles.com/p/articles/mi_m0ISW/is_265-266/ai_n15688805 |format=Reprint at findarticles.com |publisher=Townsend Letter for Doctors and Patients| date=August/September 2005}}
* {{cite journal |author=Abuaisha BB, Costanzi JB, Boulton AJ |title=Acupuncture for the treatment of chronic painful peripheral diabetic neuropathy: a long-term study |journal=Diabetes Res. Clin. Pract. |volume=39 |issue=2 |pages=115–21 |year=1998 |pmid=9597381 |doi=}}
* Altshul, Sara. "Incontinence: Finally, Relief That Works." Prevention December 2005: 33. Academic Search Premier. EBSCO. [[30 January]] [[2006]]
* {{cite journal |author=Deluze C, Bosia L, Zirbs A, Chantraine A, Vischer TL |title=Electroacupuncture in fibromyalgia: results of a controlled trial |journal=BMJ |volume=305 |issue=6864 |pages=1249–52 |year=1992 |pmid=1477566 |doi= |url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=1477566}}
* Cademartori, Lorraine. "Facing the Point." Forbes October 2005: 85. Academic Search
* {{cite journal |author=Ouyang H, Chen JD |title=Review article: therapeutic roles of acupuncture in functional gastrointestinal disorders |journal=Aliment. Pharmacol. Ther. |volume=20 |issue=8 |pages=831–41 |year=2004 |pmid=15479354 |doi=10.1111/j.1365-2036.2004.02196.x}}
* {{cite book |author=Teng, Liang-yüeh; Chʻeng, Hsin-nung |title=Chinese acupuncture and moxibustion |publisher=Foreign Language Press |location=Beijing |year=1987 |pages= |isbn=7-119-00378-X |oclc= |doi=}}
* {{cite journal |author=Helms JM |title=Acupuncture for the management of primary dysmenorrhea |journal=Obstetrics and gynecology |volume=69 |issue=1 |pages=51–6 |year=1987 |pmid=3540764 |doi=}}
* Jin, Guanyuan, Xiang, Jia-Jia and Jin, Lei: Clinical Reflexology of Acupuncture and Moxibustion (Chinese). Beijing Science and Technology Press, Beijing, 2004. ISBN 7-5304-2862-4
* Jin, Guan-Yuan, Jin, Jia-Jia X. and Jin, Louis L.: Contemporary Medical Acupuncture - A Systems Approach (English). Springer, USA & Higher Education Press, PRC, 2006. ISBN 7-04-019257-8
* {{cite book |author=Kaptchuk, Ted J. |title=The web that has no weaver: understanding Chinese medicine |publisher=Congdon & Weed |location=New York, N.Y |year=1983 |pages= |isbn=0-86553-109-9 |oclc= |doi=}}
* Premier. EBSCO. [[30 January]] [[2006]]
* "History of Acupuncture in China." Acupuncture Care. [[2 February]] [[2006]] <http://www.acupuncturecare.com/acupunct.htm>
* Howard, Cori. "An Ancient Helper for Making a Baby." Maclean’s [[23 January]] [[2006]]: 40. Academic Search Premier. EBSCO. [[30 January]] [[2006]]
* {{cite web |author=Carter B |title=Is Acupuncture Safe? |url=http://www.articleslog.com/2007/07/04/65148-is-acupuncture-safe.html |date=2007-07-04 |publisher=ArticlesLog.com |accessdate=2007-07-20}}
* Health Professions Regulatory Advisory Council, ''Minister’s Referral Letter [[January 18]], 2006 – Traditional Chinese Medicine (TCM)'' <http://www.hprac.org/english/projects.asp> [[20 March]] [[2006]]
* {{cite book |author=Porkert, Manfred |title=The theoretical foundations of Chinese medicine: systems of correspondence |publisher=MIT Press |location=Cambridge, Mass |year=1974 |pages= |isbn=0-262-16058-7 |oclc= |doi=}}
* {{cite journal |author=Wu MT, Hsieh JC, Xiong J, ''et al.'' |title=Central nervous pathway for acupuncture stimulation: localization of processing with functional MR imaging of the brain--preliminary experience |journal=Radiology |volume=212 |issue=1 |pages=133–41 |year=1999 |pmid=10405732 |doi= |url=http://radiology.rsnajnls.org/cgi/content/full/212/1/133}}
==Footnotes==
{{reflist|2}}
==External links==
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[[Category:Acupuncture| ]]
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