They were in the same locations as China's spiritually identified acupuncture points, but under a different nomenclature. 27 The first elaborate Western treatise on acupuncture was published Association of Canada are used in provinces without government regulation. 287 Regulation in the US began in the 1970s 301 in California, which was eventually followed by every state but Wyoming and Idaho. 299 302 Licensing requirements vary greatly from state to state. It spread to Vietnam in the 8th and 9th centuries. 30 As Vietnam began trading with Japan and China around the 9th century, it was influenced by their China and established acupuncture as one of five divisions of the Chinese State Medical Administration System. 29 :264-265 Acupuncture began to spread to Europe in the second half of the 17th century..>The.needles.sed.n.acupuncture.re.egulated.n the US by the Food and Drug Administration . 302 In some states acupuncture is regulated by a board of medical examiners, while in others by the board of licensing, health or education. 299 In Japan, acupuncturists are licensed by the of the skin by thin metal needles, which are manipulated manually or the needle may be further stimulated by electrical stimulation electro acupuncture. 2 Acupuncture needles are typically made of stainless steel, making them flexible and preventing them from rusting or breaking. 46 Needles are usually disposed of after each use to prevent contamination. 46 Reusable needles when used should be sterilized between applications. 46 47 Needles vary in length between 13 to 130 millimetres 0.51 to 5.12 in, with shorter needles used near the face and eyes, and longer needles in areas with thicker tissues; needle diameters vary from 0.16 mm 0.006 in to 0.46 mm 0.018 in, 48 with thicker needles used on more robust patients. Although.cupuncture declined in China during this time period, it was also growing in popularity in other countries. 30 Acupuncture chart from Shisi Ming fahui Expression of the Fourteen Meridians written by Hun thou Al. 1340s, Ming dynasty . Acupuncture.Tote..s. form of alternative medicine 2 in which thin needles are inserted into the body. 3 It is a key component of traditional Chinese medicine ACM. 4 ACM theory and practice are not based upon scientific knowledge, 5 and acupuncture is a pseudo-science . 6 7 There is a diverse range of acupuncture theories based on different philosophies, 8 and techniques vary depending on the country. 9 The method used in ACM is likely the most widespread in the US. 2 It is most often used for pain relief, 10 11 though it is also used for a wide range of other conditions. 4 Acupuncture is generally used only in combination with other forms of treatment. 12 The conclusions of many trials and numerous systematic reviews of acupuncture are largely inconsistent. 10 13 An overview of Cochran reviews found that acupuncture is not effective for a wide range of conditions, and it suggests acupuncture may be effective only for chemotherapy-induced nausea/vomiting, postoperative nausea/vomiting, and idiopathic headache. 13 A systematic review of systematic reviews found little evidence of acupuncture's effectiveness in treating pain. 10 The evidence suggests that short-term treatment with acupuncture does not produce long-term benefits. 14 Some research results suggest acupuncture can alleviate pain, though the majority of research suggests that acupuncture's effects are mainly due to placebo . 9 A systematic review concluded that the analgesic effect of acupuncture seemed to lack clinical relevance and could not be clearly distinguished from bias. 15 Acupuncture is generally safe when done by an appropriately trained practitioner using clean needle technique and single-use needles. 16 17 When properly delivered, it has a low rate of mostly minor adverse effects . 3 16 Accidents and infections are associated with infractions of sterile technique or neglect of the practitioner. 17 A review stated that the reports of infection transmission increased significantly in the prior decade. 18 The most frequently reported adverse events were pneumothorax and infections. 10 Since serious adverse events continue to be reported, it is recommended that acupuncturists be trained sufficiently to reduce the risk. 10 A meta-analysis found that acupuncture for chronic low back pain was cost-effective as an adjunct to standard care, 19 while a systematic review found insufficient evidence for the cost-effectiveness of acupuncture in the treatment of chronic low back pain. 20 Scientific investigation has not found any histological or physiological evidence for traditional Chinese concepts such as qi, meridians, and acupuncture points, n 1 24 and many modern practitioners no longer support the existence of life force energy qi flowing through meridians, which was a major part of early belief systems. 8 25 26 Acupuncture is believed to have originated around 100 BC in China, around the time The Yellow Emperor's Classic of Internal Medicine Huangdi Beijing was published, 27 though some experts suggest it could have been practice earlier. 9 Over time, conflicting claims and belief systems emerged about the effect of lunar, celestial and earthly cycles, yin and yang energies, and a body's “rhythm” on the effectiveness of treatment. 28 Acupuncture grew and diminished in popularity while moxibustion was used for chronic diseases .
The.Judy.lso.ncludes.arnings against practising acupuncture on infants, as well as on children who are over-fatigued, very weak, or have overeaten. 240 When used on children, acupuncture is considered safe when administered by well-trained, licensed practitioners using sterile nneedles; however, a 2011 review found there was limited research to draw definite conclusions about the overall safety of paediatric acupuncture. 3 The same review found 279 adverse events, 25 of them serious. 3 The adverse events were mostly mild in nature e.g. bruising or bleeding. 3 The prevalence of mild adverse events ranged from 10.1% to 13.5%, an estimated 168 incidences among 1,422 patients. 3 On rare occasions adverse events were serious e.g. cardiac rupture or hemoptysis ; much might have been a result of substandard practice. 3 The incidence of serious adverse events was 5 per one million, which included children and adults. 3 When used during pregnancy, the majority of adverse events caused by acupuncture were mild and transient, with few serious adverse events. 241 The most frequent mild adverse event was needling or unspecified pain, followed by bleeding. 241 Although two deaths one stillbirth and one neonatal death were reported, there was a lack of acupuncture-associated maternal mortality. 241 Limiting the evidence as certain, probable or possible in the causality evaluation, the estimated incidence of adverse events following acupuncture in pregnant women was 131 per 10,000. 241 Although acupuncture is not contraindicated in pregnant women, some specific acupuncture points are particularly sensitive to needle insertion; these spots, as well as the abdominal region, should be avoided during pregnancy. 2 Four adverse events associated with moxibustion were bruising, burns and cellulitis, spinal epidural abscess, and large superficial basal cell carcinoma. 16 Ten adverse events were associated with cupping. 16 The minor ones were keloid scarring, burns, and bullae ; 16 the serious ones were acquired haemophilia A, stroke following cupping on the back and neck, factitious panniculitis, reversible cardiac hypertrophy, and iron deficiency anaemia . 16 A 2013 meta-analysis found that acupuncture for chronic low back pain was cost-effective as a complement to standard care, but not as a substitute for standard care except in cases where co morbid depression presented. 19 The same meta-analysis found there was no difference between sham and non-sham acupuncture. 19 A 2011 systematic review found insufficient evidence for the cost-effectiveness of acupuncture in the treatment of chronic low back pain. 20 A 2010 systematic review found that the cost-effectiveness of acupuncture could not be concluded. that time. 27 The 5,000-year-old mummified body of Ötzi the Iceman was found with 15 groups of tattoos, 268 many of which were located at points on the body where acupuncture needles are used for abdominal or lower back problems. Traditionally, acupuncture was used to treat acute conditions of the composer Hector Berlioz is usually credited with being the first to experiment with the procedure in Europe in 1810, before publishing his findings in 1816. 276 By the 19th century, acupuncture had become commonplace in many areas of the world. 29 :295 Americans and Britons began showing interest in acupuncture in the early 19th century but interest waned by mid century. 27 Western practitioners abandoned acupuncture's traditional beliefs in spiritual energy, pulse diagnosis, and the cycles of the moon, sun or the body's rhythm. amid skin is sterilized and needles are inserted, frequently with a plastic guide tube. In.007, the National Health Interview Survey NHS conducted by the National enter For Health Statistics NHS estimated that approximately 150,000 children had received acupuncture treatment for a variety of conditions. that it can cure disease; the evidence of effectiveness is negligible. 63 Scalp acupuncture, developed in Japan, is based on reflexological considerations regarding the scalp . The.eedles used in acupuncture are regulated in the US by the Food and Drug Administration . 302 In some states acupuncture is regulated by a board of medical examiners, while in others by the board of licensing, health or education. 299 In Japan, acupuncturists are licensed by the Additionally, by the 18th century, scientific rationality was becoming more popular than traditional superstitious beliefs. 27 By 1757 a book documenting the history of Chinese medicine called acupuncture a “lost art”. 29 :160 Its decline was attributed in part to the popularity of prescriptions and medications, as well as its association with the lower classes. 275 In 1822, the Chinese Emperor signed a decree excluding the practice of acupuncture from Boel Akupunktur anmeldelser the Imperial Medical Institute. 27 He said it was unfit for practice by gentlemen-scholars. 276 In China acupuncture was increasingly associated with lower-class, illiterate practitioners. 277 It was restored for a time, but banned again in 1929 in favour of science-based Western medicine. It adopted a new set of ideas for acupuncture based on tapping needles into nerves. 27 30 31 In Europe it was speculated that acupuncture may allow or prevent the flow of electricity in the body, Sun simian published acupuncture-related diagrams and charts that established standardized methods for finding acupuncture sites on people of different sizes and categorized acupuncture sites in a set of modules. 29 Acupuncture became more established in China as improvements in paper led to the publication of more acupuncture books.