It.s.ifficult.ut.ot impossible to design rigorous research trials for acupuncture. 69 70 Due to acupuncture's invasive nature, one of the major challenges in efficacy research is in the design of an appropriate placebo control group . 71 72 For efficacy studies to determine whether acupuncture has specific effects, “sham” forms of acupuncture where the patient, practitioner, and analyst are blinded seem the most acceptable approach. 69 Sham acupuncture uses non-penetrating needles or needling at non-acupuncture points, 73 e.g. inserting needles on meridians not related to the specific condition being studied, Alternative Medicine was created within the NIH. It.as.acer revealed that the patient had been given a cocktail of aesthetics. 284 285 Acupuncture is popular in China, 235 the US, 16 Australia, 286 and Europe 287 including all five Nordic countries, though less so in Finland. 288 It is most heavily practice in China 235 and is one of the most common alternative medicine practices in Europe. 287 :45 In Switzerland, acupuncture has become the most frequently used alternative medicine since 2004. 289 In the United Kingdom, a total of 4 million acupuncture treatments were administered in 2009. 290 Acupuncture is used in most pain clinics and hospices in the UK. 41 An estimated 1 in 10 adults in Australia used acupuncture in 2004. 286 In Japan, it is estimated that 25 percent of the population will try acupuncture at some point, 32 though in most cases it is not covered by public health insurance . 32 Users of acupuncture in Japan are more likely to be elderly and to have a limited education. 32 Approximately half of users surveyed indicated a likelihood to seek such remedies in the future, while 37% did not. 32 Less than one percent of the US population reported having used acupuncture in the early 1990s. 291 By the early 2010s, more than 14 million Americans reported having used acupuncture as part of their health care. 291 In the US, acupuncture is increasingly as of 2014 updates used at academic medical canters, 77 and is usually offered through CAM canters or anaesthesia and pain management services. 292 Examples include those at Harvard University, Stanford University, Johns Hopkins University, and UCL . though it is more likely to have been brought into Korea from a Chinese colonial prefecture in 514 AD. 29 :262-263 Acupuncture use was commonplace in Korea by the 6th century.
The.old.ealth OrganizaFion recommends that before being licensed or certified, an acupuncturist receive 200 hours of specialized training if they are a physician and 2,500 hours for non-physicians; : 10.1093/rheumatology/ken161 . In 2007, 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. 2008. ISSN or a very weak constitution of the patient can be considered, all of which are thought to decrease the likelihood of successful treatment. In ACM, the four diagnostic methods are: inspection, that curing diseases relied on the alignment of both heavenly then and earthly ti forces that were attuned to cycles like that of the sun and moon. 29 :140-141 There were several belief systems that relied on a number of celestial and earthly bodies or elements that rotated and only became aligned at certain times. 29 :140-141 According to Needham and Gwei-djen, these “arbitrary predictions” were depicted by acupuncturists in complex charts and through a set of special terminology. 29 Acupuncture needles during this period were much thicker than most modern ones and often resulted in infection..Acupuncture.Tote..s..orm.f.lternative.edicine. 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 Acupuncture 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 Reports included 38 cases of infections and 42 cases of organ trauma. 10 The most frequent adverse events included pneumothorax, and bacterial and viral infections . 10 A 2013 review found without restrictions regarding publication date, study type or language 295 cases of infections; mycobacterium was the pathogen in at least 96%. 18 Likely sources of infection include towels, hot packs or boiling tank water, and reusing reprocessed needles. 18 Possible sources of infection include contaminated needles, reusing personal needles, a person's skin containing mycobacterium, and reusing needles at various sites in the same person. 18 Although acupuncture is generally considered a safe procedure, a 2013 review stated that the reports of infection transmission increased significantly in the prior decade, including those of mycobacterium. 18 Although it is recommended that practitioners of acupuncture use disposable needles, the reuse of sterilized needles is still permitted. 18 It is also recommended that thorough control practices for preventing infection be implemented and adapted. 18 The Xingnao Kaiqiao approach appears to be a safe form of treatment. 147 Fainting was the most frequent adverse event. 147 Fainting while being treated, haematoma, and pain while being treated are associated with individual physical differences and with needle manipulation. 147 A 2013 systematic review of the English-language case reports found that serious adverse events associated with acupuncture are rare, but that acupuncture is not without risk. 16 Between 2000 and 2011 the English-language literature from 25 countries and regions reported 294 adverse events. 16 The majority of the reported adverse events were relatively minor, and the incidences were low. 16 For example, a prospective survey of 34,000 acupuncture treatments found no serious adverse events and 43 minor ones, a rate of 1.3 per 1000 interventions. 16 Another survey found there were 7.1% minor adverse events, of which 5 were serious, amid 97,733 acupuncture patients. 16 The most common adverse effect observed was infection e.g. mycobacterium, and the majority of infections were bacterial in nature, caused by skin contact at the needling site. 16 Infection has also resulted from skin contact with unsterilised equipment or with dirty towels in an unhygienic clinical setting. 16 Other adverse complications included five reported cases of spinal cord injuries e.g. migrating broken needles or needling too deeply, four brain injuries, four peripheral nerve injuries, five heart injuries, seven other organ and tissue injuries, bilateral hand enema, epithelioid granuloma, pseudo lymphoma, argyria, pustules, pancytopenia, and scarring due to hot-needle technique. 16 Adverse reactions from acupuncture, which are unusual and uncommon in typical acupuncture practice, included syncope, galactorrhoea, bilateral nystagmus, pyoderma gangrenosum, hepatotoxicity, eruptive lichen planes, and spontaneous needle migration. 16 A 2013 systematic review found 31 cases of vascular injuries caused by acupuncture, three resulting in death. 232 Two died from pericardia tamponade and one was from an aortoduodenal fistula. 232 The same review found vascular injuries were rare, bleeding and pseudo aneurysm were most prevalent. 232 A 2011 systematic review without restriction in time or language, aiming to summarize all reported case of cardiac tamponade after acupuncture, found 26 cases resulting in 14 deaths, with little doubt about causality in most fatal instances. 233 The same review concluded cardiac tamponade was a serious, usually fatal, though theoretically avoidable complication following acupuncture, and urged training to minimize risk. 233 A 2012 review found a number of adverse events were reported after acupuncture in the UK's National Health Service NHS but most 95% were not severe, 42 though miscategorization and under-reporting may alter the total figures. 42 From January 2009 to December 2011, 468 safety incidents were recognized within the NHS organizations. 42 The adverse events recorded included retained needles 31%, dizziness 30%, loss of consciousness/unresponsive 19%, falls 4%, bruising or soreness at needle site 2%, pneumothorax 1% and other adverse side effects 12%. 42 Acupuncture practitioners should know, and be prepared to be responsible for, any substantial harm from treatments. 42 Some acupuncture proponents argue that the long history of acupuncture suggests it is safe. 42 However, there is an increasing literature on adverse events e.g. spinal-cord injury. 42 Acupuncture seems to be safe in people getting anticoagulants, assuming needles are used at the correct location and depth. 234 Studies are required to verify these findings. 234 The evidence suggests that acupuncture might be a safe option for people with allergic rhinitis. 118 Chinese, South Korean, and Japanese-language A 2010 systematic review of the Chinese-language literature found numerous acupuncture-related adverse events, including pneumothorax, fainting, sub arachnoid haemorrhage, and infection as the most frequent, and cardiovascular injuries, sub arachnoid haemorrhage, pneumothorax, and recurrent cerebral haemorrhage as the most serious, most of which were due to improper technique. 235 Between 1980 and 2009, the Chinese-language literature reported 479 adverse events. 235 Prospective surveys show that mild, transient acupuncture-associated adverse events ranged from 6.71% to 15%. 235 In a study with 190,924 patients, the prevalence of serious adverse events was roughly 0.024%. 235 Another study showed a rate of adverse events requiring specific treatment of 2.2%, 4,963 incidences among 229,230 patients. 235 Infections, mainly hepatitis, after acupuncture are reported often in English-language research, though are rarely reported in Chinese-language research, making it plausible that acupuncture-associated infections have been under-reported in China. 235 Infections were mostly caused by poor sterilization of acupuncture needles. 235 Other adverse events included spinal epidural haematoma in the cervical, thoracic and lumbar spine, chylothorax, injuries of abdominal organs and tissues, injuries in the neck region, injuries to the eyes, including orbital haemorrhage, traumatic cataract, injury of the oculomotor nerve and retinal puncture, haemorrhage to the cheeks and the hypo glottis, peripheral motor-nerve injuries and subsequent motor dysfunction, local allergic reactions to metal needles, stroke, and cerebral haemorrhage after acupuncture. 235 A causal link between acupuncture and the adverse events cardiac arrest, pyknolepsy, shock, fever, cough, thirst, aphonic, leg numbness, and sexual dysfunction remains uncertain. 235 The same review concluded that acupuncture can be considered inherently safe when practice by properly trained practitioners, but the review also stated there is a need to find effective strategies to minimize the health risks. 235 Between 1999 and 2010, the Republic of Korean-literature contained reports of 1104 adverse events. 236 Between the 1980s and 2002, the Japanese-language literature contained reports of 150 adverse events. 237 Although acupuncture has been practice for thousands of years in China, its use in paediatrics in the United States did not become common until the early 2000s. Rheumatology..7 8: 1132–1136. dBi 1462-0324 .