Acupuncture is an alternative form of treatment where a thin needle is inserted into the body. This is a key component of traditional Chinese medicine (TCM). The theory and practice of TCM is not based on scientific knowledge, and acupuncture is pseudosain. There are various theories of acupuncture based on different philosophies, and techniques vary depending on the country. The method used in TCM is probably the most extensive in the United States. It is most commonly used for pain relief, although it is also used for a variety of other conditions. Acupuncture is generally used only in combination with other forms of treatment.
The conclusions of many experiments and many systematic reviews of acupuncture are largely inconsistent, which suggests that it is ineffective. A review of Cochrane's review found that acupuncture is not effective for a variety of conditions. A systematic review found little evidence of the effectiveness of acupuncture in treating pain. Evidence suggests that short-term treatment with acupuncture does not produce long-term benefits. Some research results suggest acupuncture may relieve pain, although most studies show that the effects of acupuncture are mainly due to the placebo effect. A systematic review concluded that the analgesic effect of acupuncture appears to be less clinically relevant and can not be clearly distinguished from bias. A meta-analysis found that acupuncture for chronic low back pain was cost-effective in addition to standard care, while systematic reviews found insufficient evidence for the cost-effectiveness of acupuncture in the treatment of chronic low back pain.
Acupuncture is generally safe when performed by well-trained practitioners using clean needle technique and disposable needles. When delivered correctly, it has a low minor adverse effect. Accidents and infections are associated with sterile engineering violations or ignoring practitioners. A review states that infection transmission reports increased significantly in the previous decade. The most commonly reported side effects are pneumothorax and infection. Because serious side effects continue to be reported, recommended acupuncturists are trained enough to reduce the risk.
Scientific investigations have not found histological or physiological evidence for traditional Chinese concepts such as qi , meridians, and acupuncture points, and many modern practitioners no longer support the existence of life force energy ( qi ) flows through the meridians, which are a major part of the early belief system. Acupuncture is believed to have originated around 100 BC in China, around the time of The Yellow Emperor's Classic of Internal Medicine (Huangdi Neijing) published, although some experts suggest it could be practiced before. Over time, conflicting claims and systems of beliefs arose about the effects of the moon, sky and earth cycles, the energy of yin and yang, and the "rhythm" of the body on the effectiveness of treatment. Acupuncture grows and diminishes its popularity in China repeatedly, depending on the country's political leadership and supporting Western rationalism or treatment. Acupuncture spread first to Korea in the 6th century, then to Japan via medical missionaries, and then to Europe, beginning with France. In the twentieth century, when it spread to the United States and Western countries, the spiritual elements of acupuncture as opposed to Western beliefs are sometimes left out for the sake of a simple needle to the point of acupuncture.
Video Acupuncture
Clinical practice
Acupuncture is a form of alternative medicine. It is most commonly used for pain relief, although it is also used to treat various conditions. The majority of people seeking acupuncture do so for musculoskeletal problems, including low back pain, shoulder stiffness, and knee pain. Acupuncture is generally used only in combination with other forms of treatment. For example, the American Society of Anesthesiologists states that this may be considered in the treatment of non-specific non-inflammatory nonspecific back pain only in relation to conventional therapy.
Acupuncture is the insertion of a thin needle into the skin. According to the Mayo Foundation for Medical Education and Research (Mayo Clinic), typical sessions require lying still while about five to two needles are inserted; for most cases, the needle will be left in place for ten to twenty minutes. It can be associated with heat, pressure, or laser light applications. Classically, acupuncture is individualized and based on philosophy and intuition, and not on scientific research. There are also non-invasive therapies developed in the early 20th century Japan using a complex set of "needles" for the treatment of children ( sh? Nishin or sh? Nihari ).
Clinical practice varies depending on the country. The average comparison of the number of treated patients per hour found significant differences between China (10) and the United States (1,2). Chinese herbs are often used. There are a variety of acupuncture approaches, which involve multiple philosophies. Although various techniques of acupuncture practice have emerged, the methods used in traditional Chinese medicine (TCM) seem to be the most widely adopted in the US. Traditional acupuncture involves insertion of needles, moxibustion, and cupping therapy, and can be accompanied by other procedures such as feeling pulse and other parts of the body and examining the tongue. Traditional acupuncture involves the belief that the "life force" ( qi ) circulates within the body in a line called the meridian. The main methods practiced in the UK are TCM and Western medical acupuncture. The term Western medical acupuncture is used to show TCM-based acupuncture adaptations that are less focused on TCM. Western medical acupuncture approach involves the use of acupuncture after medical diagnosis. Limited research has compared contrasting acupuncture systems used in different countries to determine different acupuncture points and thus no standards are set for acupuncture points.
In traditional acupuncture, the acupuncturist decides which point should be treated by observing and questioning the patient to make a diagnosis according to the tradition used. In TCM, four diagnostic methods are: inspection, auscultation and smell, ask, and palpate. Inspection focuses on the face and especially on the tongue, including the analysis of tongue size, shape, tension, color and coating, and the absence or presence of tooth marks around the edges. Auscultation and smell involves listening to certain sounds like wheezing, and observing body odor. Questioning involves focusing on the "seven questions": shivering and fever; sweat; appetite, thirst and taste; defecate and urinate; pain; sleep; and menstruation and leukorrhea. Palpation focuses on the feeling of the body to give the points "i-shi" and feel the pulse.
Needle
The most common acupuncture point stimulation mechanism is the penetration of the skin with a thin metal needle, manipulated manually or the needle can be further stimulated by electrical stimulation (electroacupuncture). Acupuncture needles are usually made of stainless steel, making it flexible and preventing it from rusting or rupturing. Needles are usually removed after each use to prevent contamination. Reusable needles when used should be sterilized between applications. The needles vary from 13 to 130 millimeters (0.51 to 5.12 inches), with shorter needles used near the face and eyes, and longer needles in areas with thicker tissue; the diameter of the needle varies from 0.16 mm (0.006 inches) to 0.46 mm (0.018 in), with thick needles used in stronger patients. The thin needle may be flexible and require a tube for insertion. The needle tip does not have to be made too sharp to prevent damage, though a dull needle causes more pain.
Apart from the usual filiform needle, other types of needles include three-edged needles and Nine Needles. Japanese acupuncturists use very thin needles that are used superficially, sometimes without penetrating the skin, and are surrounded by guidance tubes (17th century invention adopted in China and the West). Korean acupuncture uses copper needles and has a greater focus on the hand.
Engineering Needling
Insert
Skin sterilized and needle inserted, often with plastic guide tube. Needles can be manipulated in various ways, including spinning, flicking, or moving up and down relative to the skin. Since most of the pain is felt in the skin surface layer, it is advisable to insert the needle quickly. Often the needle is stimulated by the hand to cause a tedious, localized, and painful sensation called de qi , as well as "hold the needle," the feeling of interest felt by the acupuncturist and generated by the mechanical interaction between the needle and the skin. Acupuncture can be painful. The skill level of the acupuncturist can affect how painful the insertion of the needle is, and a fairly skilled practitioner may be able to insert the needle without causing any pain.
De-qi sensation
De-qi (Chinese: ?? ; pinyin: dÃÆ' Â © qÃÆ' ¬ ; "qi arrival") refers to the sensation of numbness, distension, or electrical tingling in the needle site that may radiate along the corresponding meridians. If de-qi can not be generated, inaccurate acupoint locations, improper needle insertion depth, inadequate manual manipulation, or very weak constitution of the patient may be considered, all of which are considered to reduce the possibility of successful treatment. If the sensation of de-qi is not immediate at insertion of the needle, various manual manipulation techniques may be applied to promote it (such as "picking", "shaking" or "shaking").
Acupuncture has been extensively studied; in 2013, there are nearly 1,500 randomized controlled trials in PubMed with "acupuncture" in the title. The review results of the effectiveness of acupuncture, however, have been convincing.
Acupuncture and fake research
It is difficult but not impossible to design rigorous research trials for acupuncture. Because of the invasive nature of acupuncture, one of the main challenges in efficacy studies is in the design of appropriate placebo control groups. For efficacy studies to determine whether acupuncture has certain effects, the "fake" forms of acupuncture in which blinded patients, practitioners, and analysts seem to be the most acceptable approach. False acupuncture uses impenetrable needles or needles at non-acupuncture points, eg inserting needles in a meridian unrelated to the specific conditions being studied, or in places unrelated to the meridians. The lack of acupuncture performance in such trials may indicate that therapeutic effects are entirely due to non-specific effects, or that false treatments are not inert, or that systematic protocols result in less optimal care.
The 2014 review at Nature Review Cancer found that "contrary to the mechanisms claimed to direct the flow of qi through the meridians, researchers typically find that it is generally not a problem where needles are inserted, how often (ie, no dose-response effects are observed), or even if the needle is actually inserted.In other words, 'fake' or 'placebo' acupuncture generally produces the same effect as acupuncture 'real' and, in some cases, better. "A meta-analysis 2013 found little evidence that the effectiveness of acupuncture in pain (compared with false) has been modified by needle location, number of needles used, the experience or technique of the practitioner, or by the state of the session. The same analysis also suggests that the number of needles and sessions is important, since larger numbers increase the acupuncture yield compared to non-acupuncture controls. There is little systematic investigation of which components of acupuncture sessions may be important for therapeutic effects, including needle placement and depth, type and intensity of stimulation, and number of needles used. This study shows that needles need not stimulate acupuncture points that are traditionally defined or penetrate the skin to achieve anticipated effects (eg psychosocial factors).
The response to "fake" acupuncture in osteoarthritis can be used in the elderly, but placebo is usually considered a fraud and thus unethical. However, some physicians and ethicists have suggested circumstances for the applicable use for such placebo may present the theoretical advantages of inexpensive treatments without adverse reactions or interactions with drugs or other drugs. As evidence for most types of alternative medicine such as acupuncture is far from strong, the use of alternative medicine in health care on a regular basis can raise ethical questions.
Using evidence-based medical principles for acupuncture research is still controversial, and has produced different results. Some studies suggest acupuncture can reduce pain but most studies show that the effects of acupuncture are mainly caused by placebo. Evidence suggests that any acupuncture benefit does not last long. There is not enough evidence to support the use of acupuncture compared to mainstream medical care. Acupuncture is no better than mainstream treatment in the long run.
Publication bias
The publication bias is cited as a concern in the review of a randomized controlled trial (RCT) of acupuncture. A review of acupuncture studies in 1998 found that trials originating from China, Japan, Hong Kong and Taiwan were uniformly beneficial for acupuncture, such as ten of the eleven studies conducted in Russia. The 2011 assessment of RCT quality in TCM, including acupuncture, concludes that the methodological quality of most such experiments (including randomization, experimental control, and dazzling) is generally poor, especially for trials published in Chinese journals (though the quality of acupuncture) tests more both than the TCM treatment trial test). The study also found that trials published in non-Chinese journals tend to have higher quality. Chinese writers use more Chinese studies, which have proven positively uniformly. A 2012 review of 88 systematic review of acupuncture published in Chinese journals found that less than half of these reviews reported testing for publication bias, and that most of these reviews were published in journals with zero impact factors.
Scientist and journalist Steven Salzberg identified acupuncture and Chinese medicine generally as a focus for "fake medical journals" such as Journal of Acupuncture and Meridian and Acupuncture Studies in Medicine.
Special conditions
Pain
The conclusions of many experiments and many of the systematic reviews of acupuncture are largely inconsistent with one another. A systematic review of systematic systematic review 2011 found that to reduce pain, acupuncture is not real better than fake acupuncture, and concluded that many reviews have shown little convincing evidence that acupuncture is an effective treatment for reducing pain. The same review found that neck pain was one of only four types of pain suggesting positive effects, but cautioned that the primary study used carries considerable risk of bias. A review of Cochrane 2009 review found that acupuncture is not effective for a variety of conditions.
A systematic review of 2014 shows that the nocebo effect of acupuncture is clinically relevant and that the extent of adverse events may be a nocebo effect gauge. According to the 2014 Miller Anesthesia book, "when compared with placebo, acupuncture treatment has proven efficacy for pain relief". A meta-analysis 2012 conducted by Acupuncture Collaboration 'found "relatively simple" acupuncture efficiency "(compared with false) for the treatment of four different types of chronic pain (back and neck pain, knee osteoarthritis, chronic headache, and shoulders). pain) and on that basis concluded that it was "more than placebo" and a reasonable referral option. Commenting on this meta-analysis, both Edzard Ernst and David Colquhoun say that the results are of negligible clinical significance. Edzard Ernst later stated that "I am concerned, once we succeed in removing this bias [that operators are not blind]... we may find that the effect of acupuncture is exclusively a placebo response." By 2017, the same research group updated their previous meta-analysis and once again found acupuncture superior to fake acupuncture for non-specific musculoskeletal pain, osteoarthritis, chronic headaches, and shoulder pain. They also found that acupuncture effects decreased by about 15% after one year.
A systematic review of 2010 shows that acupuncture is more than placebo for the usual chronic pain conditions, but the authors acknowledge that it is still unknown whether the overall benefit is clinically meaningful or cost-effective. The 2010 review found real acupuncture and fake acupuncture produced similar improvements, which can only be accepted as evidence against the efficacy of acupuncture. The same review finds limited evidence that real acupuncture and fake acupuncture appear to produce biological differences despite similar effects. A systematic review and meta-analysis in 2009 found that acupuncture has a small analgesic effect, which appears to lack clinical importance and is indistinguishable from bias. The same review found that it remains unclear whether acupuncture reduces pain independent of the psychological impact of ritual acupuncture. A systematic review and meta-analysis 2017 found that ear acupuncture may be effective in reducing pain within 48 hours of use, but the average difference between acupuncture and small control groups and that "rigorous research is needed to build definitive evidence".
Lower back pain
A systematic review of 2013 found that acupuncture may be effective for non-specific lower back pain, but the authors note there are limitations in the research under study, such as heterogeneity in research characteristics and low methodological quality in many studies. A systematic review in 2012 found some supporting evidence that acupuncture is more effective than no treatment for chronic non-specific chronic low back pain; the evidence contradicts the effectiveness of other treatment approaches. A systematic review of the systematic review of 2011 found that "for chronic lower back pain, individualized acupuncture is no better at relieving symptoms than acupuncture of fake formulas or acupuncture with toothpicks that do not penetrate the skin." A 2010 review found that fake acupuncture is as effective as real acupuncture for chronic low back pain. The special therapeutic effects of acupuncture are small, while the relevant clinical benefits are largely due to contextual and psychosocial circumstances. Brain imaging studies have shown that traditional acupuncture and fake acupuncture differ in effect on limbic structures, while at the same time exhibiting equitable analgesic effects. A Cochrane review of 2005 found insufficient evidence to recommend for or against acupuncture or dry puncture for acute lower back pain. The same review found low-quality evidence for pain relief and improvement compared with no treatment therapy or false therapy for chronic low back pain only in the short term immediately after treatment. The same review also found that acupuncture is no more effective than conventional therapy and other alternative treatment treatments. A systematic review and meta-analysis concluded that, for neck pain, acupuncture is comparable in effectiveness to conventional treatment, while electroacupuncture is even more effective in relieving pain than conventional acupuncture. The same study noted that "It is difficult to draw conclusions [sic] because the included studies have a high risk of bias and inaccuracy." A review of 2015 systematic review of variable quality suggests that acupuncture can provide short-term improvement in people with chronic low back pain. The picture says this is true when acupuncture is used either in isolation or in addition to conventional therapy. Systematic review 2017 for clinical practice guidelines American College of Physicians found low to moderate evidence that acupuncture is effective for chronic back pain, and limited evidence that it is effective for acute lower back pain. The same review found that the strength of evidence for both conditions is low to moderate. Another 2017 clinical practice guideline, one produced by the Danish Health Authority, is recommended against acupuncture for low back pain and lumbar radiculopathy.
Headaches and migraines
Two separate Cochrane 2016 reviews found that acupuncture can be useful in the prophylaxis of tension-type headaches and episodic migraines. A 2016 Cochrane review evaluating acupuncture for episodic migraine prevention concluded that true acupuncture has a small effect beyond false acupuncture and finds evidence of moderate quality indicating that acupuncture is at least as effective as prophylactic drugs for this purpose. A review of 2012 found that acupuncture has shown benefits for headache treatment, but the security needs to be documented more fully in order to make strong recommendations to support its use.
Arthritis pain
The 2014 review concludes that "current evidence supports the use of acupuncture as an alternative to traditional analgesics in osteoarthritis patients." In 2014, meta-analysis showed that acupuncture may help osteoarthritis pain but noted that the effect was insignificant compared with false needles. A systematic review and meta-analysis network of 2013 found that evidence suggests that acupuncture can be considered as one of the more effective physical treatments to reduce the pain of knee osteoarthritis in the short term compared to other relevant physical treatments, although there is considerable evidence in poor quality topics and there is uncertainty about the efficacy of many treatments. A review in 2012 found that "the favorable actions of acupuncture on osteoarthritis pain seem to be irrelevant clinically." The 2010 Cochrane Review found that acupuncture showed statistically significant benefits over false acupuncture in the treatment of osteoarthritis of peripheral joints; However, these benefits are found to be so small that their clinical significance is questionable, and "probably because at least part of the placebo effect from blinding is incomplete".
Overview Cochrane 2013 found low to moderate evidence that acupuncture enhances pain and stiffness in treating people with fibromyalgia compared with no standard care and care. A 2012 review found "there is not enough evidence to recommend acupuncture for the treatment of fibromyalgia." The systematic review of 2010 discovers a small, seemingly invisible painkiller effect of bias; acupuncture is not the recommended treatment for fibromyalgia management based on this review.
A review of 2012 found that the effectiveness of acupuncture for treating rheumatoid arthritis is "uncommon and inconclusive." The 2005 Cochrane Review concluded that acupuncture used to treat rheumatoid arthritis "has no effect on ESR, CRP, pain, patient global assessment, number of joints swollen, soft joint counts, general health, disease activity and analgesic reduction." An overview of systematic review 2010 found insufficient evidence to recommend acupuncture in the treatment of most rheumatic conditions, with the exception of osteoarthritis, lower back pain, and lateral elbow pain.
Other joint pains
A systematic review in 2014 found that although manual acupuncture was effective in reducing short-term pain when used to treat tennis elbow, its long-term effects in relieving pain were "mediocre". A 2007 review found that acupuncture was significantly better than false acupuncture in treating chronic knee pain; the proof is not conclusive due to the lack of a large and high-quality trial. Cochrane 2005 reviews conclude that there is not enough evidence to determine whether acupuncture is effective as a method for treating shoulder pain.
Postoperative pain and nausea
The 2014 review of systematic reviews found insufficient evidence to suggest that acupuncture is an effective treatment for postoperative nausea and vomiting (PONV) in a clinical setting. The systematic review of 2013 concludes that acupuncture may be beneficial in the prevention and treatment of PONV. A Cochrane review of 2009 found that stimulation of acupoint P6 points on the wrist was as effective (or ineffective) as an antiemetic drug and was associated with minimal side effects. The same review found "there is no reliable evidence for differences in the risk of postoperative nausea or vomiting after stimulation of acupoint P6 compared with antiemetic drugs."
The 2014 review of systematic reviews found insufficient evidence to show that acupuncture is effective for surgical or postoperative pain. For the use of acupuncture for post-operative pain, there is contradictory evidence. The systematic review of 2014 found supportive but limited evidence for the use of acupuncture for acute post-operative pain after surgery. A systematic review in 2014 found that while evidence suggests acupuncture may be an effective treatment for postoperative gastroparesis, definite conclusions can not be achieved because trials are of low quality.
Pain and nausea associated with cancer and cancer treatment
The 2015 Cochrane Review found that there is insufficient evidence to determine whether acupuncture is an effective treatment for cancer pain in adults. A systematic review of 2014 published in the Chinese Journal of Integrative Medicine found that acupuncture may be effective as an additional treatment for palliative care for cancer patients. A review of the 2013 review published in the Journal of the Multinational Association for Supportive Care in Cancer found evidence that acupuncture may be beneficial for people with cancer-related symptoms, but also identified some rigorous trials and high heterogeneity among the trials. A systematic review of 2012 from randomized clinical trials published in the same journal found that the number and quality of RCTs to use acupuncture in the treatment of cancer pain was too low to draw any definite conclusions.
The systematic review of 2014 achieved an unconvincing result relating to the effectiveness of acupuncture to treat cancer-related fatigue. A systematic review of 2013 found that acupuncture is an acceptable adjunctive therapy for chemotherapy-induced nausea and vomiting, but further research with low risk of bias is required. A systematic review of 2013 found that the quantity and quality of RCTs available for analysis were too low to draw valid conclusions for the effectiveness of acupuncture for cancer-related fatigue.
Sleep
A systematic review and meta-analysis 2016 found that acupuncture "is associated with a significant reduction in sleep disturbance in women with menopausal sleep disorders."
Other conditions
For the following conditions, Cochrane Collaboration or other reviews conclude there is no strong evidence of the benefits: alcohol dependence, allergies, Alzheimer's disease, angina pectoris, ankle sprain, asthma, attention deficit hyperactivity disorder, autism, Bell palsy, cardiac arrhythmias, carpal tunnel syndrome , cerebral hemorrhage, chronic obstructive pulmonary disease, cocaine dependence, constipation, depression, diabetic peripheral neuropathy, dysphagia after acute stroke, drug detoxification, dry eye, primary dysmenorrhoea, dyspepsia, endometriosis, enuresis, epilepsy, erectile dysfunction, glaucoma, gynecological conditions except for possible fertility and nausea/vomiting), acute hordeolum, hot flashes, essential hypertension, hypoxic ischemic encephalopathy in newborns, in vitro fertilization (IVF), induction of labor, insomnia, irritable bowel syndrome, labor induction, labor pain, bone stenosis back lumbar, major depressive disorder in pregnant women, goiter s (children), musculosk disorders eletal on extremities, myopia, neuropathic pain, obesity, obstetrical conditions, opioid addiction, Parkinson's disease, polycystic ovary syndrome, posttraumatic stress disorder, premenstrual syndrome, preoperative anxiety, restless leg syndrome, schizophrenia, sensorineural hearing loss, smoking cessation, stress urinary incontinence, stroke, acute stroke, stroke rehabilitation, temporomandibular joint dysfunction, tennis elbow, tinnitus, traumatic brain injury, uremic itching, uterine fibroids, whiplash vascular dementia, and xerostomia.
Moxibustion and cupping
An overview of systematic review 2010 found that moxibustion is effective for some conditions but the main studies are of poor quality, so there is still considerable uncertainty, which limits the specificity of their findings.
Maps Acupuncture
Security
Bad events
Acupuncture is generally safe when administered by experienced and well-trained practitioners using clean needle techniques and sterile disposable needles. When sent incorrectly, it can cause adverse effects. Accidents and infections are associated with sterile engineering violations or neglect on the part of practitioners. To reduce the risk of serious side effects after acupuncture, acupuncturists should be adequately trained. People with serious spinal diseases, such as cancer or infection, are not good candidates for acupuncture. Contraindications to acupuncture include conditions of coagulopathy (eg, hemophilia and advanced liver disease), warfarin use, severe psychiatric disorders (eg psychosis), and skin infections or skin trauma (eg burns). Furthermore, electroacupuncture should be avoided at the place of implanted electrical devices (such as pacemakers).
A systematic review of the systematic review of 2011 (international and without language restrictions) found that serious complications after acupuncture were reported. Between 2000 and 2009, ninety-five cases of serious adverse events, including five deaths, were reported. Many such incidents are not attached to acupuncture but because of acupuncture malpractice. This is probably why such complications have not been reported in a well-trained acupuncturist survey. Most such reports are from Asia, which may reflect the large number of treatments performed there or a number of poorly trained Asian acupuncturists. Many serious adverse effects are reported from developed countries. These include Australia, Austria, Canada, Croatia, France, Germany, Ireland, the Netherlands, New Zealand, Spain, Sweden, Switzerland, United Kingdom, and the United States. The number of reported adverse effects from the UK appears very unusual, which may indicate less reported in the UK than any other country. The report included 38 infection cases and 42 cases of organ trauma. The most frequent side effects include pneumothorax, and bacterial and viral infections.
A 2013 review found (without limitation on publication date, type or language of study) 295 cases of infection; mycobacterium is a pathogen at least 96%. Possible sources of infection include a towel, hot pack or tank boiling water, and reusing the re-treated needle. Possible sources of infection include contaminated needles, reusing personal needles, skin of a person containing mycobacterium, and reusing needles in different places in the same person. Although acupuncture is generally regarded as a safe procedure, the 2013 review states that infection transmission reports increased significantly in the previous decade, including mycobacterium. Although it is recommended that acupuncture practitioners use disposable needles, the re-use of sterilized needles is still permissible. It is also recommended that overall control practices to prevent infection be implemented and adapted.
English
A systematic review of the 2013 English case report found that serious adverse events associated with acupuncture were rare, but acupuncture was not without risk. Between 2000 and 2011, English-language literature from 25 countries and regions reported 294 adverse events. The majority of reported adverse events are relatively small, and the incidence is low. For example, a prospective survey of 34,000 acupuncture treatments found no serious side effects and 43 small, 1.3 levels per 1000 interventions. Another survey found that there were 7.1% mild side effects, 5 of which were serious, among 97,733 acupuncturists. The most common side effects observed are infections (eg Mycobacterium), and most infections are bacteria in nature, caused by skin contact at the needle site. Infection also results from skin contact with unsterilized equipment or with a dirty towel in an unhygienic clinical setting. Other adverse complications include five reported cases of spinal cord injury (eg needle migration or acute needle impingement), four brain injuries, four peripheral nerve injuries, five cardiac injuries, seven other organ and tissue injuries, bilateral hand edema, granuloma epithelia, pseudolymphoma, argyria, pustules, pancytopenia, and scarring due to hot-needle technique. Side effects of acupuncture, which are unusual and not common in typical acupuncture practices, include syncope, galactorrhea, bilateral nystagmus, pioderma gangrenosum, hepatotoxicity, eruptive lichen planus, and spontaneous needle migration.
A systematic review of 2013 found 31 cases of vascular injury caused by acupuncture, three resulting in death. Two died of pericardial tamponade and one derived from an aortoduodenal fistula. The same review found that vascular injuries are rare, bleeding and pseudoaneurism are the most common. A systematic review of 2011 (without time or language restrictions), which aims to summarize all cases of cardiac tamponade after reported acupuncture, found 26 cases resulting in 14 deaths, with little doubt about causality in the most fatal example. The same reviews concluded that cardiac tamponade is a serious complication, usually fatal, although it could theoretically be avoided after acupuncture, and urged training to minimize risk.
A 2012 review found a number of reported side effects after acupuncture in the UK National Health Service (NHS) but most (95%) were not severe, although naming errors and lack of reporting could change the total number. From January 2009 to December 2011, 468 safety incidents were recognized within the NHS organization. Noted adverse events included detained needle (31%), dizziness (30%), conscious/unresponsive loss (19%), fall (4%), bruising or needle pain (2%), pneumothorax (1% ) and other side effects (12%). Acupuncture practitioners should know, and be prepared to take responsibility for, any major dangers of care. Some supporters of acupuncture argue that the long history of acupuncture suggests it is safe. However, there is an increasing literature on side effects (eg spinal cord injury).
Acupuncture seems to be safe in people who get anticoagulants, assuming the needle is used in the correct location and depth. Studies are needed to verify these findings. Evidence suggests that acupuncture may be a safe option for people with allergic rhinitis.
Chinese, South Korean and Japanese
The 2010 systematic review of the Chinese literature has found many events related to acupuncture, including pneumothorax, fainting, subarachnoid hemorrhage and infection as the most frequent, and cardiovascular injury, subarachnoid hemorrhage, pneumothorax, and recurrent cerebral hemorrhage as the most serious. , mostly due to improper techniques. Between 1980 and 2009, Chinese literature reported 479 adverse events. The prospective survey showed that mild acupuncture-related side effects, while ranging from 6.71% to 15%. In a study of 190,924 patients, the prevalence of serious adverse events was about 0.024%. Another study showed rates of adverse events requiring a special treatment of 2.2%, 4,963 incidents among 229,230 patients. Infection, particularly hepatitis, after acupuncture is often reported in English-language studies, although rarely reported in Chinese-language studies, makes it plausible that acupuncture-related infections have been reported in China. Infections are mostly caused by poor acupuncture needle sterilization. Other side effects include spinal epidural hematoma (in the cervix, thoracic and lumbar spine), chylothorax, abdominal and tissue injury, neck injury, eye injury, including hemorrhage orbital, traumatic cataract, oculomotor nerve injury and retinal puncture, bleeding to the cheeks and hypoglotis, peripheral motor nerves injury and subsequent motor dysfunction, local allergic reactions to metal needles, strokes, and cerebral hemorrhage after acupuncture.
A causal relationship between acupuncture and the adverse events of cardiac arrest, pyknolepsy, shock, fever, cough, thirst, aphonia, numb legs, and sexual dysfunction remains uncertain. The same review concluded that acupuncture can be considered inherently safe when practiced by trained practitioners, but the review also states there is a need to find effective strategies to minimize health risks. Between 1999 and 2010, the Republic of Korea-literature contains reports of 1104 adverse events. Between the 1980s and 2002, the Japanese literature contained a report of 150 adverse events.
Children and pregnancy
Although acupuncture has been practiced for thousands of years in China, its use in pediatrics in the United States did not become common until the early 2000s. In 2007, the National Health Interview Survey (NHIS) organized by the National Center for Health Statistics (NCHS) estimated that approximately 150,000 children had received acupuncture treatment for a variety of conditions.
In 2008 a study determined that the use of acupuncture needle treatment in children was "questioned" because of the possibility of adverse side effects and differences in the manifestation of pain in children compared to adults. The study also includes warnings against acupuncture practices in infants, as well as in children who are too tired, very weak, or overly fed.
When used in children, acupuncture is considered safe when administered by trained practitioners who are licensed to use a sterile needle; However, the 2011 review found no limited research to draw definitive conclusions about the safety of pediatric acupuncture as a whole. The same review found 279 side effects, 25 of them serious. Side effects are mostly mild (eg, bruising or bleeding). The prevalence of mild adverse events ranged from 10.1% to 13.5%, about 168 incidents among the 1,422 patients. In rare events, serious side effects (eg cardiac rupture or haemoptysis); many of which may be caused by substandard practices. The incidence of serious side effects is 5 per million, including children and adults.
When used during pregnancy, most of the side effects caused by acupuncture are mild and temporary, with some serious side effects. The most common mild side effects are needle pain or unspecified, followed by bleeding. Although two deaths (one stillbirth and one neonatal mortality) were reported, there was a lack of maternal death related acupuncture. Limiting the evidence as certain, possible or possible in the evaluation of causality, the estimated incidence of adverse events after acupuncture in pregnant women was 131 per 10,000. Although acupuncture is not contraindicated in pregnant women, certain acupuncture points are very sensitive to needle insertion; These spots, as well as the abdominal area, should be avoided during pregnancy.
Moxibustion and cupping
Four side effects associated with moxibustion are bruising, burns and cellulitis, spinal epidural abscess, and massive superficial basal cell carcinoma. Ten side effects associated with cupping. The small ones are keloid scarring, burns, and bullae; seriously acquired hemophilia A, stroke after bruise in the back and neck, artificial panniculitis, reversible cardiac hypertrophy, and iron deficiency anemia.
Cost effectiveness
A meta-analysis 2013 found that acupuncture for chronic low back pain is cost-effective as a complement to standard treatments, but not as a substitute for standard care except in cases where comorbid depression is presented. The same meta-analysis found no difference between fake acupuncture and non-sham. A systematic review of 2011 found insufficient evidence for the cost-effectiveness of acupuncture in the treatment of chronic low back pain. A systematic review of 2010 found that the cost effectiveness of acupuncture can not be inferred. A review of 2012 found that acupuncture appears to be cost-effective for some pain conditions.
Risk of ongoing conventional medical care
Like other alternative medicines, unethical or naive practitioners can encourage patients to spend their financial resources in the pursuit of ineffective care. Professional codes of conduct established by accreditation organizations such as the National Certification Commission for Acupuncture and Oriental Medicine require practitioners to make "timely referrals to other health care professionals who may be appropriate." Stephen Barrett stated that there is "a risk that acupuncturists whose approach to diagnosis is not based on a scientific concept will fail to diagnose dangerous conditions".
Conceptual bases
Traditional
Acupuncture is an important part of traditional Chinese medicine (TCM). The initial acupuncture belief depends on concepts common to TCM, such as the life force energy called qi . Qi is believed to flow from the main organ of the body (zang-fu organ) to the "shallow" body tissue of the skin, muscles, tendons, bones, and joints, through channels called meridians. The acupuncture points where the needle is inserted are primarily (but not always) found at locations along the meridian line. The acupuncture points that are not found along the meridians are called extraordinary points and those that do not have a site are called "A-shi" points.
In TCM, diseases are generally regarded as disharmony or imbalance in energies such as yin, yang, qi , xu?, ZÃÆ'ng-f ?, meridians, and interactions between body and environment. Therapy is based on an identifiable "pattern of disharmony." For example, some diseases are believed to be caused by meridians that are attacked with excess wind, cold, and damp. To determine which pattern is in hand, the practitioners examine such things as the color and shape of the tongue, the relative strength of the pulse-point, breath odor, breathing quality, or sound from sound. TCM and its concept of disease do not greatly distinguish between the causes and the effects of symptoms.
Recognized scientific basis
Scientific research does not support the existence of qi , meridian, or yin and yang. The Editorial Nature describes TCM as "full of pseudoscience", with the majority of treatments lacking a logical working mechanism. Quackwatch states that "The theory and practice of TCM is not based on a body of knowledge relating to health, disease and health care that has been widely accepted by the scientific community TCM practitioners disagree among themselves on how to diagnose patients and which treatment to take.With such a diagnosis, even if they can agree, the TCM theory is so vague that no scientific study has allowed TCM to offer rational treatment. "
Some modern practitioners support the use of acupuncture to treat pain, but have neglected the use of qi , meridians, yin , that and other energies based in mysticism as explanation framework. The use of qi as an explanatory framework has declined in China, even today becoming more prominent during acupuncture discussions in the US. Academic discussion of acupuncture still refers to pseudoscientific concepts such as qi and meridians despite the lack of scientific evidence. Many within the scientific community consider attempts to rationalize acupuncture in science to quackery, pseudoscience, and "placebo theater". Academics Massimo Pigliucci and Maarten Boudry described it as a "border science" situated between science and pseudoscience.
Many acupuncturists donate pain to the release of endorphins when needles penetrate, but no longer support the idea that acupuncture can affect a disease. It is a commonly held belief in the acupuncture community that acupuncture points and meridian structures are special channels for electrical signals, but no research has established a consistent anatomical structure or function for either acupuncture or meridian points. The human test to determine whether electrical continuity is significantly different near the meridians than elsewhere on the body has been convincing.
Several studies have shown acupuncture to cause a series of events within the central nervous system, and it is possible to inhibit the analgesic effects of acupuncture with naloxone opioid antagonists. The mechanical deformation of the skin by acupuncture needles seems to result in the release of adenosine. The anti-nociceptive effects of acupuncture can be mediated by the adenosine receptor A1. A review of 2014 at the Nature Review Cancer found that since the study of key rats suggesting acupuncture reduces pain through the release of local adenosine, which then triggers nearby A1 receptors "causing more tissue damage and inflammation relative to animal size in mice than in humans, such studies need not confuse the finding that local inflammation may lead to local adenosine release with analgesic effects. "
It has been suggested that the effects of acupuncture on gastrointestinal disorders may be related to their effect on the parasympathetic and sympathetic nervous system, which has been said to be a "Western" drug equivalent to "yin and yang". Another mechanism in which acupuncture may be effective for gastrointestinal dysfunction involves the promotion of gastric peristalsis in subjects with low initial gastric motility, and suppresses peristalsis in subjects with early active motility. Acupuncture has also been found to exert an anti-inflammatory effect, which may be mediated by activation of the vagus nerves and the deactivation of inflammatory macrophages. Neuroimaging studies show that acupuncture stimulation results in the deactivation of the limbic brain area and the default mode network.
History
Origins
Acupuncture, along with moxibustion, is one of the oldest practices of traditional Chinese medicine. Most historians believe that this practice began in China, although there are several conflicting narratives about its origin. Academics David Ramey and Paul Buell say the exact dates of acupuncture are established depending on the extent to which the dating of ancient texts can be trusted and the interpretation of what constitutes acupuncture.
According to an article in Rheumatology, the first documentation of the "organized system of diagnosis and treatment" for acupuncture was in The Yellow Emperor's Classic of Internal Medicine (Huangdi Neijing) from about 100 BC. The gold and silver needles found in the tomb of Liu Sheng from about 100 BC are believed to be the earliest archaeological evidence of acupuncture, though it is unclear whether that is their purpose. According to Plinio Prioreschi, the earliest known historical acupuncture record is Shih-Chi ("Record of History"), written by historians around 100 BC. It is believed that this text documents what was already practiced at that time.
Alternative theory
The fifty-year-old mummification body of ÃÆ'-tzi Iceman is found with 15 tattoo groups, many of which lie at points on the body where acupuncture needles are used for stomach problems or lower back. Evidence from the body indicates Otzi suffers from this condition. This has been cited as evidence that practices similar to acupuncture may have been practiced elsewhere in Eurasia during the early Bronze Age; However, the Oxford Handbook on Medical History calls this theory "speculative". It is considered unlikely that acupuncture was practiced before 2000 BC. The ÃÆ'-tzi mark of the Iceman tattoo shows to some experts that treatments such as acupuncture were previously used in Europe 5 millenia ago.
Acupuncture may have been practiced during the Neolithic era, near the end of the stone age, using sharp stones called Bian shi. Many Chinese texts from later times refer to sharp stones called "plen", meaning "rock probe", which may have been used for acupuncture purposes. The ancient Chinese medical text, Huangdi Neijing, suggests that sharp stones are believed at times to cure diseases on or near the surface of the body, possibly because of the short depth of rocks it can penetrate. However, most likely the stone was used for other medical purposes, such as stabbing growth to drain its pus. The Mawangdui text, believed to date from the 2nd century BC, mentions the use of a pointed stone to open an abscess, and moxibustion, but not to acupuncture. It also speculates that these stones may have been used for bloodshed, because the ancient Chinese belief that disease is caused by demons in the body can be killed or released. The likelihood of bloodshed is an antecedent to acupuncture.
According to historian Lu Gwei-djen and Joseph Needham, there is substantial evidence that acupuncture had begun around 600 BC. Some of the hieroglyphs and pictographs of that era show acupuncture and moxibustion practiced. However, historians Gwei-djen and Needham say it is unlikely the needles can be made from materials available in China during this period. It is possible Bronze is used for early acupuncture needles. Tin, copper, gold and silver are also likely, although they are considered less likely, or have been used in fewer cases. If acupuncture was practiced during the Shang dynasty (1766 to 1122 BC), organic materials such as thorns, sharp bones, or bamboo may have been used. Once the method for producing the steel is found, it will replace all other materials, as it can be used to make a very fine, but sturdy needle. Gwei-djen and Needham note that all ancient materials that can be used for acupuncture and which often produce archaeological evidence, such as bone, bamboo or stone, are also used for other purposes. An article in Rheumatology says that the absence of any mention of acupuncture in documents discovered at Ma-Wang-Dui's tomb from 198 BC shows that acupuncture was not done at the time.
Trust system
Several different and sometimes contradictory belief systems emerge regarding acupuncture. This may be the result of a rival platform of thought. Some ancient texts called using acupuncture cause bleeding, while others mix up blood and spiritual energy ideas of ch'i. Over time, the focus shifts from blood to the concept of poking certain points on the body, and finally balancing the energy of Yin and Yang as well. According to David Ramey, no single "method or theory" has ever been adopted as a standard. At the time, the scientific knowledge of the drug had not been developed, especially since in China the deceased dissection was forbidden, preventing the development of basic anatomical knowledge.
It is uncertain when special acupuncture points are introduced, but Pien Chhio's autobiography of about 400-500 BC references inserts a needle in designated areas. Bian Que believes there is a single acupuncture point at the top of a person's skull which he calls the "point of a hundred meetings." The date text became from 156-186 BC early confidence documents in the channel of life force energy called meridians which would later become an element in the early acupuncture beliefs.
Ramey and Buell say the "practice and theoretical foundation" of modern acupuncture was introduced at The Yellow Emperor's Classic (Huangdi Neijing) around 100 BC. It introduces the concept of using acupuncture to manipulate the flow of life energy ( qi ) in the tissues of the meridians (channels) in the body. The network concept consists of channels, such as the line under the arm, where it says the acupuncture point is located. Some sites using acupuncturists needle in today still have the same name as given to them by Yellow Emperor's Classic . Many additional documents published over the centuries introduce new acupuncture points. In the 4th century AD, most of the acupuncture sites used today have been named and identified. Initial development in China
Establishment and growth
In the first half of the 1st century, acupuncturists began to promote the belief that the effectiveness of acupuncture is affected by the time of day or night, the moon cycle, and the season. The Yin-Yang Cycle Science ( YÃÆ'¼n Chhi HsÃÆ'¼eh ) is a set of beliefs that curing illness depends on the alignment of the (heavenly) and worldly powers (ti) in harmony with such cycles that of the sun and moon. There are different belief systems that depend on a number of heavenly or earth bodies or spinning elements and only become aligned at certain times. According to Needham and Gwei-djen, these "random predictions" are described by acupuncturists in complex charts and through a series of special terminology.
Acupuncture needles during this period are much thicker than most modern and often lead to infection. Infection is caused by a lack of sterilization, but at the time it is believed to be caused by the use of the wrong needle, or the needle stab in the wrong place, or at the wrong time. Later, many needles are heated in boiling water, or in flames. Sometimes the needle is used while still hot, creating a cauterization effect at the injection site. Nine needles are recommended at Chen Chiu Ta Chheng from 1601, which may be due to ancient Chinese belief that nine is a magic number.
Another belief system is based on the idea that the human body is operated on rhythm and acupuncture should be applied at the right point in order for the rhythm to be effective. In some cases, the lack of balance between Yin and Yang is believed to be the cause of the disease.
In the 1st century, many of the first books on acupuncture published and acupuncturists recognized began to emerge. The Zhen Jiu Jia Yi Jing , published in the mid-3rd century, became the oldest acupuncture book still in existence
Source of the article : Wikipedia
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