241 Although Two Deaths One Stillbirth And One Neonatal Death Were Reported, There Was A Lack Of Acupuncture-associated Maternal Mortality.

Korea.s.elieved.o.e.he.irst country in Asia that acupuncture spread to outside of China. 29 Within Korea there is a legend that acupuncture was developed by emperor Dan gun, 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. Japanese reprint by Suharaya Heisuke Ed, 1. year Kyōhō = 1716. Infection is caused by a lack of sterilization, but at that time it was believed to be caused by use of the wrong needle, or needling in the wrong place, or at the wrong time. 29 :102-103 Later, many needles were heated in boiling water, or in a Alame. The study also includes warnings against practising acupuncture on infants, as well as on Phildren 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 needles; 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. 94 A 2012 review found that acupuncture seems to be cost-effective for some pain conditions. 242 Risk of forgoing conventional medical care As with other alternative medicines, unethical or naive practitioners may induce patients to exhaust financial resources by pursuing ineffective treatment. 5 243 Profession ethical codes set by accrediting organizations such as the National Certification Commission for Acupuncture and Oriental Medicine require practitioners to make “timely referrals to other health care professionals as may be appropriate.” 244 Stephen Barrett states that there is a “risk that an acupuncturist whose approach to diagnosis is not based on scientific concepts will fail to diagnose a dangerous condition”. 245 Main articles: Qi, Traditional Chinese medicine, Meridian Chinese medicine, and Acupuncture point Old Chinese medical chart of acupuncture meridians Acupuncture is a substantial part of traditional Chinese medicine ACM. 4 Early acupuncture beliefs relied on concepts that are common in ACM, such as a life force energy called qi. 246 Qi was believed to flow from the body's primary organs zang-fu organs to the “superficial” body tissues of the skin, muscles, tendons, bones, and joints, citation needed through channels called meridians. 247 Acupuncture points where needles are inserted are mainly but not always back pain acupuncture found at locations along the meridians. 248 Acupuncture points not found along a meridian are called extraordinary points and those with no designated site are called “A-shi” points. 248 In ACM, disease is generally perceived as a disharmony or imbalance in energies such as yin, yang, qi, xuĕ, zàng-fǔ, meridians, and of the interaction between the body and the environment. 249 Therapy is based on which “pattern of disharmony” can be identified. 250 251 For example, some diseases are believed to be caused by meridians being invaded with an excess of wind, cold, and damp. 252 In order to determine which pattern is at hand, practitioners examine things like the colon and shape of the tongue, the relative strength of pulse-points, the smell of the breath, the quality of breathing, or the sound of the voice. 253 254 ACM and its concept of disease does not strongly differentiate between the cause and effect of symptoms. 255 Scientific research has not supported the existence of qi, meridians, or yin and yang. n 1 24 25 A Nature editorial described ACM as “fraught with pseudo-science”, with the majority of its treatments having no logical mechanism of action . 256 Quackwatch states that “ACM theory and practice are not based upon the body of knowledge related to health, disease, and health care that has been widely accepted by the scientific community. Acupuncture became the most popular alternative medicine in the US. 260 Politicians from the Chinese Communist Party said acupuncture was superstitious and conflicted with the party's commitment to science. 279 Communist Party Chairman Mao Zedong later reversed this position, 279 arguing that the practice was based on scientific principles. 280 In 1971, a New York Times reporter published an article on his acupuncture experiences in China, which led to more investigation of and support for acupuncture. 27 The US President Richard Nixon visited China in 1972 . 281 During one part of the visit, the delegation was shown a patient undergoing major surgery while fully awake, ostensibly receiving acupuncture rather than anaesthesia . 281 Later it was found that the patients selected for the surgery had both a high pain tolerance and received heavy indoctrination before the operation; these demonstration cases were also frequently receiving morphine surreptitiously through an intravenous drip that observers were told contained only fluids and nutrients. 281 One patient receiving open heart surgery while awake was ultimately found to have received a combination of three powerful sedatives as well as large injections of a local aesthetic into the wound. 57 After the National Institute of Health expressed support for acupuncture for a limited number of conditions, adoption in the US grew further. 27 In 1972 the first legal acupuncture canter in the US was established in Washington DC 282 and in 1973 the American Internal Revenue Service allowed acupuncture to be deducted as a medical expense. 283 In 2006, a BBC documentary Alternative Medicine filmed a patient undergoing open heart surgery allegedly under acupuncture-induced anaesthesia. Although acupuncture 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 fl. 1340s, Ming dynasty . David Ramey, no single “method or theory” was ever predominantly adopted as the standard. 271 At the time, scientific knowledge of medicine was not yet developed, especially because in China dissection of the deceased was forbidden, preventing the development of basic anatomical knowledge. 27 It is not certain when specific acupuncture points were introduced, but the autobiography of lien Chhio from around 400–500 BC references inserting needles at designated areas. 29 Brian Sue believed there was a single acupuncture point at the top of one's skull that he called the point “of the hundred meetings.” 29 :83 Texts dated to be from 156–186 BC document early beliefs in channels of life force energy called meridians that would later be an element in early acupuncture beliefs. 267 Ramey and quell said the “practice and theoretical underpinnings” of modern acupuncture were introduced in the Yellow Emperor's Classic Huangdi Beijing around 100 BC. 28 267 It introduced the concept of using acupuncture to manipulate the flow of life energy qi in a network of meridian channels in the body. 267 272 The network concept was made up of acu-tracts, such as a line down the arms, where it said acupoints were located. This may have been the result of competing schools of thought. 27 Some ancient texts referred to using acupuncture to cause bleeding, while others mixed the ideas of blood-letting and spiritual ch'i energy. Rheumatology. 47 8: 1132–1136. dBi : 10.1093/rheumatology/ken161 . Over time, the focus shifted from blood to the concept of puncturing specific points on the body, and eventually to balancing Yin and Yang energies as well. 28 According to Dr. In ACM, the four diagnostic methods are: inspection, auscultation and olfaction, inquiring, and palpation. In 1999, the National enter for Complementary and Alternative Medicine was created within the NIH.

If.he.e-qi.ensation.oes.ot.mmediately occur upon needle insertion, various manual manipulation techniques can be applied to promote it such as “plucking”, “shaking” or “trembling”. 52 Once de-qi is achieved, further techniques might be utilized which aim to “influence” the de-qi; for example, by certain manipulation the de-qi sensation allegedly can be conducted from the needling site towards more distant sites of the body. Even if they could agree, the ACM theories are so nebulous that no amount of scientific study will enable ACM to offer rational care.” 5 Some modern practitioners support the use of acupuncture to treat pain, but have abandoned the use of qi, meridians, yin, yang and other energies based in mysticism, as explanatory frameworks. 8 25 26 The use of qi as an explanatory framework has been decreasing in China, even as it becomes more prominent during discussions of acupuncture in the US. 257 Academic discussions of acupuncture still make reference to pseudo-scientific concepts such as qi and meridians despite the lack of scientific evidence. 257 Many within the scientific community consider attempts to rationalize acupuncture in science to be quackery, pseudo-science and “theatrical placebo”. 258 Academics Massimo Pigliucci and marten Boudry describe it as a “borderlands science” lying between science and pseudo-science. 259 Many acupuncturists attribute pain relief to the release of endorphins when needles penetrate, but no longer support the idea that acupuncture can affect a disease. 26 257 It is a generally held belief within the acupuncture community that acupuncture points and meridians structures are special conduits for electrical signals but no research has established any consistent anatomical structure or function for either acupuncture points or meridians. n 1 24 Human tests to determine whether electrical continuity was significantly different near meridians than other places in the body have been inconclusive. 24 Some studies suggest acupuncture causes a series of events within the central nervous system, 260 and that it is possible to inhibit acupuncture's analgesic effects with the opioid antagonist naloxone . 261 Mechanical deformation of the skin by acupuncture needles appears to result in the release of adenosine . 2 The anti-nociceptive effect of acupuncture may be mediated by the adenosine A1 receptor . 262 A 2014 Nature Reviews Cancer review article found that since the key mouse studies that suggested acupuncture relieves pain via the local release of adenosine, which then triggered close-by A1 receptors “caused more tissue damage and inflammation relative to the size of the animal in mice than in humans, such studies unnecessarily muddled a finding that local inflammation can result in the local release of adenosine with analgesic effect.” 77 It has been proposed that acupuncture's effects in gastrointestinal disorders may relate to its effects on the parasympathetic and sympathetic nervous system, which have been said to be the “Western medicine” equivalent of “yin and yang”. 263 Another mechanism whereby acupuncture may be effective for gastrointestinal dysfunction involves the promotion of gastric peristalsis in subjects with low initial gastric motility, and suppressing peristalsis in subjects with active initial motility. 264 Acupuncture has also been found to exert anti-inflammatory effects, which may be mediated by the activation of the vague nerve and deactivation of inflammatory macrophages . 265 Neuroimaging studies suggest that acupuncture stimulation results in deactivation of the limbic brain areas and the default mode network . 266 Acupuncture chart from the Ming dynasty c. 1368–1644 Acupuncture, along with moxibustion, is one of the oldest practices of Traditional Chinese Medicine. 29 Most historians believe the practice began in China, though there are some conflicting narratives on when it originated. 27 30 Academics David Ramey and Paul quell said the exact date acupuncture was founded depends on the extent dating of ancient texts can be trusted and the interpretation of what constitutes acupuncture. 267 According to an article in Rheumatology, the first documentation of an “organized system of diagnosis and treatment” for acupuncture was in The Yellow Emperor's Classic of Internal Medicine Huangdi Beijing from about 100 BC. 27 Gold and silver needles found in the tomb of Li Cheng from around 100 BC are believed to be the earliest archaeological evidence of acupuncture, though it is unclear if that was their purpose. 267 According to Dr. Since most pain is felt in the superficial layers of the skin, a quick insertion of the needle is recommended. 50 Often the needles are stimulated by hand in order to cause a dull, localized, aching sensation that is called de qi, as well as “needle grasp,” a tugging feeling felt by the acupuncturist and generated by a mechanical interaction between the needle and skin. 2 Acupuncture can be painful. 51 The skill level of the acupuncturist may influence how painful the needle insertion is, and a sufficiently skilled practitioner may be able to insert the needles without causing any pain. 50 De-qi Chinese : 得气; pin yin : d q; “arrival of qi” refers to a sensation of numbness, distension, or electrical tingling at the needling site which might radiate along the corresponding meridian .

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