Needles being inserted into a person's skin
Acupuncture (from Latin, 'acus' (needle) + 'punctura' (to puncture)) is the stimulation of specific acupuncture points along the skin of the body involving various methods such as penetration by thin needles or the application of heat, pressure, or laser light. Clinical practice varies depending on the country. Traditional acupuncture involves needle insertion, moxibustion, and cupping therapy. It is a form of alternative medicine and a key component of traditional Chinese medicine (TCM). According to TCM, stimulating specific acupuncture points corrects imbalances in the flow of qi through channels known as meridians. The TCM theory and practice are not based upon scientific knowledge. Acupuncture aims to treat a range of conditions, though is most commonly used for pain relief. It is rarely used alone but rather as an adjunct to other treatment modalities.
Any evidence on the effectiveness of acupuncture is "variable and inconsistent" for all conditions. An overview of high-quality Cochrane reviews suggested that acupuncture may alleviate some, but not all, kinds of pain. A systematic review of systematic reviews found that for reducing pain, real acupuncture was no better than sham acupuncture and concluded that there is little evidence that acupuncture is an effective treatment for reducing pain.[n 1] Although minimally invasive, the puncturing of the skin with acupuncture needles poses problems when designing trials that adequately control for placebo effects. Some of the research results suggest acupuncture can alleviate pain but others consistently suggest that acupuncture's effects are mainly due to placebo. The evidence suggests that short-term treatment with acupuncture does not produce long-term benefits. A meta-review concluded that the analgesic effect of acupuncture seemed to lack clinical relevance and could not be clearly distinguished from bias.
Acupuncture is generally safe when done by an appropriately trained practitioner using clean technique and single-use needles. When properly delivered, it has a low rate of mostly minor adverse effects. Between 2000 and 2009, at least ninety-five cases of serious adverse events, including five deaths, were reported to have resulted from acupuncture. Many of the serious events were reported from developed countries and many were due to malpractice. The most frequently reported adverse events were pneumothorax and infections. Since serious adverse events continue to be reported, it is recommended that acupuncturists be trained sufficiently to reduce the risk. A meta-analysis found that acupuncture for chronic low back pain was cost-effective as an adjunct to standard care, but not as a substitute for standard care except in cases where comorbid depression presented, while a systematic review found insufficient evidence for the cost-effectiveness of acupuncture in the treatment of chronic low back pain.
Acupuncture has been the subject of active scientific research, both in regard to its basis and therapeutic effectiveness, since the late 20th century. Scientific investigation has not found any histological or physiological evidence for traditional Chinese concepts such as qi, meridians, and acupuncture points,[n 2] and some contemporary practitioners use acupuncture without following the traditional Chinese approach and have abandoned the concepts of qi and meridians as pseudoscientific. TCM is largely pseudoscience, with no valid mechanism of action for the majority of its treatments. Acupuncture is currently used widely throughout China and many other countries, including the United States. It is uncertain exactly when acupuncture originated or how it evolved, but it is generally thought to derive from ancient China. Chinese history attributes the introduction of acupuncture to the emperor Shennong. Hieroglyphs and pictographs have been found dating from the Shang Dynasty (1600–1100 BCE), which suggests that acupuncture was practiced along with moxibustion.
- 1 Clinical practice
- 2 Effectiveness
- 2.1 Pain
- 2.2 Low back
- 2.3 Headaches and migraines
- 2.4 Extremity conditions
- 2.5 Nausea and vomiting and post-operative
- 2.6 Allergies
- 2.7 Attention deficit hyperactivity disorder
- 2.8 Cancer-related conditions
- 2.9 Depression
- 2.10 Fertility and childbirth
- 2.11 Rheumatological conditions
- 2.12 Stroke
- 2.13 Tinnitus
- 2.14 Menopause-related symptoms
- 2.15 Other conditions
- 2.16 Moxibustion and cupping
- 3 Safety
- 4 Theory
- 5 History
- 6 Ethics
- 7 Reception
- 8 Legal and political status
- 9 See also
- 10 Bibliography
- 11 Notes
- 12 References
- 13 Further reading
- 14 External links
Acupuncture is the stimulation of precisely defined, specific acupuncture points along the skin of the body involving various methods such as penetration by thin needles or the application of heat, pressure, or laser light. In a modern acupuncture session, an initial consultation is followed by taking the pulse on both arms and inspecting the tongue. Classically, in clinical practice, acupuncture is highly individualized and based on philosophy and intuition, and not on controlled scientific research. The number and frequency of acupuncture sessions vary, but most practitioners do not think one session is sufficient. The initial evaluation may last up to 60 minutes. Subsequent visits typically last about a half an hour. A common treatment plan for a single complaint usually involves six to twelve treatments, planned out over a few months. A typical session entails lying still while approximately five to twenty needles are inserted; for the majority of cases, the needles will be left in place for ten to twenty minutes.
Clinical practice varies depending on the country. A comparison of the average number of patients treated per hour found significant differences between China (10) and the United States (1.2). Traditional acupuncture involves needle insertion, moxibustion, and cupping therapy. Traditional acupuncture may be accompanied by various ancillary procedures, such as palpation of the radial artery and other parts of the body and examining the tongue. Acupuncturists generally practice acupuncture as an overall system of care, which includes using traditional diagnostic techniques, acupuncture needling, and other adjunctive treatments. Chinese herbs are also often used. Although various different techniques of acupuncture practice have emerged, the method used in traditional Chinese medicine (TCM) seems to be the most widely adapted in the US. The main methods practiced in the UK are TCM and Western medical acupuncture.
Acupuncture needles are typically made of stainless steel, making them flexible and preventing them from rusting or breaking. Needles are usually disposable, and are thrown away after use to prevent contamination. Reusable needles are sometimes used as well, though they must be sterilized between uses. 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 more fleshy areas; needle diameters vary from 0.16 mm (0.006 in) to 0.46 mm (0.018 in), with thicker needles used on more robust patients. Thinner needles may be flexible and require tubes for insertion. The tip of the needle should not be made too sharp to prevent breakage, although blunt needles cause more pain.
Apart from the usual filiform needle, other needle types include three-edged needles and the Nine Ancient Needles. Japanese acupuncturists use extremely thin needles that are used superficially, sometimes without penetrating the skin, and surrounded by a guide tube (a 17th-century invention adopted in China and the West). Korean acupuncture uses copper needles and has a greater focus on the hand.
The skin is sterilized, such as with alcohol, and the needles are inserted, frequently with a plastic guide tube. Needles may be manipulated in various ways, including spinning, flicking, or moving up and down relative to the skin. Since most pain is felt in the superficial layers of the skin, a quick insertion of the needle is recommended. 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. Acupuncture can be painful. 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.
De-qi (Chinese: 得气; pinyin: dé qì; "arrival of qi") refers to a sensation of numbness, distension, or electrical tingling at the needling site which might radiate along the corresponding meridian. If de-qi can not be generated, then inaccurate location of the acupoint, improper depth of needle insertion, inadequate manual manipulation, or a very weak constitution of the patient have to be considered, all of which are thought to decrease the likelihood of successful treatment. If the de-qi sensation doesn't immediately occur upon needle insertion, various manual manipulation techniques can be applied to promote it (such as "plucking", "shaking" or "trembling").
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. Other techniques aim at "tonifying" (Chinese: 补; pinyin: bǔ) or "sedating" (Chinese: 泄; pinyin: xiè) qi. The former techniques are used in deficiency patterns, the latter in excess patterns.
De qi is more important in Chinese acupuncture, while Western and Japanese patients may not consider it a necessary part of the treatment.
Acupressure, a non-invasive form of acupuncture, uses physical pressure applied to acupressure points by the hand, elbow, or with various devices. Acupuncture is often accompanied by moxibustion, the burning of cone-shaped preparations of moxa (made from dried mugwort) on or near the skin, often but not always near or on an acupuncture point. Traditionally, acupuncture was used to treat acute conditions while moxibustion was used for chronic diseases. Moxibustion could be direct (the cone was placed directly on the skin and allowed to burn the skin producing a blister and eventually a scar), or indirect (either a cone of moxa was placed on a slice of garlic, ginger or other vegetable, or a cylinder of moxa was held above the skin, close enough to either warm or burn it). Cupping therapy is an ancient Chinese form of alternative medicine in which a local suction is created on the skin; practitioners believe this mobilizes blood flow in order to promote healing. Tui na is a TCM method of attempting to stimulate the flow of qi by various bare-handed techniques that do not involve needles. Electroacupuncture is a form of acupuncture in which acupuncture needles are attached to a device that generates continuous electric pulses (this has been described as "essentially transdermal electrical nerve stimulation [TENS] masquerading as acupuncture"). Sonopuncture is a stimulation of the body similar to acupuncture using sound instead of needles. This may be done using purpose-built transducers to direct a narrow ultrasound beam to a depth of 6–8 centimetres at acupuncture meridian points on the body. Alternatively, tuning forks or other sound emitting devices are used. Acupuncture point injection is the injection of various substances (such as drugs, vitamins or herbal extracts) into acupoints. Auriculotherapy, commonly known as ear acupuncture, auricular acupuncture, or auriculoacupuncture, is considered to date back to ancient China which involves inserting needles to stimulate points on the outer ear. The modern approach was developed in France during the early 1950s. There is no scientific evidence that it can cure disease; the evidence of effectiveness is negligible. Scalp acupuncture, developed in Japan, is based on reflexological considerations regarding the scalp area. Hand acupuncture, developed in Korea, centers around assumed reflex zones of the hand. Medical acupuncture attempts to integrate reflexological concepts, the trigger point model, and anatomical insights (such as dermatome distribution) into acupuncture practice, and emphasizes a more formulaic approach to acupuncture point location. Cosmetic acupuncture is the use of acupuncture in an attempt to reduce wrinkles on the face. Veterinary acupuncture is performed on animals; evidence is sparse.
The application of evidence-based medicine to researching acupuncture's effectiveness is a controversial activity, and has produced different results in a growing evidence base of research. Some research results suggest acupuncture can alleviate pain but others consistently suggest that acupuncture's effects are mainly due to placebo. It is difficult but not impossible to design rigorous research trials for acupuncture. Due to acupuncture's invasive nature, one of the major challenges in efficacy research is in the design of an appropriate placebo control group. 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. The under-performance of acupuncture interventions in such sham controlled trials may indicate that therapeutic effects are due entirely to non-specific effects, or that the sham treatments are not inert or systematic protocols yield less than optimal treatment. A 2012 review found "A common control procedure has been the use of sham acupuncture where needles are inserted on either meridians not specific for the condition under study, or in areas outside meridians; often this is coupled with a more superficial needle insertion than what is performed in the true acupuncture group." The research seems to suggest that needles do not need to stimulate the traditionally specified acupuncture points or penetrate the skin to attain an anticipated effect (e.g. psychosocial factors). A 2012 review found "acupuncture was not better than sham interventions or conventional therapy in the longer term." The evidence suggests that any benefits of acupuncture are short-lasting.
Any evidence on the effectiveness of acupuncture is "variable and inconsistent" for all conditions, and publication bias is cited as a concern in the reviews of randomized controlled trials (RCTs) of acupuncture. A 1998 review of studies on acupuncture found that trials originating in China, Japan, Hong Kong and Taiwan were uniformly favourable to acupuncture, as were ten out of 11 studies conducted in Russia. A 2011 assessment of the quality of RCTs on TCM, including acupuncture, concluded that the methodological quality of most such trials (including randomization, experimental control and blinding) was generally poor, particularly for trials published in Chinese journals (though the quality of acupuncture trials was better than the drug-related trials). The study also found that trials published in non-Chinese journals tended to be of higher quality.
A 2014 Nature Reviews Cancer article found that "contrary to the claimed mechanism of redirecting the flow of qi through meridians, researchers usually find that it generally does not matter where the needles are inserted, how often (that is, no dose-response effect is observed), or even if needles are actually inserted. In other words, ‘sham’ or ‘placebo’ acupuncture generally produces the same effects as ‘real’ acupuncture and, in some cases, does better." A 2013 meta-analysis found little evidence that the effectiveness of acupuncture on pain (compared to sham) was modified by the location of the needles, the number of needles used, the experience or technique of the practitioner, or by the circumstances of the sessions. The same analysis also suggested that the number of needles and sessions is important, as greater numbers improved the outcomes of acupuncture compared to non-acupuncture controls. A 2013 editorial found that the inconsistency of results of acupuncture studies (that acupuncture relieved pain in some conditions but had no effect in other very similar conditions) suggests false positive results, which may be caused by factors like biased study designs, poor blinding, and the classification of electrified needles (a type of TENS) as acupuncture. The same editorial suggested that given the inability to find consistent results despite more than 3,000 studies of acupuncture, the treatment seems to be a placebo effect and the existing equivocal positive results are noise one expects to see after a large number of studies are performed on an inert therapy. It concluded that the best controlled studies showed a clear pattern, in which the outcome does not rely upon needle location or even needle insertion, and since "these variables are those that define acupuncture, the only sensible conclusion is that acupuncture does not work."
A 2014 systematic review suggests that the nocebo effect of acupuncture is clinically relevant and the rate of people with any adverse event may be a more applicable gauge of the nocebo effect. A 2012 meta-analysis conducted by the Acupuncture Trialists' Collaboration found "relatively modest" efficiency of acupuncture (in comparison to sham) for the treatment of four different types of chronic pain, and on that basis concluded that it "is more than a placebo" and a reasonable referral option. Commenting on this meta-analysis, both Edzard Ernst and David Colquhoun said the results were of negligible clinical significance.
A 2011 overview of high-quality Cochrane reviews suggested that acupuncture is effective for some but not all kinds of pain. A 2011 systematic review of systematic reviews which highlighted recent high-quality RCTs found that for reducing pain, real acupuncture was no better than sham acupuncture, and concluded that numerous 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 for which a positive effect was suggested, but cautioned that the primary studies used carried a considerable risk of bias.
A 2010 systematic review suggested that acupuncture is more than a placebo for commonly occurring chronic pain conditions, but the authors acknowledged that it is still unknown if the overall benefit is clinically meaningful or cost-effective. A 2010 review found real acupuncture and sham acupuncture produce similar improvements, which can only be accepted as evidence against the efficacy of acupuncture. The same review found limited evidence that real acupuncture and sham acupuncture appear to produce biological differences despite similar effects. A 2009 systematic review and meta-analysis found that acupuncture had a small analgesic effect, which appeared to lack any clinical importance and could not be discerned from bias. The same review found that it remains unclear whether acupuncture reduces pain independent of a psychological impact of the needling ritual.
A 2013 systematic review found supportive evidence that real acupuncture may be more effective than sham acupuncture with respect to relieving lower back pain, but there were methodological limitations with the studies. A 2013 systematic review found that acupuncture may be effective for nonspecific lower back pain, but the authors noted there were limitations in the studies examined, such as heterogeneity in study characteristics and low methodological quality in many studies. A 2012 systematic review found some supporting evidence that acupuncture was more effective than no treatment for chronic non-specific low back pain; the evidence was conflicting comparing the effectiveness over other treatment approaches. A 2011 overview of Cochrane reviews found inconclusive evidence regarding acupuncture efficacy in treating low back pain. A 2011 systematic review of systematic reviews found that "for chronic low back pain, individualized acupuncture is not better in reducing symptoms than formula acupuncture or sham acupuncture with a toothpick that does not penetrate the skin." A 2010 review found that sham acupuncture was as effective as real acupuncture for chronic low back pain. The specific therapeutic effects of acupuncture were small, whereas its clinically relevant benefits were mostly due to contextual and psychosocial circumstances. Brain imaging studies have shown that traditional acupuncture and sham acupuncture differ in their effect on limbic structures, while at the same time showed equivalent analgesic effects. Commenting on this review, David Gorski stated "if quackademic medicine can infiltrate the NEJM, there’s nowhere it can't go." A 2005 Cochrane review found insufficient evidence to recommend for or against either acupuncture or dry needling for acute low back pain. The same review found low quality evidence for pain relief and improvement compared to no treatment or sham therapy for chronic low back pain only in the short term immediately after treatment. The same review also found that acupuncture is not more effective than conventional therapy and other alternative medicine treatments.
Headaches and migraines
A 2012 review found that acupuncture has demonstrated benefit for the treatment of headaches, but that safety needed to be more fully documented in order to make any strong recommendations in support of its use. A 2009 Cochrane review of the use of acupuncture for migraine prophylaxis treatment concluded that "true" acupuncture was no more efficient than sham acupuncture, but "true" acupuncture appeared to be as effective as, or possibly more effective than routine care in the treatment of migraines, with fewer adverse effects than prophylactic drug treatment. The same review stated that the specific points chosen to needle may be of limited importance. A 2009 Cochrane review found insufficient evidence to support acupuncture for tension-type headaches. The same review found evidence that suggested that acupuncture might be considered a helpful non-pharmacological approach for frequent episodic or chronic tension-type headache.
As of 2014[update] a meta-analysis showed that acupuncture may help osteoarthritis pain but it was noted that the effects were insignificant in comparison to sham needles. A 2013 systematic review and network meta-analysis found that the evidence suggests that acupuncture may be considered one of the more effective physical treatments for alleviating pain due to osteoarthritis of the knee in the short-term compared to other relevant physical treatments, though much of the evidence in the topic is of poor quality and there is uncertainty about the efficacy of many of the treatments. A 2012 review found "the potential beneficial action of acupuncture on osteoarthritis pain does not appear to be clinically relevant." A 2014 review concluded that "current evidence supports the use of acupuncture as an alternative to traditional analgesics in osteoarthritis patients." A 2010 Cochrane review found that acupuncture shows statistically significant benefit over sham acupuncture in the treatment of peripheral joint osteoarthritis; however, these benefits were found to be so small that their clinical significance was doubtful, and "probably due at least partially to placebo effects from incomplete blinding". The Osteoarthritis Research Society International released a set of consensus recommendations in 2008 which concluded that acupuncture may be useful for treating the symptoms of osteoarthritis of the knee. A 2007 review found that acupuncture was significantly better than sham acupuncture at treating chronic knee pain; the evidence was not conclusive due to the lack of large, high-quality trials.
Nausea and vomiting and post-operative
A 2014 overview of systematic reviews found insufficient evidence to suggest that acupuncture is an effective treatment for postoperative nausea and vomiting (PONV) in a clinical setting. A 2013 systematic review concluded that acupuncture might be beneficial in prevention and treatment of PONV. A 2009 Cochrane review found that stimulation of the P6 acupoint on the wrist was as effective (or ineffective) as antiemetic drugs and was associated with minimal side effects. The same review found "no reliable evidence for differences in risks of postoperative nausea or vomiting after P6 acupoint stimulation compared to antiemetic drugs."
A 2014 overview of systematic reviews found insufficient evidence to suggest that acupuncture is effective for surgical or post-operative pain. For the use of acupuncture for post-operative pain, there was contradictory evidence. A 2014 systematic review found supportive but limited evidence for use of acupuncture for acute post-operative pain after back surgery. A 2014 systematic review found that while the evidence suggested acupuncture could be an effective treatment for postoperative gastroparesis, a firm conclusion could not be reached because the trials examined were of low quality.
Several randomized clinical trials (RCTs) support the use of acupuncture for allergic rhinitis (AR) and itch. Experimental studies refer to a specific effect of acupuncture in atopic eczema and asthma, but large RCTs are lacking. Using acupuncture to treat other allergic conditions such as contact eczema, drug rashes, or anaphylaxis is not recommended. Additional research is required to clearly determine any effects of allergic disease therapy above placebo. There is insufficient evidence that acupuncture has specific effects on seasonal allergic rhinitis (SAR). There is some evidence that acupuncture might have specific effects on perennial allergic rhinitis (PAR), though all of the efficacy studies were small and conclusions should be made with caution. There is mixed evidence for the symptomatic treatment or prevention of AR. For seasonal AR, the evidence failed to demonstrate specific effects for acupuncture. For perennial AR, there was suggestive evidence for the effectiveness of acupuncture. Acupuncture is an unproven treatment for allergic-immunologic conditions.
Attention deficit hyperactivity disorder
A 2011 Cochrane review concluded that there was no evidence to support the use of acupuncture for attention deficit hyperactivity disorder (ADHD). A 2011 review concluded there was limited evidence as to the effectiveness of acupuncture as a treatment option for ADHD but cautioned that firm conclusions could not be drawn because of the risk of bias.
A 2012 systematic review of randomised clinical trials (RCTs) using acupuncture in the treatment of cancer pain found that the number and quality of RCTs was too low to draw definite conclusions. A 2011 Cochrane review found that there is insufficient evidence to determine whether acupuncture is an effective treatment for cancer pain in adults. There is too little evidence available to make a recommendation for the use of acupuncture to improve the health and well-being in pediatric oncology.
A 2013 systematic review found that acupuncture is an acceptable adjunctive treatment for chemotherapy-induced nausea and vomiting, but that further research with a low risk of bias is needed. A 2013 systematic review found that the quantity and quality of available RCTs for analysis were too low to draw valid conclusions for the effectiveness of acupuncture for cancer-related fatigue. A 2012 systematic review and meta-analysis found very limited evidence regarding the effectiveness of acupuncture compared with conventional intramuscular injections for the treatment of hiccups in cancer patients. The methodological quality and amount of RCTs in the review was low.
A 2013 Cochrane review found unclear evidence for major depressive disorders in pregnant women. A 2010 Cochrane review found insufficient evidence to recommend acupuncture to treat depression. A 2010 systematic review of systematic reviews found that the effectiveness of acupuncture to treat depression is unproven and their conclusions are "consistent with acupuncture effects in depression being indistinguishable from placebo effects." A 2010 review concluded that acupuncture was safe and effective in the treatment of major depressive disorder and post-stroke depression.
Fertility and childbirth
A 2014 systematic review and meta-analysis found poor quality evidence for use of acupuncture in infertile men to improve sperm motility, sperm concentration, and the pregnancy rate; the evidence was rated as insufficient to draw any conclusion regarding efficacy. A 2013 Cochrane review found no evidence of acupuncture for improving the success of in vitro fertilization (IVF). A 2013 systematic review found no benefit of adjuvant acupuncture for IVF on pregnancy success rates. A 2012 systematic review found that acupuncture may be a useful adjunct to IVF, but its conclusions were rebutted after reevaluation using more rigorous, high quality meta-analysis standards.
A 2013 Cochrane review found low to moderate evidence that acupuncture improves pain and stiffness in treating people with fibromyalgia compared with no treatment and standard care. A 2012 review found "there is insufficient evidence to recommend acupuncture for the treatment of fibromyalgia." A 2010 systematic review found a small pain relief effect that was not apparently discernible from bias; acupuncture is not a recommendable treatment for the management of fibromyalgia on the basis of this review.
A 2012 review found that the effectiveness of acupuncture to treat rheumatoid arthritis is "sparse and inconclusive." A 2005 Cochrane review concluded that acupuncture use to treat rheumatoid arthritis "has no effect on ESR, CRP, pain, patient's global assessment, number of swollen joints, number of tender joints, general health, disease activity and reduction of analgesics."
A 2014 overview of systematic reviews and meta-analyses found that the evidence does not demonstrate acupuncture helps reduce the rates of death or disability after a stroke or improve other aspects of stroke recovery, such as poststroke motor dysfunction, but the evidence suggests it may help with poststroke neurological impairment and dysfunction such as dysphagia, which would need to be confirmed with future rigorous studies. A 2012 review found evidence of benefit for acupuncture combined with exercise in treating shoulder pain after stroke. A 2008 Cochrane review found that evidence was insufficient to draw any conclusion about the effect of acupuncture on dysphagia after acute stroke. A 2006 Cochrane review found no clear evidence for acupuncture on subacute or chronic stroke. A 2005 Cochrane review found no clear evidence of benefit for acupuncture on acute stroke.
A 2012 systematic review found that existing RCTs of acupuncture were insufficient to draw firm conclusions regarding acupuncture's effectiveness to treat tinnitus. A 2014 systematic review found that acupuncture might be beneficial as a treatment for tinnitus, but noted that many of the included studies had methodological flaws.
A 2009 review found no evidence that acupuncture was superior to sham acupuncture with respect to reducing hot flashes associated with menopause. A 2014 Cochrane review found insufficient evidence to support the effectiveness of acupuncture in the treatment of menopausal vasomotor symptoms. A 2014 meta-analysis found that acupuncture was effective at improving the frequency and severity of hot flashes.
For the following conditions, the Cochrane Collaboration or other reviews have concluded there is no strong evidence of benefit: alcohol dependence, ankle sprain, autism, chronic asthma, bell's palsy, traumatic brain injury, carpal tunnel syndrome, chronic obstructive pulmonary disease, cardiac arrhythmias, cocaine dependence, depression, drug detoxification, primary dysmenorrhoea, enuresis, endometriosis, epilepsy, erectile dysfunction, essential hypertension, glaucoma, gynaecological conditions (except possibly fertility and nausea/vomiting), hot flashes, hypoxic ischemic encephalopathy in neonates, insomnia, irritable bowel syndrome, induction of childbirth, labor pain, mumps, myopia, obstetrical conditions, Parkinson's disease, polycystic ovary syndrome, preoperative anxiety, restless legs syndrome, schizophrenia, smoking cessation, stress urinary incontinence, acute stroke, and stroke rehabilitation temporomandibular joint dysfunction, tennis elbow, uremic pruritus, uterine fibroids, and vascular dementia.
Moxibustion and cupping
A 2010 overview of systematic reviews found that moxibustion was effective for several conditions but the primary studies were of poor quality, so there persists ample uncertainty, which limits the conclusiveness of their findings. A 2012 systematic review suggested that cupping therapy seems to be effective for herpes zoster and various other conditions but due to the high risk of publication bias, larger studies are needed to draw definitive conclusions.
Acupuncture is generally safe when administered by an experienced, appropriately trained practitioner using clean technique and sterile single-use needles. When not delivered properly by a qualified practitioner it can cause potentially serious adverse effects. To reduce the risk of serious adverse events after acupuncture, acupuncturists should be trained sufficiently. People with serious spinal disease, such as cancer or infection, are not good candidates for acupuncture. Contraindications to acupuncture are conditions that should not be treated with acupuncture; these contraindications include coagulopathy disorders (e.g. haemophilia and advanced liver disease), warfarin use, severe psychiatric disorders (e.g. psychosis), and skin infections or skin trauma (e.g. burns). Further, electroacupuncture should be avoided at the spot of implanted electrical devices (e.g. pacemakers).
A 2011 systematic review of systematic reviews (internationally and without language restrictions) found that serious complications following acupuncture continue to be reported. Between 2000 and 2009, ninety-five cases of serious adverse events, including five deaths, were reported. Many such events are not inherent to acupuncture but are due to malpractice of acupuncturists. This might be why such complications have not been reported in surveys of adequately-trained acupuncturists. Most such reports are from Asia, which may reflect the large number of treatments performed there or it might be because there are a relatively higher number of poorly trained Asian acupuncturists. Many serious adverse events were reported from developed countries. This included Australia, Austria, Canada, Croatia, France, Germany, Holland, Ireland, New Zealand, Spain, Sweden, Switzerland, the UK, and the US. The number of adverse effects reported from the UK appears particularly unusual, which may indicate less under-reporting in the UK than other countries. 38 cases of infections were reported and 42 cases of organ trauma were reported. The most frequent adverse events included pneumothorax, and bacterial and viral infections.
A 2013 review found (without restrictions regarding publication date, study type or language) 295 cases of infections were reported, mycobacterium was the pathogen in at least 96%. Likely sources of infection include towels, hot packs or boiling tank water, and reusing reprocessed needles. Possible sources of infection include contaminated needles, reusing personal needles, a person's skin contained mycobacterium and reusing needles at various sites in the same person. Although acupuncture is generally considered a safe procedure, in the last decade reports of infection transmission have increased significantly, including those of mycobacterium. Although it is recommended that practitioners of acupuncture use disposable needles, the reuse of sterilized needles is still permitted. It is also recommended that thorough control practices for preventing infection be implemented and adapted.
A 2013 systematic review of the English-language case reports found that serious adverse events associated with acupuncture are rare, but acupuncture is not without risk. Between 2000 and 2011, there were 294 adverse events reported in the English-language literature from 25 countries and regions. The majority of the reported adverse events were relatively minor, and the incidences were low. 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. Another survey found there were 7.1% minor adverse events, of which 5 were serious, amid 97,733 acupuncture patients. 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. Infection has also resulted from skin contact with unsterilized equipment or dirty towels, in an unhygienic clinical setting. 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 edema, epithelioid granuloma, pseudolymphoma, argyria, pustules, pancytopenia, and scarring due to hot needle technique. Adverse reactions from acupuncture, which are unusual and uncommon in typical acupuncture practice, were syncope, galactorrhoea, bilateral nystagmus, pyoderma gangrenosum, hepatotoxicity, eruptive lichen planus, and spontaneous needle migration.
A 2013 systematic review found 31 cases of vascular injuries were caused by acupuncture, 3 resulting in death. Two died from pericardial tamponade and one was from an aortoduodenal fistula. The same review found vascular injuries were rare, bleeding and pseudoaneurysm were most prevalent. 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. The same review concluded cardiac tamponade was a serious, usually fatal, though theoretically avoidable complication following acupuncture, and urged training to minimize risk.
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. Though, miscategorization and under-reporting may alter the total figures. From January 2009 to December 2011, there were 468 safety incidents recognized within the NHS organizations. 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%). Acupuncture practitioners should know, and be prepared to be responsible for, any substantial harm from treatments. Some acupuncture proponents argue that because of its long history this suggests it is safe. However, there is an increasing literature on adverse events (e.g. spinal cord injury).
Chinese, South Korean, and Japanese-language
A 2010 systematic review of the Chinese-language literature found numerous acupuncture related adverse events including pneumothorax, fainting, subarachnoid hemorrhage, and infection as the most frequent, and cardiovascular injuries, subarachnoid hemorrhage, pneumothorax, and recurrent cerebral hemorrhage as the most serious, most of which were due to improper technique. Between 1980 and 2009, the Chinese literature reported 479 adverse events. Prospective surveys shown that mild, transient acupuncture-associated adverse events ranged from 6.71% to 15%. A study with 190,924 patients, the prevalence of serious adverse events was roughly 0.024%. Another study shown a rate of adverse events requiring specific treatment was 2.2%, 4,963 incidences were among 229,230 patients. Infections, mainly hepatitis, after acupuncture are reported often in the English-language research, though it is rarely reported in the Chinese-language research, making it plausible that in China acupuncture-associated infections have been underreported. Infections were mostly caused by poor sterilization of acupuncture needles. 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 hemorrhage, traumatic cataract, injury of the oculomotor nerve and retinal puncture, hemorrhage to the cheeks and the hypoglottis, peripheral motor nerve injuries and subsequent motor dysfunction, local allergic reactions to metal needles, stroke, and cerebral hemorrhage after acupuncture. A causal link between acupuncture and the adverse events cardiac arrest, pyknolepsy, shock, fever, cough, thirst, aphonia, leg numbness, and sexual dysfunction remains uncertain. The same review concluded that acupuncture can be considered inherently safe when practiced by properly trained practitioners, but the review also stated there is a need to find effective strategies to minimize the health risks. Between 1999 and 2010, the Republic of Korean-literature contained reports of 1104 adverse events. Between the 1980s and 2002, the Japanese-language literature contained reports of 150 adverse events.
Children and pregnancy
When used on children, acupuncture is safe when administered by well-trained, licensed practitioners using sterile needles; however, there was limited research to draw definite conclusions about the overall safety of pediatric acupuncture. The same review found 279 adverse events, of which 25 were serious. The adverse events were mostly mild in nature (e.g. bruising or bleeding). The prevalence of mild adverse events ranged from 10.1% to 13.5%, an estimated 168 incidences were among 1,422 patients. On rare occasions adverse events were serious (e.g. cardiac rupture or hemoptysis), many might have been a result of substandard practice. The incidence of serious adverse events was 5 per one million, which included children and adults. When used during pregnancy, the majority of adverse events caused by acupuncture were mild and transient, with few serious adverse events. The most frequent mild adverse event was needling or unspecified pain, followed by bleeding. Although two deaths (one stillbirth and one neonatal death) were reported, there was a lack of acupuncture associated maternal mortality. 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. Although acupuncture is not contraindicated in pregnant women, some specific acupuncture points that are particularly sensitive to needle insertion; these spots, as well as the abdominal region, should be avoided during pregnancy.
Moxibustion and cupping
Four adverse events associated with moxibustion were bruising, burns and cellulitis, spinal epidural abscess, and large superficial basal cell carcinoma. Ten adverse events were associated with cupping. The minor ones were keloid scarring, burns, and bullae; the serious ones were acquired hemophilia A, stroke following cupping on the back and neck, factitious panniculitis, reversible cardiac hypertrophy, and iron deficiency anemia.
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 comorbid depression presented. The same meta-analysis found there was no difference between sham and non-sham acupuncture. A 2011 systematic review found insufficient evidence for the cost-effectiveness of acupuncture in the treatment of chronic low back pain. A 2010 systematic review found that the cost-effectiveness of acupuncture could not be concluded.
Risk of forgoing conventional medical care
As with other alternative medicines, unethical or naïve practitioners may induce patients to exhaust financial resources by pursuing ineffective treatment. 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."
Acupuncture is a key component of traditional Chinese medicine (TCM). TCM is largely pseudoscience with no valid mechanism of action for the majority of its treatments. It has notions of a superstitious pre-scientific culture, similar to European humoral theory. According to TCM, the general theory of acupuncture is based on the premise that bodily functions are regulated by an energy called qi (氣) that flows through the body; disruptions of this flow are believed to be responsible for disease. Health is viewed by traditional acupuncturists as a balance of yin and yang, sometimes equated to the sympathetic and parasympathetic nervous systems. Acupuncture describes a family of procedures aiming to correct imbalances in the flow of qi by stimulation of anatomical locations on or under the skin (usually called acupuncture points or acupoints), by a variety of techniques. The most common mechanism of stimulation of acupuncture points employs penetration of the skin by thin metal needles, which are manipulated manually or the needle may be further stimulated by electrical stimulation (electroacupuncture).
Qi, meridians and acupuncture points
Actuation (推動, tuīdòng) is of all physical processes in the body, especially the circulation of all body fluids such as blood in their vessels. This includes actuation of the functions of the zang-fu organs and meridians. Warming (溫煦, pinyin: wēnxù) the body, especially the limbs. Defense (防御, pinyin: fángyù) against Exogenous Pathogenic Factors Containment (固攝, pinyin: gùshè) of body fluids, i.e. keeping blood, sweat, urine, semen etc. from leakage or excessive emission. Transformation (氣化, pinyin: qìhuà) of food, drink, and breath into qi, xue (blood), and jinye ("fluids"), and/or transformation of all of the latter into each other.
To fulfill its functions, qi has to steadily flow from the inside of the body (where the zang-fu organs are located) to the "superficial" body tissues of the skin, muscles, tendons, bones, and joints. It is assisted in its flow by "channels" referred to as meridians. TCM identifies 12 "regular" and 8 "extraordinary" meridians; the Chinese terms being 十二经脉 (pinyin: shí-èr jīngmài, lit. "the Twelve Vessels") and 奇经八脉 (pinyin: qí jīng bā mài). There's also a number of less customary channels branching off from the "regular" meridians. Contemporary research has not supported the existence of qi or meridians. The meridians are believed to connect to the bodily organs, of which those considered hollow organs (such as the stomach and intestines) were also considered yang while those considered solid (such as the liver and lungs) were considered yin. They were also symbolically linked to the rivers found in ancient China, such as the Yangtze, Wei and Yellow Rivers.
Acupuncture points are mainly (but not always) found at specified locations along the meridians. There also is a number of acupuncture points with specified locations outside of the meridians; these are called extraordinary points and are credited to treat certain diseases. A third category of acupuncture points called "A-shi" points have no fixed location but represent tender or reflexive points appearing in the course of pain syndromes. The actual number of points have varied considerably over time, initially they were considered to number 365, symbolically aligning with the number of days in the year (and in Han times, the number of bones thought to be in the body). The Nei ching mentioned only 160 and a further 135 could be deduced giving a total of 295. The modern total was once considered 670 but subsequently expanded due to more recent interest in auricular (ear) acupuncture and the treatment of further conditions. In addition, it is considered likely that some points used historically have since ceased being used.
TCM concept of disease
In TCM, disease is generally perceived as a disharmony or imbalance in the functions or interactions of such concepts as yin, yang, qi, xuĕ, zàng-fǔ, meridians, and of the interaction between the body and the environment. Therapy is based on which "pattern of disharmony" can be identified. In the case of the meridians, typical disease patterns are invasions with wind, cold, and damp Excesses. In order to determine which pattern is at hand, practitioners will examine things like the color 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. TCM and its concept of disease do not strongly differentiate between cause and effect. In theory, however, endogenous, exogenous and miscellaneous causes of disease are recognized.
The acupuncturist decides which points to treat by observing and questioning the patient to make a diagnosis according to the tradition used. In TCM, the four diagnostic methods are: inspection, ausculation and olfaction, inquiring, and palpation. Inspection focuses on the face and particularly on the tongue, including analysis of the tongue size, shape, tension, color and coating, and the absence or presence of teeth marks around the edge. Auscultation and olfaction is listening for particular sounds (such as wheezing) and attending to body odor. Inquiring is focusing on the "seven inquiries": chills and fever; perspiration; appetite, thirst and taste; defecation and urination; pain; sleep; and menses and leukorrhea. Palpation is focusing on feeling the body for tender A-shi points and feeling the left and right radial pulses. There is significant heterogeneity among acupuncturists considering appropriate treatment protocols.
Tongue and pulse
Examination of the tongue and the pulse are among the principal diagnostic methods in TCM. Certain sectors of the tongue's surface are believed to correspond to the zàng-fŭ. For example, teeth marks on one part of the tongue might indicate a problem with the heart, while teeth marks on another part of the tongue might indicate a problem with the liver.
Pulse palpation involves measuring the pulse at a superficial and at a deep level at three locations on the radial artery (Cun, Guan, Chi, located two fingerbreadths from the wrist crease, one fingerbreadth from the wrist crease, and right at the wrist crease, respectively, usually palpated with the index, middle and ring finger) of each arm, for 12 pulses, all of which are thought to correspond with certain zàng-fŭ. The pulse is examined for several characteristics including rhythm, strength, and volume, and is described with qualities like "floating, slippery, bolstering-like, feeble, thready and quick". Each of these qualities indicate certain disease patterns. Training on the use of TCM pulse diagnosis can take several years.
Scientific view on TCM theory
Some modern practitioners have embraced the use of acupuncture to treat pain, but have abandoned the use of qi, meridians, yin and yang as explanatory frameworks. Some practitioners no longer consider the idea of an energy flow to apply. They, along with acupuncture researchers, explain the analgesic effects of acupuncture as caused by the release of endorphins, and recognize the lack of evidence that it can affect the course of any disease. A 2014 review stated that despite ample controversy encircling the validity of acupuncture as a modality, developing literature on its physiological effects in animals and humans is giving new views into the basic mechanisms for acupuncture needling. The same review proposed a model combining both connective tissue plasticity and peripheral sensory modulation as a needle response for acupuncture's physiological effects. The evidence indicates that acupuncture-induced pain relief effect has physiological, anatomical and neurochemical origins. The mechanism of action for acupuncture is still unclear. Evidence suggests that acupuncture generates a sequence of events that include the release of endogenous opioid-like substances that modulate pain signals within the central nervous system. However, a 2014 Nature Reviews Cancer article found that 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." 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 United States. Despite the scientific evidence against such mystical explanations, academic discussions of acupuncture still make reference to pseudoscientific concepts like qi and meridians, in practice making many scholarly efforts to integrate evidence for efficacy and discussions of the mechanism impossible. Qi, yin, yang and meridians have no counterpart in modern studies of chemistry, biology, physics, or human physiology and to date scientists have been unable to find evidence that supports their existence.[n 2]
There has been little systematic investigation of which components of an acupuncture session may be important for any therapeutic effect, including needle placement and depth, type and intensity of stimulation, and number of needles used. 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 2] The electrical resistance of acupuncture points and meridians have also been studied, with conflicting results.
TCM 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. TCM practitioners disagree among themselves about how to diagnose patients and which treatments should go with which diagnoses. Even if they could agree, the TCM theories are so nebulous that no amount of scientific study will enable TCM to offer rational care.
The precise start date that acupuncture was generally held to have originated in ancient China and how it evolved from early times are uncertain. Chinese history attributes the introduction of acupuncture to the emperor Shennong. One explanation is that Han Chinese doctors observed that some soldiers wounded in battle by arrows were believed to have been cured of chronic afflictions that were otherwise untreated, and there are variations on this idea. Sharpened stones known as Bian shi have been found in China, suggesting the practice may date to the Neolithic or possibly even earlier in the Stone Age. Hieroglyphs and pictographs have been found dating from the Shang Dynasty (1600–1100 BCE) which suggests that acupuncture was practiced along with moxibustion. It has also been suggested that acupuncture has its origins in bloodletting or demonology.
Despite improvements in metallurgy over centuries, it was not until the 2nd century BCE during the Han Dynasty that stone and bone needles were replaced with metal. The earliest examples of metal needles were found in a tomb dated to c. 113 BCE, though their use might not necessarily have been acupuncture. The earliest example of the unseen meridians (经络, pinyin: jīng-luò) used for diagnosis and treatment are dated to the second century BCE but these records do not mention needling, while the earliest reference to therapeutic needling occurs in the historical Shiji text (史記, English: Records of the Grand Historian) but does not mention the meridians and may be a reference to lancing rather than acupuncture.
The earliest written record of acupuncture is found in the Huangdi Neijing (黄帝内经; translated as The Yellow Emperor's Inner Canon), dated approximately 200 BCE. It does not distinguish between acupuncture and moxibustion and gives the same indication for both treatments. The Mawangdui texts, which also date from the 2nd century BCE (though antedating both the Shiji and Huangdi Neijing), mention the use of pointed stones to open abscesses, and moxibustion, but not acupuncture. However, by the 2nd century BCE, acupuncture replaced moxibustion as the primary treatment of systemic conditions.
The practice of acupuncture expanded out of China into the areas now part of Japan, Korea, Vietnam and Taiwan, diverging from the narrower theory and practice of mainland TCM in the process. A large number of contemporary practitioners outside of China follow these non-TCM practices, particularly in Europe.
In Europe, examinations of the 5,000-year-old mummified body of Ötzi the Iceman have identified 15 groups of tattoos on his body, some of which are located on what are now seen as contemporary acupuncture points. This has been cited as evidence that practices similar to acupuncture may have been practiced elsewhere in Eurasia during the early Bronze Age.
Korea is believed to be the second country that acupuncture spread to outside of China. Within Korea there is a legend that acupuncture was developed by the legendary emperor Dangun though it is more likely to have been brought into Korea from a Chinese colonial prefecture.
Around 90 works on acupuncture were written in China between the Han Dynasty and the Song Dynasty, and the Emperor Renzong of Song, in 1023, ordered the production of a bronze statuette (Dongren) depicting the meridians and acupuncture points then in use. However, after the end of the Song Dynasty, acupuncture lost status, and started to be seen as a technical profession, in comparison to the more scholarly profession of herbalism. It became rarer in the following centuries, and was associated with less prestigious practices like alchemy, shamanism, midwifery and moxibustion.
Portuguese missionaries in the 16th century were among the first to bring reports of acupuncture to the West. Jacob de Bondt, a Dutch surgeon traveling in Asia, described the practice in both Japan and Java. However, in China itself the practice was increasingly associated with the lower-classes and illiterate practitioners.
In 1674, Hermann Buschoff, a Dutch priest in Batavia, published the first book on moxibustion (from Japanese mogusa). The first elaborate Western treatise on acupuncture was published in 1683 by Willem ten Rhijne, a Dutch physician who had worked at the Dutch trading post Dejima in Nagasaki for two years. In 1712 a detailed description of the treatment of "Colics" in Japan was published by the German physician Engelbert Kaempfer. But while moxibustion was widely discussed among central European physicians, ten Rhijne's and especially Kaempfer's explanations about piercing the abdomen had caused some misunderstandings that eventually led to the refutal of acupuncture by influential scholars such as Lorenz Heister and Georg Stahl.
In 1757 the Chinese physician Xu Daqun described the further decline of acupuncture, saying it was a lost art, with few experts to instruct; its decline was attributed in part to the popularity of prescriptions and medications, as well as its association with the lower classes. In 1822, an edict from the Emperor Daoguang banned the practice and teaching of acupuncture within the Imperial Academy of Medicine outright, as unfit for practice by gentlemen-scholars. At this point, acupuncture was still cited in Europe with both skepticism and praise, with little study and only a small amount of experimentation.
While the details of how acupuncture came to Europe are debated, the French doctor Louis Berlioz (the father of the composer Hector Berlioz) is usually credited with first experimenting the procedure in 1810, before publishing his findings in 1816. In the United States, the earliest reports of acupuncture date back to 1826, when Franklin Bache, a surgeon of the United States Navy, published a report in the North American Medical and Surgical Journal on his use of acupuncture to treat lower back pain. Since the beginning of the 19th century, acupuncture was practiced by Asian immigrants living in Chinatowns.
In the early years after the Chinese Civil War, Chinese Communist Party leaders ridiculed traditional Chinese medicine, including acupuncture, as superstitious, irrational and backward, claiming that it conflicted with the Party's dedication to science as the way of progress. Communist Party Chairman Mao Zedong later reversed this position, saying that "Chinese medicine and pharmacology are a great treasure house and efforts should be made to explore them and raise them to a higher level." Under Mao's leadership, in response to the lack of modern medical practitioners, acupuncture was revived and its theory rewritten to adhere to the political, economic and logistic necessities of providing for the medical needs of China's population. Despite Mao proclaiming the practice of Chinese medicine to be "scientific", the practice was based more on the materialist assumptions of Marxism in opposition to superstition rather than the Western practice of empirical investigation of nature. Later the 1950s TCM's theory was again rewritten at Mao's insistence as a political response to the lack of unity between scientific and traditional Chinese medicine, and to correct the supposed "bourgeois thought of Western doctors of medicine". Despite publicly promoting the practice, Mao himself did not believe in or use traditional Chinese medicine.
Acupuncture gained attention in the United States when the U.S. President Richard Nixon visited China in 1972. During one part of the visit, the delegation was shown a patient undergoing major surgery while fully awake, ostensibly receiving acupuncture rather than anesthesia. 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. 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 anesthetic into the wound.
The greatest exposure in the West came after New York Times reporter James Reston received acupuncture in Beijing for post-operative pain in 1971 and wrote complaisantly about it in his newspaper. In 1972 the first legal acupuncture center in the U.S. was established in Washington DC; during 1973-1974, this center saw up to one thousand patients. In 1973 the American Internal Revenue Service allowed acupuncture to be deducted as a medical expense.
Acupuncture has been the subject of active scientific research both in regard to its basis and therapeutic effectiveness since the late 20th century. Even though acupuncture is currently widely used in clinical practice, it remains a controversial topic. In 2006, a BBC documentary Alternative Medicine filmed a patient undergoing open heart surgery allegedly under acupuncture-induced anesthesia. It was later revealed that the patient had been given a cocktail of weak anesthetics that in combination could have a much more powerful effect. The program was also criticized for its fanciful interpretation of the results of a brain scanning experiment. In 2010, acupuncture was recognized by UNESCO as part of the world's intangible cultural heritage.
The National Institutes of Health (NIH) consensus statement and conference that produced it in 1997 were criticized by Wallace Sampson, founder of the Scientific Review of Alternative Medicine, writing for an affiliated publication of Quackwatch who stated the meeting was chaired by a strong proponent of acupuncture and failed to include speakers who had obtained negative results on studies of acupuncture. Sampson also stated he believed the report showed evidence of pseudoscientific reasoning.
The 2003 World Health Organization's (WHO) report was controversial; critics assailed it as being problematic since, in spite of the disclaimer, supporters used it to claim that the WHO endorsed acupuncture that were lacking sufficient evidence-basis. Medical scientists expressed concern that the evidence supporting acupuncture outlined in the report was weak, and Willem Betz of SKEPP (Studie Kring voor Kritische Evaluatie van Pseudowetenschap en het Paranormale, the Study Circle for the Critical Evaluation of Pseudoscience and the Paranormal) said that the report was evidence that the "WHO has been infiltrated by missionaries for alternative medicine". The WHO 2003 report was also criticized in the 2008 book Trick or Treatment for, in addition to being produced by a panel that included no critics of acupuncture, containing two major errors – including too many results from low-quality clinical trials, and including a large number of trials originating in China where, probably due to publication bias, no negative trials have ever been produced. Ernst and Singh, the authors of the book, described the report as "highly misleading" and a "shoddy piece of work that was never rigorously scrutinized" and stated that the results of high-quality clinical trials do not support the use of acupuncture to treat anything but pain and nausea. Ernst also described the statement in a 2006 peer reviewed article as "[p]erhaps the most obviously over-optimistic overview [of acupuncture]", noting that of the 35 conditions that the WHO stated acupuncture was effective for, 27 of the systematic reviews that the WHO report was based on found that acupuncture was not effective for treating the specified condition.
Placebos have been used in medical care to treat the elderly. For example, a response to "sham" acupuncture in osteoarthritis may be used in the elderly. Placebos have usually been regarded as deception and thus unethical. However, some physicians and ethicists have suggested circumstances for applicable uses for placebos such as it might present a theoretical advantage of an inexpensive treatment without adverse reactions or interactions with drugs or other medications.
Acupuncture is a commonly used alternative medicine modality. Many physicians in the UK appear to recommend alternative medicine, which raises ethical issues. Physicians have a duty of care requiring that each patient be treated with the best treatment for a given condition and situation. As the evidence for most types of alternative medicine is far from strong, the use of alternative medicine in regular healthcare can present an ethical question. A large proportion of physicians in the UK appear to employ some type of alternative medicine, but many have not received the relevant training, which raises issues associated with medical ethics and professional competence.
"What Berman is doing in this article in the NEJM is the same thing that CAM advocates in general and acupuncture apologists in particular have a maddening tendency to do. They either cherry pick studies that appear to indicate that their favored woo works. When, as Berman et al were, they are forced to admit that well-designed studies with lots of patients show that their woo is no better than a valid placebo control, they then shift to embracing the placebo, to owning it, so to speak, all without actually calling it placebo," Steve Novella explained in 2010.
Acupuncture is perceptibly used at academic medical centers despite little or no convincing scientific evidence for explicit effects for any condition that is discernible from placebo. The evidence that the majority of CAM modalities, such as acupuncture, are little more than 'theatrical placebos' is so compelling that some proponents of acupuncture have essentially conceded this position by advocating the 'harnessing of placebo effects' or developing 'meaningful placebos'.
Acupuncture has become popular in the U.S., China, and other parts of the world. It is viewed as a form of alternative medicine that aims to treat a range of conditions. Acupuncture is most commonly used for pain relief. There is limited evidence that acupuncture is rarely used alone but rather as an adjunct to other treatment modalities.
In Australia, a 2005 national survey revealed that nearly 1 in 10 adults have used acupuncture in the previous year.
Acupuncture is most popular in China.
According to several public health insurance organizations, women comprise over two-thirds of all acupuncture users in Germany. After the results of the German Acupuncture Trials were published in 2007, the number of regular users of acupuncture jumped by 20%, surpassing one million in 2011.
Utilization of acupuncture in Japan is estimated at around 6% annually, with around 25% of the population experiencing acupuncture at some point in life. The majority of patients who seek out acupuncture do so for musculoskeletal problems, including lower back pain, shoulder stiffness, and knee pain. Practice is governed by a national licensing program and protected by law. Use is generally not covered by public health insurance, and skews towards the elderly and people with a lower education level. Approximately half of users surveyed indicated a likelihood to seek such remedies in the future, while 37% did not.
In the United Kingdom, a total of 4 million acupuncture treatments were administered in 2009.
In the U.S., less than one percent of the total population reported having used acupuncture in the early 1990s. In 2002, the National Center for Complementary and Alternative Medicine revealed that 2.1 million adults have used acupuncture in the previous 12 months. By the early 2010s, over 14 million Americans reported having used acupuncture as part of their health care. Each year, around 10 million acupuncture treatments are administered in the US. Acupuncture is used at many academic medical centers, including Duke Center for Integrative Medicine, the Johns Hopkins School of Medicine, Mayo Clinic, Stanford University School of Medicine, David Geffen School of Medicine at UCLA, Harvard Medical School, and Yale School of Medicine. "Probably the most common form of pseudoscience to wend its way into what should be bastions of scientific medicine is acupuncture," David Gorski explained in 2010. "Acupuncture and reiki remain widely practised and even embraced at academic institutions, and even homeopathy continued to be practised despite clinical trials that demonstrate effects indistinguishable from placebo effects," David Gorski and Steven Novella wrote in the 2014 journal Trends in Molecular Medicine.
Legal and political status
In 2000, the Chinese Medicine Registration Board of Victoria, Australia (CMBV) established an independent government agency to oversee the practice of Chinese Herbal Medicine and Acupuncture in the state. Acupuncturists in New South Wales are bound by the guidelines in the Public Health (Skin Penetration) Regulation 2000.
Since acupuncture is deregulated in Finland many people without education in healthcare are able to give acupuncture treatment.
The German acupuncture trials were a series of nationwide acupuncture trials set up in 2001 and published in 2006 on behalf of several German statutory health insurance companies due to a dispute as to the usefulness of acupuncture. The trials were considered to be one of the largest clinical studies in the field of acupuncture. As a result of the trials, acupuncture was paid for in Germany by the social insurance scheme for low back pain and osteoarthritis of the knee. but coverage was not offered for headache or migraine. However, because of the outcome of these trials, in the case of the other conditions, insurance corporations in Germany were not convinced that acupuncture had adequate benefits over usual care or sham treatments. Highlighting the results of the placebo group, researchers refused to accept a placebo therapy as efficient.
Traditional/lay acupuncture is not a regulated health profession. Osteopaths have a scope of practice for Western Medical Acupuncture and Related Needling Techniques.
Acupuncturists are not a nationally regulated profession in the United Kingdom. Acupuncture practice is regulated by law in England and Wales for health and safety criteria under The Local Government (Miscellaneous Provisions).
In 1996, the Food and Drug Administration reclassified acupuncture needles as a Class II medical device, meaning that "general acupuncture use" is done by licensed practitioners. All states permit acupuncture to be administered; some by physicians only and some by acupuncturists under medical supervision, and some with no supervision.
- Aung, SKH; Chen WPD (2007). Clinical Introduction to Medical Acupuncture. Thieme Medical Publishers. ISBN 9781588902214.
- Barnes, LL (2005). Needles, Herbs, Gods, and Ghosts: China, Healing, and the West to 1848. Harvard University Press. ISBN 0674018729.
- Cheng, X (1987). Chinese Acupuncture and Moxibustion (1st ed.). Foreign Languages Press. ISBN 711900378X.
- Needham, J; Lu GD (2002). Celestial Lancets: A History and Rationale of Acupuncture and Moxa. Routledge. ISBN 0700714588.
- Singh, S; Ernst, E (2008). Trick or Treatment: Alternative Medicine on Trial. London: Bantam. ISBN 9780593061299.
- Stux, G; Pomeranz B (1988). Basics of Acupuncture. Berlin: Springer-Verlag. ISBN 354053072X.
- Wiseman, N; Ellis, A (1996). Fundamentals of Chinese medicine. Paradigm Publications. ISBN 9780912111445.
- Madsen, M. V.; Gøtzsche, P. C; Hróbjartsson, A. (2009). "Acupuncture treatment for pain: systematic review of randomised clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups". BMJ 338: a3115. doi:10.1136/bmj.a3115. PMC 2769056. PMID 19174438.
- Placebo or sham acupuncture is a form of acupuncture that uses non-penetrating needles or needling at non-acupuncture points.
- Singh & Ernst (2008) stated, "Scientists are still unable to find a shred of evidence to support the existence of meridians or Ch'i", "The traditional principles of acupuncture are deeply flawed, as there is no evidence at all to demonstrate the existence of Ch'i or meridians" and "Acupuncture points and meridians are not a reality, but merely the product of an ancient Chinese philosophy"
- Pyne, D.; Shenker, N. G. (2008). "Demystifying acupuncture". Rheumatology 47 (8): 1132–1136. doi:10.1093/rheumatology/ken161. ISSN 1462-0324. PMID 18460551.
- Adams, D; Cheng, F; Jou, H; Aung, S; Yasui, Y; Vohra, S (Dec 2011). "The safety of pediatric acupuncture: a systematic review.". Pediatrics 128 (6): e1575–87. doi:10.1542/peds.2011-1091. PMID 22106073.
- Ernst, E. (2006). "Acupuncture--a critical analysis". Journal of Internal Medicine 259 (2): 125–137. doi:10.1111/j.1365-2796.2005.01584.x. ISSN 0954-6820. PMID 16420542.
- Xu, Shifen, et al. (2013). "Adverse Events of Acupuncture: A Systematic Review of Case Reports". Evidence Based Complementary and Alternative Medicine 2013: 581203. doi:10.1155/2013/581203. PMC 3616356. PMID 23573135.
- Berman, Brian; Langevin, Helene; Witt, Claudia; Dubner, Ronald (July 29, 2010). "Acupuncture for Low Back Pain". New England Journal of Medicine 363 (5): 454–61. doi:10.1056/NEJMct0806114. PMID 20818865.
- Liu, Gang; Ma, Hui-juan; Hu, Pan-pan; Tian, Yang-hua; Hu, Shen; Fan, Jin; Wang, Kai (2013). "Effects of painful stimulation and acupuncture on attention networks in healthy subjects". Behavioral and Brain Functions 9 (1): 23. doi:10.1186/1744-9081-9-23. ISSN 1744-9081. PMC 3680197. PMID 23758880.
- Barrett, S (30 December 2007). "Be Wary of Acupuncture, Qigong, and "Chinese Medicine"". Quackwatch. Archived from the original on 29 September 2010. Retrieved 3 November 2010.
- Ernst, E.; Lee, Myeong Soo; Choi, Tae-Young (2011). "Acupuncture: Does it alleviate pain and are there serious risks? A review of reviews" (PDF). Pain 152 (4): 755–764. doi:10.1016/j.pain.2010.11.004. ISSN 0304-3959. PMID 21440191.
- "Acupuncture for Pain". NCCAM. Retrieved 9 May 2014.
- Hutchinson, Amanda J P; Ball, Simon; Andrews, Jeremy C H; Jones, Gareth G (2012). "The effectiveness of acupuncture in treating chronic non-specific low back pain: a systematic review of the literature". Journal of Orthopaedic Surgery and Research 7 (1): 36. doi:10.1186/1749-799X-7-36. ISSN 1749-799X. PMID 23111099.
- Colquhoun, D; Novella S (2013). "Acupuncture is a theatrical placebo: the end of a myth" (PDF). Anesthesia & Analgesia 116 (6): 1360–1363. doi:10.1213/ANE.0b013e31828f2d5e. PMID 23709076.
- Lee, MS; Ernst, E (2011). "Acupuncture for pain: An overview of Cochrane reviews". Chinese Journal of Integrative Medicine 17 (3): 187–9. doi:10.1007/s11655-011-0665-7. PMID 21359919.
- Madsen 2009, p. a3115
- Ernst, E.; Pittler, MH; Wider, B; Boddy, K (2007). "Acupuncture: its evidence-base is changing". The American Journal of Chinese Medicine 35 (1): 21–5. doi:10.1142/S0192415X07004588. PMID 17265547.
- Johnson, M. I. (2006). "The clinical effectiveness of acupuncture for pain relief--you can be certain of uncertainty". Acupuncture in medicine : journal of the British Medical Acupuncture Society 24 (2): 71–79. doi:10.1136/aim.24.2.71. PMID 16783282.
- Wang, Shu-Ming; Kain, Zeev N.; White, Paul F. (2008). "Acupuncture Analgesia: II. Clinical Considerations". Anesthesia & Analgesia 106 (2): 611–621. doi:10.1213/ane.0b013e318160644d. ISSN 0003-2999. PMID 18227323.
- Madsen, M. V.; Gøtzsche, P. C; Hróbjartsson, A. (2009). "Acupuncture treatment for pain: systematic review of randomised clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups". BMJ 338: a3115. doi:10.1136/bmj.a3115. PMC 2769056. PMID 19174438.
- "Acupuncture: An Introduction". NCCAM. September 2012. Retrieved 1 July 2014.
- Taylor P, Pezzullo L, Grant SJ, Bensoussan A. (2013). "Cost-effectiveness of Acupuncture for Chronic Nonspecific Low Back Pain.". Pain Practice: The Official Journal of World Institute of Pain. doi:10.1111/papr.12116. PMID 24138020.
- Standaert CJ, Friedly J, Erwin MW, Lee MJ, Rechtine G, Henrikson NB, Norvell DC (2011). "Comparative effectiveness of exercise, acupuncture, and spinal manipulation for low back pain". Spine 1 (36): 21 Suppl):S120–30. doi:10.1097/BRS.0b013e31822ef878. PMID 21952184.
- Singh & Ernst 2008, p. 72
- Singh & Ernst 2008, p. 107
- Singh & Ernst 2008, p. 387
- Bauer, M (2006). "The Final Days of Traditional Beliefs? – Part One". Chinese Medicine Times 1 (4): 31.
- Ahn, Andrew C.; Colbert, Agatha P.; Anderson, Belinda J.; Martinsen, ØRjan G.; Hammerschlag, Richard; Cina, Steve; Wayne, Peter M.; Langevin, Helene M. (2008). "Electrical properties of acupuncture points and meridians: A systematic review". Bioelectromagnetics 29 (4): 245–56. doi:10.1002/bem.20403. PMID 18240287.
- Mann, F (2000). Reinventing Acupuncture: A New Concept of Ancient Medicine. Elsevier. ISBN 0750648570.
- de las Peñas, César Fernández; Arendt-Nielsen, Lars; Gerwin, Robert D (2010). Tension-type and cervicogenic headache: pathophysiology, diagnosis, and management. Jones & Bartlett Learning. pp. 251–4. ISBN 9780763752835.
- Williams, WF (2013). Encyclopedia of Pseudoscience: From Alien Abductions to Zone Therapy. Encyclopedia of Pseudoscience (Routledge). pp. 3–4. ISBN 1135955220.
- Ulett, GA (2002). "Acupuncture". In Shermer, M. The Skeptic: Encyclopedia of Pseudoscience. ABC-CLIO. pp. 283–91. ISBN 1576076539.
- "Hard to swallow". Nature (journal) 448 (7150): 105–6. 2007. doi:10.1038/448106a. PMID 17625521.
- Zhang J, Shang H, Gao X, Ernst E (December 2010). "Acupuncture-related adverse events: a systematic review of the Chinese literature". Bull World Health Organ 88 (12): 915–921C. doi:10.2471/BLT.10.076737. PMC 2995190. PMID 21124716.
- White, A.; Ernst, E. (2004). "A brief history of acupuncture". Rheumatology (Oxford, England) 43 (5): 662–663. doi:10.1093/rheumatology/keg005. PMID 15103027.
- "Classics of Traditional Medicine". United States National Library of Medicine. 2012.
- Robson, T (2004). An Introduction to Complementary Medicine. Allen & Unwin. pp. 90. ISBN 1741140544.
- Schwartz, L (2000). "Evidence-Based Medicine And Traditional Chinese Medicine: Not Mutually Exclusive". Medical Acupuncture 12 (1): 38–41.
- "What you can expect". Mayo Clinic Staff. Mayo Foundation for Medical Education and Research. January 2012.
- Young, J (2007). Complementary Medicine For Dummies. John Wiley & Sons. pp. 126–8. ISBN 0470519681.
- Napadow, Vitaly; Kaptchuk, Ted J. (June 2004). "Patient Characteristics for Outpatient Acupuncture in Beijing, China". The Journal of Alternative and Complementary Medicine 10 (3): 565–572. doi:10.1089/1075553041323849. ISSN 1075-5535. PMID 15253864.
- Sherman KJ, Cherkin DC, Eisenberg DM, Erro J, Hrbek A, Deyo RA (2005). "The practice of acupuncture: who are the providers and what do they do?". Ann Fam Med 3 (2): 151–8. doi:10.1370/afm.248. PMC 1466855. PMID 15798042.
- Wheway, Jayne; Agbabiaka, Taofikat B.; Ernst, Edzard (2012). "Patient safety incidents from acupuncture treatments: a review of reports to the National Patient Safety Agency". International Journal of Risk & Safety In Medicine 24 (3): 163–169. doi:10.3233/JRS-2012-0569. PMID 22936058.
- Angela Hicks (2005). The Acupuncture Handbook: How Acupuncture Works and How It Can Help You (1 ed.). Piatkus Books. p. 41. ISBN 978-0749924720.
- Collinge, William J. (1996). The American Holistic Health Association Complete guide to alternative medicine. New York: Warner Books. ISBN 0-446-67258-0.
- Aung & Chen, 2007, p. 116.
- Ellis, A; Wiseman N; Boss K (1991). Fundamentals of Chinese Acupuncture. Paradigm Publications. pp. 2–3. ISBN 091211133X.
- Aung & Chen, 2007, p. 113-4.
- Loyeung, B. Y.; Cobbin, D. M. (2013). "Investigating the effects of three needling parameters (manipulation, retention time, and insertion site) on needling sensation and pain profiles: A study of eight deep needling interventions". Evidence-Based Complementary and Alternative Medicine 2013: 136763. doi:10.1155/2013/136763. PMC 3789497. PMID 24159337.
- Steven Aung; William Chen (10 January 2007). Clinical Introduction to Medical Acupuncture. Thieme. p. 116. ISBN 9781588902214. Retrieved 20 September 2012.
- Stephen Birch (2011). Japanese Pediatric Acupuncture. Thieme. ISBN 978-3131500618.
- Thomas Wernicke (2014). The Art of Non-Invasive Paediatric Acupuncture. Jessica Kingsley Publishers. ISBN 978-1848191600.
- Stephen Barrett (March 9, 2006). "Massage Therapy: Riddled with Quackery". Quackwatch.
- Lee, Eun Jin; Frazier, Susan K (2011). "The Efficacy of Acupressure for Symptom Management: A Systematic Review". Journal of Pain and Symptom Management 42 (4): 589–603. doi:10.1016/j.jpainsymman.2011.01.007. PMC 3154967. PMID 21531533.
- Needham & Lu, 2002, pp 170–173.
- "British Cupping Society".
- Farlex (2012). "Tui na". Farlex.
- "Sonopuncture". Educational Opportunities in Integrative Medicine. The Hunter Press. 2008. p. 34. ISBN 9780977655243.
- Bhagat (2004). Alternative Therapies. pp. 164–165. ISBN 9788180612206.
- "Sonopuncture". American Cancer Society's Guide to complementary and alternative cancer methods. American Cancer Society. 2000. p. 158. ISBN 9780944235249.
- "Cancer Dictionary – Acupuncture point injection". National Cancer Institute. Archived from the original on 27 March 2011. Retrieved 4 April 2011.
- Barrett, M.D., Stephen. "Auriculotherapy: A Skeptical Look". Acupuncture Watch.
- Braverman S (2004). "Medical Acupuncture Review: Safety, Efficacy, And Treatment Practices". Medical Acupuncture 15 (3).
- Isaacs, Nora (13 December 2007). "Hold the Chemicals, Bring on the Needles". New York Times. Retrieved 23 November 2009.
- Habacher, Gabriele; Pittler, Max H.; Ernst, Edzard (2006). "Effectiveness of Acupuncture in Veterinary Medicine: Systematic Review". Journal of Veterinary Internal Medicine 20 (3): 480–488. doi:10.1111/j.1939-1676.2006.tb02885.x. ISSN 0891-6640. PMID 16734078.
- White, A.R.; Filshie, J.; Cummings, T.M.; International Acupuncture Research Forum (2001). "Clinical trials of acupuncture: consensus recommendations for optimal treatment, sham controls and blinding". Complementary Therapies in Medicine 9 (4): 237–245. doi:10.1054/ctim.2001.0489. ISSN 0965-2299. PMID 12184353.
- Witt, Claudia M; Aickin, Mikel; Baca, Trini; Cherkin, Dan; Haan, Mary N; Hammerschlag, Richard; Hao, Jason; Kaplan, George A; Lao, Lixing; McKay, Terri; Pierce, Beverly; Riley, David; Ritenbaugh, Cheryl; Thorpe, Kevin; Tunis, Sean; Weissberg, Jed; Berman, Brian M (2012). "Effectiveness guidance document (EGD) for acupuncture research - a consensus document for conducting trials". BMC Complementary and Alternative Medicine 12 (1): 148. doi:10.1186/1472-6882-12-148. ISSN 1472-6882. PMID 22953730.
- Langevin, Helene M.; Wayne, Peter M.; MacPherson, Hugh; Schnyer, Rosa; Milley, Ryan M.; Napadow, Vitaly; Lao, Lixing; Park, Jongbae; Harris, Richard E.; Cohen, Misha; Sherman, Karen J.; Haramati, Aviad; Hammerschlag, Richard (2011). "Paradoxes in Acupuncture Research: Strategies for Moving Forward". Evidence-Based Complementary and Alternative Medicine 2011: 1–11. doi:10.1155/2011/180805. ISSN 1741-427X. PMC 2957136. PMID 20976074.
- Paterson, C.; Dieppe, P. (2005). "Characteristic and incidental (placebo) effects in complex interventions such as acupuncture". BMJ 330 (7501): 1202–1205. doi:10.1136/bmj.330.7501.1202. PMC 558023. PMID 15905259.
- Amezaga Urruela, Matxalen; Suarez-Almazor, Maria E. (2012). "Acupuncture in the Treatment of Rheumatic Diseases". Current Rheumatology Reports 14 (6): 589–597. doi:10.1007/s11926-012-0295-x. ISSN 1523-3774. PMC 3691014. PMID 23055010.
- Lee A, Copas JB, Henmi M, Gin T, Chung RC (2006). "Publication bias affected the estimate of postoperative nausea in an acupoint stimulation systematic review". J Clin Epidemiol. 59 (9): 980–3. doi:10.1016/j.jclinepi.2006.02.003. PMID 16895822.
- Tang, JL; Zhan, SY; Ernst, E (1999). "Review of randomised controlled trials of traditional Chinese medicine". BMJ (Clinical research ed.) 319 (7203): 160–1. doi:10.1136/bmj.319.7203.160. PMC 28166. PMID 10406751.
- Vickers, A; Goyal, N; Harland, R; Rees, R (1998). "Do Certain Countries Produce Only Positive Results? A Systematic Review of Controlled Trials". Controlled Clinical Trials 19 (2): 159–66. doi:10.1016/S0197-2456(97)00150-5. PMID 9551280.
- He, J; Du, L; Liu, G; Fu, J; He, X; Yu, J; Shang, L (2011). "Quality assessment of reporting of randomization, allocation concealment, and blinding in traditional Chinese medicine RCTs: A review of 3159 RCTs identified from 260 systematic reviews". Trials 12: 122. doi:10.1186/1745-6215-12-122. PMC 3114769. PMID 21569452.
- Gorski, David H. (2014). "Integrative oncology: really the best of both worlds?". Nature Reviews Cancer. doi:10.1038/nrc3822. ISSN 1474-175X. PMID 25230880.
- MacPherson, Hugh; Maschino, Alexandra C; Lewith, George; Foster, Nadine E; Witt, Claudia; Vickers, Andrew J; Acupuncture Trialists' Collaboration (2013). Eldabe, Sam, ed. "Characteristics of Acupuncture Treatment Associated with Outcome: An Individual Patient Meta-Analysis of 17,922 Patients with Chronic Pain in Randomised Controlled Trials". PLoS ONE 8 (10): e77438. doi:10.1371/journal.pone.0077438. PMC 3795671. PMID 24146995.
- Koog, Yun Hyung; Lee, Jin Su; Wi, Hyungsun (2014). "Clinically meaningful nocebo effect occurs in acupuncture treatment: a systematic review". Journal of Clinical Epidemiology 67 (8): 858–869. doi:10.1016/j.jclinepi.2014.02.021. ISSN 0895-4356. PMID 24780405.
- Vickers, AJ; Cronin, AM; Maschino, AC; Lewith, G; MacPherson, H; Foster, N; Sherman, N; Witt, K; Linde, C (2012). for the Acupuncture Trialists' Collaboration. "Acupuncture for chronic pain: individual patient data meta-analysis". JAMA Internal Medicine 12 (Suppl 1): 1444–53. doi:10.1001/archinternmed.2012.3654. PMC 3658605. PMID 22965186.
- Jha, Alok (10 September 2012). "Acupuncture useful, but overall of little benefit, study shows". The Guardian.
- Colquhoun, David (17 September 2012). "Re: Risks of acupuncture range from stray needles to pneumothorax, finds study". BMJ.
- Hopton, Ann; MacPherson, Hugh (2010). "Acupuncture for Chronic Pain: Is Acupuncture More than an Effective Placebo? A Systematic Review of Pooled Data from Meta-analyses". Pain Practice 10 (2): 94–102. doi:10.1111/j.1533-2500.2009.00337.x. ISSN 1530-7085. PMID 20070551.
- Enck, Paul; Klosterhalfen, Sibylle; Zipfel, Stephan (2010). "Acupuncture, psyche and the placebo response". Autonomic Neuroscience 157 (1-2): 68–73. doi:10.1016/j.autneu.2010.03.005. ISSN 1566-0702. PMID 20359961.
- Lee, Jun-Hwan; Choi, Tae-Young; Lee, Myeong Soo; Lee, Hyejung; Shin, Byung-Cheul; Lee, Hyangsook (February 2013). "Acupuncture for Acute Low Back Pain". The Clinical Journal of Pain 29 (2): 172–185. doi:10.1097/AJP.0b013e31824909f9. PMID 23269281.
- Lam, Megan; Curry, Philip (November 2013). "Effectiveness of Acupuncture for Nonspecific Chronic Low Back Pain". Spine 38 (24): 2124–2138. doi:10.1097/01.brs.0000435025.65564.b7. PMID 24026151.
- David Gorski (August 3, 2010). "Credulity about acupuncture infiltrates the New England Journal of Medicine". Science-based Medicine.
- Furlan, AD et al. (2005). Furlan, AD, ed. "Acupuncture and dry-needling for low back pain". Cochrane Database of Systematic Reviews (1): CD001351. doi:10.1002/14651858.CD001351.pub2. PMID 15674876.
- Lee, Courtney; Crawford, Cindy; Wallerstedt, Dawn; York, Alexandra; Duncan, Alaine et al. (2012). "The effectiveness of acupuncture research across components of the trauma spectrum response (tsr): A systematic review of reviews". Systematic Reviews 1: 46. doi:10.1186/2046-4053-1-46. PMC 3534620. PMID 23067573.
- Linde, K; Allais, G; Brinkhaus, B; Manheimer, E; Vickers, A; White, AR (2009). Linde, Klaus, ed. "Acupuncture for migraine prophylaxis". Cochrane Database of Systematic Reviews (1): CD001218. doi:10.1002/14651858.CD001218.pub2. PMC 3099267. PMID 19160193.
- Kmietowicz, Z. (2014). "Acupuncture does not improve chronic knee pain, study finds". BMJ 349 (sep30 27): g5899–g5899. doi:10.1136/bmj.g5899. ISSN 1756-1833. PMID 25273362.
- Corbett, M.S.; Rice, S.J.C.; Madurasinghe, V.; Slack, R.; Fayter, D.A.; Harden, M.; Sutton, A.J.; MacPherson, H.; Woolacott, N.F. (2013). "Acupuncture and other physical treatments for the relief of pain due to osteoarthritis of the knee: network meta-analysis". Osteoarthritis and Cartilage 21 (9): 1290–1298. doi:10.1016/j.joca.2013.05.007. ISSN 1063-4584. PMID 23973143.
- Manyanga, Taru; Froese, Maria; Zarychanski, Ryan; Abou-Setta, Ahmed; Friesen, Carol; Tennenhouse, Michael; Shay, Barbara L (2014). "Pain management with acupuncture in osteoarthritis: a systematic review and meta-analysis". BMC Complementary and Alternative Medicine 14 (1): 312. doi:10.1186/1472-6882-14-312. PMID 25151529.
- Manheimer, E; Cheng, K; Linde, K; Lao, L; Yoo, J; Wieland, S; Van Der Windt, DAWM; Berman, BM; Bouter, LM (2010). Manheimer, Eric, ed. "Acupuncture for peripheral joint osteoarthritis (Review)". Cochrane Database of Systematic Reviews (10): CD001977. doi:10.1002/14651858.CD001977.pub2. PMC 3169099. PMID 20091527.
- Zhang, W.; Moskowitz, R.W.; Nuki, G.; Abramson, S.; Altman, R.D.; Arden, N.; Bierma-Zeinstra, S.; Brandt, K.D. et al. (2008). "OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines". Osteoarthritis and Cartilage 16 (2): 137–162. doi:10.1016/j.joca.2007.12.013. PMID 18279766.
- White, A.; Foster, N. E.; Cummings, M.; Barlas, P. (25 January 2007). "Acupuncture treatment for chronic knee pain: a systematic review". Rheumatology 46 (3): 384–390. doi:10.1093/rheumatology/kel413. PMID 17215263.
- Lee, M. S.; Ernst, E. (2014). "Acupuncture for surgical conditions: an overview of systematic reviews". International Journal of Clinical Practice 68 (6): 783–789. doi:10.1111/ijcp.12372. ISSN 1368-5031. PMID 24447388.
- Cheong, Kah Bik; Zhang, Ji-ping; Huang, Yong; Zhang, Zhang-jin; Baradaran, Hamid Reza (13 December 2013). "The Effectiveness of Acupuncture in Prevention and Treatment of Postoperative Nausea and Vomiting - A Systematic Review and Meta-Analysis". PLoS ONE 8 (12): e82474. doi:10.1371/journal.pone.0082474. PMID 24349293.
- Lee A, Fan, LTY (2009). Lee, Anna, ed. "Stimulation of the wrist acupuncture point P6 for preventing postoperative nausea and vomiting". Cochrane Database Syst Rev (2): CD003281. doi:10.1002/14651858.CD003281.pub3. PMC 3113464. PMID 19370583.
- Cho, Young-Hun; Kim, Chang-Kyu; Heo, Kwang-Ho; Lee, Myeong Soo; Ha, In-Hyuk; Son, Dong Wuk; Choi, Byung Kwan; Song, Geun-Sung; Shin, Byung-Cheul (2014). "Acupuncture for Acute Postoperative Pain after Back Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials". Pain Practice: n/a–n/a. doi:10.1111/papr.12208. ISSN 1530-7085. PMID 24766648.
- Cheong, Kah Bik; Zhang, Ji-ping; Huang, Yong (August 2014). "The effectiveness of acupuncture in postoperative gastroparesis syndrome – A systematic review and meta-analysis". Complementary Therapies in Medicine 22 (4): 767–786. doi:10.1016/j.ctim.2014.05.002. PMID 25146082.
- Pfab, Florian; Schalock, Peter C; Napadow, Vitaly; Athanasiadis, Georgios I; Huss-Marp, Johannes; Ring, Johannes (2014). "Acupuncture for allergic disease therapy – the current state of evidence". Expert Review of Clinical Immunology 10 (7): 1–11. doi:10.1586/1744666X.2014.924855. ISSN 1744-666X. PMID 24881629.
- Witt, C.M.; Brinkhaus, B. (2010). "Efficacy, effectiveness and cost-effectiveness of acupuncture for allergic rhinitis — An overview about previous and ongoing studies". Autonomic Neuroscience 157 (1-2): 42–45. doi:10.1016/j.autneu.2010.06.006. ISSN 1566-0702. PMID 20609633.
- Lee, Myeong Soo; Pittler, Max H.; Shin, Byung-Cheul; Kim, Jong-In; Ernst, Edzard (2009). "Acupuncture for allergic rhinitis: a systematic review". Annals of Allergy, Asthma & Immunology 102 (4): 269–279. doi:10.1016/S1081-1206(10)60330-4. ISSN 1081-1206. PMID 19441597.
- Shah, Rachna; Greenberger, Paul A. (2012). "Chapter 29: Unproved and controversial methods and theories in allergy-immunology". Allergy and Asthma Proceedings 33 (3): 100–102. doi:10.2500/aap.2012.33.3562. ISSN 1088-5412. PMID 22794702.
- Li S, Yu B, Zhou D, et al. (2011). "Acupuncture for Attention Deficit Hyperactivity Disorder (ADHD) in children and adolescents". Cochrane Database Syst Rev (Systematic review) (4): CD007839. doi:10.1002/14651858.CD007839.pub2. PMID 21491402.
- Lee MS, Choi TY, Kim JI, Kim L, Ernst E (April 2011). "Acupuncture for treating attention deficit hyperactivity disorder: a systematic review and meta-analysis". Chin J Integr Med (Systematic review) 17 (4): 257–60. doi:10.1007/s11655-011-0701-7. PMID 21509667.
- Choi, T. Y.; Lee, M. S.; Kim, T. H.; Zaslawski, C; Ernst, E (2012). "Acupuncture for the treatment of cancer pain: A systematic review of randomised clinical trials". Supportive Care in Cancer 20 (6): 1147–58. doi:10.1007/s00520-012-1432-9. PMID 22447366.
- Paley, C. A.; Johnson, M. I.; Tashani, O. A.; Bagnall, A. M. (2011). "Acupuncture for cancer pain in adults". "Cochrane Database of Systematic Reviews". The Cochrane database of systematic reviews (1): CD007753. doi:10.1002/14651858.CD007753.pub2. PMID 21249694.
- Poder, Thomas G; Lemieux, Renald (2013). "How Effective Are Spiritual Care and Body Manipulation Therapies in Pediatric Oncology? A Systematic Review of the Literature". Global Journal of Health Science 6 (2): 112–27. doi:10.5539/gjhs.v6n2p112. ISSN 1916-9744. PMID 24576371.
- Garcia, M. K.; McQuade, J; Haddad, R; Patel, S; Lee, R; Yang, P; Palmer, J. L.; Cohen, L (2013). "Systematic review of acupuncture in cancer care: A synthesis of the evidence". Journal of Clinical Oncology 31 (7): 952–60. doi:10.1200/JCO.2012.43.5818. PMC 3577953. PMID 23341529.
- Posadzki, P; Moon, T. W.; Choi, T. Y.; Park, T. Y.; Lee, M. S.; Ernst, E (2013). "Acupuncture for cancer-related fatigue: A systematic review of randomized clinical trials". Supportive Care in Cancer 21 (7): 2067–73. doi:10.1007/s00520-013-1765-z. PMID 23435597.
- Choi, T. Y.; Lee, M. S.; Ernst, E (2012). "Acupuncture for cancer patients suffering from hiccups: A systematic review and meta-analysis". Complementary Therapies in Medicine 20 (6): 447–55. doi:10.1016/j.ctim.2012.07.007. PMID 23131378.
- Dennis, CL; Dowswell, T (Jul 31, 2013). "Interventions (other than pharmacological, psychosocial or psychological) for treating antenatal depression.". The Cochrane database of systematic reviews 7: CD006795. doi:10.1002/14651858.CD006795.pub3. PMID 23904069.
- Smith, Caroline A; Hay, Phillipa PJ; MacPherson, Hugh; Smith, Caroline A (2010). "Acupuncture for depression". Cochrane Database Syst Rev (1): CD004046. doi:10.1002/14651858.CD004046.pub3. PMID 20091556.
- Ernst, E.; Lee, M. S.; Choi, T.-Y. (2010). "Acupuncture for Depression?: A Systematic Review of Systematic Reviews". Evaluation & the Health Professions 34 (4): 403–412. doi:10.1177/0163278710386109. ISSN 0163-2787. PMID 21138913.
- Zhang, Zhang-Jin; Chen, Hai-Yong; Yip, Ka-chee; Ng, Roger; Wong, Vivian Taam (July 2010). "The effectiveness and safety of acupuncture therapy in depressive disorders: Systematic review and meta-analysis". Journal of Affective Disorders 124 (1-2): 9–21. doi:10.1016/j.jad.2009.07.005.
- Jerng, UiMin; Jo, Jun-Young; Lee, Seunghoon; Lee, Jin-Moo; Kwon, Ohmin (2014). "The effectiveness and safety of acupuncture for poor semen quality in infertile males: a systematic review and meta-analysis". Asian Journal of Andrology 0 (5): 0. doi:10.4103/1008-682X.129130. ISSN 1008-682X. PMID 25038176.
- Cheong, YC; Dix, S; Hung Yu Ng, E; Ledger, WL; Farquhar, C (Jul 26, 2013). "Acupuncture and assisted reproductive technology.". The Cochrane database of systematic reviews 7: CD006920. doi:10.1002/14651858.CD006920.pub3. PMID 23888428.
- Manheimer, E; Van Der Windt, D; Cheng, K; Stafford, K; Liu, J; Tierney, J; Lao, L; Berman, BM; Langenberg, P; Bouter, LM (2013). "The effects of acupuncture on rates of clinical pregnancy among women undergoing in vitro fertilization: A systematic review and meta-analysis". Human reproduction update 19 (6): 696–713. doi:10.1093/humupd/dmt026. PMC 3796945. PMID 23814102.
- Zheng, CH; Huang, GY; Zhang, MM; Wang, W (Mar 2012). "Effects of acupuncture on pregnancy rates in women undergoing in vitro fertilization: a systematic review and meta-analysis.". Fertility and Sterility 97 (3): 599–611. doi:10.1016/j.fertnstert.2011.12.007. PMID 22243605.
- Meldrum, David R.; Fisher, Andrew R.; Butts, Samantha F.; Su, H. Irene; Sammel, Mary D. (2013). "Acupuncture—help, harm, or placebo?". Fertility and Sterility 99 (7): 1821–1824. doi:10.1016/j.fertnstert.2012.12.046. ISSN 0015-0282. PMID 23357452.
- Deare JC, Zheng Z, Xue CC, Liu JP, Shang J, Scott SW, Littlejohn G (2013). "Acupuncture for treating fibromyalgia". Cochrane Database Syst Rev 31 (5): CD007070. doi:10.1002/14651858.CD007070.pub2. PMC 4105202. PMID 23728665.
- Langhorst, J.; Klose, P.; Musial, F.; Irnich, D.; Hauser, W. (2010). "Efficacy of acupuncture in fibromyalgia syndrome--a systematic review with a meta-analysis of controlled clinical trials". Rheumatology 49 (4): 778–788. doi:10.1093/rheumatology/kep439. ISSN 1462-0324. PMID 20100789.
- Casimiro, L; Barnsley, L; Brosseau, L; Milne, S et al. (2005). Casimiro, Lynn, ed. "Acupuncture and electroacupuncture for the treatment of rheumatoid arthritis". Cochrane Database of Systematic Reviews 2005 (4): CD003788. doi:10.1002/14651858.CD003788.pub2. PMID 16235342. Archived from the original on 13 April 2008. Retrieved 6 May 2008.
- Zhang JH, Wang D, Liu M (2014). "Overview of systematic reviews and meta-analyses of acupuncture for stroke". Neuroepidemiology (Systematic review) 42 (1): 50–8. doi:10.1159/000355435. PMID 24356063.
- Lee, JA et al. (September 2012). "Acupuncture for shoulder pain after stroke: A systematic review". Journal of Alternative and Complementary Medicine 18(9):818-23. 18 (9): 213–8. doi:10.1089/acm.2011.0457. PMC 3429280. PMID 22924414.
- Xie, Yue; Wang, Liping; He, Jinghua; Wu, Taixiang; Xie, Yue (2008). "Acupuncture for dysphagia in acute stroke". Cochrane Database Syst Rev (3): CD006076. doi:10.1002/14651858.CD006076.pub2. PMID 18646136.
- Wu, Hong Mei; Tang, Jin-Ling; Lin, Xiao Ping; Lau, Joseph TF; Leung, Ping Chung; Woo, Jean; Li, Youping; Wu, Hong Mei (2006). "Acupuncture for stroke rehabilitation" (3). pp. CD004131. doi:10.1002/14651858.CD004131.pub2. PMID 16856031.
- Zhang, Shihong; Liu, Ming; Asplund, Kjell; Li, Lin; Liu, Ming (2005). "Acupuncture for acute stroke" (2). pp. CD003317. doi:10.1002/14651858.CD003317.pub2. PMID 15846657.
- Kim, J. I.; Choi, J. Y.; Lee, D. H.; Choi, T. Y. et al. (2012). "Acupuncture for the treatment of tinnitus: A systematic review of randomized clinical trials". BMC Complementary and Alternative Medicine 12: 97. doi:10.1186/1472-6882-12-97. PMC 3493359. PMID 22805113.
- Liu, F; Han, X; Li, Y; Yu, S (25 October 2014). "Acupuncture in the treatment of tinnitus: a systematic review and meta-analysis.". European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery. PMID 25344063.
- Cho, S. H.; Whang, W. W. (2009). "Acupuncture for vasomotor menopausal symptoms". Menopause 16 (5): 1065–1073. doi:10.1097/gme.0b013e3181a48abd. PMID 19424092.
- Dodin, Sylvie; Blanchet, Claudine; Marc, Isabelle; Ernst, Edzard; Wu, Taixiang; Vaillancourt, Caroline; Paquette, Joalee; Maunsell, Elizabeth; Dodin, Sylvie (2013). "Acupuncture for menopausal hot flushes". Cochrane Database Syst Rev 7: CD007410. doi:10.1002/14651858.CD007410.pub2. PMID 23897589.
- Chiu, HY; Pan, CH; Shyu, YK; Han, BC; Tsai, PS (7 July 2014). "Effects of acupuncture on menopause-related symptoms and quality of life in women on natural menopause: a meta-analysis of randomized controlled trials.". Menopause (New York, N.Y.). PMID 25003620.
- Cho, Seung-Hun; Whang, Wei-Wan (2009). "Acupuncture for Alcohol Dependence: A Systematic Review". Alcoholism: Clinical and Experimental Research 33 (8): 1305–1313. doi:10.1111/j.1530-0277.2009.00959.x. ISSN 0145-6008. PMID 19413653.
- Kim, T.H.; Lee, M.S.; Kim, K.H.; Kang, J.W. et al. (23 June 2014). "Acupuncture for treating acute ankle sprains in adults". Bone, Joint and Muscle Trauma Group. Cochrane Database of Systematic Reviews (John Wiley & Sons) 6 (6): Art. no. CD009065. doi:10.1002/14651858.CD009065.pub2. PMID 24953665. (subscription required (. ))
- Park, J; Hahn, S; Park, JY; Park, HJ; Lee, H (2013). "Acupuncture for ankle sprain: Systematic review and meta-analysis". BMC Complementary and Alternative Medicine 13: 55. doi:10.1186/1472-6882-13-55. PMC 3606608. PMID 23496981.
- Cheuk, D. K.; Wong, V.; Chen, W. X. (2011). "Acupuncture for autism spectrum disorders (ASD)". In Cheuk, Daniel KL. "Cochrane Database of Systematic Reviews". Cochrane database of systematic reviews (Online) 9 (9): CD007849. doi:10.1002/14651858.CD007849.pub2. PMID 21901712.
- Lee, Myeong Soo; Choi, Tae-Young; Shin, Byung-Cheul; Ernst, Edzard (29 November 2011). "Acupuncture for Children with Autism Spectrum Disorders: A Systematic Review of Randomized Clinical Trials". Journal of Autism and Developmental Disorders 42 (8): 1671–1683. doi:10.1007/s10803-011-1409-4. PMID 22124580.
- Mccarney, RW; Brinkhaus, B; Lasserson, TJ; Linde, K (2003). McCarney, Robert W, ed. "Acupuncture for chronic asthma". Cochrane Database of Systematic Reviews 2003 (3): CD000008. doi:10.1002/14651858.CD000008.pub2. PMID 14973944. Archived from the original on 19 April 2008. Retrieved 2 May 2008.
- Chen, N; Zhou, M; He, L; Zhou, D; Li, N (2010). "Acupuncture for Bell's palsy". "Cochrane Database of Systematic Reviews". The Cochrane database of systematic reviews (8): CD002914. doi:10.1002/14651858.CD002914.pub5. PMID 20687071.
- Wong, Virginia; Cheuk, Daniel KL; Lee, Simon; Chu, Vanessa; Wong, Virginia (2013). "Acupuncture for acute management and rehabilitation of traumatic brain injury". Cochrane Database Syst Rev 3: CD007700. doi:10.1002/14651858.CD007700.pub3. PMID 23543554.
- Sim, H; Shin, B. C.; Lee, M. S.; Jung, A; Lee, H; Ernst, E (2011). "Acupuncture for carpal tunnel syndrome: A systematic review of randomized controlled trials". The Journal of Pain 12 (3): 307–14. doi:10.1016/j.jpain.2010.08.006. PMID 21093382.
- Choi, T.-Y.; Jun, J. H.; Choi, J.-Y.; Kim, J.-I.; Lee, M. S.; Ernst, E. (2014). "Acupuncture for the treatment of chronic obstructive pulmonary disease: a protocol of a systematic review". BMJ Open 4 (4): e004590–e004590. doi:10.1136/bmjopen-2013-004590. ISSN 2044-6055. PMID 24776710.
- Kim, Tae-Hun; Choi, Tae Yong; Lee, Myeong Soo; Ernst, Edzard (2011). "Acupuncture treatment for cardiac arrhythmias: A systematic review of randomized controlled trials". International Journal of Cardiology 149 (2): 263–265. doi:10.1016/j.ijcard.2011.02.049. ISSN 0167-5273. PMID 21421272.
- Gates, S; Smith, LA; Foxcroft, DR; Gates, Simon (2006). Gates, Simon, ed. "Auricular acupuncture for cocaine dependence". Cochrane Database of Systematic Reviews 2006 (1): CD005192. doi:10.1002/14651858.CD005192.pub2. PMID 16437523. Retrieved 2 May 2008.
- Jordan, J (2006). "Acupuncture treatment for opiate addiction: A systematic review". Journal of Substance Abuse Treatment 30 (4): 309–14. doi:10.1016/j.jsat.2006.02.005. PMID 16716845.
- Gates, Simon; Smith, Lesley A; Foxcroft, David (2006). Gates, Simon, ed. "Auricular acupuncture for cocaine dependence". Cochrane Database of Systematic Reviews (1): CD005192. doi:10.1002/14651858.CD005192.pub2. PMID 16437523.
- Smith, C. A.; Zhu, X; He, L; Song, J (2011). "Acupuncture for dysmenorrhoea". "Acupuncture for primary dysmenorrhoea". The Cochrane database of systematic reviews (1): CD007854. doi:10.1002/14651858.CD007854.pub2. PMID 21249697.
- Huang, T.; Shu, X.; Huang, Y. S.; Cheuk, D. K. (2011). "Complementary and miscellaneous interventions for nocturnal enuresis in children". In Huang, Tao. "Cochrane Database of Systematic Reviews". Cochrane database of systematic reviews (Online) 12 (12): CD005230. doi:10.1002/14651858.CD005230.pub2. PMID 22161390.
- Zhu, Xiaoshu; Hamilton, Kindreth D; McNicol, Ewan D; Zhu, Xiaoshu (2011). "Acupuncture for pain in endometriosis". Cochrane Database Syst Rev (9): CD007864. doi:10.1002/14651858.CD007864.pub2. PMID 21901713.
- Cheuk, Daniel KL; Wong, Virginia; Cheuk, Daniel KL (2014). "Acupuncture for epilepsy". Cochrane Database Syst Rev 5: CD005062. doi:10.1002/14651858.CD005062.pub4. PMID 24801225.
- Ernst, E.; Posadzki, P.; Lee, M. S. (2011). "Complementary and alternative medicine (CAM) for sexual dysfunction and erectile dysfunction in older men and women: An overview of systematic reviews". Maturitas 70 (1): 37–41. doi:10.1016/j.maturitas.2011.06.011. PMID 21782365.
- Wang, Jie; Xiong, Xingjiang; Liu, Wei (2013). "Acupuncture for essential hypertension". International Journal of Cardiology 169 (5): 317–326. doi:10.1016/j.ijcard.2013.09.001. ISSN 0167-5273. PMID 24060112.
- Law, Simon K; Li, Tianjing; Law, Simon K (2013). "Acupuncture for glaucoma". Cochrane Database Syst Rev 5: CD006030. doi:10.1002/14651858.CD006030.pub3. PMID 23728656.
- Kang, H. S.; Jeong, D.; Kim, D. I.; Lee, M. S. (2011). "The use of acupuncture for managing gynaecologic conditions: An overview of systematic reviews". Maturitas 68 (4): 346–354. doi:10.1016/j.maturitas.2011.02.001. PMID 21376483.
- Lee, Myeong Soo; Kim, Kun-Hyung; Shin, Byung-Cheul; Choi, Sun-Mi; Ernst, Edzard (2009). "Acupuncture for treating hot flushes in men with prostate cancer: a systematic review". Supportive Care in Cancer 17 (7): 763–770. doi:10.1007/s00520-009-0589-3. ISSN 0941-4355. PMID 19224253.
- Wong, Virginia; Cheuk, Daniel KL; Chu, Vanessa; Wong, Virginia (2013). "Acupuncture for hypoxic ischemic encephalopathy in neonates". doi:10.1002/14651858.CD007968.pub2.
- Cheuk, DK; Yeung, WF; Chung, KF; Wong, V; Cheuk, Daniel KL (2012). Cheuk, Daniel KL, ed. "Acupuncture for insomnia". Cochrane Database of Systematic Reviews 12 (9): CD005472. doi:10.1002/14651858.CD005472.pub3. PMID 22972087.
- Ernst, E.; Lee, M. S.; Choi, T. Y. (2011). "Acupuncture for insomnia? An overview of systematic reviews". European Journal of General Practice 17 (2): 116–123. doi:10.3109/13814788.2011.568475. PMID 21463162.
- Manheimer, E; Cheng, K; Wieland, L. S.; Min, L. S.; Shen, X; Berman, B. M.; Lao, L (2012). "Acupuncture for treatment of irritable bowel syndrome". "Cochrane Database of Systematic Reviews". The Cochrane database of systematic reviews 5: CD005111. doi:10.1002/14651858.CD005111.pub3. PMC 3718572. PMID 22592702.
- Manheimer, Eric; Wieland, L Susan; Cheng, Ke; Li, Shih Min; Shen, Xueyong; Berman, Brian M; Lao, Lixing (10 April 2012). "Acupuncture for Irritable Bowel Syndrome: Systematic Review and Meta-Analysis". The American Journal of Gastroenterology 107 (6): 835–847. doi:10.1038/ajg.2012.66. PMID 22488079.
- Smith, Caroline A; Crowther, Caroline A; Grant, Suzanne J; Smith, Caroline A (2013). "Acupuncture for induction of labour". Cochrane Database Syst Rev 8: CD002962. doi:10.1002/14651858.CD002962.pub3. PMID 23945980.
- Smith, C. A.; Collins, C. T.; Crowther, C. A.; Levett, K. M. (2011). "Acupuncture or acupressure for pain management in labour". "Cochrane Database of Systematic Reviews". The Cochrane database of systematic reviews (7): CD009232. doi:10.1002/14651858.CD009232. PMID 21735441.
- Cho, S-H; Lee, H; Ernst, E (July 2010). "Acupuncture for pain relief in labour: a systematic review and meta-analysis". BJOG: An International Journal of Obstetrics & Gynaecology 117 (8): 907–920. doi:10.1111/j.1471-0528.2010.02570.x. PMID 20438555.
- He, Jing; Zheng, Min; Zhang, Mingming; Jiang, Hua; Zhang, Mingming (2012). "Acupuncture for mumps in children". Cochrane Database Syst Rev 9: CD008400. doi:10.1002/14651858.CD008400.pub2. PMID 22972121.
- Wei, M. L.; Liu, J. P.; Li, N.; Liu, M. (2011). "Acupuncture for slowing the progression of myopia in children and adolescents". In Wei, Mao Ling. "Cochrane Database of Systematic Reviews". Cochrane database of systematic reviews (Online) 9 (9): CD007842. doi:10.1002/14651858.CD007842.pub2. PMID 21901710.
- Ernst, E; Lee, M. S.; Choi, T. Y. (2011). "Acupuncture in obstetrics and gynecology: An overview of systematic reviews". The American Journal of Chinese Medicine 39 (3): 423–31. doi:10.1142/S0192415X11008920. PMID 21598411.
- Kim, Hee Jin; Jeon, Beom S. (2014). "Is acupuncture efficacious therapy in Parkinson's disease?". Journal of the Neurological Sciences 341 (1-2): 1–7. doi:10.1016/j.jns.2014.04.016. ISSN 0022-510X. PMID 24798223.
- Lim, D.C.; Chen, W.; Cheng, L.N.; Xue, C.C. et al. (2011). "Acupuncture for polycystic ovarian syndrome". In Lim, Danforn CE. "Cochrane Database of Systematic Reviews". Cochrane database of systematic reviews (Online) (8): CD007689. doi:10.1002/14651858.CD007689.pub2. PMID 21833961.
- Bae, H; Bae, H; Min, BI; Cho, S (2014). "Efficacy of acupuncture in reducing preoperative anxiety: a meta-analysis.". Evidence-based complementary and alternative medicine: eCAM 2014: 850367. doi:10.1155/2014/850367. PMID 25254059.
- Cui, Ye; Wang, Yin; Liu, Zhishun; Cui, Ye (2008). "Acupuncture for restless legs syndrome". Cochrane Database Syst Rev (4): CD006457. doi:10.1002/14651858.CD006457.pub2. PMID 18843716.
- Shen, Xiaohong; Xia, Jun; Adams, Clive E; Shen, Xiaohong (2014). "Acupuncture for schizophrenia". Cochrane Database Syst Rev 10: CD005475. doi:10.1002/14651858.CD005475.pub2. PMID 25330045.
- White AR, Rampes H, Liu JP, Stead LF, Campbell J (2014). "Acupuncture and related interventions for smoking cessation". Cochrane Database Syst Rev (Systematic review) 1: CD000009. doi:10.1002/14651858.CD000009.pub4. PMID 24459016.
- Wang, Yang; Zhishun, Liu; Peng, Weina; Zhao, Jie; Liu, Baoyan; Wang, Yang (2013). "Acupuncture for stress urinary incontinence in adults". Cochrane Database Syst Rev 7: CD009408. doi:10.1002/14651858.CD009408.pub2. PMID 23818069.
- Zhang, SH; Liu, M; Asplund, K; Li, L; Liu, Ming (2005). Liu, Ming, ed. "Acupuncture for acute stroke". Cochrane Database of Systematic Reviews 2005 (2): CD003317. doi:10.1002/14651858.CD003317.pub2. PMID 15846657. Archived from the original on 29 April 2008. Retrieved 6 May 2008.
- Wu, HM; Tang, JL; Lin, XP; Lau, J et al. (2006). Wu, Hong Mei, ed. "Acupuncture for stroke rehabilitation". Cochrane Database of Systematic Reviews 2006 (3): CD004131. doi:10.1002/14651858.CD004131.pub2. PMID 16856031. Retrieved 6 May 2008.
- Laurence, B. (2012). "Acupuncture may be no more Effective than Sham Acupuncture in Treating Temporomandibular Joint Disorders". Journal of Evidence Based Dental Practice 12 (1): 2–4. doi:10.1016/j.jebdp.2011.12.001. PMID 22326146.
- La Touche, Roy; Goddard, Greg; De-la-Hoz, José Luis; Wang, Kelun; Paris-Alemany, Alba; Angulo-Díaz-Parreño, Santiago; Mesa, Juan; Hernández, Mar (2010). "Acupuncture in the Treatment of Pain in Temporomandibular Disorders: A Systematic Review and Meta-analysis of Randomized Controlled Trials". The Clinical Journal of Pain 26 (6): 541–550. doi:10.1097/AJP.0b013e3181e2697e. ISSN 0749-8047. PMID 20551730.
- Green, S; Buchbinder, R; Barnsley, L; Hall, S et al. (2002). Green, Sally, ed. "Acupuncture for lateral elbow pain". Cochrane Database of Systematic Reviews 2002 (1): CD003527. doi:10.1002/14651858.CD003527. PMID 11869671. Retrieved 6 May 2008.
- Kim, K. H.; Lee, M. S.; Choi, S. M. (2010). "Acupuncture for treating uremic pruritus in patients with end-stage renal disease: A systematic review". Journal of pain and symptom management 40 (1): 117–125. doi:10.1016/j.jpainsymman.2009.11.325. PMID 21796811.
- Zhang, Yan; Peng, Weina; Clarke, Jane; Zhishun, Liu; Zhang, Yan (2010). "Acupuncture for uterine fibroids". Cochrane Database Syst Rev (1): CD007221. doi:10.1002/14651858.CD007221.pub2. PMID 20091625.
- Peng, WN; Zhao, H; Liu, ZS; Wang, S; Weina, Peng (2008). Weina, Peng, ed. "Acupuncture for vascular dementia". Cochrane Database of Systematic Reviews 2007 (2): CD004987. doi:10.1002/14651858.CD004987.pub2. PMID 17443563. Retrieved 6 May 2008.
- Lee, MS; Kang, JW; Ernst, E (2010). "Does moxibustion work? An overview of systematic reviews". BMC research notes 3: 284. doi:10.1186/1756-0500-3-284. PMC 2987875. PMID 21054851.
- Cao, H.; Li, X.; Liu, J. (2012). Malaga, German, ed. "An Updated Review of the Efficacy of Cupping Therapy". PLoS ONE 7 (2): e31793. doi:10.1371/journal.pone.0031793. PMC 3289625. PMID 22389674.
- Gnatta JR, Kurebayashi LF, Paes da Silva MJ (2013). "Atypical mycobacterias associated to acupuncuture: an integrative review". Rev Lat Am Enfermagem 21 (1): 450–8. doi:10.1590/s0104-11692013000100022. PMID 23546331.
- Bergqvist D (2013). "Vascular injuries caused by acupuncture. A systematic review". International Angiology 32 (1): 1–8. PMID 23435388.
- Ernst E, Zhang J (2011). "Cardiac tamponade caused by acupuncture: a review of the literature". Int J Cardiol 16 (3): 287–289. doi:10.1016/j.ijcard.2010.10.016. PMID 21093944.
- Shin, H. K.; Jeong, S. J.; Lee, M. S.; Ernst, E (2013). "Adverse events attributed to traditional Korean medical practices: 1999-2010". Bulletin of the World Health Organization 91 (8): 569–75. doi:10.2471/BLT.12.111609. PMC 3738306. PMID 23940404.
- Yamashita H, Tsukayama H (2008). "Safety of acupuncture practice in Japan: patient reactions, therapist negligence and error reduction strategies". Evid Based Complement Alternat Med 5 (4): 391–8. doi:10.1093/ecam/nem086. PMC 2586322. PMID 18955234.
- Park J1, Sohn Y, White AR, Lee H (February 2014). "The safety of acupuncture during pregnancy: a systematic review". Acupunct Med (Systematic review) 32 (3): 257–66. doi:10.1136/acupmed-2013-010480. PMC 4112450. PMID 24554789.
- "Final Report, Report into Traditional Chinese Medicine" (PDF). Parliament of New South Wales. 9 November 2005. Retrieved 3 November 2010.
- "NCCAOM Code of Ethics" (PDF). National Certification Commission for Acupuncture and Oriental Medicine. Archived from the original on 27 November 2010. Retrieved 3 November 2010.
- Steven Novella (25 January 2012). "What Is Traditional Chinese Medicine?". Science-based Medicine.
- Takahashi, Toku (2011). "Mechanism of Acupuncture on Neuromodulation in the Gut-A Review". Neuromodulation: Technology at the Neural Interface 14 (1): 8–12. doi:10.1111/j.1525-1403.2010.00295.x. ISSN 1094-7159. PMID 21992155.
- Aung & Chen, 2007, pp 11–12.
- "氣的生理功能...(一)推動作用...(二)溫煦作用...(三)防御作用...(四)固攝作用...(五)氣化作用 [Physiological functions of qi ... 1.) Function of actuation ... 2.) Function of warming ... 3.) Function of defense ... 4.) Function of containment ... 5.) Function of transformation ...] as seen at 郭卜樂 (24 October 2009). 氣 [Qi] (in Chinese). Archived from the original on 8 January 2009. Retrieved 2 December 2010.
- "（三）十二经脉 ...（四）奇经八脉 ..." [(3.) The Twelve Vessels ... (4.) The Extraordinary Eight Vessels ...] as seen at 经络学 [meridian theory] (in Chinese). Retrieved 22 February 2011.
- Aung & Chen, 2007, pp 19–20.
- Singh & Ernst 2008, Chapter 2: The Truth About Acupuncture
- Needham & Lu, 2002, p. 23.
- Aung & Chen, 2007, p. 101.
- Needham & Lu, 2002, p. 15.
- Wiseman & Ellis 1996, p. 77
- Ergil, MC; Ergil, KV (2009). Pocket Atlas of Chinese Medicine. Stuttgart: Thieme. p. 19, 148. ISBN 9783131416117.
- Flaws, B; Finney D (2007). A handbook of TCM patterns & their treatments (6th ed.). Blue Poppy Press. pp. 1. ISBN 9780936185705.
- Flaws, B; Finney, D (1996). A handbook of TCM patterns & their treatments (6 (2007) ed.). Blue Poppy Press. pp. 169–173. ISBN 9780936185705.
- Maciocia, G (1995). Tongue Diagnosis in Chinese Medicine. Eastland Press. ISBN 093961619X.
- Maciocia, G (2005). The Foundations of Chinese Medicine. Churchill Livingstone. ISBN 0443074895.
- Ross, J (1984). Zang Fu, the organ systems of traditional Chinese medicine. Elsevier. pp. 26. ISBN 9780443034824.
- anon (1980). Essentials of Chinese Acupuncture (1st ed.). Beijing: Foreign Languages Press. pp. 39–46.
- Cheng, 1987, chapter 12.
- Eisenberg, David (1995). Encounters with Qi: exploring Chinese medicine. New York: Norton. p. 260. ISBN 0393312135.
- Langevin, Helene M. (2014). "Acupuncture, Connective Tissue, and Peripheral Sensory Modulation". Critical Reviews in Eukaryotic Gene Expression 24 (3): 249–253. doi:10.1615/CritRevEukaryotGeneExpr.2014008284. ISSN 1045-4403. PMID 25072149.
- Zhao, Zhi-Qi (2008). "Neural mechanism underlying acupuncture analgesia". Progress in Neurobiology 85 (4): 355–375. doi:10.1016/j.pneurobio.2008.05.004. ISSN 0301-0082. PMID 18582529.
- Wang, Shu-Ming; Kain, Zeev N.; White, Paul (2008). "Acupuncture Analgesia: I. The Scientific Basis". Anesthesia & Analgesia 106 (2): 602–610. doi:10.1213/01.ane.0000277493.42335.7b. ISSN 0003-2999. PMID 18227322.
- Tiran, D; Mack S (2000). Complementary therapies for pregnancy and childbirth. Elsevier Health Sciences. pp. 79. ISBN 0702023280.
- e.g. White, A; Ernst E (1999). Acupuncture: a scientific appraisal. Elsevier Health Sciences. pp. 1. ISBN 0750641630.
- Chiu, M (1993). Chinese acupuncture and moxibustion. Elsevier Health Sciences. p. 2. ISBN 0443042233.
- Ma, K.-W. (1992). "The roots and development of Chinese acupuncture: from prehistory to early 20th century". Acupuncture in Medicine 10: 92–9. doi:10.1136/aim.10.Suppl.92.
- Epler Jr, D. C. (1980). "Bloodletting in early Chinese medicine and its relation to the origin of acupuncture". Bulletin of the history of medicine 54 (3): 337–367. PMID 6998524.
- Barnes, L. L. (1998). "The psychologizing of Chinese healing practices in the United States". Culture, medicine and psychiatry 22 (4): 413–43. PMID 10063466.
- Ramey, D; Buell D (2004). "A true history of acupuncture". Focus on Complementary and Alternative Therapies 9 (4): 269–73. doi:10.1211/fact.2004.00244 (inactive 2014-03-25).
- Prioreschi, P (2004). A history of Medicine, Volume 2. Horatius Press. pp. 147–8. ISBN 1888456019.
- Fruehauf H (2010). "Chinese Medicine In Crisis: Science, Politics, And The Making Of "TCM"". Retrieved 15 June 2011.
- Hicks, Angela; Hicks, John; Mole, Peter (2004). Five Element Constitutional Acupuncture (1st ed.). London: Churchill Livingstone. pp. ix. ISBN 0443071705.
- Dorfer, L; Moser, M; Bahr, F; Spindler, K; Egarter-Vigl, E; Giullén, S; Dohr, G; Kenner, T (1999). "A medical report from the stone age?". The Lancet 354 (9183): 1023–5. doi:10.1016/S0140-6736(98)12242-0. PMID 10501382.
- Needham & Lu, 2002, p. 262.
- Barnes, 2005, p. 25.
- Unschuld, P (1998). Chinese Medicine. Paradigm Publications. p. 94. ISBN 0912111550.based on Michel, Wolfgang (1993). "Frühe westliche Beobachtungen zur Akupunktur und Moxibustion [Early Western Observations on Acupuncture and Moxibustion]". Sudhoffs Archiv. Zeitschrift für Wissenschaftsgeschichte 354: 194–222. doi:10.2307/20777697. ISSN 0039-4564.
- Barnes, 2005, pp. 58–9.
- Michel, Wolfgang, Michel-Zaitsu, Wolfgang. "Collections | Kyushu University Library". Hdl.handle.net. Retrieved 2014-06-16.
- Barnes, 2005, p. 75.
- Michel, Wolfgang (2004). "Far Eastern Medicine in Seventeenth and Early Eighteenth Century Germany". Studies in Languages and Cultures 20: 67–82. doi:10.2307/20777697. ISSN 0039-4564.
- Barnes, 2005, p. 188.
- Barnes, 2005, pp. 308–9.
- "Acupuncture (PDQ®)". National Cancer Institute. Retrieved 15 September 2013.
- Crozier RC (1968). Traditional medicine in modern China: science, nationalism, and the tensions of cultural change (1 ed.). Cambridge: Harvard University Press. ISBN 978-0674901056.[page needed]
- Taylor, K (2005). Chinese Medicine in Early Communist China, 1945–63: a Medicine of Revolution. RoutledgeCurzon. p. 109. ISBN 041534512X.
- Li, Zhi-Sui (2011). The Private Life of Chairman Mao. Random House. pp. 84. ISBN 0307791394.
- Beyerstein, BL; Sampson W (1996). "Traditional Medicine and Pseudoscience in China: A Report of the Second CSICOP Delegation (Part 1)". Skeptical Inquirer (Committee for Skeptical Inquiry) 20 (4).
- Davidson JP (1999). The complete idiot's guide to managing stress. Indianapolis, Ind: Alpha Books. pp. 255. ISBN 0028629558.
- Fan, AY (2012). "The first acupuncture center in the United States: an interview with Dr. Yao Wu Lee, Washington Acupuncture Center". Journal of Integrative Medicine (Committee for Journal of Chinese Integrative Medicine) 20 (5).
- Frum, David (2000). How We Got Here: The '70s. New York, New York: Basic Books. p. 133. ISBN 0465041957.
- Simon Singh (26 March 2006). "A groundbreaking experiment ... or a sensationalized TV stunt?". The Guardian.
- Simon Singh (14 February 2006). "Did we really witness the 'amazing power' of acupuncture?". Daily Telegraph.
- "Acupuncture and moxibustion of traditional Chinese medicine". UNESCO. Retrieved 25 May 2013.
- Sampson, W (23 March 2005). "Critique of the NIH Consensus Conference on Acupuncture". Quackwatch. Archived from the original on 6 June 2009. Retrieved 5 June 2009.
- McCarthy, Michael (2005). "Critics slam draft WHO report on homoeopathy". The Lancet 366 (9487): 705–6. doi:10.1016/S0140-6736(05)67159-0. PMID 16130229.
- Singh & Ernst, 2008, p. 277-8.
- Cherniack, E Paul (2010). "Would the elderly be better off if they were given more placebos?". Geriatrics & Gerontology International 10 (2): 131–7. doi:10.1111/j.1447-0594.2009.00580.x. ISSN 1444-1586. PMID 20100289.
- Posadzki, P.; Alotaibi, A.; Ernst, E. (2012). "Prevalence of use of complementary and alternative medicine (CAM) by physicians in the UK: a systematic review of surveys". Clinical Medicine 12 (6): 505–512. doi:10.7861/clinmedicine.12-6-505. ISSN 1470-2118. PMID 23342401.
- Xue, CC et al. (2008). "Acupuncture, chiropractic and osteopathy use in Australia: A national population survey". BMC Public Health 88: 108. doi:10.1186/1471-2458-8-105. PMC 2322980. PMID 18377663. Retrieved 25 May 2013.
- Skovgaard, L.; Nicolajsen, P. H.; Pedersen, E.; Kant, M.; Fredrikson, S.; Verhoef, M.; Meyrowitsch, D. W. (2012). "Use of Complementary and Alternative Medicine among People with Multiple Sclerosis in the Nordic Countries". Autoimmune Diseases 2012: 1–13. doi:10.1155/2012/841085. ISSN 2090-0422. PMID 23304461.
- "Frauen häufiger mit Akupunktur behandelt" (in German). Rheinische Post. Retrieved 25 May 2013.
- Ishizaki, Naoto; Yano, Tadashi; Kawakita, Kenji (2010). "Public Status and Prevalence of Acupuncture in Japan". Evidence-Based Complementary and Alternative Medicine 7 (4): 493–500. doi:10.1093/ecam/nen037. ISSN 1741-427X. PMID 18955345.
- Carruzzo, P; Graz, B; Rodondi, PY; Michaud, PA (6 September 2013). "Offer and use of complementary and alternative medicine in hospitals of the French-speaking part of Switzerland". Swiss Medical Weekly 143: w13756. doi:10.4414/smw.2013.13756. PMID 24018633.
- Hopton, AK; Curnoe, S; Kanaan, M; MacPherson, H (2012). "Acupuncture in practice: Mapping the providers, the patients and the settings in a national cross-sectional survey". BMJ Open (bmj.com) 2 (1): e000456. doi:10.1136/bmjopen-2011-000456. PMC 3278493. PMID 22240649. Retrieved 25 May 2013.
- David B. Samadi. "More Americans using acupuncture for common ailments". Fox News Channel. Retrieved 25 May 2013.
- Alderman, L (7 May 2010). "Acupuncture is popular, but you’ll need to pay". The New York Times. Retrieved 25 May 2013.
- "Acupuncture". The Skeptic's Dictionary.
- Swingle, Anne Bennett (2005). "Acupuncture, Actually". Dome (8) (The Johns Hopkins University). Retrieved 5 September 2014.
- Mudur, GS (20 August 2014). "US doctors spark homeopathy row". The Telegraph.
- "Welcome to the Chinese Medicine Registration Board of Victoria".
- "Public health (skin penetration) regulation" (PDF). Health board of New South Wales. 2000. Retrieved 25 May 2013.
- "CTCMA". College of Traditional Chinese Medicine Practitioners and Acupuncturists of British Columbia. Retrieved 25 May 2013.
- "Traditional Chinese Medicine Act, 2006". S.O. 2006, c. 27.
- Birgitta Ojala. "Acupuncture in Finland". Åland Medical Acupuncture Association.
- Bossy, Jean. Acupuncture in France. Acupunct Med.
- Hackenbroch, Veronika (25 October 2004). "Die eingebildete Heilung" [The Imaginary Healing]. Der Spiegel (in German).
- Birch, S. (2007). "Reflections on the German Acupuncture studies". Journal of Chinese Medicine (83): 12–17.
- TJ Hinrichs, Linda L. Barnes (2013). TJ Hinrichs, Linda L. Barnes, ed. Chinese Medicine and Healing: An Illustrated History (1 ed.). Belknap Press. p. 314. ISBN 0674047370.
- Stuart B. Porter (2013). Stuart B. Porter, ed. Tidy's Physiotherapy (15 ed.). Churchill Livingstone. p. 408. ISBN 0702043443.
- "Scopes of Practice". osteopathiccouncil.org.nz.
- "The Statutory Regulation of the Acupuncture Profession". Acupuncture Regulatory Working Group. September 2003.
- Acupuncture Needles No Longer Investigational, FDA Consumer at the Wayback Machine (archived December 19, 2007)
- Barrett, Stephen; Taub, Arthur (February 21, 2005). "Chapter 18: Acupuncture: Nonsense with Needles". The Health Robbers: A Close Look at Quackery in America. Acupuncture Watch (1st ed.) (Amherst, New York: Prometheus Books, published September 30, 1993). pp. 259–268.
- Deadman, P.; Baker, K; Al-Khafaji, M. (2007). A Manual of Acupuncture. Journal of Chinese Medicine Publications. ISBN 0951054651.
- Jin, G.; Jin, J.X.; Jin, L.L. (2006). Contemporary Medical Acupuncture – A Systems Approach. Springer. ISBN 7040192578.
- Ulett GA (2002). "Acupuncture". In Shermer M. The Skeptic Encyclopedia of Pseudoscience. ABC-CLIO. pp. 283–. ISBN 978-1-57607-653-8.
- William FW, ed. (2013). "Acupuncture". Encyclopedia of Pseudoscience: From Alien Abductions to Zone Therapy. Routledge. pp. 3–4. ISBN 978-1-135-95522-9.
|Wikiquote has quotations related to: Traditional Chinese medicine|
|Energy medicine - edit|