Needles being inserted into a person's skin
|Energy medicine - edit|
Acupuncture (from Latin, acus (needle) and punctura (to puncture)) is a form of alternative medicine and a key component of traditional Chinese medicine (TCM) involving thin needles inserted into the body at acupuncture points. It can be associated with the application of heat, pressure, or laser light to these same points. Acupuncture is commonly used for pain relief, though it is also used for a wide range of other conditions. Clinical practice varies depending on the country. There is a diverse range of acupuncture approaches, involving different philosophies. The method used in TCM is likely the most widely adopted in the US; it is rarely used alone but rather as an adjunct to other forms of treatment. TCM theory and practice are not based upon scientific knowledge, and acupuncture has been described as a type of pseudoscience.
The conclusions of many trials and numerous systematic reviews of acupuncture are largely inconsistent. An overview of Cochrane reviews found that acupuncture is not effective for a wide range of conditions, and they suggest it may be effective for only chemotherapy-induced nausea/vomiting, postoperative nausea/vomiting, and idiopathic headache. An overview of high-quality Cochrane reviews suggests that acupuncture may alleviate certain kinds of pain. A systematic review of systematic reviews found little evidence of acupuncture's effectiveness in treating pain. The evidence suggests that short-term treatment with acupuncture does not produce long-term benefits. Some research results suggest acupuncture can alleviate pain, though the majority of research suggests that acupuncture's effects are mainly due to placebo. A systematic 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 needle technique and single-use needles. When properly delivered, it has a low rate of mostly minor adverse effects. Accidents and infections are associated with infractions of sterile technique or neglect of the practitioner. A review stated that the reports of infection transmission increased significantly in the prior decade. 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, while a systematic review found insufficient evidence for the cost-effectiveness of acupuncture in the treatment of chronic low back pain.
Scientific investigation has not found any histological or physiological evidence for traditional Chinese concepts such as qi, meridians, and acupuncture points,[n 1] and many modern practitioners no longer support the existence of life force energy (qi) flowing through meridians, which was a major part of early belief systems. Acupuncture is believed to have originated around 100 BC in China, around the time The Yellow Emperor's Classic of Internal Medicine (Huangdi Neijing) was published, though some experts suggest it could have been practiced earlier. Over time, conflicting claims and belief systems emerged about the effect of lunar, celestial and earthly cycles, yin and yang energies, and a body's "rhythm" on the effectiveness of treatment. Acupuncture grew and diminished in popularity in China repeatedly, depending on the country's political leadership and the favor of rationalism or Western medicine. Acupuncture spread first to Korea in the 6th century AD, then to Japan through medical missionaries, and then to Europe, starting with France. In the 20th century, as it spread to the United States and Western countries, the spiritual elements of acupuncture that conflict with Western beliefs were abandoned in favor of tapping needles into nerves.
- 1 Clinical practice
- 2 Effectiveness
- 2.1 Sham acupuncture and research
- 2.2 Publication bias
- 2.3 Specific conditions
- 2.3.1 Pain
- 2.3.2 Low back
- 2.3.3 Headaches and migraines
- 2.3.4 Osteoarthritis
- 2.3.5 Extremity conditions
- 2.3.6 Nausea and vomiting and post-operative pain
- 2.3.7 Allergies
- 2.3.8 Cancer-related conditions
- 2.3.9 Dyspepsia
- 2.3.10 Fertility and childbirth
- 2.3.11 Rheumatological conditions
- 2.3.12 Stroke
- 2.3.13 Other conditions
- 2.4 Moxibustion and cupping
- 3 Safety
- 4 Conceptual basis
- 5 History
- 6 Adoption
- 7 Regulation
- 8 See also
- 9 Bibliography
- 10 Notes
- 11 References
- 12 Further reading
- 13 External links
Acupuncture is a form of alternative medicine. It is commonly used for pain relief, though it is also used to treat a wide range of conditions. The majority of people who seek out acupuncture do so for musculoskeletal problems, including low back pain, shoulder stiffness, and knee pain. Acupuncture is rarely used alone but rather as an adjunct to other treatment modalities. Published guidelines recommend the use of acupuncture for the management of non-specific low back pain, among other treatments. For example, the American Society of Anesthesiologists states it may be considered in the treatment for nonspecific, noninflammatory low back pain only in conjunction with conventional therapy.
Acupuncture is the stimulation of specific acupuncture points along the skin of the body using thin needles. It can be associated with the application of heat, pressure, or laser light to these points. Classically, acupuncture is individualized and based on philosophy and intuition, and not on scientific research. In modern acupuncture, a consultation is followed by taking the pulse on both arms and inspecting the tongue. This initial evaluation may last up to sixty minutes. Subsequent visits typically last about a half an hour. The number and frequency of acupuncture sessions vary, but most practitioners do not think one session is sufficient. A common treatment plan for a single complaint usually involves six to twelve treatments, to be carried 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. There is also a non-invasive therapy developed in early 20th century Japan using an elaborate set of "needles" for the treatment of children (shōnishin or shōnihari).
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). 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. There is a diverse range of acupuncture approaches, involving different philosophies. Although various different techniques of acupuncture practice have emerged, the method used in traditional Chinese medicine (TCM) seems to be the most widely adopted in the US. 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. Traditional acupuncture involves the belief that a "life force" (qi) circulates within the body in lines called meridians. The main methods practiced in the UK are TCM and Western medical acupuncture. The term Western medical acupuncture is used to indicate an adaptation of TCM-based acupuncture which focuses less on TCM. The Western medical acupuncture approach involves using acupuncture after a medical diagnosis. Limited research has compared the contrasting acupuncture systems used in various countries for determining different acupuncture points and thus there is no defined standard for acupuncture points.
In traditional acupuncture, 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, auscultation 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 involves listening for particular sounds (such as wheezing) and attending to body odor. Inquiring involves 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.
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). Acupuncture needles are typically made of stainless steel, making them flexible and preventing them from rusting or breaking. Needles are usually disposed of after each use to prevent contamination. Reusable needles when used should be sterilized between applications. Needles vary in length between 13 to 130 millimetres (0.51 to 5.12 in), with shorter needles used near the face and eyes, and longer needles in areas with thicker tissues; needle diameters vary from 0.16 mm (0.006 in) to 0.46 mm (0.018 in), 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 and 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 can be considered, all of which are thought to decrease the likelihood of successful treatment. If the de-qi sensation does not 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 bodywork, uses physical pressure applied to acupressure points by the hand or 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").
- Fire needle acupuncture also known as fire needling is a technique which involves quickly inserting a flame-heated needle into areas on the body.
- 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. It 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. 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.
- Bee venom acupuncture is a treatment approach of injecting purified, diluted bee venom into acupoints.
- A 2006 review of veterinary acupuncture found that there is insufficient evidence to "recommend or reject acupuncture for any condition in domestic animals". Rigorous evidence for complementary and alternative techniques is lacking in veterinary medicine but evidence has been growing.
Sham acupuncture and research
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. Sham acupuncture uses non-penetrating needles or needling at non-acupuncture points, e.g. inserting needles on meridians not related to the specific condition being studied, or in places not associated with meridians. The under-performance of acupuncture in such trials may indicate that therapeutic effects are due entirely to non-specific effects, or that the sham treatments are not inert, or that systematic protocols yield less than optimal treatment.
A 2014 Nature Reviews Cancer review 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. 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. 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 response to "sham" acupuncture in osteoarthritis may be used in the elderly, but 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. As the evidence for most types of alternative medicine such as acupuncture is far from strong, the use of alternative medicine in regular healthcare can present an ethical question.
Using the principles of evidence-based medicine to research acupuncture is controversial, and has produced different results. Some research suggests acupuncture can alleviate pain but the majority of research suggests that acupuncture's effects are mainly due to placebo. Evidence suggests that any benefits of acupuncture are short-lasting. There is insufficient evidence to support use of acupuncture compared to mainstream medical treatments. Acupuncture is not better than mainstream treatment in the long term.
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 eleven 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 trials testing TCM remedies). The study also found that trials published in non-Chinese journals tended to be of higher quality. Chinese authors use more Chinese studies, which have been demonstrated to be uniformly positive. A 2012 review of 88 systematic reviews of acupuncture published in Chinese journals found that less than half of these reviews reported testing for publication bias, and that the majority of these reviews were published in journals with impact factors of zero.
The conclusions of many trials and numerous systematic reviews of acupuncture are largely inconsistent with each other. A 2011 overview of high-quality Cochrane reviews suggests that acupuncture is effective for certain types of pain. A 2011 systematic review of systematic reviews 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 2009 overview of Cochrane reviews found acupuncture is not effective for a wide range of conditions, and suggested that it may be effective for only chemotherapy-induced nausea/vomiting, postoperative nausea/vomiting, and idiopathic headache.
A 2014 systematic review suggests that the nocebo effect of acupuncture is clinically relevant and that the rate of adverse events may be a gauge of the nocebo effect. According to the 2014 Miller's Anesthesia book, "when compared with placebo, acupuncture treatment has proven efficacy for relieving pain". 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 (back and neck pain, knee osteoarthritis, chronic headache, and shoulder 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. Edzard Ernst later stated that "I fear that, once we manage to eliminate this bias [that operators are not blind] … we might find that the effects of acupuncture exclusively are a placebo response." Andrew Vickers, lead author of the original 2012 paper and chair of the Acupuncture Trialists' Collaboration, rejects that analysis, stating that the differences between acupuncture and sham acupuncture are statistically significant.
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 2016 Cochrane review found moderate quality evidence that real acupuncture was more effective than sham acupuncture or inactive for short-term relief of neck pain measured either upon completion of treatment or at short-term follow-up.
A 2013 meta-analysis found that acupuncture was better than no treatment for reducing lower back pain, but not better than sham acupuncture, and concluded that the effect of acupuncture "is likely to be produced by the nonspecific effects of manipulation". 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. 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
Two separate 2016 Cochrane reviews found that acupuncture could be useful in the prophylaxis of tension-type headaches and episodic migraines. The 2016 Cochrane review evaluating acupuncture for episodic migraine prevention concluded that true acupuncture had a small effect beyond sham acupuncture and found moderate-quality evidence to suggest that acupuncture is at least similarly effective to prophylactic medications for this purpose. 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.
A 2014 review concluded that "current evidence supports the use of acupuncture as an alternative to traditional analgesics in osteoarthritis patients." 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 knee osteoarthritis 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 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".
A 2014 systematic review found moderate quality evidence that acupuncture was more effective than sham acupuncture in the treatment of lateral elbow pain. A 2014 systematic review found that although manual acupuncture was effective at relieving short-term pain when used to treat tennis elbow, its long-term effect in relieving pain was "unremarkable". 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 pain
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.
Acupuncture is an unproven treatment for allergic-immunologic conditions. A 2015 meta-analysis suggests that acupuncture might be a good option for people with allergic rhinitis (AR), and a number of randomized clinical trials (RCTs) support the use of acupuncture for AR and itch. 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 allergic rhinitis (SAR), the evidence failed to demonstrate specific effects for acupuncture. Using acupuncture to treat other allergic conditions such as contact eczema, drug rashes, or anaphylaxis is not recommended.
A 2015 Cochrane review found that there is insufficient evidence to determine whether acupuncture is an effective treatment for cancer pain in adults. A 2014 systematic review found that acupuncture may be effective as an adjunctive treatment to palliative care for cancer patients. A 2013 overview of reviews found evidence that acupuncture could be beneficial for people with cancer-related symptoms, but also identified few rigorous trials and high heterogeneity between trials. 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 2014 systematic review reached inconclusive results with regard to the effectiveness of acupuncture for treating cancer-related fatigue. 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 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 2015 systematic review and meta-analysis found some evidence that acupuncture was effective for FD, but also called for further well-designed, long-term studies to be conducted to evaluate its efficacy for this condition. A 2014 Cochrane review found that "it remains unknown whether manual acupuncture or electroacupuncture is more effective or safer than other treatments" for functional dyspepsia (FD).
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 2012 systematic review and meta-analysis found that acupuncture did not significantly improve the outcomes of in vitro fertilization. A 2011 overview of systematic reviews found that the evidence that acupuncture was effective was not compelling for most gynecologic conditions. The exceptions to this conclusion included the use of acupuncture during embryo transfer as an adjunct to in vitro fertilization.
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 2010 overview of systematic reviews found insufficient evidence to recommend acupuncture in the treatment of most rheumatic conditions, with the exceptions of osteoarthritis, low back pain, and lateral elbow pain.
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 2010 systematic review found that acupuncture was not effective as a treatment for functional recovery after a stroke. A 2012 overview of systematic reviews found inconclusive evidence supporting the effectiveness of acupuncture for stroke.
A 2015 systematic review found limited evidence that the method of Xingnao Kaiqiao needling had a better effect than Xingnao Kaiqiao alone or combined with other treatments in reducing disability rate for ischemic stroke, and that the long-term effect was better than traditional acupuncture or combination treatment. A 2014 meta-analysis found tentative evidence for acupuncture in cerebral infarction, a type of ischemic stroke, but the authors noted the trials reviewed were often of poor quality. 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.
For the following conditions, the Cochrane Collaboration or other reviews have concluded there is no strong evidence of benefit: alcohol dependence, angina pectoris, ankle sprain, Alzheimer's disease, attention deficit hyperactivity disorder, autism, asthma, bell's palsy, traumatic brain injury, carpal tunnel syndrome, chronic obstructive pulmonary disease, cardiac arrhythmias, cerebral hemorrhage, cocaine dependence, constipation, depression, diabetic peripheral neuropathy, drug detoxification, dry eye, 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, induction of childbirth, irritable bowel syndrome, labor pain, lumbar spinal stenosis, major depressive disorders in pregnant women, musculoskeletal disorders of the extremities, myopia, obesity, obstetrical conditions, Parkinson's disease, polycystic ovary syndrome, premenstrual syndrome, preoperative anxiety, psychological symptoms associated with opioid addiction, restless legs syndrome, schizophrenia, sensorineural hearing loss, smoking cessation, stress urinary incontinence, acute stroke, stroke rehabilitation, temporomandibular joint dysfunction, tennis elbow, labor induction, tinnitus, uremic itching, uterine fibroids, vascular dementia, and whiplash.
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-needle technique and sterile single-use needles. When improperly delivered it can cause adverse effects. Accidents and infections are associated with infractions of sterile technique or neglect on the part of the practitioner. 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 (conditions that should not be treated with acupuncture) include coagulopathy disorders (e.g. hemophilia 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 (such as 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 originate from Asia, which may reflect the large number of treatments performed there or a relatively higher number of poorly trained Asian acupuncturists. Many serious adverse events were reported from developed countries. These included Australia, Austria, Canada, Croatia, France, Germany, Ireland, the Netherlands, 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. Reports included 38 cases of infections and 42 cases of organ trauma. 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; 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 containing mycobacterium, and reusing needles at various sites in the same person. Although acupuncture is generally considered a safe procedure, a 2013 review stated that the reports of infection transmission increased significantly in the prior decade, including those of mycobacterium. 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.
The Xingnao Kaiqiao approach appears to be a safe form of treatment. Fainting was the most frequent adverse event. Fainting while being treated, hematoma, and pain while being treated are associated with individual physical differences and with needle manipulation.
A 2013 systematic review of the English-language case reports found that serious adverse events associated with acupuncture are rare, but that acupuncture is not without risk. Between 2000 and 2011 the English-language literature from 25 countries and regions reported 294 adverse events. 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 with 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, included syncope, galactorrhoea, bilateral nystagmus, pyoderma gangrenosum, hepatotoxicity, eruptive lichen planus, and spontaneous needle migration.
A 2013 systematic review found 31 cases of vascular injuries caused by acupuncture, three 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, 468 safety incidents were 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 the long history of acupuncture suggests it is safe. However, there is an increasing literature on adverse events (e.g. spinal-cord injury).
Acupuncture seems to be safe in people getting anticoagulants, assuming needles are used at the correct location and depth. Studies are required to verify these findings. The evidence suggests that acupuncture might be a safe option for people with allergic rhinitis.
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-language literature reported 479 adverse events. Prospective surveys show that mild, transient acupuncture-associated adverse events ranged from 6.71% to 15%. In a study with 190,924 patients, the prevalence of serious adverse events was roughly 0.024%. Another study showed a rate of adverse events requiring specific treatment of 2.2%, 4,963 incidences among 229,230 patients. Infections, mainly hepatitis, after acupuncture are reported often in English-language research, though are rarely reported in Chinese-language research, making it plausible that acupuncture-associated infections have been underreported in China. Infections were mostly caused by poor sterilization of acupuncture needles. Other adverse events included spinal epidural hematoma (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
Although acupuncture has been practiced for thousands of years in China, its use in pediatrics in the United States did not become common until the early 2000s. In 2007, the National Health Interview Survey (NHIS) conducted by the National Center For Health Statistics (NCHS) estimated that approximately 150,000 children had received acupuncture treatment for a variety of conditions.
Acupuncture can potentially improve a number of common pediatric issues, including gastrointestinal issues, reflux, colic, asthma, allergies, ADHD, and headaches, however, its safety has been debated. In 2008 a study determined that the use of acupuncture-needle treatment on children was "questionable" due to the possibility of adverse side-effects and the pain manifestation differences in children versus adults. The study also includes warnings against practicing acupuncture on infants, as well as on children who are over-fatigued, very weak, or have over-eaten.
When used on children, acupuncture is considered safe when administered by well-trained, licensed practitioners using sterile needles; however, a 2011 review found there was limited research to draw definite conclusions about the overall safety of pediatric acupuncture. The same review found 279 adverse events, 25 of them 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 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 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. A 2012 review found that acupuncture seems to be cost-effective for some pain conditions.
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." Stephen Barrett states that there is a "risk that an acupuncturist whose approach to diagnosis is not based on scientific concepts will fail to diagnose a dangerous condition".
Acupuncture is a substantial part of traditional Chinese medicine (TCM). Early acupuncture beliefs relied on concepts that are common in TCM, such as a life force energy called qi. Qi was believed to flow from the body's primary organs (zang-fu organs) to the "superficial" body tissues of the skin, muscles, tendons, bones, and joints, through channels called meridians. Acupuncture points where needles are inserted are mainly (but not always) found at locations along the meridians. Acupuncture points not found along a meridian are called extraordinary points and those with no designated site are called "A-shi" points.
In TCM, disease is generally perceived as a disharmony or imbalance in energies such as yin, yang, qi, xuĕ, zàng-fǔ, meridians, and of the interaction between the body and the environment. Therapy is based on which "pattern of disharmony" can be identified. For example, some diseases are believed to be caused by meridians being invaded with an excess of wind, cold, and damp. In order to determine which pattern is at hand, practitioners 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 does not strongly differentiate between the cause and effect of symptoms.
Purported scientific basis
Scientific research has not supported the existence of qi, meridians, or yin and yang.[n 1] A Nature editorial described TCM as "fraught with pseudoscience", with the majority of its treatments having no logical mechanism of action. Quackwatch states that "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."
Some modern practitioners support the use of acupuncture to treat pain, but have abandoned the use of qi, meridians, yin, yang and other energies based in mysticism, as explanatory frameworks. The use of qi as an explanatory framework has been decreasing in China, even as it becomes more prominent during discussions of acupuncture in the US. Academic discussions of acupuncture still make reference to pseudoscientific concepts such as qi and meridians despite the lack of scientific evidence. Many within the scientific community consider attempts to rationalize acupuncture in science to be quackery, pseudoscience and "theatrical placebo". Academics Massimo Pigliucci and Maarten Boudry describe it as a "borderlands science" lying between science and pseudoscience.
Many acupuncturists attribute pain relief to the release of endorphins when needles penetrate, but no longer support the idea that acupuncture can affect a disease. It is a generally held belief within the acupuncture community that acupuncture points and meridians structures are special conduits for electrical signals but no research has established any consistent anatomical structure or function for either acupuncture points or meridians.[n 1] Human tests to determine whether electrical continuity was significantly different near meridians than other places in the body have been inconclusive.
Some studies suggest acupuncture causes a series of events within the central nervous system, and that it is possible to inhibit acupuncture's analgesic effects with the opioid antagonist naloxone. Mechanical deformation of the skin by acupuncture needles appears to result in the release of adenosine. The anti-nociceptive effect of acupuncture may be mediated by the adenosine A1 receptor. A 2014 Nature Reviews Cancer review 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."
It has been proposed that acupuncture's effects in gastrointestinal disorders may relate to its effects on the parasympathetic and sympathetic nervous system, which have been said to be the "Western medicine" equivalent of "yin and yang". Another mechanism whereby acupuncture may be effective for gastrointestinal dysfunction involves the promotion of gastric peristalsis in subjects with low initial gastric motility, and suppressing peristalsis in subjects with active initial motility. Acupuncture has also been found to exert anti-inflammatory effects, which may be mediated by the activation of the vagus nerve and deactivation of inflammatory macrophages. Neuroimaging studies suggest that acupuncture stimulation results in deactivation of the limbic brain areas and the default mode network.
Acupuncture, along with moxibustion, is one of the oldest practices of Traditional Chinese Medicine. Most historians believe the practice began in China, though there are some conflicting narratives on when it originated. Academics David Ramey and Paul Buell said the exact date acupuncture was founded depends on the extent dating of ancient texts can be trusted and the interpretation of what constitutes acupuncture.
According to an article in Rheumatology, the first documentation of an "organized system of diagnosis and treatment" for acupuncture was in The Yellow Emperor's Classic of Internal Medicine (Huangdi Neijing) from about 100 BC. Gold and silver needles found in the tomb of Liu Sheng from around 100 BC are believed to be the earliest archeological evidence of acupuncture, though it is unclear if that was their purpose. According to Dr. Plinio Prioreschi, the earliest known historical record of acupuncture is the Shih-Chi ("Record of History"), written by a historian around 100 BC. It is believed that this text was documenting what was established practice at that time.
The 5,000-year-old mummified body of Ötzi the Iceman was found with 15 groups of tattoos, many of which were located at points on the body where acupuncture needles are used for abdominal or lower back problems. Evidence from the body suggests Otzi suffered from these conditions. This has been cited as evidence that practices similar to acupuncture may have been practiced elsewhere in Eurasia during the early Bronze Age; however, The Oxford Handbook of the History of Medicine calls this theory "speculative". It is considered unlikely that acupuncture was practiced before 2000 BC. The Ötzi the Iceman's tattoo marks suggest to some experts that an acupuncture-like treatment was previously used in Europe 5 millennia ago.
Acupuncture may have been practiced during the Neolithic era, near the end of the stone age, using sharpened stones called Bian shi.:70 Many Chinese texts from later eras refer to sharp stones called "plen", which means "stone probe", that may have been used for acupuncture purposes.:70 The ancient Chinese medical text, Huangdi Neijing, indicates that sharp stones were believed at-the-time to cure illnesses at or near the body's surface, perhaps because of the short depth a stone could penetrate.:71 However, it is more likely that stones were used for other medical purposes, such as puncturing a growth to drain its pus. The Mawangdui texts, which are believed to be from the 2nd century BC, mention the use of pointed stones to open abscesses, and moxibustion, but not for acupuncture. It is also speculated that these stones may have been used for bloodletting, due to the ancient Chinese belief that illnesses were caused by demons within the body that could be killed or released. It is likely bloodletting was an antecedent to acupuncture.
According to historians Lu Gwei-djen and Joseph Needham, there is substantial evidence that acupuncture may have begun around 600 BC. Some hieroglyphs and pictographs from that era suggests acupuncture and moxibustion were practiced. However, historians Gwei-djen and Needham said it was unlikely a needle could be made out of the materials available in China during this time period.:71-72 It is possible Bronze was used for early acupuncture needles. Tin, copper, gold and silver are also possibilities, though they are considered less likely, or to have been used in fewer cases.:69 If acupuncture was practiced during the Shang dynasty (1766 to 1122 BC), organic materials like thorns, sharpened bones, or bamboo may have been used.:70 Once methods for producing steel were discovered, it would replace all other materials, since it could be used to create a very fine, but sturdy needles.:74 Gwei-djen and Needham noted that all the ancient materials that could have been used for acupuncture and which often produce archeological evidence, such as sharpened bones, bamboo or stones, were also used for other purposes. An article in Rheumatology said that the absence of any mention of acupuncture in documents found in the tomb of Ma-Wang-Dui from 198 BC suggest that acupuncture was not practiced by that time.
Several different and sometimes conflicting belief systems emerged regarding acupuncture. This may have been the result of competing schools of thought. Some ancient texts referred to using acupuncture to cause bleeding, while others mixed the ideas of blood-letting and spiritual ch'i energy. Over time, the focus shifted from blood to the concept of puncturing specific points on the body, and eventually to balancing Yin and Yang energies as well. According to Dr. David Ramey, no single "method or theory" was ever predominantly adopted as the standard. At the time, scientific knowledge of medicine was not yet developed, especially because in China dissection of the deceased was forbidden, preventing the development of basic anatomical knowledge.
It is not certain when specific acupuncture points were introduced, but the autobiography of Pien Chhio from around 400–500 BC references inserting needles at designated areas. Bian Que believed there was a single acupuncture point at the top of one's skull that he called the point "of the hundred meetings.":83 Texts dated to be from 156–186 BC document early beliefs in channels of life force energy called meridians that would later be an element in early acupuncture beliefs.
Ramey and Buell said the "practice and theoretical underpinnings" of modern acupuncture were introduced in the The Yellow Emperor's Classic (Huangdi Neijing) around 100 BC. It introduced the concept of using acupuncture to manipulate the flow of life energy (qi) in a network of meridian (channels) in the body. The network concept was made up of acu-tracts, such as a line down the arms, where it said acupoints were located. Some of the sites acupuncturists use needles at today still have the same names as those given to them by the Yellow Emporer's Classic.:93 Numerous additional documents were published over the centuries introducing new acupoints.:101 By the 4th century AD, most of the acupuncture sites in use today had been named and identified.:101
Early development in China
Establishment and growth
In the first half of the 1st century AD, acupuncturists began promoting the belief that acupuncture's effectiveness was influenced by the time of day or night, the lunar cycle, and the season.:140-141 The Science of the Yin-Yang Cycles (Yün Chhi Hsüeh) was a set of beliefs that curing diseases relied on the alignment of both heavenly (thien) and earthly (ti) forces that were attuned to cycles like that of the sun and moon.:140-141 There were several different belief systems that relied on a number of celestial and earthly bodies or elements that rotated and only became aligned at certain times.:140-141 According to Needham and Gwei-djen, these "arbitrary predictions" were depicted by acupuncturists in complex charts and through a set of special terminology.
Acupuncture needles during this period were much thicker than most modern ones and often resulted in infection. Infection is caused by a lack of sterilization, but at that time it was believed to be caused by use of the wrong needle, or needling in the wrong place, or at the wrong time.:102-103 Later, many needles were heated in boiling water, or in a flame. Sometimes needles were used while they were still hot, creating a cauterizing effect at the injection site.:104 Nine needles were recommended in the Chen Chiu Ta Chheng from 1601, which may have been because of an ancient Chinese belief that nine was a magic number.:102-103
Other belief systems were based on the idea that the human body operated on a rhythm and acupuncture had to be applied at the right point in the rhythm to be effective.:140-141 In some cases a lack of balance between Yin and Yang were believed to be the cause of disease.:140-141
In the 1st century AD, many of the first books about acupuncture were published and recognized acupuncturist experts began to emerge. The Zhen Jiu Jia Yi Jing, which was published in the mid-3rd century, became the oldest acupuncture book that is still in existence in the modern era. Other books like the Yu Kuei Chen Ching, written by the Director of Medical Services for China, were also influential during this period, but were not preserved. In the mid 7th century, Sun Simiao published acupuncture-related diagrams and charts that established standardized methods for finding acupuncture sites on people of different sizes and categorized acupuncture sites in a set of modules.
Acupuncture became more established in China as improvements in paper led to the publication of more acupuncture books. The Imperial Medical Service and the Imperial Medical College, which both supported acupuncture, became more established and created medical colleges in every province.:129 The public was also exposed to stories about royal figures being cured of their diseases by prominent acupuncturists.:129–135 By time The Great Compendium of Acupuncture and Moxibustion was published during the Ming dynasty (1368–1644 AD), most of the acupuncture practices used in the modern era had been established.
By the end of the Song dynasty (1279 AD), acupuncture had lost much of its status in China. It became rarer in the following centuries, and was associated with less prestigious professions like alchemy, shamanism, midwifery and moxibustion. Additionally, by the 18th century, scientific rationality was becoming more popular than traditional superstitious beliefs. By 1757 a book documenting the history of Chinese medicine called acupuncture a "lost art".:160 Its decline was attributed in part to the popularity of prescriptions and medications, as well as its association with the lower classes.
In 1822, the Chinese Emperor signed a decree excluding the practice of acupuncture from the Imperial Medical Institute. He said it was unfit for practice by gentlemen-scholars. In China acupuncture was increasingly associated with lower-class, illiterate practitioners. It was restored for a time, but banned again in 1929 in favor of science-based Western medicine. Although acupuncture declined in China during this time period, it was also growing in popularity in other countries.
Korea is believed to be the first country in Asia that acupuncture spread to outside of China. Within Korea there is a legend that acupuncture was developed by emperor Dangun, though it is more likely to have been brought into Korea from a Chinese colonial prefecture in 514 AD.:262-263 Acupuncture use was commonplace in Korea by the 6th century. It spread to Vietnam in the 8th and 9th centuries. As Vietnam began trading with Japan and China around the 9th century, it was influenced by their acupuncture practices as well. China and Korea sent "medical missionaries" that spread traditional Chinese medicine to Japan, starting around 219 AD. In 553, several Korean and Chinese citizens were appointed to re-organize medical education in Japan and they incorporated acupuncture as part of that system.:264 Japan later sent students back to China and established acupuncture as one of five divisions of the Chinese State Medical Administration System.:264-265
Acupuncture began to spread to Europe in the second half of the 17th century. Around this time the surgeon-general of the Dutch East India Company met Japanese and Chinese acupuncture practitioners and later encouraged Europeans to further investigate it.:264-265 He published the first in-depth description of acupuncture for the European audience and created the term "acupuncture" in his 1683 work De Acupunctura. France was an early adopter among the West due to the influence of Jesuit missionaries, who brought the practice to French clinics in the 16th century. The French doctor Louis Berlioz (the father of the composer Hector Berlioz) is usually credited with being the first to experiment with the procedure in Europe in 1810, before publishing his findings in 1816.
By the 19th century, acupuncture had become commonplace in many areas of the world.:295 Americans and Britains began showing interest in acupuncture in the early 20th century. Western practitioners abandoned acupuncture's traditional beliefs in spiritual energy, pulse diagnosis, and the cycles of the moon, sun or the body's rhythm. Diagrams of the flow of spiritual energy, for example, conflicted with the West's own anatomical diagrams. It adopted a new set of ideas for acupuncture based on tapping needles into nerves. In Europe it was speculated that acupuncture may allow or prevent the flow of electricity in the body, as electrical pulses were found to make a frog's leg twitch after death.
The West eventually created a belief system based on Travell trigger points that were believed to inhibit pain. They were in the same locations as China's spiritually identified acupuncture points, but under a different nomenclature. The first elaborate Western treatise on acupuncture was published in 1683 by Willem ten Rhijne.
In China, the popularity of acupuncture rebounded in 1949 when Mao Zedong took power and sought to unite China behind traditional cultural values. It was also during this time that many Eastern medical practices were consolidated under the name Traditional Chinese Medicine (TCM).
New practices were adopted in the 20th century, such as using a cluster of needles,:164 electrified needles, or leaving needles inserted for up to a week.:164 A lot of emphasis developed on using acupuncture on the ear.:164 Acupuncture research organizations were founded in the 1950s and acupuncture services became available in modern hospitals. China, where acupuncture was believed to have originated, was increasingly influenced by Western medicine. Meanwhile, acupuncture grew in popularity in the US. The US Congress created the Office of Alternative Medicine in 1992 and the National Institutes of Health (NIH) declared support for acupuncture for some conditions in November 1997. In 1999, the National Center for Complementary and Alternative Medicine was created within the NIH. Acupuncture became the most popular alternative medicine in the US.
Politicians from the Chinese Communist Party said acupuncture was superstitious and conflicted with the party's commitment to science. Communist Party Chairman Mao Zedong later reversed this position, arguing that the practice was based on scientific principles.
In 1971, a New York Times reporter published an article on his acupuncture experiences in China, which led to more investigation of and support for acupuncture. The US 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. After the National Institute of Health expressed support for acupuncture for a limited number of conditions, adoption in the US grew further. In 1972 the first legal acupuncture center in the US was established in Washington DC and in 1973 the American Internal Revenue Service allowed acupuncture to be deducted as a medical expense.
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 anesthetics.
Acupuncture is popular in China, the US, Australia, and Europe including all five Nordic countries, though less so in Finland. It is most heavily practiced in China and is one of the most common alternative medicine practices in Europe.:45 In Switzerland, acupuncture has become the most frequently used alternative medicine since 2004. In the United Kingdom, a total of 4 million acupuncture treatments were administered in 2009. Acupuncture is used in most pain clinics and hospices in the UK. An estimated 1 in 10 adults in Australia used acupuncture in 2004. In Japan, it is estimated that 25 percent of the population will try acupuncture at some point, though in most cases it is not covered by public health insurance. Users of acupuncture in Japan are more likely to be elderly and to have a limited education. Approximately half of users surveyed indicated a likelihood to seek such remedies in the future, while 37% did not. Less than one percent of the US population reported having used acupuncture in the early 1990s. By the early 2010s, more than 14 million Americans reported having used acupuncture as part of their health care.
In the US, acupuncture is increasingly (as of 2014[update]) used at academic medical centers, and is usually offered through CAM centers or anesthesia and pain management services. Examples include those at Harvard University, Stanford University, Johns Hopkins University, and UCLA. This usage has been criticized owing to there being little scientific evidence for explicit effects, or the mechanisms for its supposed effectiveness, for any condition that is discernible from placebo. Acupuncture has been called 'theatrical placebo', and David Gorski argues that when acupuncture proponents advocate 'harnessing of placebo effects' or work on developing 'meaningful placebos', they essentially concede it is little more than that.
The use of acupuncture in Germany increased by 20% in 2007, after the German acupuncture trials supported its efficacy for certain uses. In 2011, there were more than one million users, and insurance companies have estimated that two-thirds of German users are women. As a result of the trials, German public health insurers began to cover acupuncture for chronic low back pain and osteoarthritis of the knee, but not tension headache or migraine. This decision was based in part on socio-political reasons. Some insurers in Germany chose to stop reimbursement of acupuncture because of the trials. For other conditions, insurers 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.
There are various government and trade association regulatory bodies for acupuncture in the United Kingdom, the United States, Saudi Arabia, Australia, Japan, Canada, and in European countries and elsewhere. The World Health Organization recommends that before being licensed or certified, an acupuncturist receive 200 hours of specialized training if they are a physician and 2,500 hours for non-physicians; many governments have adopted similar standards.
In China, the practice of acupuncture is regulated by the Chinese Medicine Council that was formed in 1999 by the Legislative Council. It includes a licensing exam and registration, as well as degree courses approved by the board. Canada has acupuncture licensing programs in the provinces of British Columbia, Ontario, Alberta and Quebec; standards set by the Chinese Medicine and Acupuncture Association of Canada are used in provinces without government regulation. Regulation in the US began in the 1970s in California, which was eventually followed by every state but Wyoming and Idaho. Licensing requirements vary greatly from state to state. The needles used in acupuncture are regulated in the US by the Food and Drug Administration. In some states acupuncture is regulated by a board of medical examiners, while in others by the board of licensing, health or education.
In Japan, acupuncturists are licensed by the Minister of Health, Labour and Welfare after passing an examination and graduating from a technical school or university. Australia regulates Chinese medical traditions through the Chinese Medicine Board of Australia and the Public Health (Skin Penetration) Regulation of 2000. It restricts the use of words like "Acupuncture" and "Registered Acupuncturist". At least 28 countries in Europe have professional associations for acupuncturists. In France, the Académie Nationale de Médecine (National Academy of Medicine) has regulated acupuncture since 1955.
- 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.
- 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.
- Wiseman, N; Ellis, A (1996). Fundamentals of Chinese medicine. Paradigm Publications. ISBN 9780912111445.
- 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 "As yin and yang, 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.
- Berman, Brian; Langevin, Helene; Witt, Claudia; Dubner, Ronald (29 July 2010). "Acupuncture for Chronic Low Back Pain". New England Journal of Medicine 363 (5): 454–461. 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.
- 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–e1587. doi:10.1542/peds.2011-1091. PMID 22106073.
- 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". NCCIH. Retrieved 9 May 2014.
- 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.
- 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. 251–254. ISBN 9780763752835.
- 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.
- Barrett, S (30 December 2007). "Be Wary of Acupuncture, Qigong, and "Chinese Medicine"". Quackwatch. Retrieved 4 May 2015.
- Baran GR, Kiana MF, Samuel SP (2014). Chapter 2: Science, Pseudoscience, and Not Science: How Do They Differ?. Healthcare and Biomedical Technology in the 21st Century (Springer). pp. 19–57. doi:10.1007/978-1-4614-8541-4_2. ISBN 978-1-4614-8540-7.
various pseudosciences maintain their popularity in our society: acupuncture, astrology, homeopathy, etc.
- Good R (2012). Khine MS, ed. Chapter 5: Why the Study of Pseudoscience Should Be Included in Nature of Science Studies. Advances in Nature of Science Research: Concepts and Methodologies (Springer). p. 103. ISBN 978-94-007-2457-0.
Believing in something like chiropractic or acupuncture really can help relieve pain to a small degree [...] but many related claims of medical cures by these pseudosciences are bogus.
- Ernst, Edzard (2009). "Acupuncture: What Does the Most Reliable Evidence Tell Us?". Journal of Pain and Symptom Management 37 (4): 709–714. doi:10.1016/j.jpainsymman.2008.04.009. ISSN 0885-3924. PMID 18789644.
- Lee, MS; Ernst, E (2011). "Acupuncture for pain: An overview of Cochrane reviews". Chinese Journal of Integrative Medicine 17 (3): 187–189. doi:10.1007/s11655-011-0665-7. PMID 21359919.
- 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.
- 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.
- "Acupuncture–for health professionals (PDQ)". National Cancer Institute. Retrieved 16 July 2015.
- Gnatta JR, Kurebayashi LF, Paes da Silva MJ (2013). "Atypical mycobacterias associated to acupuncuture: an integrative review". Rev Lat Am Enfermagem 21 (1): 450–458. doi:10.1590/s0104-11692013000100022. PMID 23546331.
- Taylor P, Pezzullo L, Grant SJ, Bensoussan A (2013). "Cost-effectiveness of Acupuncture for Chronic Nonspecific Low Back Pain.". Pain Practice 14 (7): 599–606. 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
- 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" (PDF). Bioelectromagnetics 29 (4): 245–256. doi:10.1002/bem.20403. PMID 18240287.
- Mann, F (2000). Reinventing Acupuncture: A New Concept of Ancient Medicine. Elsevier. ISBN 0750648570.
- Williams, WF (2013). Encyclopedia of Pseudoscience: From Alien Abductions to Zone Therapy. Encyclopedia of Pseudoscience (Routledge). pp. 3–4. ISBN 1135955220.
- White, A.; Ernst, E. (2004). "A brief history of acupuncture". Rheumatology (Oxford, England) 43 (5): 662–663. doi:10.1093/rheumatology/keg005. PMID 15103027.
- Prioreschi, P (2004). A history of Medicine, Volume 2. Horatius Press. pp. 147–148. ISBN 1888456019.
- Gwei-Djen Lu; Joseph Needham (October 25, 2002). Celestial Lancets: A History and Rationale of Acupuncture and Moxa. ISBN 0700714588.
- Porter, S.B. (2013). Tidy's Physiotherapy15: Tidy's Physiotherapy. Churchill Livingstone. Elsevier. p. 403. ISBN 978-0-7020-4344-4. Retrieved July 14, 2015.
- Jackson, M. (2011). The Oxford Handbook of the History of Medicine. Oxford Handbooks in History. OUP Oxford. p. 610. ISBN 978-0-19-954649-7. Retrieved July 14, 2015.
- 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.
- American Society of Anesthesiologists Task Force on Chronic Pain Management; American Society of Regional Anesthesia and Pain Medicine (April 2010). "Practice guidelines for chronic pain management: an updated report by the American Society of Anesthesiologists Task Force on Chronic Pain Management and the American Society of Regional Anesthesia and Pain Medicine.". Anesthesiology 112 (4): 810–33. doi:10.1097/ALN.0b013e3181c43103. PMID 20124882.
- 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.
- 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.
- Young, J (2007). Complementary Medicine For Dummies. John Wiley & Sons. pp. 126–128. 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): 151–158. doi:10.1370/afm.248. PMC 1466855. PMID 15798042.
- "Acupuncture". NHSChoices. Retrieved 2 May 2015.
- 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.
- Adrian White; Mike Cummings; Jacqueline Filshie (2008). "2". An Introduction to Western Medical Acupuncture. Churchill Livingstone. p. 7. ISBN 978-0-443-07177-5.
- Miller's Anesthesia. Elsevier. 2014. p. 1235. ISBN 0702052833.
- Cheng, 1987, chapter 12.
- 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. 113–114.
- 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.
- 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.
- 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.
- Cui-lan Yan (January 1997). The Treatment of External Diseases with Acupuncture and Moxibustion. Blue Poppy Enterprises, Inc. pp. 112–. ISBN 978-0-936185-80-4.
- "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.
- Lim SM, Lee SH (2015). "Effectiveness of bee venom acupuncture in alleviating post-stroke shoulder pain: a systematic review and meta-analysis". J Integr Med 13 (4): 241–7. doi:10.1016/S2095-4964(15)60178-9. PMID 26165368.
- 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.
- Alvarez, L. (2015). "Chapter 18: Acupuncture". In James S. Gaynor & William W. Muir III. Handbook of Veterinary Pain Management (3rd edition). Elsevier. ISBN 978-0323089357.
- 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.
- Ernst, E.; Pittler, MH; Wider, B; Boddy, K (2007). "Acupuncture: its evidence-base is changing". The American Journal of Chinese Medicine 35 (1): 21–25. 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 24 (2): 71–79. doi:10.1136/aim.24.2.71. PMID 16783282.
- Madsen 2009, p. a3115
- 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.
- 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.
- 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.
- Cherniack, E Paul (2010). "Would the elderly be better off if they were given more placebos?". Geriatrics & Gerontology International 10 (2): 131–137. 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.
- Lee Goldman; Andrew I. Schafer (21 April 2015). Goldman-Cecil Medicine: Expert Consult - Online. Elsevier Health Sciences. pp. 98–. ISBN 978-0-323-32285-0.
- 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): 980–983. 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): 160–161. 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): 159–166. 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 (1): 122. doi:10.1186/1745-6215-12-122. PMC 3114769. PMID 21569452.
- Ernst, Edzard (2012). "Acupuncture: What Does the Most Reliable Evidence Tell Us? An Update". Journal of Pain and Symptom Management 43 (2): e11–e13. doi:10.1016/j.jpainsymman.2011.11.001. ISSN 0885-3924. PMID 22248792.
- Ma, B; Qi, GQ; Lin, XT; Wang, T; Chen, ZM; Yang, KH (September 2012). "Epidemiology, quality, and reporting characteristics of systematic reviews of acupuncture interventions published in Chinese journals.". Journal of alternative and complementary medicine (New York, N.Y.) 18 (9): 813–7. doi:10.1089/acm.2011.0274. PMID 22924413.
- 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): 1444–1453. 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.
- Vickers, A. J.; Maschino, A. C.; Lewith, G.; MacPherson, H.; Sherman, K. J.; Witt, C. M. (2013). "Responses to the Acupuncture Trialists' Collaboration individual patient data meta-analysis". Acupuncture in Medicine 31 (1): 98–100. doi:10.1136/acupmed-2013-010312. ISSN 0964-5284. PMID 23449559.
- 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.
- Trinh, K; Graham, N; Irnich, D; Cameron, ID; Forget, M (4 May 2016). "Acupuncture for neck disorders.". The Cochrane database of systematic reviews 5: CD004870. PMID 27145001.
- Xu, Mai; Yan, Shi; Yin, Xu; Li, Xiuyang; Gao, Shuguang; Han, Rui; Wei, Licheng; Luo, Wei; Lei, Guanghua (January 2013). "Acupuncture for Chronic Low Back Pain in Long-Term Follow-Up: A Meta-Analysis of 13 Randomized Controlled Trials". The American Journal of Chinese Medicine 41 (01): 1–19. doi:10.1142/S0192415X13500018. PMID 23336503.
- 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.
- Furlan, AD; et al. (2005). Furlan, AD, ed. "Acupuncture and dry-needling for low back pain" (PDF). Cochrane Database of Systematic Reviews (1): CD001351. doi:10.1002/14651858.CD001351.pub2. PMID 15674876.
- Linde, K; Allais, G; Brinkhaus, B; Fei, Y; Mehring, M; Shin, BC; Vickers, A; White, AR (19 April 2016). "Acupuncture for the prevention of tension-type headache.". The Cochrane database of systematic reviews 4: CD007587. doi:10.1002/14651858.CD007587.pub2. PMID 27092807.
- Linde, K; Allais, G; Brinkhaus, B; Fei, Y; Mehring, M; Vertosick, EA; Vickers, A; White, AR (28 June 2016). "Acupuncture for the prevention of episodic migraine". The Cochrane database of systematic reviews (Systematic Review) 6: CD001218. doi:10.1002/14651858.CD001218.pub3. PMID 27351677.
- 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 (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.
- 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.
- Kmietowicz, Z. (2014). "Acupuncture does not improve chronic knee pain, study finds". BMJ 349 (sep30 27): 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.
- 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)" (PDF). Cochrane Database of Systematic Reviews (10): CD001977. doi:10.1002/14651858.CD001977.pub2. PMC 3169099. PMID 20091527.
- Gadau, Marcus; Yeung, Wing-Fai; Liu, Hua; Zaslawski, Chris; Tan, Yuan-Sheng; Wang, Fu-Chun; Bangrazi, Sergio; Chung, Ka-Fai; Bian, Zhao-Xiang; Zhang, Shi-Ping (2014). "Acupuncture and moxibustion for lateral elbow pain: a systematic review of randomized controlled trials". BMC Complementary and Alternative Medicine 14 (1): 136. doi:10.1186/1472-6882-14-136. PMID 24726029.
- Chang, WD; Lai, PT; Tsou, YA (2014). "Analgesic effect of manual acupuncture and laser acupuncture for lateral epicondylalgia: a systematic review and meta-analysis.". The American journal of Chinese medicine 42 (6): 1301–1314. doi:10.1142/S0192415X14500815. PMID 25384448.
- 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 15 (3): 279–291. 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.
- 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.
- Feng, S; Han, M; Fan, Y; Liao, Z. "Acupuncture for the treatment of allergic rhinitis: A systematic review and meta-analysis". American Journal of Rhinologic Society 29 (1): 57–62. doi:10.2500/ajra.2015.29.4116. PMID 25590322.
- 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.
- Paley, CA; Johnson, MI; Tashani, OA; Bagnall, AM (15 October 2015). "Acupuncture for cancer pain in adults.". The Cochrane database of systematic reviews 10: CD007753. doi:10.1002/14651858.CD007753.pub3. PMID 26468973.
- Lian, WL; Pan, MQ; Zhou, DH; Zhang, ZJ (February 2014). "Effectiveness of acupuncture for palliative care in cancer patients: a systematic review.". Chinese journal of integrative medicine 20 (2): 136–147. doi:10.1007/s11655-013-1439-1. PMID 24338183.
- Towler, P; Molassiotis, A; Brearley, SG (October 2013). "What is the evidence for the use of acupuncture as an intervention for symptom management in cancer supportive and palliative care: an integrative overview of reviews.". Supportive Care in Cancer 21 (10): 2913–2923. doi:10.1007/s00520-013-1882-8. PMID 23868190.
- 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): 1147–1158. doi:10.1007/s00520-012-1432-9. PMID 22447366.
- Ling, Wai-man; Lui, Liza Y. Y.; So, Winnie K. W.; Chan, Kuen (1 November 2014). "Effects of Acupuncture and Acupressure on Cancer-Related Fatigue: A Systematic Review". Oncology Nursing Forum 41 (6): 581–592. doi:10.1188/14.ONF.581-592. PMID 25355016.
- 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): 952–960. 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): 2067–2073. 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): 447–455. doi:10.1016/j.ctim.2012.07.007. PMID 23131378.
- Kim, KN; Chung, SY; Cho, SH (December 2015). "Efficacy of acupuncture treatment for functional dyspepsia: A systematic review and meta-analysis.". Complementary therapies in medicine 23 (6): 759–66. doi:10.1016/j.ctim.2015.07.00. PMID 26645513.
- Lan, L; Zeng, F; Liu, GJ; Ying, L; Wu, X; Liu, M; Liang, FR (13 October 2014). "Acupuncture for functional dyspepsia.". The Cochrane database of systematic reviews 10: CD008487. doi:10.1002/14651858.CD008487.pub2. PMID 25306866.
- 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): 884–91. doi:10.4103/1008-682X.129130. ISSN 1008-682X. PMID 25038176.
- Cheong, YC; Dix, S; Hung Yu Ng, E; Ledger, WL; Farquhar, C (26 July 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.
- Qu, F; Zhou, J; Ren, RX (May 2012). "Effects of acupuncture on the outcomes of in vitro fertilization: a systematic review and meta-analysis.". Journal of alternative and complementary medicine (New York, N.Y.) 18 (5): 429–439. doi:10.1089/acm.2011.0158. PMID 22540969.
- Kang, Hyun-Sun; Jeong, Daun; Kim, Dong-Il; Lee, Myeong Soo (April 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.
- 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.
- Ernst, E.; Lee, M. S. (29 June 2010). "Acupuncture for rheumatic conditions: an overview of systematic reviews". Rheumatology 49 (10): 1957–1961. doi:10.1093/rheumatology/keq180. PMID 20591833.
- Zhang JH, Wang D, Liu M (2014). "Overview of systematic reviews and meta-analyses of acupuncture for stroke". Neuroepidemiology (Systematic review) 42 (1): 50–58. 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. doi:10.1089/acm.2011.0457. PMC 3429280. PMID 22924414.
- Kong, J. C.; Lee, M. S.; Shin, B.-C.; Song, Y.-S.; Ernst, E. (27 September 2010). "Acupuncture for functional recovery after stroke: a systematic review of sham-controlled randomized clinical trials". Canadian Medical Association Journal 182 (16): 1723–1729. doi:10.1503/cmaj.091113. PMID 20876268.
- Zhao, XF; Du, Y; Liu, PG; Wang, S (2012). "Acupuncture for stroke: evidence of effectiveness, safety, and cost from systematic reviews.". Topics in stroke rehabilitation 19 (3): 226–33. doi:10.1310/tsr1903-226. PMID 22668677.
- Yang, ZX; Xie, JH; Liu, YP; Miao, GX; Wang, YH; Wu, SM; Li, Y (2015). "Systematic review of long-term Xingnao Kaiqiao needling effcacy in ischemic stroke treatment.". Neural Regeneration Research 10: 583–8. doi:10.4103/1673-5374.155431. PMID 26170818.
- Li, L; Zhang, H; Meng, SQ; Qian, HZ (2014). "An updated meta-analysis of the efficacy and safety of acupuncture treatment for cerebral infarction.". PLOS ONE 9 (12): e114057. doi:10.1371/journal.pone.0114057. PMID 25438041.
- 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". Protocols (3): CD004131. doi:10.1002/14651858.CD004131.pub2. PMID 16856031.
- Zhang, Shihong; Liu, Ming; Asplund, Kjell; Li, Lin; Liu, Ming (2005). "Acupuncture for acute stroke". Protocols (2): CD003317. doi:10.1002/14651858.CD003317.pub2. PMID 15846657.
- 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.
- Yu, C; Ji, K; Cao, H; Wang, Y; Jin, HH; Zhang, Z; Yang, G (28 March 2015). "Effectiveness of acupuncture for angina pectoris: a systematic review of randomized controlled trials.". BMC Complementary and Alternative Medicine 15 (1): 90. doi:10.1186/s12906-015-0586-7. PMID 25888363.
- 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 (1): 55. doi:10.1186/1472-6882-13-55. PMC 3606608. PMID 23496981.
- Lee, MS; Shin, BC; Ernst, E (June 2009). "Acupuncture for Alzheimer's disease: a systematic review.". International journal of clinical practice 63 (6): 874–9. doi:10.1111/j.1742-1241.2009.02043.x. PMID 19490197.
- 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): 257–260. doi:10.1007/s11655-011-0701-7. PMID 21509667.
- Cheuk, D. K.; Wong, V.; Chen, W. X. (2011). Cheuk, Daniel KL, ed. "Acupuncture for autism spectrum disorders (ASD)". 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.
- Zhang, J; Li, X; Xu, J; Ernst, E (September 2012). "Laser acupuncture for the treatment of asthma in children: a systematic review of randomized controlled trials.". The Journal of asthma : official journal of the Association for the Care of Asthma 49 (7): 773–777. doi:10.3109/02770903.2012.691194. PMID 22873427.
- Chen, N; Zhou, M; He, L; Zhou, D; Li, N (2010). "Acupuncture for Bell's palsy". The Cochrane database of systematic reviews (8): CD002914. doi:10.1002/14651858.CD002914.pub5. PMID 20687071.
- Li, P; Qiu, T; Qin, C (2015). "Efficacy of Acupuncture for Bell's Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.". PLOS ONE 10 (5): e0121880. doi:10.1371/journal.pone.0121880. PMID 25974022.
- 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): 307–314. 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. 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.
- Zheng, Guo-qing; Zhao, Zhi-Ming; Wang, Yan; Gu, Yong; Li, Yue; Chen, Xing-miao; Fu, Shu-Ping; Shen, Jiangang (April 2011). "Meta-Analysis of Scalp Acupuncture for Acute Hypertensive Intracerebral Hemorrhage". The Journal of Alternative and Complementary Medicine 17 (4): 293–299. doi:10.1089/acm.2010.0156. PMID 21438797.
- 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.
- Zhang, T; Chon, TY; Liu, B; Do, A; Li, G; Bauer, B; Wang, L; Liu, Z (2013). "Efficacy of acupuncture for chronic constipation: a systematic review.". The American journal of Chinese medicine 41 (4): 717–742. doi:10.1142/S0192415X13500493. PMID 23895148.
- 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.
- Chen, W; Yang, GY; Liu, B; Manheimer, E; Liu, JP (2013). "Manual acupuncture for treatment of diabetic peripheral neuropathy: a systematic review of randomized controlled trials.". PLOS ONE 8 (9): e73764. doi:10.1371/journal.pone.0073764. PMID 24069229.
- Jordan, J (2006). "Acupuncture treatment for opiate addiction: A systematic review". Journal of Substance Abuse Treatment 30 (4): 309–314. 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.
- Lee, MS; Shin, BC; Choi, TY; Ernst, E (March 2011). "Acupuncture for treating dry eye: a systematic review.". Acta ophthalmologica 89 (2): 101–106. doi:10.1111/j.1755-3768.2009.01855.x. PMID 20337604.
- Smith, C. A.; Armour, M; Zhu, X; Li, X; Song, J (2016). "Acupuncture for dysmenorrhoea". The Cochrane database of systematic reviews (Systematic Review) (4): CD007854. doi:10.1002/14651858.CD007854.pub3. PMID 27087494.
- Huang, T.; Shu, X.; Huang, Y. S.; Cheuk, D. K. (2011). Huang, Tao, ed. "Complementary and miscellaneous interventions for nocturnal enuresis in children". 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.
- 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.
- 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". Cochrane Database Syst Rev. 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.
- Shergis, Johannah Linda; Ni, Xiaojia; Jackson, Melinda L.; Zhang, Anthony Lin; Guo, Xinfeng; Li, Yan; Lu, Chuanjian; Xue, Charlie Changli (June 2016). "A systematic review of acupuncture for sleep quality in people with insomnia". Complementary Therapies in Medicine 26: 11–20. doi:10.1016/j.ctim.2016.02.007. PMID 27261976.
- 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.
- 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". The Cochrane database of systematic reviews 5: CD005111. doi:10.1002/14651858.CD005111.pub3. PMC 3718572. PMID 22592702.
- Smith, C. A.; Collins, C. T.; Crowther, C. A.; Levett, K. M. (2011). "Acupuncture or acupressure for pain management in labour". 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.
- Kim, KH; Kim, TH; Lee, BR; Kim, JK; Son, DW; Lee, SW; Yang, GY (October 2013). "Acupuncture for lumbar spinal stenosis: a systematic review and meta-analysis.". Complementary therapies in medicine 21 (5): 535–56. doi:10.1016/j.ctim.2013.08.007. PMID 24050593.
- Dennis, CL; Dowswell, T (31 July 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.
- Cox, J; Varatharajan, S; Côté, P; Yu, H; Wong, JJ; Sutton, D; Randhawa, K; Goldgrub, R; Southerst, D; Shearer, HM; Stern, PJ; Dion, S; D'Angelo, K; Brown, C; Menta, R; Bohay, R; Nordin, M; Carroll, LJ; Mior, S; Stupar, M; Jacobs, C; Taylor-Vaisey, A (26 April 2016). "Are Acupuncture Therapies Effective for the Management of Musculoskeletal Disorders of the Extremities? A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.". The Journal of orthopaedic and sports physical therapy: 1–80. doi:10.2519/jospt.2016.6270. PMID 27117725.
- Wei, M. L.; Liu, J. P.; Li, N.; Liu, M. (2011). Wei, Mao Ling, ed. "Acupuncture for slowing the progression of myopia in children and adolescents". Cochrane database of systematic reviews (Online) 9 (9): CD007842. doi:10.1002/14651858.CD007842.pub2. PMID 21901710.
- Sui, Y.; Zhao, H. L.; Wong, V. C. W.; Brown, N.; Li, X. L.; Kwan, A. K. L.; Hui, H. L. W.; Ziea, E. T. C.; Chan, J. C. N. (May 2012). "A systematic review on use of Chinese medicine and acupuncture for treatment of obesity". Obesity Reviews 13 (5): 409–430. doi:10.1111/j.1467-789X.2011.00979.x. PMID 22292480.
- Esteghamati A; et al. (Apr 2015). "Complementary and alternative medicine for the treatment of obesity: a critical review". Int J Endocrinol Metab 13 (2): e19678. doi:10.5812/ijem.19678. PMC 4386228. PMID 25892995.
- 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): 423–431. 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.
- Lee, HS; Park, HL; Lee, SJ; Shin, BC; Choi, JY; Lee, MS (April 2013). "Scalp acupuncture for Parkinson's disease: a systematic review of randomized controlled trials.". Chinese journal of integrative medicine 19 (4): 297–306. doi:10.1007/s11655-013-1431-9. PMID 23546633.
- Lim, D.C.; Chen, W.; Cheng, L.N.; Xue, C.C.; et al. (2011). Lim, Danforn CE, ed. "Acupuncture for polycystic ovarian syndrome". Cochrane database of systematic reviews (Online) (8): CD007689. doi:10.1002/14651858.CD007689.pub2. PMID 21833961.
- Kim, SY; Park, HJ; Lee, H; Lee, H (July 2011). "Acupuncture for premenstrual syndrome: a systematic review and meta-analysis of randomised controlled trials.". BJOG : an international journal of obstetrics and gynaecology 118 (8): 899–915. doi:10.1111/j.1471-0528.2011.02994.x. PMID 21609380.
- 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 2014. ID 850367. doi:10.1155/2014/850367. PMID 25254059.
- Boyuan, Zhang; Yang, Chen; Ke, Cheng; Xueyong, Shen; Sheng, Liu (2014). "Efficacy of Acupuncture for Psychological Symptoms Associated with Opioid Addiction: A Systematic Review and Meta-Analysis". Evidence-Based Complementary and Alternative Medicine 2014: 1–13. doi:10.1155/2014/313549.
- 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.
- Zhang, XC; Xu, XP; Xu, WT; Hou, WZ; Cheng, YY; Li, CX; Ni, GX (2015). "Acupuncture Therapy for Sudden Sensorineural Hearing Loss: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.". PLOS ONE 10 (4): e0125240. doi:10.1371/journal.pone.0125240. PMID 25919000.
- 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.
- Santesso, Nancy (2014). "A Summary of a Cochrane Review: Acupuncture for Induction of Labor". Global Advances in Health and Medicine 3 (4): 64–65. doi:10.7453/gahmj.2014.027. ISSN 2164-957X. PMID 25105081.
- 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 (1): 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. doi:10.1007/s00405-014-3341-7. PMID 25344063.
- 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.
- Moon, TW; Posadzki, P; Choi, TY; Park, TY; Kim, HJ; Lee, MS; Ernst, E (2014). "Acupuncture for treating whiplash associated disorder: a systematic review of randomised clinical trials.". Evidence-Based Complementary and Alternative Medicine 2014: 870271. doi:10.1155/2014/870271. PMC 4034516. PMID 24899912.
- Lee, MS; Kang, JW; Ernst, E (2010). "Does moxibustion work? An overview of systematic reviews". BMC research notes 3 (1): 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.
- 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.
- Mcculloch, M. (2014). "Acupuncture Safety in Patients Receiving Anticoagulants: A Systematic Review". The Permanente Journal 19 (1): 68–73. doi:10.7812/TPP/14-057. ISSN 1552-5767. PMID 25432001.
- 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.
- 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): 569–575. 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): 391–398. doi:10.1093/ecam/nem086. PMC 2586322. PMID 18955234.
- Barnes, Patricia M. (2008-12-10). "Complementary and Alternative Medicine Use Among Adults and Children: United States, 2007" (PDF). National Center for Complimentary and Integrative Health. NCHS. Retrieved 2016-02-05.
- "Can acupuncture help your child?". Fairfield Acupuncture - Stamford. Retrieved 2016-02-05.
- Jindal, Vanita; Ge, Adeline; Mansky, Patrick J. (2008-06-01). "Safety and efficacy of acupuncture in children: a review of the evidence". Journal of Pediatric Hematology/Oncology 30 (6): 431–442. doi:10.1097/MPH.0b013e318165b2cc. ISSN 1077-4114. PMC 2518962. PMID 18525459.
- Park J, Sohn Y, White AR, Lee H (February 2014). "The safety of acupuncture during pregnancy: a systematic review". Acupunct Med (Systematic review) 32 (3): 257–266. doi:10.1136/acupmed-2013-010480. PMC 4112450. PMID 24554789.
- Ambrósio, E.M.M.; Bloor, K.; MacPherson, H. (October 2012). "Costs and consequences of acupuncture as a treatment for chronic pain: A systematic review of economic evaluations conducted alongside randomised controlled trials". Complementary Therapies in Medicine 20 (5): 364–374. doi:10.1016/j.ctim.2012.05.002. PMID 22863652.
- "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 (PDF) on 27 November 2010. Retrieved 3 November 2010.
- Barrett, Stephen (2013). "'Alternative' Medicine: More Hype Than Hope". In Humber, James M.; Almeder, Robert F. Alternative Medicine and Ethics. Springer Science & Business Media. p. 10. ISBN 978-1-4757-2774-6.
- Aung & Chen Steven K. H. Aung; William Pai-Dei Chen (2007). Clinical Introduction to Medical Acupuncture. Thieme. pp. 11–12. ISBN 978-1-58890-221-4.
- "（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, p. 101.
- 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.
- "Hard to swallow". Nature 448 (7150): 105–106. 2007. doi:10.1038/448106a. PMID 17625521.
- Ulett, GA (2002). "Acupuncture". In Shermer, M. The Skeptic: Encyclopedia of Pseudoscience. ABC-CLIO. p. 283291. ISBN 1576076539.
- Wang, Shu-Ming (2013). "Acupuncture in 21st Century Anesthesia: Is There a Needle in the Haystack?" (PDF). Anesthesia & Analgesia 116 (6): 1356–1359. doi:10.1213/ANE.0b013e31828f5efa. PMID 23709075.
- Pigliucci, Massimo (2013). Philosophy of Pseudoscience: Reconsidering the Demarcation Problem. University of Chicago Press. p. 206.
- 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.
- Staud, R; Price, DD (May 2006). "Mechanisms of acupuncture analgesia for clinical and experimental pain". Expert Review of Neurotherapeutics 6 (5): 661–667. doi:10.1586/1473722.214.171.1241. PMID 16734514.
- Langevin, Helene (2014). "Acupuncture, Connective Tissue, and Peripheral Sensory Modulation". Critical Reviews in Eukaryotic Gene Expression 24 (3): 249–53. doi:10.1615/CritRevEukaryotGeneExpr.2014008284. PMID 25072149.
- Takahashi, T (January 2011). "Mechanism of acupuncture on neuromodulation in the gut--a review". Neuromodulation : journal of the International Neuromodulation Society 14 (1): 8–12; discussion 12. doi:10.1111/j.1525-1403.2010.00295.x. PMID 21992155.
- Li, H; He, T; Xu, Q; Li, Z; Liu, Y; Li, F; Yang, BF; Liu, CZ (21 July 2015). "Acupuncture and regulation of gastrointestinal function". World journal of gastroenterology : WJG 21 (27): 8304–13. doi:10.3748/wjg.v21.i27.8304. PMID 26217082.
- Kavoussi, B; Ross, BE (September 2007). "The neuroimmune basis of anti-inflammatory acupuncture". Integrative cancer therapies 6 (3): 251–257. doi:10.1177/1534735407305892. PMID 17761638.
- Huang, Wenjing; Pach, Daniel; Napadow, Vitaly; Park, Kyungmo; Long, Xiangyu; Neumann, Jane; Maeda, Yumi; Nierhaus, Till; Liang, Fanrong; Witt, Claudia M.; Harrison, Ben J. (9 April 2012). "Characterizing Acupuncture Stimuli Using Brain Imaging with fMRI - A Systematic Review and Meta-Analysis of the Literature". PLOS ONE 7 (4): e32960. doi:10.1371/journal.pone.0032960.
- Ramey, D; Buell D (2004). "A true history of acupuncture". Focus on Alternative and Complementary Therapies 9 (4): 269–273. doi:10.1211/fact.2004.00244 (inactive 2015-02-02).
- 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?" (PDF). The Lancet 354 (9183): 1023–1025. doi:10.1016/S0140-6736(98)12242-0. PMID 10501382.
- Singh, S.; Ernst, E. (2008). Trick Or Treatment: The Undeniable Facts about Alternative Medicine. Norton paperback. W. W. Norton. p. 42. ISBN 978-0-393-06661-6. Retrieved July 21, 2015.
- Robson, T (2004). An Introduction to Complementary Medicine. Allen & Unwin. p. 90. ISBN 1741140544.
- Ramey, D.W. "Inaccurate acupuncture history". Rheumatology 43 (12): 1593. doi:10.1093/rheumatology/keh363.
- 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, 2005, p. 25.
- Barnes, L.L. (2005). Needles, Herbs, Gods, and Ghosts: China, Healing, and the West to 1848. Harvard University Press. p. 25. ISBN 978-0-674-01872-3. Retrieved July 21, 2015.
- Barnes, 2005, p. 188.
- Barnes, L.L. (2005). Needles, Herbs, Gods, and Ghosts: China, Healing, and the West to 1848. Harvard University Press. p. 308. ISBN 978-0-674-01872-3. Retrieved July 21, 2015.
- Barnes, L.L. (2005). Needles, Herbs, Gods, and Ghosts: China, Healing, and the West to 1848. Harvard University Press. p. 58. ISBN 978-0-674-01872-3. Retrieved July 14, 2015.
- Barnes, L.L. (2005). Needles, Herbs, Gods, and Ghosts: China, Healing, and the West to 1848. Harvard University Press. p. 75. ISBN 978-0-674-01872-3. Retrieved July 14, 2015.
- 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.
- 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).
- 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 City: 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.
- Xue, CC; et al. (2008). "Acupuncture, chiropractic and osteopathy use in Australia: A national population survey". BMC Public Health 88 (1): 108. doi:10.1186/1471-2458-8-105. PMC 2322980. PMID 18377663. Retrieved 25 May 2013.
- Cynthia Ramsay (2009). Unnatural Regulation: Complementary and Alternative Medicine Policy in Canada. The Fraser Institute. p. 43. GGKEY:0KK0XUSQASK.
- 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.
- 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.
- Bennett Swingle, Anne (October 2005), Acupuncture, Actually, Johns Hopkins University, retrieved November 2015
- Highfield, ES; Kaptchuk, TJ; Ott, MJ; Barnes, L; Kemper, KJ (September 2003). "Availability of acupuncture in the hospitals of a major academic medical center: a pilot study.". Complementary Therapies in Medicine (Elsevier) 11 (3): 177–83. doi:10.1016/S0965-2299(03)00069-4. PMID 14659382. Retrieved November 8, 2015.
- "Frauen häufiger mit Akupunktur behandelt" (in German). Rheinische Post. Retrieved 25 May 2013.
- Birch, S. (2007). "Reflections on the German Acupuncture studies" (PDF). Journal of Chinese Medicine (83): 12–17.
- He, W.; Tong, Y.; Zhao, Y.; Zhang, L.; et al. (2013). "Review of controlled clinical trials on acupuncture versus sham acupuncture in Germany". Journal of traditional Chinese medicine 33 (3): 403–7. doi:10.1016/s0254-6272(13)60187-9. PMID 24024341.
- Stuart B. Porter (2013). Stuart B. Porter, ed. Tidy's Physiotherapy (15 ed.). Churchill Livingstone. p. 408. ISBN 0702043443.
- TJ Hinrichs; Linda L. Barnes (2013). TJ Hinrichs; Linda L. Barnes, eds. Chinese Medicine and Healing: An Illustrated History (1 ed.). Belknap Press. p. 314. ISBN 0674047370.
- Beverly E. Pybus; Carol S. Cairns (1 January 2004). A Guide to AHP Credentialing: Challenges and Opportunities to Credentialing Allied Health Professionals. HCPro. p. 178. ISBN 978-1-57839-478-4.
- O'Neill, Mark (23 July 2007). "Hong Kong's traditional Chinese medicine laws 'putting public at risk'". South China Morning Post.
- L. Ac. Bauer (1 April 2011). Making Acupuncture Pay: Real-World Advice for Successful Private Practice. Dog Ear Publishing. pp. 42–. ISBN 978-1-4575-0279-8.
- Kevin Chan; Henry Lee (6 December 2001). The Way Forward for Chinese Medicine. CRC Press. p. 349. ISBN 978-1-4200-2423-4.
- WHO Global Atlas of Traditional, Complementary and Alternative Medicine. World Health Organization. 2005. p. 195. ISBN 978-92-4-156286-7.
- Bossy, Jean. Acupuncture in France (PDF). Acupunct Med.
Since 1955, the French Academy of Medicine accetr ted and included Acupunchlre as a part of medicine because it includes both diagnosis and therapeutic treatment
- 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 ff. 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|