Diagrams.f the flow of spiritual energy, for example, Alternative Medicine was created within the NIH. Korean.acupuncture uses copper needles and has a greater focus on the hand. 38 The 51 The skill level of the acupuncturist may influence how painful the needle insertion is, and a sufficiently skilled practitioner may be able to insert the needles without causing any pain. 50 De-qi Chinese : 得气; pin yin : d q; “arrival of qi” refers to a sensation of numbness, distension, or electrical tingling at the needling site which might radiate along the corresponding meridian .

G. Sun simian 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. 29 Acupuncture became more established in China as improvements in paper led to the publication of more acupuncture books. If de-qi can not be generated, then inaccurate location of the acupoint, improper depth of needle insertion, inadequate manual manipulation, of the skin by thin metal needles, which are manipulated manually or the needle may be further stimulated by electrical stimulation electro acupuncture. 2 Acupuncture needles are typically made of stainless steel, making them flexible and preventing them from rusting or breaking. 46 Needles are usually disposed Acupuncture of after each use to prevent contamination. 46 Reusable needles when used should be sterilized between applications. 46 47 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, 48 with thicker needles used on more robust patients.

It.restricts.he.se of words like “Acupuncture” and “Registered Acupuncturist”. citation needed At least 28 countries in Europe have professional associations for acupuncturists. 303 In France, the Académie rationale de Médecine National Academy of Medicine has regulated acupuncture since 1955. 304 ^ From Latin, aces needle and puncture to puncture 1 ^ a b c sigh & Ernst 2008 stated, “Scientists 1462-0324 . Sometimes needles were used while they were still hot, creating a cauterizing effect at the injection site. 29 :104 Nine needles were recommended in the Chen chi Ta Cheng from 1601, which may have been because of an ancient Chinese belief that nine was a magic number. 29 :102-103 Other belief systems were based on the idea that the human body operated China and established acupuncture as one of five divisions of the Chinese State Medical Administration System. 29 :264-265 Acupuncture began to spread to Europe in the second half of the 17th century. If.e-qi can not be generated, then inaccurate location of the acupoint, improper depth of needle insertion, inadequate manual manipulation, Reports included 38 cases of infections and 42 cases of organ trauma. 10 The most frequent adverse events included pneumothorax, and bacterial and viral infections . 10 A 2013 review found without restrictions regarding publication date, study type or language 295 cases of infections; mycobacterium was the pathogen in at least 96%. 18 Likely sources of infection include towels, hot packs or boiling tank water, and reusing reprocessed needles. 18 Possible sources of infection include contaminated needles, reusing personal needles, a person's skin containing mycobacterium, and reusing needles at various sites in the same person. 18 Although acupuncture is generally considered a safe procedure, a 2013 review stated that the reports of infection transmission increased significantly in the prior decade, including those of mycobacterium. 18 Although it is recommended that practitioners of acupuncture use disposable needles, the reuse of sterilized needles is still permitted. 18 It is also recommended that thorough control practices for preventing infection be implemented and adapted. 18 The Xingnao Kaiqiao approach appears to be a safe form of treatment. 147 Fainting was the most frequent adverse event. 147 Fainting while being treated, haematoma, and pain while being treated are associated with individual physical differences and with needle manipulation. 147 A 2013 systematic review of the English-language case reports found that serious adverse events associated with acupuncture are rare, but that acupuncture is not without risk. 16 Between 2000 and 2011 the English-language literature from 25 countries and regions reported 294 adverse events. 16 The majority of the reported adverse events were relatively minor, and the incidences were low. 16 For example, a prospective survey of 34,000 acupuncture treatments found no serious adverse events and 43 minor ones, a rate of 1.3 per 1000 interventions. 16 Another survey found there were 7.1% minor adverse events, of which 5 were serious, amid 97,733 acupuncture patients. 16 The most common adverse effect observed was infection e.g. mycobacterium, and the majority of infections were bacterial in nature, caused by skin contact at the needling site. 16 Infection has also resulted from skin contact with unsterilised equipment or with dirty towels in an unhygienic clinical setting. 16 Other adverse complications included five reported cases of spinal cord injuries e.g. migrating broken needles or needling too deeply, four brain injuries, four peripheral nerve injuries, five heart injuries, seven other organ and tissue injuries, bilateral hand enema, epithelioid granuloma, pseudo lymphoma, argyria, pustules, pancytopenia, and scarring due to hot-needle technique. 16 Adverse reactions from acupuncture, which are unusual and uncommon in typical acupuncture practice, included syncope, galactorrhoea, bilateral nystagmus, pyoderma gangrenosum, hepatotoxicity, eruptive lichen planes, and spontaneous needle migration. 16 A 2013 systematic review found 31 cases of vascular injuries caused by acupuncture, three resulting in death. 232 Two died from pericardia tamponade and one was from an aortoduodenal fistula. 232 The same review found vascular injuries were rare, bleeding and pseudo aneurysm were most prevalent. 232 A 2011 systematic review without restriction in time or language, aiming to summarize all reported case of cardiac tamponade after acupuncture, found 26 cases resulting in 14 deaths, with little doubt about causality in most fatal instances. 233 The same review concluded cardiac tamponade was a serious, usually fatal, though theoretically avoidable complication following acupuncture, and urged training to minimize risk. 233 A 2012 review found a number of adverse events were reported after acupuncture in the UK's National Health Service NHS but most 95% were not severe, 42 though miscategorization and under-reporting may alter the total figures. 42 From January 2009 to December 2011, 468 safety incidents were recognized within the NHS organizations. 42 The adverse events recorded included retained needles 31%, dizziness 30%, loss of consciousness/unresponsive 19%, falls 4%, bruising or soreness at needle site 2%, pneumothorax 1% and other adverse side effects 12%. 42 Acupuncture practitioners should know, and be prepared to be responsible for, any substantial harm from treatments. 42 Some acupuncture proponents argue that the long history of acupuncture suggests it is safe. 42 However, there is an increasing literature on adverse events e.g. spinal-cord injury. 42 Acupuncture seems to be safe in people getting anticoagulants, assuming needles are used at the correct location and depth. 234 Studies are required to verify these findings. 234 The evidence suggests that acupuncture might be a safe option for people with allergic rhinitis. 118 Chinese, South Korean, and Japanese-language A 2010 systematic review of the Chinese-language literature found numerous acupuncture-related adverse events, including pneumothorax, fainting, sub arachnoid haemorrhage, and infection as the most frequent, and cardiovascular injuries, sub arachnoid haemorrhage, pneumothorax, and recurrent cerebral haemorrhage as the most serious, most of which were due to improper technique. 235 Between 1980 and 2009, the Chinese-language literature reported 479 adverse events. 235 Prospective surveys show that mild, transient acupuncture-associated adverse events ranged from 6.71% to 15%. 235 In a study with 190,924 patients, the prevalence of serious adverse events was roughly 0.024%. 235 Another study showed a rate of adverse events requiring specific treatment of 2.2%, 4,963 incidences among 229,230 patients. 235 Infections, mainly hepatitis, after acupuncture are reported often in English-language research, though are rarely reported in Chinese-language research, making it plausible that acupuncture-associated infections have been under-reported in China. 235 Infections were mostly caused by poor sterilization of acupuncture needles. 235 Other adverse events included spinal epidural haematoma in the cervical, thoracic and lumbar spine, chylothorax, injuries of abdominal organs and tissues, injuries in the neck region, injuries to the eyes, including orbital haemorrhage, traumatic cataract, injury of the oculomotor nerve and retinal puncture, haemorrhage to the cheeks and the hypo glottis, peripheral motor-nerve injuries and subsequent motor dysfunction, local allergic reactions to metal needles, stroke, and cerebral haemorrhage after acupuncture. 235 A causal link between acupuncture and the adverse events cardiac arrest, pyknolepsy, shock, fever, cough, thirst, aphonic, leg numbness, and sexual dysfunction remains uncertain. 235 The same review concluded that acupuncture can be considered inherently safe when practice by properly trained practitioners, but the review also stated there is a need to find effective strategies to minimize the health risks. 235 Between 1999 and 2010, the Republic of Korean-literature contained reports of 1104 adverse events. 236 Between the 1980s and 2002, the Japanese-language literature contained reports of 150 adverse events. 237 Although acupuncture has been practice for thousands of years in China, its use in paediatrics in the United States did not become common until the early 2000s.