Needles.Dy.e manipulated in various ways, including spinning, 29 :71 However, it is more likely that stones were used for other medical purposes, such as puncturing a growth to drain its pus . 27 30 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. 28 It is also speculated that these stones may have been used for blood-letting, due to the ancient Chinese belief that illnesses were caused by demons within the body that could be killed or released. 269 It is likely blood-letting was an antecedent to acupuncture. 30 According to historians Lu Gwei-djen and Joseph Needham, there is substantial evidence that acupuncture may have begun around 600 BC. 29 Some hieroglyphs and pictographs from that era suggests acupuncture and moxibustion were practice. 270 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. 29 :71-72 It is possible Bronze was used for early acupuncture needles. Rheumatology. 47 8: 1132–1136. dBi as electrical pulses were found to make a frog's leg twitch after death. 269 The West eventually created a belief system based on travel trigger points that were believed to inhibit pain. A woman receiving fire 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. 276 By the 19th century, acupuncture had become commonplace in many areas of the world. 29 :295 Americans and Britons began showing interest in acupuncture in the early 19th century but interest waned by mid century. 27 Western practitioners abandoned acupuncture's traditional beliefs in spiritual energy, pulse diagnosis, and the cycles of the moon, sun or the body's rhythm.

If the de-qi feeling does not promptly happen upon needle insertion, various hand-operated adjustment strategies could be related to promote it suPh as “plucking”, “drinking” or “trembling”. 52 Once de-qi is achieved, better acupuncture practices too. 27 China and Korea sent “clinical missionaries” that spread conventional Chinese medication to Japan, beginning around 219 AD. “Demystifying In addition, by the 18th century, clinical rationality was coming to be more prominent than typical superstitious beliefs. 27 By 1757 a publication recording the background of Chinese medicine called acupuncture a “lost art”. 29:160 Its decline was associated partially to the popularity of prescriptions and also medications, in addition to its association with the lowers ranks. 275 In 1822, the Chinese Emperor authorized a mandate excluding the method of acupuncture from the Imperial Medical Institute. 27 He said it was unfit for practice by gentlemen-scholars. 276 In China acupuncture was increasingly related to lower-class, illiterate specialists. 277 It was recovered for a while, but banned once more in 1929 in favour of science-based Western medicine. It.evolves putting needles to promote factors on the outer ear. 63 The modern approach was developed in France during the early 1950s. 63 There is no scientific proof acupuncture to trigger bleeding, while others blended the concepts of blood-letting as well as spiritual ch'i energy.

“Demystifying.f.he.omposer Hector Berlioz is usually credited with being the first to experiment with the procedure in Europe in 1810, before publishing his findings in 1816. 276 By the 19th century, acupuncture had become commonplace in many areas of the world. 29 :295 Americans and Britons began showing interest in acupuncture in the early 19th century but interest waned by mid century. 27 Western practitioners abandoned acupuncture's traditional beliefs in spiritual energy, pulse diagnosis, and the cycles of the moon, sun or the body's rhythm. In.ether.Ards, 'sham' or 'placebo' acupuncture generally produces the same effects as 'real' acupuncture and, in some cases, does better.” 77 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. 78 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. 78 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. 75 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. 2 A response to “sham” acupuncture in osteoarthritis may be used in the elderly, but placebos have usually been regarded as deception and thus unethical. 79 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. 79 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. 80 Using the principles of evidence-based medicine to research acupuncture is controversial, and has produced different results. 71 Some research suggests acupuncture can alleviate pain but the majority of research suggests that acupuncture's effects are mainly due to placebo. 9 Evidence suggests that any benefits of acupuncture are short-listing. 14 There is insufficient evidence to support use of acupuncture compared to mainstream medical treatments . 81 Acupuncture is not better than mainstream treatment in the long term. 74 Publication bias is cited as a concern in the reviews of randomized controlled trials CRTs of acupuncture. 57 82 83 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. 84 A 2011 assessment of the quality of CRTs on ACM, 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 ACM remedies. 85 The study also found that trials published in non-Chinese journals tended to be of higher quality. 85 Chinese authors use more Chinese studies, which have been demonstrated to be uniformly positive. 86 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. 87 Scientist and journalist Steven Salzburg identifies acupuncture and Chinese medicine generally as a focus for “fake medical journals” such as the Journal of Acupuncture and Meridian Studies and Acupuncture in Medicine . 88 The conclusions of many trials and numerous systematic reviews of acupuncture are largely inconsistent with each other. 13 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. 10 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. 10 A 2009 overview of Cochran reviews found acupuncture is not effective for a wide range of conditions, and suggested that it may be effective for only chemotherapy-induced Acupuncture nausea/vomiting, postoperative nausea/vomiting, and idiopathic headache. 13 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. 89 According to the 2014 Miller's anaesthesia book, “when compared with placebo, acupuncture treatment has proven efficacy for relieving pain”. 44 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. 90 Commenting on this meta-analysis, both Eduard Ernst and David Colquhoun said the results were of negligible clinical significance. 91 92 Eduard 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.” 93 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. 94 A 2010 review found real acupuncture and sham acupuncture produce similar improvements, which can only be accepted as evidence against the efficacy of acupuncture. 95 The same review found limited evidence that real acupuncture and sham acupuncture appear to produce biological differences despite similar effects. 95 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. 15 The same review found that it remains unclear whether acupuncture reduces pain independent of a psychological impact of the needling ritual. 15 A 2016 Cochran 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. 96 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 non-specific effects of manipulation”. 97 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. 98 A 2013 systematic review found that acupuncture may be effective for non-specific 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. 99 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. 12 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.” 10 A 2010 review found that sham acupuncture was as effective as real acupuncture for chronic low back pain. 2 The specific therapeutic effects of acupuncture were small, whereas its clinically relevant benefits were mostly due to contextual and psychosocial circumstances. 2 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. 2 A 2005 Cochran review found insufficient evidence to recommend for or against either acupuncture or dry needling for acute low back pain. 100 The same review found low quality evidence for pain relief and improvement compared Additionally, by the 18th century, scientific rationality was becoming more popular than traditional superstitious beliefs. 27 By 1757 a book documenting the history of Chinese medicine called acupuncture a “lost art”. 29 :160 Its decline was attributed in part to the popularity of prescriptions and medications, as well as its association with the lower classes. 275 In 1822, the Chinese Emperor signed a decree excluding the practice of acupuncture from the Imperial Medical Institute. 27 He said it was unfit for practice by gentlemen-scholars. 276 In China acupuncture was increasingly associated with lower-class, illiterate practitioners. 277 It was restored for a time, but banned again in 1929 in favour of science-based Western medicine. Other.techniques aim at “tonifying” Chinese : 补; pin yin : b or “sedating” Chinese : 泄; pin yin : xii qi. 52 The former techniques are used in deficiency patterns, the latter in excess patterns. 52 De qi is more important in Chinese acupuncture, while Western and Japanese patients may not consider it a necessary part of the treatment. 38 while moxibustion was used for chronic diseases . ACM practitioners disagree among themselves about how to diagnose that time. 27 The 5,000-year-old mummified body of Ötzi the Iceman was found with 15 groups of tattoos, 268 many of which were located at points on the body where acupuncture needles are used for abdominal or lower back problems. 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. 64 Cosmetic acupuncture is the use of acupuncture in an attempt to reduce wrinkles on the face. 65 Bee venom acupuncture is a treatment approach Ed, 1. year Kyōhō = 1716.