Editing Acupuncture (section)

== Clinical practice ==
[[File:Aiguille d acupuncture avec regle.dsc02265.untilted+cropped+WB.jpg|thumb|One type of acupuncture needle]]

Acupuncture is a form of alternative medicine.<ref name=Berman2010/> It is used most commonly for pain relief,<ref name="Ernst 2011"/><ref name=NCCAM2010>{{cite web|title=Acupuncture for Pain|url=http://nccih.nih.gov/health/acupuncture/acupuncture-for-pain.htm|work=NCCIH|access-date=9 May 2014|date=January 2008|archive-url=https://archive.today/20151011153254/https://nccih.nih.gov/health/acupuncture/introduction|archive-date=11 October 2015|url-status=dead}}</ref> though it is also used to treat a wide range of conditions. Acupuncture is generally only used in combination with other forms of treatment.<ref name=Hutchinson2012/> For example, the [[American Society of Anesthesiologists]] states it may be considered in the treatment of nonspecific, noninflammatory low back pain only in conjunction with conventional therapy.<ref>{{cite journal | vauthors = Benzon HT, Connis RT, De Leon-Casasola OA, Glass DD, Korevaar WC, Cynwyd B, Mekhail NA, Merrill DG, Nickinovich DG, Rathmell JP, Sang CN, Simon DL | title = 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 | journal = Anesthesiology | volume = 112 | issue = 4 | pages = 810–33 | date = April 2010 | pmid = 20124882 | doi = 10.1097/ALN.0b013e3181c43103 | doi-access = free }}</ref>

Acupuncture is the insertion of thin needles into the skin.<ref name="Adams 2011"/> According to the [[Mayo Foundation for Medical Education and Research]] (Mayo Clinic), 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.<ref name=mayo2012>{{cite web|url=http://www.mayoclinic.org/tests-procedures/acupuncture/basics/what-you-can-expect/prc-20020778|work=Mayo Clinic Staff|publisher=[[Mayo Foundation for Medical Education and Research]]|title=What you can expect|date=January 2012|access-date=21 July 2014|archive-date=8 August 2014|archive-url=https://web.archive.org/web/20140808235324/http://www.mayoclinic.org/tests-procedures/acupuncture/basics/what-you-can-expect/prc-20020778|url-status=live}}</ref> It can be associated with the application of heat, pressure, or [[laser light]].<ref name="Adams 2011"/> Classically, acupuncture is individualized and based on philosophy and intuition, and not on scientific research.<ref>{{cite journal | last=Schwartz | first=L | url=http://medicalacupuncture.org/aama_marf/journal/vol12_1/evidence.html|archive-url=https://web.archive.org/web/20011121060240/http://medicalacupuncture.org/aama_marf/journal/vol12_1/evidence.html|archive-date=21 November 2001 |journal=Medical Acupuncture | pages=38–41 | year=2000 |volume=12 | issue=1 | title=Evidence-Based Medicine And Traditional Chinese Medicine: Not Mutually Exclusive}}</ref> There is also a [[invasiveness of surgical procedures#Non-invasive procedure|non-invasive]] therapy developed in early 20th-century Japan using an elaborate set of instruments other than needles for the treatment of children ({{Lang|ja-latn|shōnishin}} or {{Lang|ja-latn|shōnihari}}).<ref>{{cite book | first = Stephen | last = Birch | name-list-style = vanc |title=Japanese Pediatric Acupuncture|publisher=Thieme |year=2011 |isbn=978-3131500618}}</ref><ref>{{cite book | first = Thomas | last = Wernicke | name-list-style = vanc |title=The Art of Non-Invasive Paediatric Acupuncture|publisher=Jessica Kingsley Publishers |year=2014 |isbn=978-1848191600}}</ref>

Clinical practice varies depending on the country.<ref name=Ernst2006>{{cite journal | vauthors = Ernst E | title = Acupuncture – a critical analysis | journal = Journal of Internal Medicine | volume = 259 | issue = 2 | pages = 125–37 | date = February 2006 | pmid = 16420542 | doi = 10.1111/j.1365-2796.2005.01584.x | s2cid = 22052509 | doi-access = free }}</ref><ref name=Dummies/> A comparison of the average number of patients treated per hour found significant differences between China (10) and the United States (1.2).<ref>{{cite journal | vauthors = Napadow V, Kaptchuk TJ | s2cid = 2094918 | title = Patient characteristics for outpatient acupuncture in Beijing, China | journal = Journal of Alternative and Complementary Medicine | volume = 10 | issue = 3 | pages = 565–72 | date = June 2004 | pmid = 15253864 | doi = 10.1089/1075553041323849 }}</ref> [[Chinese herbs]] are often used.<ref name=Sherman>{{cite journal | vauthors = Sherman KJ, Cherkin DC, Eisenberg DM, Erro J, Hrbek A, Deyo RA | title = The practice of acupuncture: who are the providers and what do they do? | journal = Annals of Family Medicine | volume = 3 | issue = 2 | pages = 151–58 | year = 2005 | pmid = 15798042 | pmc = 1466855 | doi = 10.1370/afm.248 }}</ref> There is a diverse range of acupuncture approaches, involving different philosophies.<ref name="Peñas2010"/> 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.<ref name=Berman2010/> Traditional acupuncture involves needle insertion, [[moxibustion]], and [[cupping therapy]],<ref name="Xu S"/> and may be accompanied by other procedures such as feeling the [[Radial pulse|pulse]] and other parts of the body and examining the tongue.<ref name=Berman2010/> Traditional acupuncture involves the belief that a "life force" (''[[qi]]'') circulates within the body in lines called meridians.<ref name=NHS>{{cite web|url=http://www.nhs.uk/conditions/Acupuncture/Pages/Introduction.aspx|title=Acupuncture|publisher=NHSChoices|access-date=2 May 2015|archive-date=3 May 2015|archive-url=https://web.archive.org/web/20150503085352/http://www.nhs.uk/conditions/Acupuncture/Pages/Introduction.aspx|url-status=live}}</ref> The main methods practiced in the UK are TCM and Western medical acupuncture.<ref name=Wheway2012/> The term Western medical acupuncture is used to indicate an adaptation of TCM-based acupuncture which focuses less on TCM.<ref name=NHS/><ref name=WhiteCummings2008>{{cite book | first1 = Adrian | last1 = White | first2 = Mike | last2 = Cummings | first3 = Jacqueline | last3 = Filshie | name-list-style = vanc |title=An Introduction to Western Medical Acupuncture|chapter-url=https://books.google.com/books?id=Miw5AAAACAAJ|year=2008|publisher=Churchill Livingstone|isbn=978-0-443-07177-5|page=7|chapter=2}}</ref> The Western medical acupuncture approach involves using acupuncture after a medical diagnosis.<ref name=NHS/> 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.<ref name=Millers2014>{{cite book|title=Miller's Anesthesia|date=2014|publisher=Elsevier|isbn=978-0702052835|page=1235}}</ref>

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.<ref name=Cheng1987/> Auscultation and olfaction involve listening for particular sounds, such as wheezing, and observing body odor.<ref name=Cheng1987/> Inquiring involves focusing on the "seven inquiries": chills and fever; perspiration; appetite, thirst and taste; defecation and urination; pain; sleep; and [[menses]] and [[leukorrhea]].<ref name=Cheng1987/> Palpation is focusing on feeling the body for tender {{Lang|zh-latn|A-shi}} points and feeling the pulse.<ref name=Cheng1987>[[#Cheng1987|Cheng]], 1987, chapter 12.</ref>

=== Needles ===
[[File:Acupuncture Needles.jpg|thumb|right|Acupuncture needles]]
[[File:Japanese kudabari.jpg|thumb|right|Traditional and modern Japanese guiding tube needles]]

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]]).<ref name=Berman2010/> Acupuncture needles are typically made of [[stainless steel]], making them flexible and preventing them from [[Rust|rusting]] or breaking.<ref name=Hicks2005/> Needles are usually disposed of after each use to prevent contamination.<ref name=Hicks2005/> Reusable needles when used should be sterilized between applications.<ref name=Hicks2005>{{cite book | first = Angela | last = Hicks | name-list-style = vanc |edition=1 |page=41 |title=The Acupuncture Handbook: How Acupuncture Works and How It Can Help You |publisher=[[Piatkus Books]] |year=2005 |isbn=978-0749924720}}</ref><ref>{{cite book |last=Collinge |first=William J. |name-list-style=vanc |title=The American Holistic Health Association Complete guide to alternative medicine |publisher=Warner Books |location=New York |year=1996 |isbn=978-0-446-67258-0 |url=https://archive.org/details/americanholistic00coll }}</ref> In many areas, only sterile, single-use acupuncture needles are allowed, including the [[California|State of California]].<ref>Department of Consumer Affairs, California Acupuncture Board. Title 16, Article 5. Standards of Practice, 1399.454. Single Use Needles. www.acupuncture.ca.gov/pubs_forms/laws_regs/art5.shtml 1-10-2020.</ref> Needles vary in length between {{convert|13|and|130|mm|in}}, with shorter needles used near the face and eyes, and longer needles in areas with thicker tissues; needle diameters vary from 0{{convert|.16|mm|3|abbr=on}} to 0{{convert|.46|mm|3|abbr=on}},<ref name=Aung116>[[#Aung2007|Aung & Chen]], 2007, p. [https://books.google.com/books?id=I6NclaeDWjgC&pg=PA116 116].</ref> 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.<ref name=FCA>{{cite book| pages =[https://books.google.com/books?id=bKoMiuhSb3YC&pg=PA2 2–3] | title=Fundamentals of Chinese Acupuncture | vauthors = Ellis A, Wiseman N, Boss K | isbn=978-0912111339 | publisher=Paradigm Publications | year=1991 }}</ref>

Apart from the usual filiform needle, other needle types include three-edged needles and the Nine Ancient Needles.<ref name=Aung116/> 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.<ref name=Dummies>{{cite book | pages=[https://books.google.com/books?id=b6_1FOwC_GYC&pg=PA126 126–28] | title=Complementary Medicine For Dummies | last=Young | first=J | publisher=[[John Wiley & Sons]] | year=2007 | isbn=978-0470519684}}</ref>

=== Needling technique ===

==== Insertion ====

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 [[Epidermis|superficial layers of the skin]], a quick insertion of the needle is recommended.<ref name=Aung2007>[[#Aung2007|Aung & Chen]], 2007, pp. [https://books.google.com/books?id=I6NclaeDWjgC&pg=PA113 113–14].</ref> 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.<ref name=Berman2010/> Acupuncture can be painful.<ref>{{cite journal | vauthors = Loyeung BY, Cobbin DM | title = 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 | journal = Evidence-Based Complementary and Alternative Medicine | volume = 2013 | pages = 1–12 | year = 2013 | pmid = 24159337 | pmc = 3789497 | doi = 10.1155/2013/136763 | doi-access = free }}</ref> The acupuncturist's skill level may influence the painfulness of the needle insertion; a sufficiently skilled practitioner may be able to insert the needles without causing any pain.<ref name=Aung2007/>

==== ''{{Lang|zh-latn|De-qi}}'' sensation ====

{{Lang|zh-latn|De-qi}} ({{lang-zh|s=得气|p=dé qì}}; "arrival of qi") refers to a claimed sensation of numbness, distension, or electrical tingling at the needling site. If these sensations are not observed then inaccurate location of the [[acupoint]], improper depth of needle insertion, inadequate manual manipulation, are blamed. If {{Lang|zh-latn|de-qi}} is not immediately observed upon needle insertion, various manual manipulation techniques are often applied to promote it (such as "plucking", "shaking" or "trembling").<ref name="AungChen2007">{{cite book | first1 = Steven | last1 = Aung | first2 = William | last2 = Chen | name-list-style = vanc |title=Clinical Introduction to Medical Acupuncture|url=https://books.google.com/books?id=I6NclaeDWjgC|year=2007|publisher=Thieme|isbn=978-1588902214|page=116}}</ref>

Once ''{{Lang|zh-latn|de-qi}}'' is observed, techniques might be used which attempt to "influence" the ''{{Lang|zh-latn|de-qi}}''; for example, by certain manipulation the ''{{Lang|zh-latn|de-qi}}'' can allegedly be conducted from the needling site towards more distant sites of the body.<!---is this threading?---> Other techniques aim at "tonifying" ({{lang-zh|s=补|p=bǔ}}) or "sedating" ({{lang-zh|s=泄|p=xiè}}) ''qi''.<ref name="AungChen2007"/> The former techniques are used in [[Traditional Chinese medicine#Eight principles of diagnosis|deficiency]] patterns, the latter in excess patterns.<ref name="AungChen2007"/> ''De qi'' is more important in Chinese acupuncture, while Western and Japanese patients may not consider it a necessary part of the treatment.<ref name=Dummies/>

=== Related practices ===
* [[Acupressure]], a non-invasive form of bodywork, uses physical pressure applied to acupressure points by the hand or elbow, or with various devices.<ref>{{cite journal | vauthors = Lee EJ, Frazier SK | title = The efficacy of acupressure for symptom management: a systematic review | journal = Journal of Pain and Symptom Management | volume = 42 | issue = 4 | pages = 589–603 | date = October 2011 | pmid = 21531533 | pmc = 3154967 | doi = 10.1016/j.jpainsymman.2011.01.007 }}</ref>
* 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 (medicine)|acute conditions]] while moxibustion was used for [[Chronic (medicine)|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).<ref>[[#Needham2002|Needham & Lu]], 2002, pp. [https://books.google.com/books?id=0-0tdqBr58cC&pg=PA170 170–73] {{Webarchive|url=https://web.archive.org/web/20230328220246/https://books.google.com/books?id=0-0tdqBr58cC&pg=PA170 |date=28 March 2023 }}.</ref>
* [[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.<ref>{{cite web | url=http://www.britishcuppingsociety.org/ | title=British Cupping Society | access-date=25 March 2014 | archive-date=27 December 2021 | archive-url=https://web.archive.org/web/20211227225757/https://www.britishcuppingsociety.org/ | url-status=live }}</ref>
* [[Tui na]] is a TCM method of attempting to stimulate the flow of ''qi'' by various bare-handed techniques that do not involve needles.<ref>{{cite web |url=http://medical-dictionary.thefreedictionary.com/tui+na |title=Tui na |author=Farlex |year=2012 |publisher=Farlex |access-date=25 March 2014 |archive-date=23 October 2013 |archive-url=https://web.archive.org/web/20131023061520/http://medical-dictionary.thefreedictionary.com/tui+na |url-status=live }}</ref>
* [[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 <nowiki>[</nowiki>[[Transcutaneous electrical nerve stimulation|TENS]]<nowiki>]</nowiki> masquerading as acupuncture").<ref name=Colquhoun2013>{{cite journal | vauthors = Colquhoun D, Novella SP | title = Acupuncture is theatrical placebo | journal = Anesthesia and Analgesia | volume = 116 | issue = 6 | pages = 1360–63 | date = June 2013 | pmid = 23709076 | doi = 10.1213/ANE.0b013e31828f2d5e | s2cid = 207135491 | url = http://www.dcscience.net/Colquhoun-Novella-A%26A-2013.pdf | author-link = David Colquhoun | access-date = 9 February 2014 | archive-date = 20 November 2018 | archive-url = https://web.archive.org/web/20181120055409/http://www.dcscience.net/Colquhoun-Novella-A%26A-2013.pdf | url-status = live }}</ref>
* [[Fire needle acupuncture]] also known as fire needling is a technique which involves quickly inserting a flame-heated needle into areas on the body.<ref name="Yan1997">{{cite book | first = Cui-lan | last = Yan | name-list-style = vanc | title = The Treatment of External Diseases with Acupuncture and Moxibustion|url=https://books.google.com/books?id=W0Ety2Hqug8C&pg=PA112|date=1997|publisher=Blue Poppy Enterprises, Inc.|isbn=978-0-936185-80-4|page=112}}</ref>
* Sonopuncture is a stimulation of the body similar to acupuncture using sound instead of needles.<ref>{{Cite book |title=Educational Opportunities in Integrative Medicine |chapter=Sonopuncture |page=[https://books.google.com/books?id=BNR1KGJXX9cC&pg=PA34 34] |publisher=The Hunter Press |year=2008 |isbn=978-0977655243}}</ref> 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.<ref>{{Cite book |title=Alternative Therapies |author=Bhagat |year=2004 |isbn=978-8180612206 |pages=[https://books.google.com/books?id=oKfvc8bvGwsC&pg=PA165 164–65]|publisher=Jaypee Brothers Medical Publishers }}</ref> Alternatively, [[tuning fork]]s or other sound emitting devices are used.<ref>{{Cite book |publisher=[[American Cancer Society]] |year=2000 |isbn=978-0944235249 |page=[https://archive.org/details/americancancerso00amer_0/page/158 158] |chapter=Sonopuncture |title=American Cancer Society's Guide to complementary and alternative cancer methods |chapter-url=https://archive.org/details/americancancerso00amer_0/page/158 }}</ref>
* Acupuncture point injection is the injection of various substances (such as drugs, [[vitamin]]s or [[herbal extract]]s) into acupoints.<ref>{{cite web | url=http://www.cancer.gov/dictionary?CdrID=467825 | title=Cancer Dictionary – Acupuncture point injection | access-date=4 April 2011 | publisher=[[National Cancer Institute]] | archive-url=https://web.archive.org/web/20110327191321/http://www.cancer.gov/dictionary?CdrID=467825| archive-date=27 March 2011| date=2 February 2011 }}</ref> This technique combines traditional acupuncture with injection of what is often an effective dose of an approved pharmaceutical drug, and proponents claim that it may be more effective than either treatment alone, especially for the treatment of some kinds of chronic pain. However, a 2016 review found that most published trials of the technique were of poor value due to methodology issues and larger trials would be needed to draw useful conclusions.<ref>{{cite journal | vauthors = Sha T, Gao LL, Zhang CH, Zheng JG, Meng ZH | title = An update on acupuncture point injection | journal = QJM | volume = 109 | issue = 10 | pages = 639–41 | date = October 2016 | pmid = 27083985 | doi = 10.1093/qjmed/hcw055 | doi-access = free }}</ref>
* [[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]].<ref name=Barrett2008/> The modern approach was developed in France during the early 1950s.<ref name=Barrett2008/> There is no scientific evidence that it can cure disease; the evidence of effectiveness is negligible.<ref name=Barrett2008>{{cite web|last1=Barrett|first1=Stephen|title=Auriculotherapy: A Skeptical Look|url=http://www.acuwatch.org/reports/auriculotherapy.shtml|website=Acupuncture Watch|date=2 February 2008|access-date=31 August 2014|archive-date=28 May 2019|archive-url=https://web.archive.org/web/20190528151121/https://www.acuwatch.org/reports/auriculotherapy.shtml|url-status=live}}</ref>
* Scalp acupuncture, developed in Japan, is based on reflexological considerations regarding the [[scalp]].
* [[Koryo 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 (anatomy)|dermatome]] distribution) into acupuncture practice, and emphasizes a more formulaic approach to acupuncture point location.<ref name="AAMA list">{{cite journal | vauthors = Braverman S |title=Medical Acupuncture Review: Safety, Efficacy, And Treatment Practices |journal=Medical Acupuncture |volume=15 |issue=3 |year=2004 |url=http://www.medicalacupuncture.org/aama_marf/journal/vol15_3/article1.html|archive-url=https://web.archive.org/web/20050327073325/http://www.medicalacupuncture.org/aama_marf/journal/vol15_3/article1.html|archive-date=27 March 2005}}</ref>
* Cosmetic acupuncture is the use of acupuncture in an attempt to reduce wrinkles on the face.<ref name=NYT>{{cite news|work=The New York Times|title=Hold the Chemicals, Bring on the Needles|last=Isaacs|first=Nora|name-list-style=vanc|date=13 December 2007|access-date=23 November 2009|url=https://www.nytimes.com/2007/12/13/fashion/13SKIN.html|archive-date=28 August 2011|archive-url=https://web.archive.org/web/20110828113916/http://www.nytimes.com/2007/12/13/fashion/13SKIN.html|url-status=live}}</ref>
* Bee venom acupuncture is a treatment approach of injecting purified, diluted [[bee venom]] into acupoints.<ref>{{cite journal | vauthors = Lim SM, Lee SH | title = Effectiveness of bee venom acupuncture in alleviating post-stroke shoulder pain: a systematic review and meta-analysis | journal = Journal of Integrative Medicine | volume = 13 | issue = 4 | pages = 241–47 | date = July 2015 | pmid = 26165368 | doi = 10.1016/S2095-4964(15)60178-9 }}</ref>
* [[Veterinary acupuncture]] is the use of acupuncture on domesticated animals.<ref>{{cite journal | vauthors = Habacher G, Pittler MH, Ernst E | title = Effectiveness of acupuncture in veterinary medicine: systematic review | journal = Journal of Veterinary Internal Medicine | volume = 20 | issue = 3 | pages = 480–88 | year = 2006 | pmid = 16734078 | doi = 10.1111/j.1939-1676.2006.tb02885.x }}</ref>

{{gallery
|File:Acupuncture point Hegu (LI 4).jpg|Acupressure being applied to a hand|File:Sujichim (hand acupuncture).jpg|''Sujichim'', hand acupuncture|File:A Dose of Moxa.jpg|Japanese moxibustion|File:Fire cupping in Haikou - 02.JPG|A woman receiving [[fire cupping]] in China}}