Editing Acupuncture (section)

==== English-language ====
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.<ref name="Xu S"/> Between 2000 and 2011 the English-language literature from 25 countries and regions reported 294 adverse events.<ref name="Xu S"/> The majority of the reported adverse events were relatively minor, and the incidences were low.<ref name="Xu S"/> 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.<ref name="Xu S"/> Another survey found there were 7.1% minor adverse events, of which 5 were serious, amid 97,733 acupuncture patients.<ref name="Xu S"/> 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.<ref name="Xu S"/> Infection has also resulted from skin contact with unsterilized equipment or with dirty towels in an unhygienic clinical setting.<ref name="Xu S"/> 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]], [[granuloma|epithelioid granuloma]], [[pseudolymphoma]], [[argyria]], pustules, [[pancytopenia]], and scarring due to hot-needle technique.<ref name="Xu S"/> 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.<ref name="Xu S">{{cite journal | vauthors = Xu S, Wang L, Cooper E, Zhang M, Manheimer E, Berman B, Shen X, Lao L | title = Adverse events of acupuncture: a systematic review of case reports | journal = Evidence-Based Complementary and Alternative Medicine | volume = 2013 | pages = 1–15 | year = 2013 | pmid = 23573135 | pmc = 3616356 | doi = 10.1155/2013/581203 | doi-access = free }}</ref>

A 2013 systematic review found 31 cases of vascular injuries caused by acupuncture, three causing death.<ref name=Bergqvist/> Two died from pericardial tamponade and one was from an aortoduodenal fistula.<ref name=Bergqvist>{{cite journal | vauthors = Bergqvist D | title = Vascular injuries caused by acupuncture. A systematic review | journal = International Angiology | volume = 32 | issue = 1 | pages = 1–8 | date = February 2013 | pmid = 23435388 | url = http://www.minervamedica.it/en/journals/international-angiology/article.php?cod=R34Y2013N01A0001 | access-date = 1 March 2014 | archive-date = 1 March 2014 | archive-url = https://web.archive.org/web/20140301091317/http://www.minervamedica.it/en/journals/international-angiology/article.php?cod=R34Y2013N01A0001 | url-status = live }}</ref> The same review found vascular injuries were rare, bleeding and pseudoaneurysm were most prevalent.<ref name=Bergqvist/> 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 cause in most fatal instances.<ref name=Ernst-Zhang/> The same review concluded that cardiac tamponade was a serious, usually fatal, though theoretically avoidable complication following acupuncture, and urged training to minimize risk.<ref name=Ernst-Zhang>{{cite journal | vauthors = Ernst E, Zhang J | title = Cardiac tamponade caused by acupuncture: a review of the literature | journal = International Journal of Cardiology | volume = 149 | issue = 3 | pages = 287–89 | date = June 2011 | pmid = 21093944 | doi = 10.1016/j.ijcard.2010.10.016 }}</ref>

A 2012 review found that a number of adverse events were reported after acupuncture in the UK's [[National Health Service (England)|National Health Service]] (NHS), 95% of which were not severe,<ref name=Wheway2012/> though miscategorization and under-reporting may alter the total figures.<ref name=Wheway2012/> From January 2009 to December 2011, 468 safety incidents were recognized within the NHS organizations.<ref name=Wheway2012/> 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%).<ref name=Wheway2012/> Acupuncture practitioners should know, and be prepared to be responsible for, any substantial harm from treatments.<ref name=Wheway2012/> Some acupuncture proponents argue that the long history of acupuncture suggests it is safe.<ref name=Wheway2012/> However, there is an increasing literature on adverse events (e.g. spinal-cord injury).<ref name=Wheway2012>{{cite journal | vauthors = Wheway J, Agbabiaka TB, Ernst E | title = Patient safety incidents from acupuncture treatments: a review of reports to the National Patient Safety Agency | journal = The International Journal of Risk & Safety in Medicine | volume = 24 | issue = 3 | pages = 163–69 | date = January 2012 | pmid = 22936058 | doi = 10.3233/JRS-2012-0569 }}</ref>

Acupuncture seems to be safe in people getting [[anticoagulant]]s, assuming needles are used at the correct location and depth,<ref name=Mcculloch2014/> but studies are required to verify these findings.<ref name="Mcculloch2014">{{cite journal | vauthors = Mcculloch M, Nachat A, Schwartz J, Casella-Gordon V, Cook J | title = Acupuncture safety in patients receiving anticoagulants: a systematic review | journal = The Permanente Journal | volume = 19 | issue = 1 | pages = 68–73 | year = 2014 | pmid = 25432001 | pmc = 4315381 | doi = 10.7812/TPP/14-057 }}</ref>