Editing Acupuncture (section)

== Conceptual basis ==
{{Infobox Chinese|s=针刺|hp=zhēncì}}

===Traditional===
{{Main|Qi|Traditional Chinese medicine|Meridian (Chinese medicine)|List of acupuncture points}}
[[File:ChineseMedecine.JPG|thumb|right|Old Chinese medical chart of acupuncture meridians]]

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''.<ref name=Aung11>[[#Aung2007|Aung & Chen]] {{cite book| first1 = Steven K. H. | last1 = Aung| first2 = William Pai-Dei | last2 = Chen | name-list-style = vanc |title=Clinical Introduction to Medical Acupuncture|url=https://books.google.com/books?id=I6NclaeDWjgC&pg=PR1|year=2007|publisher=Thieme|isbn=978-1-58890-221-4|pages=11–12}}</ref> ''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.<ref name=meridian-theory>"（三）十二经脉 ...（四）奇经八脉 ..." [(3.) The Twelve Vessels ... (4.) The Extraordinary Eight Vessels ...] as seen at {{cite web |url= http://www.pharmnet.com.cn/tcm/knowledge/detail/100044.html |archive-url= https://web.archive.org/web/20161110121328/http://www.pharmnet.com.cn/tcm/knowledge/detail/100044.html |archive-date= 10 November 2016 |script-title=zh:经络学 |access-date=22 February 2011 |language=zh |trans-title=Meridian theory}}</ref> Acupuncture points where needles are inserted are mainly (but not always) found at locations along the meridians.<ref name=Aung101/> Acupuncture points not found along a meridian are called extraordinary points and those with no designated site are called {{Lang|zh-latn|A-shi}} points.<ref name=Aung101>[[#Aung2007|Aung & Chen]], 2007, p. [https://books.google.com/books?id=I6NclaeDWjgC&pg=PA101 101].</ref>

In TCM, disease is generally perceived as a disharmony or imbalance in energies such as [[Traditional Chinese medicine#Yin and yang|yin, yang]], [[Traditional Chinese medicine#Model of the body|''qi'', xuĕ, zàng-fǔ, meridians]], and of the interaction between the body and the environment.<ref>{{harvnb|Wiseman & Ellis|1996|page=77}}</ref> Therapy is based on which "pattern of disharmony" can be identified.<ref>{{Cite book | vauthors = Ergil MC, Ergil KV | page = [https://books.google.com/books?id=kdZ1rFKW&pg=PA19 19], [https://books.google.com/books?id=kdZ1rFKW&pg=PA148 148] | title = Pocket Atlas of Chinese Medicine | year = 2009 | publisher = Thieme | location = Stuttgart | isbn = 978-3131416117}}</ref><ref>{{cite book | vauthors = Flaws B, Finney D | year = 2007 | title = A handbook of TCM patterns & their treatments | edition = 6th | publisher = Blue Poppy Press | isbn = 978-0936185705 | pages = [https://books.google.com/books?id=iJT3mz20yHoC&pg=PA1 1] }}</ref> For example, some diseases are believed to be caused by meridians being invaded with an excess of wind, cold, and damp.<ref>{{cite book | vauthors = Flaws B, Finney D | title = A handbook of TCM patterns & their treatments | publisher = Blue Poppy Press | year = 1996 | edition = 6 (2007) |isbn = 978-0936185705 | pages = [https://books.google.com/books?id=iJT3mz20yHoC&pg=PA169 169–73] }}</ref> In order to determine which [[Traditional chinese medicine#Patterns|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.<ref name=Tongue>{{cite book | title = Tongue Diagnosis in Chinese Medicine | last = Maciocia | first = G | publisher = Eastland Press | year = 1995 | isbn = 978-0939616190 }}</ref><ref name=Maciocia>{{Cite book | first = G | last = Maciocia | title = The Foundations of Chinese Medicine | publisher = Churchill Livingstone | year = 2005 | isbn = 978-0443074899 }}</ref> TCM and its concept of disease does not strongly differentiate between the cause and effect of symptoms.<ref>{{cite book| page=[https://books.google.com/books?id=t23zKB1FSVYC&pg=PA26 26]| last=Ross |first=J|title=Zang Fu, the organ systems of traditional Chinese medicine| publisher=Elsevier |year=1984 | isbn=978-0443034824 }}</ref>

===Purported scientific basis===
[[File:Archie McPhee acupuncture.jpg|thumb|right|Modern acupuncture model]]

Many within the [[scientific community]] consider acupuncture to be [[quackery]]{{efn|name="quackery"|Attributed to multiple sources:<ref name="Wang2013" /><ref name="rank" /><ref name=crappy/><ref name=Jarvis>{{cite journal|url=https://pubmed.ncbi.nlm.nih.gov/1643742/|title=Quackery: a national scandal|first=W.T.|last=Jarvis|journal=Clinical Chemistry|date=August 1992|volume=38|issue=8B part 2|pages=1574–86|pmid=1643742}}</ref><ref name=Naudet>{{cite journal|url=https://hal.science/hal-01138648|title=Has evidence-based medicine left quackery behind?|first1=Florian|last1=Naudet|first2=Bruno|last2=Falissard|author2-link= Bruno Falissard |first3=Rémy|last3=Boussageon|first4=David|last4=Healy|journal=Internal and Emergency Medicine|volume=10|issue=5|pages=631–4|date=2015|doi=10.1007/s11739-015-1227-3|pmid=25828467|s2cid=20697592 }}</ref>}} and pseudoscience, having no effect other than as "theatrical placebo".<ref name=Wang2013>{{cite journal | vauthors = Wang SM, Harris RE, Lin YC, Gan TJ | title = Acupuncture in 21st century anesthesia: is there a needle in the haystack? | journal = Anesthesia and Analgesia | volume = 116 | issue = 6 | pages = 1356–59 | date = June 2013 | pmid = 23709075 | doi = 10.1213/ANE.0b013e31828f5efa | s2cid = 1106695 | url = http://www.dcscience.net/Wang-acupunc-A%26A-2013.pdf | access-date = 22 March 2015 | archive-date = 23 September 2015 | archive-url = https://web.archive.org/web/20150923213155/http://www.dcscience.net/Wang-acupunc-A%26A-2013.pdf | url-status = live }}</ref><ref name=rank>{{cite web |author=Gorski D |author-link=David Gorski |website=[[Science-Based Medicine]] |date=23 June 2014 |title=Ketogenic diet does not 'beat chemo for almost all cancers' |url=https://sciencebasedmedicine.org/ketogenic-diets-for-cancer-hype-versus-science/ |quote=it is quite obvious that modalities such as homeopathy, acupuncture, reflexology, craniosacral therapy, Hulda Clark's "zapper," the Gerson therapy and Gonzalez protocol for cancer, and reiki (not to mention every other "energy healing" therapy) are the rankest quackery |access-date=6 August 2019 |archive-date=27 September 2019 |archive-url=https://web.archive.org/web/20190927214952/https://sciencebasedmedicine.org/ketogenic-diets-for-cancer-hype-versus-science/ |url-status=live }}</ref> [[David Gorski]] has argued that of all forms of quackery, acupuncture has perhaps gained most acceptance among physicians and institutions.<ref name=crappy>{{cite web |author=Gorski D |author-link=David Gorski |website=[[Science-Based Medicine]] |date=7 May 2018 |title=PLOS ONE, peer review, and a 'crappy' acupuncture study |url=https://sciencebasedmedicine.org/plos-one-peer-review-and-a-crappy-acupuncture-study/}}</ref> Academics [[Massimo Pigliucci]] and [[Maarten Boudry]] describe acupuncture as a "borderlands science" lying between science and pseudoscience.<ref name=Massimo2013>{{cite book | url=https://books.google.com/books?id=Pc4OAAAAQBAJ | title=Philosophy of Pseudoscience: Reconsidering the Demarcation Problem | publisher=University of Chicago Press | last=Pigliucci | first=Massimo | name-list-style=vanc | year=2013 | page=206 | isbn=978-0226051826 | access-date=3 June 2020 | archive-date=15 April 2023 | archive-url=https://web.archive.org/web/20230415011850/https://books.google.com/books?id=Pc4OAAAAQBAJ | url-status=live }}</ref>

A 2015 paper by several professors states that acupuncture has "no credible or respectable place in medicine", because it is often considered to be pseudoscience or quackery.<ref name="Naudet Falissard Boussageon Healy 2015 pp. 631–634">{{Cite journal |last1=Naudet |first1=Florian |last2=Falissard |first2=Bruno |last3=Boussageon |first3=Rémy |last4=Healy |first4=David |date=2015 |title=Has evidence-based medicine left quackery behind? |url=https://hal-univ-rennes1.archives-ouvertes.fr/hal-01138648/file/Has%20evidence-based%20medicine%20left%20quackery%20behind_accepted.pdf |journal=Internal and Emergency Medicine |volume=10 |issue=5 |pages=631–634 |doi=10.1007/s11739-015-1227-3 |issn=1970-9366 |pmid=25828467 |s2cid=20697592 |quote=Treatments such as relaxation techniques, chiropractic, therapeutic massage, special diets, megavitamins, acupuncture, naturopathy, homeopathy, hypnosis and psychoanalysis are often considered as ‘‘pseudoscience’’ or ‘‘quackery’’ with no credible or respectable place in medicine, because in evaluation they have not been shown to ‘‘work’’}}</ref>

====Rationalizations of traditional medicine====
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.{{efn|name=SinghErnst2008}}<ref name="Ahn2008">{{cite journal | vauthors = Ahn AC, Colbert AP, Anderson BJ, Martinsen OG, Hammerschlag R, Cina S, Wayne PM, Langevin HM | title = Electrical properties of acupuncture points and meridians: a systematic review | journal = Bioelectromagnetics | volume = 29 | issue = 4 | pages = 245–56 | date = May 2008 | pmid = 18240287 | doi = 10.1002/bem.20403 | s2cid = 7001749 | url = https://mn.uio.no/fysikk/english/research/projects/bioimpedance/publications/papers/meridian_rev.pdf | access-date = 2 March 2012 | archive-date = 18 May 2021 | archive-url = https://web.archive.org/web/20210518004121/https://www.mn.uio.no/fysikk/english/research/projects/bioimpedance/publications/papers/meridian_rev.pdf | url-status = live }}</ref> Human tests to determine whether electrical continuity was significantly different near meridians than other places in the body have been inconclusive.<ref name="Ahn2008"/> Scientific research has not supported the existence of ''qi'', meridians, or yin and yang.{{efn|name=SinghErnst2008}}<ref name="Ahn2008"/><ref name=Mann2000>{{cite book | last = Mann | first = F | author-link = Felix Mann | isbn = 978-0750648578 | publisher = [[Elsevier Health Sciences|Elsevier]] | year = 2000 | title = Reinventing Acupuncture: A New Concept of Ancient Medicine}}</ref> A ''[[Nature (journal)|Nature]]'' editorial described TCM as "fraught with pseudoscience", with the majority of its treatments having no logical [[mechanism of action]].<ref name=swallow>{{cite journal | title = Hard to swallow | journal = Nature | volume = 448 | issue = 7150 | pages = 105–06 | date = July 2007 | pmid = 17625521 | doi = 10.1038/448106a | bibcode = 2007Natur.448S.105. | doi-access = free }}</ref> [[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."<ref name=Barrett2007/> Academic discussions of acupuncture still make reference to pseudoscientific concepts such as ''qi'' and meridians despite the lack of scientific evidence.<ref name=Ulett2002/>

====Release of endorphins or adenosine====
Some modern practitioners support the use of acupuncture to treat pain, but have abandoned the use of ''qi'', meridians, ''yin'', ''yang'' and other mystical energies as an explanatory frameworks.<ref name="Peñas2010">{{cite book |last1=de las Peñas |first1=César Fernández |last2=Arendt-Nielsen |first2=Lars |last3=Gerwin |first3=Robert D |name-list-style=vanc |title=Tension-type and cervicogenic headache: pathophysiology, diagnosis, and management |publisher=[[Jones & Bartlett Learning]] |year=2010 |isbn=978-0763752835 |pages=251–54 |url=https://books.google.com/books?id=HpRwMB-cNCoC&pg=PA251 |access-date=27 January 2016 |archive-date=4 February 2023 |archive-url=https://web.archive.org/web/20230204181953/https://books.google.com/books?id=HpRwMB-cNCoC&pg=PA251 |url-status=live }}</ref><ref name=Mann2000/><ref name=Williams2013/> 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.<ref name=Ulett2002/>

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.<ref name=Williams2013>{{cite encyclopedia | last = Williams | first = WF | title = Encyclopedia of Pseudoscience: From Alien Abductions to Zone Therapy | isbn = 978-1135955229 | encyclopedia = [[Encyclopedia of Pseudoscience: From Alien Abductions to Zone Therapy|Encyclopedia of Pseudoscience]] | publisher = [[Routledge]] | year = 2013 | pages = 3–4 | url = https://books.google.com/books?id=vH1EAgAAQBAJ }}</ref><ref name=Ulett2002>{{cite book | last = Ulett | first = GA | title = The Skeptic: Encyclopedia of Pseudoscience | publisher = [[ABC-CLIO]] | editor = [[Michael Shermer|Shermer, M]] | isbn = 978-1576076538 | chapter-url = https://books.google.com/books?id=Gr4snwg7iaEC&pg=PA283 | pages = 283–91 | chapter = Acupuncture | year = 2002 }}</ref> Some studies suggest acupuncture causes a series of events within the [[central nervous system]],<ref name=Wang2008>{{cite journal | vauthors = Wang SM, Kain ZN, White P | title = Acupuncture analgesia: I. The scientific basis | journal = Anesthesia and Analgesia | volume = 106 | issue = 2 | pages = 602–10 | date = February 2008 | pmid = 18227322 | doi = 10.1213/01.ane.0000277493.42335.7b | s2cid = 29330113 | doi-access = free }}</ref> and that it is possible to inhibit acupuncture's analgesic effects with the opioid antagonist [[naloxone]].<ref>{{cite journal | vauthors = Staud R, Price DD | title = Mechanisms of acupuncture analgesia for clinical and experimental pain | journal = Expert Review of Neurotherapeutics | volume = 6 | issue = 5 | pages = 661–67 | date = May 2006 | pmid = 16734514 | doi = 10.1586/14737175.6.5.661 | s2cid = 2647845 }}</ref> Mechanical deformation of the skin by acupuncture needles appears to result in the release of [[adenosine]].<ref name=Berman2010/> The [[Nociception|anti-nociceptive]] effect of acupuncture may be mediated by the [[adenosine A1 receptor]].<ref>{{cite journal | vauthors = Langevin HM | title = Acupuncture, connective tissue, and peripheral sensory modulation | journal = Critical Reviews in Eukaryotic Gene Expression | volume = 24 | issue = 3 | pages = 249–53 | year = 2014 | pmid = 25072149 | doi = 10.1615/CritRevEukaryotGeneExpr.2014008284 }}</ref> A 2014 review in ''Nature Reviews Cancer'' analyzed mouse studies that suggested acupuncture relieves pain via the local release of adenosine, which then triggered nearby A1 receptors. The review found that in those studies, because acupuncture "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."<ref name=Gorski2014/>