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==Acupuncture and moxibustion== {{Main|Acupuncture|Moxibustion}} [[File:Acupuncture1-1.jpg|thumb|200px|Needles being inserted into the skin]] [[File:Ming Bronze Acupuncture Statue.jpg|thumb|300x300px|A bronze acupuncture statue from the Ming dynasty being displayed inside a museum]] Acupuncture is the insertion of needles into superficial structures of the body (skin, subcutaneous tissue, muscles) – usually at acupuncture points (acupoints) – and their subsequent manipulation; this aims at influencing the flow of [[qi]].<ref name="Npn8K">{{cite web |url=http://consensus.nih.gov/1997/1997Acupuncture107html.htm |publisher=National Institutes of Health |title=Acupuncture – Consensus Development Conference Statement |date=5 November 1997 |access-date=3 February 2007 |archive-url=https://web.archive.org/web/20110825052220/http://consensus.nih.gov/1997/1997Acupuncture107html.htm |archive-date=25 August 2011 |url-status=live}}</ref> According to TCM it relieves [[pain]] and treats (and prevents) various diseases.<ref name="Dorlands">{{cite book | vauthors = Novak PD, Dorland NW, Dorland WA |title=Dorland's Pocket Medical Dictionary |publisher=W.B. Saunders |location=Philadelphia |year=1995 |edition= 25th |isbn=978-0-7216-5738-7 |oclc=33123537 |title-link=Dorland's Pocket Medical Dictionary}}</ref> The US FDA classifies single-use acupuncture needles as Class II medical devices, under CFR 21.<ref name="PwhYY">{{cite web|title=CFR – Code of Federal Regulations Title 21|url=https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/cfrsearch.cfm?fr=880.5580|website=FDA US Food and Drug Administration|publisher=U.S. Department of Health and Human Services|access-date=4 March 2018|archive-url=https://web.archive.org/web/20190327071747/https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/cfrsearch.cfm?fr=880.5580|archive-date=27 March 2019|url-status=live}}</ref> Acupuncture is often accompanied by moxibustion – the Chinese characters for acupuncture ({{zh|labels=no|s=针灸|t=針灸|p=zhēnjiǔ}}) literally meaning "acupuncture-moxibustion" – which involves burning [[mugwort]] on or near the skin at an acupuncture point.<ref name="MAT">{{cite web |url=http://acupuncturetoday.com/abc/moxibustion.php |title=Moxibustion, Acupuncture Today |publisher=Acupuncturetoday.com |access-date=17 May 2011 |archive-url=https://web.archive.org/web/20110811033311/http://acupuncturetoday.com/abc/moxibustion.php |archive-date=11 August 2011 |url-status=live}}</ref> According to the [[American Cancer Society]], "available scientific evidence does not support claims that moxibustion is effective in preventing or treating cancer or any other disease".<ref name="acs-moxi">{{cite web |title=Moxibustion |url=http://www.cancer.org/treatment/treatmentsandsideeffects/complementaryandalternativemedicine/manualhealingandphysicaltouch/moxibustion |publisher=[[American Cancer Society]] |date=8 March 2011 |access-date=15 August 2013 |archive-url=https://web.archive.org/web/20130809061732/http://www.cancer.org/treatment/treatmentsandsideeffects/complementaryandalternativemedicine/manualhealingandphysicaltouch/moxibustion |archive-date=9 August 2013 |url-status=live}}</ref> In [[electroacupuncture]], an electric current is applied to the needles once they are inserted, to further stimulate the respective acupuncture points.<ref name="Robertson2006">{{cite book | vauthors = Robertson V, Ward A, Low J, Reed A |title=Electrotherapy explained: principles and practice |publisher=[[Elsevier Health Sciences]] |year=2006 |isbn=978-0-7506-8843-7}}</ref> A recent historian of Chinese medicine remarked that it is "nicely ironic that the specialty of acupuncture – arguably the most questionable part of their medical heritage for most Chinese at the start of the twentieth century – has become the most marketable aspect of Chinese medicine." She found that acupuncture as we know it today has hardly been in existence for sixty years. Moreover, the fine, [[Glossary of botanical terms#filiform|filiform]] needle we think of as the acupuncture needle today was not widely used a century ago. Present day acupuncture was developed in the 1930s and put into wide practice only as late as the 1960s.{{sfnb|Andrews|2013a|pp=237–238}} ===Efficacy=== {{Further|Acupuncture#Efficacy|Acupuncture#Safety}} A 2013 editorial in the American journal ''[[Anesthesia and Analgesia]]'' stated that acupuncture studies produced inconsistent results, (i.e. acupuncture relieved pain in some conditions but had no effect in other very similar conditions) which suggests the presence of [[Type I and type II errors#Type I error|false positive results]]. These may be caused by factors like biased study design, poor blinding, and the classification of electrified needles (a type of [[Transcutaneous electrical nerve stimulation|TENS]]) as a form of acupuncture. The inability to find consistent results despite more than 3,000 studies, the editorial continued, suggests that the treatment seems to be a [[placebo effect]] and the existing equivocal positive results are the type of [[statistical noise|noise]] one expects to see after a large number of studies are performed on an inert therapy. The editorial concluded that the best controlled studies showed a clear pattern, in which the outcome does not rely upon needle location or even needle insertion, and since "these variables are those that define acupuncture, the only sensible conclusion is that acupuncture does not work."<ref name="Colquhoun2013">{{cite journal | vauthors = Colquhoun D, Novella SP | title = Acupuncture is theatrical placebo | journal = Anesthesia and Analgesia | volume = 116 | issue = 6 | pages = 1360–3 | date = June 2013 | pmid = 23709076 | doi = 10.1213/ANE.0b013e31828f2d5e | url = http://www.dcscience.net/Colquhoun-Novella-A&A-2013.pdf | access-date = 3 June 2020 | url-status = live | author2-link = Steven Novella | s2cid = 207135491 | archive-url = https://web.archive.org/web/20181120055409/http://www.dcscience.net/Colquhoun-Novella-A%26A-2013.pdf | archive-date = 20 November 2018 | author-link = David Colquhoun }}</ref> According to the US NIH National Cancer Institute, a review of 17,922 patients reported that real acupuncture relieved muscle and joint pain, caused by aromatase inhibitors, much better than sham acupuncture.<ref name="nihnci">{{cite web|last1=U.S. National Institute of Health|title=Complementary and Alternative Medicine: Questions and Answers About Acupuncture|url=https://www.cancer.gov/about-cancer/treatment/cam/patient/acupuncture-pdq#section/_3|publisher=National Cancer Institute|access-date=4 March 2018|date=11 May 2006|archive-url=https://web.archive.org/web/20180304172443/https://www.cancer.gov/about-cancer/treatment/cam/patient/acupuncture-pdq#section/_3|archive-date=4 March 2018|url-status=live}}</ref> Regarding cancer patients, the review hypothesized that acupuncture may cause physical responses in nerve cells, the pituitary gland, and the brain – releasing proteins, hormones, and chemicals that are proposed to affect blood pressure, body temperature, immune activity, and endorphin release.<ref name="nihnci" /> A 2012 meta-analysis concluded that the mechanisms of acupuncture "are clinically relevant, but that an important part of these total effects is not due to issues considered to be crucial by most acupuncturists, such as the correct location of points and depth of needling ... [but is] ... associated with more potent placebo or context effects".<ref name="XsseQ">{{cite journal | vauthors = Vickers AJ, Cronin AM, Maschino AC, Lewith G, MacPherson H, Foster NE, Sherman KJ, Witt CM, Linde K | display-authors = 6 | title = Acupuncture for chronic pain: individual patient data meta-analysis | journal = Archives of Internal Medicine | volume = 172 | issue = 19 | pages = 1444–53 | date = October 2012 | pmid = 22965186 | pmc = 3658605 | doi = 10.1001/archinternmed.2012.3654 }}</ref> Commenting on this meta-analysis, both [[Edzard Ernst]] and David Colquhoun said the results were of negligible clinical significance.<ref name="Jha">{{cite news | vauthors = Jha A | title = Acupuncture useful, but overall of little benefit, study shows | url = https://www.theguardian.com/science/2012/sep/10/acupuncture-useful-little-benefit-study | newspaper = [[The Guardian]] | date = 10 September 2012 | access-date = 18 December 2016 | archive-url = https://web.archive.org/web/20170104002226/https://www.theguardian.com/science/2012/sep/10/acupuncture-useful-little-benefit-study | archive-date = 4 January 2017 | url-status = live}}</ref><ref name="Colquhoun">{{cite journal |last1=Colquhoun |first1=David |title=Re: Risks of acupuncture range from stray needles to pneumothorax, finds study |website=BMJ |url=https://www.bmj.com/content/345/bmj.e6060/rr/603200 |date=17 September 2012 |access-date=10 January 2022 |archive-date=11 January 2022 |archive-url=https://web.archive.org/web/20220111091904/https://www.bmj.com/content/345/bmj.e6060/rr/603200 |url-status=live }} Reply to: {{cite journal |last1=Kmietowicz |first1=Z. |title=Risks of acupuncture range from stray needles to pneumothorax, finds study |journal=BMJ |date=7 September 2012 |volume=345 |issue=sep07 2 |pages=e6060 |doi=10.1136/bmj.e6060 |pmid=22960463 |s2cid=32788662 }}</ref> A 2011 overview of [[Cochrane Collaboration|Cochrane reviews]] found evidence that suggests acupuncture is effective for some but not all kinds of pain.<ref name="pmid21359919">{{cite journal | vauthors = Lee MS, Ernst E | title = Acupuncture for pain: an overview of Cochrane reviews | journal = Chinese Journal of Integrative Medicine | volume = 17 | issue = 3 | pages = 187–9 | date = March 2011 | pmid = 21359919 | doi = 10.1007/s11655-011-0665-7 | s2cid = 21513259 }}</ref> A 2010 systematic review found that there is evidence "that acupuncture provides a short-term clinically relevant effect when compared with a waiting list control or when acupuncture is added to another intervention" in the treatment of chronic low back pain.<ref name="VlCfc">{{cite journal | vauthors = Rubinstein SM, van Middelkoop M, Kuijpers T, Ostelo R, Verhagen AP, de Boer MR, Koes BW, van Tulder MW | display-authors = 6 | title = A systematic review on the effectiveness of complementary and alternative medicine for chronic non-specific low-back pain | journal = European Spine Journal | volume = 19 | issue = 8 | pages = 1213–28 | date = August 2010 | pmid = 20229280 | pmc = 2989199 | doi = 10.1007/s00586-010-1356-3 }}</ref> Two review articles discussing the effectiveness of acupuncture, from 2008 and 2009, have concluded that there is not enough evidence to conclude that it is effective beyond the placebo effect.<ref name="RetractingNeedleStudies">{{cite book | vauthors = Singh S, Ernst EE | author-link1 = Simon Singh |author-link2=Edzard Ernst | year = 2008 | title =Trick or treatment: The undeniable facts about alternative medicine | isbn = 978-0-393-06661-6 | publisher = [[W. W. Norton & Company]] | pages = 103–06 | chapter = The Truth about Acupuncture | quote="These initial conclusions have generally been disappointing for acupuncturists: They provide no convincing evidence that real acupuncture is significantly more effective than placebo." (p. 104)| title-link = Trick or Treatment}}</ref><ref name="Madsen2009">{{cite journal | vauthors = Madsen MV, Gøtzsche PC, Hróbjartsson A | title = Acupuncture treatment for pain: systematic review of randomised clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups | journal = BMJ | volume = 338 | pages = a3115 | date = January 2009 | pmid = 19174438 | pmc = 2769056 | doi = 10.1136/bmj.a3115 }}</ref> Acupuncture is generally safe when administered using Clean Needle Technique (CNT).<ref name="Xu S" /> Although serious [[adverse effects]] are rare, acupuncture is not without risk.<ref name="Xu S">{{cite journal | vauthors = Xu S, Wang L, Cooper E, Zhang M, Manheimer E, Berman B, Shen X, Lao L | display-authors = 6 | title = Adverse events of acupuncture: a systematic review of case reports | journal = Evidence-Based Complementary and Alternative Medicine | volume = 2013 | pages = 581203 | year = 2013 | pmid = 23573135 | pmc = 3616356 | doi = 10.1155/2013/581203 | doi-access = free }}</ref> Severe adverse effects, including very rarely death (five case reports), have been reported.<ref name="Ernst 2011">{{cite journal | vauthors = Ernst E, Lee MS, Choi TY | title = Acupuncture: does it alleviate pain and are there serious risks? A review of reviews | journal = Pain | volume = 152 | issue = 4 | pages = 755–764 | date = April 2011 | pmid = 21440191 | doi = 10.1016/j.pain.2010.11.004 | s2cid = 20205666 }}</ref>
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