Acupuncture Hint

7/29/2019 Acupuncture Hint

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AcupunctureFrom Wikipedia, the free encyclopedia

Acupuncture

Medicine: CAM

NCCAM: Alternative Medical Systems[1]

NCCAM: Energy Medicine[2]

Modality: Professionalized

Culture: East/West

Acupuncture chart from Hua Shou (fl. 1340s,Ming Dynasty). This image from Shi si jing fa hui (Expression of the

Fourteen Meridians).(Tokyo : Suharaya Heisuke kanko, Kyoho gan 1716).

Acupuncture is the procedure of inserting and manipulatingfiliform needles into various points

on the body to relievepainor for therapeutic purposes.[3] The word acupuncture comes from the

Latin acus, "needle", andpungere, "to prick". InStandard Chinese, acupuncture is called

(zhnbin), or a related word, (zhnji), which refers to acupuncture together

withmoxibustion.[4]According totraditional Chinese medicine,acupuncture points are situated

on meridiansalong which qi(a "life energy"), flows. Modern acupuncture texts present them as

ideas that are useful in clinical practice and continue to inform the practice of acupuncture, but
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there is no evidence to support their existence and they have not been reconciled with

contemporary knowledge about biology, physics or chemistry.

The earliest written record of acupuncture is the Chinese text Shiji(, English: Records of the

Grand Historian) with elaboration of its history in the second century BCE medical text Huangdi

Neijing(, English: Yellow Emperor's Inner Canon). Different variations of acupuncture

are practiced and taught throughout the world. Acupuncture has been the subject of

active scientific research since the late 20th century but it remains controversial among

conventional medical researchers and clinicians. Due to the invasive nature of acupuncture

treatments, it is difficult to create studies that use properscientific controls. Some scholarly

reviews have concluded that the effectiveness of acupuncture as a treatment can be explained

largely through theplacebo effect,[15][16] while other studies have suggested some efficacy in the

treatment of specific conditions.[10][17][18] The World Health Organization published a review of

controlled trials using acupuncture and concluded it was effective for the treatment of 28

conditions and there was evidence to suggest it may be effective for several dozen more, though

this review has been criticized by several scientists for bias and a focus on studies with a poor

methodology.[20][21]Reports from theNational Center for Complementary and Alternative

Medicine (NCCAM), theAmerican Medical Association (AMA) and various government reports

have studied and commented on the efficacy (or lack thereof) of acupuncture. There is general

agreement that acupuncture is safe when administered by well-trained practitioners using sterile

needles, and that further research is appropriate.[11][22][23][24]

Contents[hide]

1 History

o 1.1 Antiquity

o 1.2 Middle history

o 1.3 Modern era

2 Traditional theory

o 2.1 Traditional Chinese medicine

o 2.2 Acupuncture points and meridians

o 2.3 Traditional diagnosis

o 2.4 Traditional Chinese medicine perspective

o 2.5 Criticism of traditional Chinese medicine theory

3 Clinical practice
http://en.wikipedia.org/wiki/Chinahttp://en.wikipedia.org/wiki/Records_of_the_Grand_Historianhttp://en.wikipedia.org/wiki/Records_of_the_Grand_Historianhttp://en.wikipedia.org/wiki/Huangdi_Neijinghttp://en.wikipedia.org/wiki/Huangdi_Neijinghttp://en.wikipedia.org/wiki/Scientific_methodhttp://en.wikipedia.org/wiki/Scientific_controlhttp://en.wikipedia.org/wiki/Scientific_controlhttp://en.wikipedia.org/wiki/Placebo_effecthttp://en.wikipedia.org/wiki/Placebo_effecthttp://en.wikipedia.org/wiki/Acupuncture#cite_note-14%23cite_note-14http://en.wikipedia.org/wiki/Acupuncture#cite_note-Ernst_2006-02-15%23cite_note-Ernst_2006-02-15http://en.wikipedia.org/wiki/Acupuncture#cite_note-pmid17265547-9%23cite_note-pmid17265547-9http://en.wikipedia.org/wiki/Acupuncture#cite_note-Cochrane_back_2005-16%23cite_note-Cochrane_back_2005-16http://en.wikipedia.org/wiki/Acupuncture#cite_note-pmid15266478-17%23cite_note-pmid15266478-17http://en.wikipedia.org/wiki/World_Health_Organizationhttp://en.wikipedia.org/wiki/Acupuncture#cite_note-Lancet_WHO_2005-19%23cite_note-Lancet_WHO_2005-19http://en.wikipedia.org/wiki/Acupuncture#cite_note-TorT70-20%23cite_note-TorT70-20http://en.wikipedia.org/wiki/Acupuncture#cite_note-TorT70-20%23cite_note-TorT70-20http://en.wikipedia.org/wiki/National_Center_for_Complementary_and_Alternative_Medicinehttp://en.wikipedia.org/wiki/National_Center_for_Complementary_and_Alternative_Medicinehttp://en.wikipedia.org/wiki/National_Center_for_Complementary_and_Alternative_Medicinehttp://en.wikipedia.org/wiki/American_Medical_Associationhttp://en.wikipedia.org/wiki/American_Medical_Associationhttp://en.wikipedia.org/wiki/Acupuncture#cite_note-NIH-1997consensus-10%23cite_note-NIH-1997consensus-10http://en.wikipedia.org/wiki/Acupuncture#cite_note-NCCAM2006-Acupuncture-21%23cite_note-NCCAM2006-Acupuncture-21http://en.wikipedia.org/wiki/Acupuncture#cite_note-pmid12801494-22%23cite_note-pmid12801494-22http://en.wikipedia.org/wiki/Acupuncture#cite_note-23%23cite_note-23http://toggletoc%28%29/http://en.wikipedia.org/wiki/Acupuncture#History%23Historyhttp://en.wikipedia.org/wiki/Acupuncture#Antiquity%23Antiquityhttp://en.wikipedia.org/wiki/Acupuncture#Middle_history%23Middle_historyhttp://en.wikipedia.org/wiki/Acupuncture#Modern_era%23Modern_erahttp://en.wikipedia.org/wiki/Acupuncture#Traditional_theory%23Traditional_theoryhttp://en.wikipedia.org/wiki/Acupuncture#Traditional_Chinese_medicine%23Traditional_Chinese_medicinehttp://en.wikipedia.org/wiki/Acupuncture#Acupuncture_points_and_meridians%23Acupuncture_points_and_meridianshttp://en.wikipedia.org/wiki/Acupuncture#Traditional_diagnosis%23Traditional_diagnosishttp://en.wikipedia.org/wiki/Acupuncture#Traditional_Chinese_medicine_perspective%23Traditional_Chinese_medicine_perspectivehttp://en.wikipedia.org/wiki/Acupuncture#Criticism_of_traditional_Chinese_medicine_theory%23Criticism_of_traditional_Chinese_medicine_theoryhttp://en.wikipedia.org/wiki/Acupuncture#Clinical_practice%23Clinical_practicehttp://en.wikipedia.org/wiki/Chinahttp://en.wikipedia.org/wiki/Records_of_the_Grand_Historianhttp://en.wikipedia.org/wiki/Records_of_the_Grand_Historianhttp://en.wikipedia.org/wiki/Huangdi_Neijinghttp://en.wikipedia.org/wiki/Huangdi_Neijinghttp://en.wikipedia.org/wiki/Scientific_methodhttp://en.wikipedia.org/wiki/Scientific_controlhttp://en.wikipedia.org/wiki/Placebo_effecthttp://en.wikipedia.org/wiki/Acupuncture#cite_note-14%23cite_note-14http://en.wikipedia.org/wiki/Acupuncture#cite_note-Ernst_2006-02-15%23cite_note-Ernst_2006-02-15http://en.wikipedia.org/wiki/Acupuncture#cite_note-pmid17265547-9%23cite_note-pmid17265547-9http://en.wikipedia.org/wiki/Acupuncture#cite_note-Cochrane_back_2005-16%23cite_note-Cochrane_back_2005-16http://en.wikipedia.org/wiki/Acupuncture#cite_note-pmid15266478-17%23cite_note-pmid15266478-17http://en.wikipedia.org/wiki/World_Health_Organizationhttp://en.wikipedia.org/wiki/Acupuncture#cite_note-Lancet_WHO_2005-19%23cite_note-Lancet_WHO_2005-19http://en.wikipedia.org/wiki/Acupuncture#cite_note-TorT70-20%23cite_note-TorT70-20http://en.wikipedia.org/wiki/National_Center_for_Complementary_and_Alternative_Medicinehttp://en.wikipedia.org/wiki/National_Center_for_Complementary_and_Alternative_Medicinehttp://en.wikipedia.org/wiki/American_Medical_Associationhttp://en.wikipedia.org/wiki/Acupuncture#cite_note-NIH-1997consensus-10%23cite_note-NIH-1997consensus-10http://en.wikipedia.org/wiki/Acupuncture#cite_note-NCCAM2006-Acupuncture-21%23cite_note-NCCAM2006-Acupuncture-21http://en.wikipedia.org/wiki/Acupuncture#cite_note-pmid12801494-22%23cite_note-pmid12801494-22http://en.wikipedia.org/wiki/Acupuncture#cite_note-23%23cite_note-23http://toggletoc%28%29/http://en.wikipedia.org/wiki/Acupuncture#History%23Historyhttp://en.wikipedia.org/wiki/Acupuncture#Antiquity%23Antiquityhttp://en.wikipedia.org/wiki/Acupuncture#Middle_history%23Middle_historyhttp://en.wikipedia.org/wiki/Acupuncture#Modern_era%23Modern_erahttp://en.wikipedia.org/wiki/Acupuncture#Traditional_theory%23Traditional_theoryhttp://en.wikipedia.org/wiki/Acupuncture#Traditional_Chinese_medicine%23Traditional_Chinese_medicinehttp://en.wikipedia.org/wiki/Acupuncture#Acupuncture_points_and_meridians%23Acupuncture_points_and_meridianshttp://en.wikipedia.org/wiki/Acupuncture#Traditional_diagnosis%23Traditional_diagnosishttp://en.wikipedia.org/wiki/Acupuncture#Traditional_Chinese_medicine_perspective%23Traditional_Chinese_medicine_perspectivehttp://en.wikipedia.org/wiki/Acupuncture#Criticism_of_traditional_Chinese_medicine_theory%23Criticism_of_traditional_Chinese_medicine_theoryhttp://en.wikipedia.org/wiki/Acupuncture#Clinical_practice%23Clinical_practice


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o 3.1 An example of acupuncture treatment

o 3.2 Indications according to acupuncturists in the West

4 Scientific theories and mechanisms of action

o 4.1 Gate-control theory of pain

o 4.2 Neurohormonal theory

[edit]History

[edit]Antiquity

Acupuncture's origins in China are uncertain. One explanation is that some soldiers wounded in

battle byarrows were cured of chronic afflictions that were otherwise untreated, [25]and there are

variations on this idea.[26]

In China, the practice of acupuncture can perhaps be traced as far backas the Stone Age, with the Bian shi, or sharpened stones.[27] In 1963 a bianstone was found in

Duolon County, Mongolia, pushing the origins of acupuncture into the Neolithicage.

[28] Hieroglyphs andpictographshave been found dating from the Shang Dynasty(1600-1100

BCE) which suggest that acupuncture was practiced along with moxibustion. [29]Despite

improvements in metallurgyover centuries, it was not until the 2nd century BCE during the Han

Dynasty that stone and bone needles were replaced with metal. [28] The earliest records of

acupuncture is in the Shiji(, in English,Records of the Grand Historian) with references in

later medical texts that are equivocal, but could be interpreted as discussing acupuncture. The

earliest Chinese medical text to describe acupuncture is the Huangdi Neijing, the

legendary Yellow Emperor's Classic of Internal Medicine (History of Acupuncture) which was

compiled around 305204 B.C. The Huangdi Neijingdoes not distinguish between acupuncture

andmoxibustion and gives the same indication for both treatments. TheMawangduitexts, which

also date from the second century BC though antedating both the ShijiandHuangdi Neijing,

mentions the use of pointed stones to open abscessesand moxibustion but not acupuncture, but

by the second century BCE, acupuncture replaced moxibustion as the primary treatment of

systemic conditions.[9]

In Europe, examinations of the 5,000-year-old mummified body oftzi the Iceman have identified

15 groups oftattooson his body, some of which are located on what are now seen as

contemporary acupuncture points. This has been cited as evidence that practices similar to

acupuncture may have been practiced elsewhere in Eurasia during the earlyBronze Age.[30]

[edit]Middle history

Acupuncture spread from China to Korea,Japan and Vietnam and elsewhere in East Asia.
http://en.wikipedia.org/wiki/Acupuncture#An_example_of_acupuncture_treatment%23An_example_of_acupuncture_treatmenthttp://en.wikipedia.org/wiki/Acupuncture#Indications_according_to_acupuncturists_in_the_West%23Indications_according_to_acupuncturists_in_the_Westhttp://en.wikipedia.org/wiki/Acupuncture#Scientific_theories_and_mechanisms_of_action%23Scientific_theories_and_mechanisms_of_actionhttp://en.wikipedia.org/wiki/Acupuncture#Gate-control_theory_of_pain%23Gate-control_theory_of_painhttp://en.wikipedia.org/wiki/Acupuncture#Neurohormonal_theory%23Neurohormonal_theoryhttp://en.wikipedia.org/w/index.php?title=Acupuncture&action=edit&section=1http://en.wikipedia.org/w/index.php?title=Acupuncture&action=edit&section=1http://en.wikipedia.org/w/index.php?title=Acupuncture&action=edit&section=2http://en.wikipedia.org/w/index.php?title=Acupuncture&action=edit&section=2http://en.wikipedia.org/wiki/Arrowhttp://en.wikipedia.org/wiki/Arrowhttp://en.wikipedia.org/wiki/Acupuncture#cite_note-24%23cite_note-24http://en.wikipedia.org/wiki/Acupuncture#cite_note-24%23cite_note-24http://en.wikipedia.org/wiki/Acupuncture#cite_note-25%23cite_note-25http://en.wikipedia.org/wiki/Acupuncture#cite_note-25%23cite_note-25http://en.wikipedia.org/wiki/Chinahttp://en.wikipedia.org/wiki/Chinahttp://en.wikipedia.org/wiki/Acupuncture#cite_note-26%23cite_note-26http://en.wikipedia.org/wiki/Acupuncture#cite_note-26%23cite_note-26http://en.wikipedia.org/wiki/Mongoliahttp://en.wikipedia.org/wiki/Mongoliahttp://en.wikipedia.org/wiki/Neolithichttp://en.wikipedia.org/wiki/Neolithichttp://en.wikipedia.org/wiki/Acupuncture#cite_note-Chiu-27%23cite_note-Chiu-27http://en.wikipedia.org/wiki/Pictogramhttp://en.wikipedia.org/wiki/Pictogramhttp://en.wikipedia.org/wiki/Pictogramhttp://en.wikipedia.org/wiki/Shang_Dynastyhttp://en.wikipedia.org/wiki/Acupuncture#cite_note-28%23cite_note-28http://en.wikipedia.org/wiki/Acupuncture#cite_note-28%23cite_note-28http://en.wikipedia.org/wiki/Metallurgyhttp://en.wikipedia.org/wiki/Metallurgyhttp://en.wikipedia.org/wiki/Han_Dynastyhttp://en.wikipedia.org/wiki/Han_Dynastyhttp://en.wikipedia.org/wiki/Acupuncture#cite_note-Chiu-27%23cite_note-Chiu-27http://en.wikipedia.org/wiki/Records_of_the_Grand_Historianhttp://en.wikipedia.org/wiki/Records_of_the_Grand_Historianhttp://en.wikipedia.org/wiki/Huangdi_Neijinghttp://en.wikipedia.org/wiki/Huangdi_Neijinghttp://en.wikipedia.org/wiki/Yellow_Emperorhttp://en.wikipedia.org/wiki/Yellow_Emperorhttp://en.wikipedia.org/wiki/Moxibustionhttp://en.wikipedia.org/wiki/Moxibustionhttp://en.wikipedia.org/wiki/Mawangduihttp://en.wikipedia.org/wiki/Mawangduihttp://en.wikipedia.org/wiki/Abscesshttp://en.wikipedia.org/wiki/Abscesshttp://en.wikipedia.org/wiki/Acupuncture#cite_note-Prioreschi2004-8%23cite_note-Prioreschi2004-8http://en.wikipedia.org/wiki/Acupuncture#cite_note-Prioreschi2004-8%23cite_note-Prioreschi2004-8http://en.wikipedia.org/wiki/%C3%96tzi_the_Icemanhttp://en.wikipedia.org/wiki/Tattoohttp://en.wikipedia.org/wiki/Tattoohttp://en.wikipedia.org/wiki/Tattoohttp://en.wikipedia.org/wiki/Eurasiahttp://en.wikipedia.org/wiki/Bronze_Agehttp://en.wikipedia.org/wiki/Bronze_Agehttp://en.wikipedia.org/wiki/Acupuncture#cite_note-29%23cite_note-29http://en.wikipedia.org/w/index.php?title=Acupuncture&action=edit&section=3http://en.wikipedia.org/w/index.php?title=Acupuncture&action=edit&section=3http://en.wikipedia.org/wiki/Koreahttp://en.wikipedia.org/wiki/Japanhttp://en.wikipedia.org/wiki/Japanhttp://en.wikipedia.org/wiki/Vietnamhttp://en.wikipedia.org/wiki/Acupuncture#An_example_of_acupuncture_treatment%23An_example_of_acupuncture_treatmenthttp://en.wikipedia.org/wiki/Acupuncture#Indications_according_to_acupuncturists_in_the_West%23Indications_according_to_acupuncturists_in_the_Westhttp://en.wikipedia.org/wiki/Acupuncture#Scientific_theories_and_mechanisms_of_action%23Scientific_theories_and_mechanisms_of_actionhttp://en.wikipedia.org/wiki/Acupuncture#Gate-control_theory_of_pain%23Gate-control_theory_of_painhttp://en.wikipedia.org/wiki/Acupuncture#Neurohormonal_theory%23Neurohormonal_theoryhttp://en.wikipedia.org/w/index.php?title=Acupuncture&action=edit&section=1http://en.wikipedia.org/w/index.php?title=Acupuncture&action=edit&section=2http://en.wikipedia.org/wiki/Arrowhttp://en.wikipedia.org/wiki/Acupuncture#cite_note-24%23cite_note-24http://en.wikipedia.org/wiki/Acupuncture#cite_note-25%23cite_note-25http://en.wikipedia.org/wiki/Chinahttp://en.wikipedia.org/wiki/Acupuncture#cite_note-26%23cite_note-26http://en.wikipedia.org/wiki/Mongoliahttp://en.wikipedia.org/wiki/Neolithichttp://en.wikipedia.org/wiki/Acupuncture#cite_note-Chiu-27%23cite_note-Chiu-27http://en.wikipedia.org/wiki/Pictogramhttp://en.wikipedia.org/wiki/Shang_Dynastyhttp://en.wikipedia.org/wiki/Acupuncture#cite_note-28%23cite_note-28http://en.wikipedia.org/wiki/Metallurgyhttp://en.wikipedia.org/wiki/Han_Dynastyhttp://en.wikipedia.org/wiki/Han_Dynastyhttp://en.wikipedia.org/wiki/Acupuncture#cite_note-Chiu-27%23cite_note-Chiu-27http://en.wikipedia.org/wiki/Records_of_the_Grand_Historianhttp://en.wikipedia.org/wiki/Huangdi_Neijinghttp://en.wikipedia.org/wiki/Yellow_Emperorhttp://en.wikipedia.org/wiki/Moxibustionhttp://en.wikipedia.org/wiki/Mawangduihttp://en.wikipedia.org/wiki/Abscesshttp://en.wikipedia.org/wiki/Acupuncture#cite_note-Prioreschi2004-8%23cite_note-Prioreschi2004-8http://en.wikipedia.org/wiki/%C3%96tzi_the_Icemanhttp://en.wikipedia.org/wiki/Tattoohttp://en.wikipedia.org/wiki/Eurasiahttp://en.wikipedia.org/wiki/Bronze_Agehttp://en.wikipedia.org/wiki/Acupuncture#cite_note-29%23cite_note-29http://en.wikipedia.org/w/index.php?title=Acupuncture&action=edit&section=3http://en.wikipedia.org/wiki/Koreahttp://en.wikipedia.org/wiki/Japanhttp://en.wikipedia.org/wiki/Vietnam


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Around ninety works on acupuncture were written in China between theHan Dynasty and

the Song Dynasty, and the Emperor Renzong of Song, in 1023, ordered the production of a

bronze statuette depicting the meridians and acupuncture points then in use. However, after the

end of the Song Dynasty, acupuncture and its practitioners began to be seen as a technical

rather than scholarly profession. It became more rare in the succeeding centuries, supplanted by

medications and became associated with the less prestigious practices of

shamanism, midwiferyand moxibustion.[31]Portuguese missionaries in the 16th century were

among the first to bring reports of acupuncture to the West. [32]Jacob de Bondt, a Danish surgeon

travelling in Asia, described the practice in both Japan and Java. However, in China itself the

practice was increasingly associated with the lower-classes and illiterate practitioners. [33] The first

European text on acupuncture was written by Willem ten Rhijne, a Dutch physician who studied

the practice for two years in Japan. It consisted of an essay in a 1683 medical text on arthritis;

Europeans were also at the time becoming more interested in moxibustion, which ten Rhijne alsowrote about.[34] In 1757 the physician Xu Daqun described the further decline of acupuncture,

saying it was a lost art, with few experts to instruct; its decline was attributed in part to the

popularity of prescriptions and medications, as well as its association with the lower classes. [35]

In 1822, an edict from the Chinese Emperor banned the practice and teaching of acupuncture

within the Imperial Academy of Medicine outright, as unfit for practice by gentlemen-scholars. At

this point, acupuncture was still cited in Europe with both skepticism and praise, with little study

and only a small amount of experimentation.[36]

[edit]Modern era

In the 1970s, acupuncture became better known in the United States after an article appeared

inThe New York Times by James Reston, who underwent an emergency appendectomywhile

visiting China. While standardanesthesia was used for the actual surgery, Mr. Reston was

treated with acupuncture for post-operative discomfort. [37]The National Acupuncture Association

(NAA), the first national association of acupuncture in the US, introduced acupuncture to the

West through seminars and research presentations. The NAA created and staffed the UCLA

Acupuncture Pain clinic in 1972. This was the first legal clinic in a medical school setting in the

US.[citation needed] The first acupuncture clinic in the United States is claimed to have been opened by

Dr. Yao Wu Lee in Washington, D.C. on July 9, 1972. [38][unreliable source?] The Internal Revenue

Serviceallowed acupuncture to be deducted as a medical expense beginning in 1973. [39]

In 2006, a BBC documentaryAlternative Medicine filmed a patient undergoing open heart surgery

allegedly under acupuncture-induced anaesthesia. It was later revealed that the patient had been

given a cocktail of weak anaesthetics that in combination could have a much more powerful
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effect. The program was also criticised for its fanciful interpretation of the results of a brain

scanning experiment.[40][41][42]

Cosmetic acupunctureis also being increasingly used in attempts to reduce wrinkles and age-

lines.[43][44]

[edit]Traditional theory

Needles being inserted into a patient's skin.

[edit]Traditional Chinese medicine

This article includes alist of references, related reading orexternal links, but itssources remain unclear because it lacksinline citations. Please improvethis

article by introducing more precise citations where appropriate.(December 2008)

Main article: Traditional Chinese medicine

TCM is based on a pre-scientificparadigmof medicine that developed over several thousand

years and involves concepts that have no counterpart within contemporary medicine.[11] In TCM,

the body is treated as a whole that is composed of several "systems of function" known as

the zang-fu (). These systems are named after specific organs, though the systems and

organs are not directly associated. The zangsystems are associated with the solid,yin organs

such as the liverwhile the fu systems are associated with the hollow yangorganssuch as

the intestines. Health is explained as a state of balance between the yin and yang, with disease

ascribed to either of these forces being unbalanced, blocked or stagnant. The yangforce is the

immaterial qi, a concept that is roughly translated as "vital energy". The yin counterpart is Blood,

which is linked to but not identical with physical blood, and capitalized to distinguish the two. TCMuses a variety of interventions, including pressure, heat and acupuncture applied to the

body'sacupuncture points (in Chinese orxue meaning "cavities") to modify the activity of

the zang-fu.

[edit]Acupuncture points and meridians

See also:Acupuncture pointandMeridian (Chinese medicine)
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Classical texts describe most[dubiousdiscuss] of the main acupuncture points as existing on the twelve

main and two of eight extra meridians (also referred to as mai) for a total of fourteen "channels"

through which qiand Blood flow. Other points not on the fourteen channels are also needled.

Local pain is treated by needling the tender "ashi" points where qior Blood is believed to have

stagnated. The zang-fu of the twelve main channels are Lung, Large Intestine, Stomach, Spleen,

Heart, Small Intestine, Bladder, Kidney, Pericardium, Gall Bladder, Liver and the intangible San

Jiao. The eight other pathways, referred to collectively as the qi jing ba mai, include the Luo

Vessels, Divergents, Sinew Channels, ren maiand du maithough only the latter two

(corresponding to the anterior and posteriorsagittal plane of the torso respectively) are needled.

The remaining six qi jing ba maiare manipulated by needling points on the twelve main

meridians.

Normally qiis described as flowing through each channel in a continuous circuit. In addition, each

channel has a specific aspect and occupies two hours of the "Chinese clock".

Flow ofqithrough the meridians

Zang-fu Aspect Hours

Lung taiyin 0300-0500

Large Intestine yangming 0500-0700

Stomach yangming 0700-0900

Spleen taiyin 0900-1100

Heart shaoyin 1100-1300

Small Intestine taiyang 1300-1500

Bladder taiyang 1500-1700

Kidney shaoyin 1700-1900

Pericardium jueyin 1900-2100

San Jiao shaoyang 2100-2300

Gallbladder shaoyang 2300-0100

Liver jueyin 0100-0300

Lung (repeats cycle)

The zang-fu are divided into yin and yangchannels, with three of each type located on each

limb. Qiis believed to move in a circuit through the body, travelling both superficially and deeply.The external pathways correspond to the acupuncture points shown on an acupuncture chart

while the deep pathways correspond to where a channel enters the bodily cavity related to each

organ. The three yin channels of the hand (Lung, Pericardium, and Heart) begin on the chest and

travel along the inner surface of the arm to the hand. The three yang channels of the hand (Large

Intestine, San Jiao, and Small Intestine) begin on the hand and travel along the outer surface of
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the arm to the head. The three yin channels of the foot (Spleen, Liver, and Kidney) begin on the

foot and travel along the inner surface of the leg to the chest or flank. The three yang channels of

the foot (Stomach, Gallbladder, and Urinary Bladder) begin on the face, in the region of the eye,

and travel down the body and along the outer surface of the leg to the foot. Each channel is also

associated with a yin oryangaspect, either "absolute" (jue-), "lesser" (shao-), "greater" (tai-) or

"brightness" (-ming).

A standard teaching text comments on the nature and relationship of meridians (or channels) and

the Zang Fu organs:

The theory of the channels is interrelated with the theory of the Organs. Traditionally, the internal Organs

have never been regarded as independent anatomical entities. Rather, attention has centered upon the

functional and pathological interrelationships between the channel network and the Organs. So close is this

identification that each of the twelve traditional Primary channels bears the name of one or another of the

vital Organs. In the clinic, the entire framework of diagnostics, therapeutics and point selection is based

upon the theoretical framework of the channels."It is because of the twelve Primary channels that people

live, that disease is formed, that people are treated and disease arises." [(Spiritual Axis, chapter 12)]. From

the beginning, however, we should recognize that, like other aspects of traditional medicine, channel theory

reflects the limitations in the level of scientific development at the time of its formation, and is therefore

tainted with the philosophical idealism and metaphysics of its day. That which has continuing clinical value

needs to be reexamined through practice and research to determine its true nature .[5]

The meridians are part of the controversy in the efforts to reconcile acupuncture with conventional

medicine. TheNational Institutes of Health 1997 consensus development statement on

acupuncture stated that acupuncture points, Qi, the meridian system and related theories play an

important role in the use of acupuncture, but are difficult to relate to a contemporaryunderstanding of the body.[11] Chinese medicine forbade dissection, and as a result the

understanding of how the body functioned was based on a system that related to the world

around the body rather than its internal structures. The 365 "divisions" of the body were based on

the number of days in a year, and the twelve meridians proposed in the TCM system are thought

to be based on the twelve major rivers that run through China. However, these ancient traditions

of Qi and meridians have no counterpart in modern studies ofchemistry,biology andphysics and

to date scientists have been unable to find evidence that supports their existence. [7]A 2008

review ofelectrical impedance studies concluded that although results were suggestive, the

studies available were of poor quality with significant limitations, and because of this there was no

clear evidence to demonstrate the existence of acupuncture points or meridians.[45]

[edit]Traditional diagnosis
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The acupuncturist decides which points to treat by observing and questioning the patient in order

to make a diagnosis according to the tradition which he or she utilizes. In TCM, there are four

diagnostic methods: inspection, auscultation and olfaction, inquiring, and palpation. [46]

Inspection focuses on the face and particularly on the tongue, including analysis of thetongue size, shape, tension, color and coating, and the absence or presence of teeth marks

around the edge.

Auscultation and olfaction refer, respectively, to listening for particular sounds (such as

wheezing) and attending to body odor.

Inquiring focuses on the "seven inquiries", which are: chills and fever; perspiration;

appetite, thirst and taste; defecation and urination; pain; sleep; and menses and leukorrhea.

Palpation includes feeling the body for tender "ashi" points, and palpation of the left and

right radial pulses at two levels of pressure (superficial and deep) and three positions Cun,

Guan, Chi(immediately proximal to the wrist crease, and one and two fingers' breadth

proximally, usually palpated with the index, middle and ring fingers).

Other forms of acupuncture employ additional diagnostic techniques. In many forms of classical

Chinese acupuncture, as well as Japanese acupuncture, palpation of the muscles and

thehara (abdomen) are central to diagnosis.

[edit]Traditional Chinese medicine perspective

Although TCM is based on the treatment of "patterns of disharmony" rather than biomedical

diagnoses, practitioners familiar with both systems have commented on relationships between

the two. A given TCM pattern of disharmony may be reflected in a certain range of biomedical

diagnoses: thus, the pattern called Deficiency of Spleen Qi could manifest as chronic fatigue,

diarrhea or uterine prolapse. Likewise, a population of patients with a given biomedical diagnosis

may have varying TCM patterns. These observations are encapsulated in the TCM aphorism

"One disease, many patterns; one pattern, many diseases". (Kaptchuk, 1982)

Classically, in clinical practice, acupuncture treatment is typically highly individualized and based

on philosophical constructs as well as subjective and intuitive impressions, and not on controlled

scientific research.[47]

[edit]Criticism of traditional Chinese medicine theory

Felix Mann, founder and past-president of the Medical Acupuncture Society (19591980), the first

president of the British Medical Acupuncture Society[48] (1980), and the author of the first

comprehensive English language acupuncture textbookAcupuncture: The Ancient Chinese Art of
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Healingfirst published in 1962, has stated in his book Reinventing Acupuncture: A New Concept

of Ancient Medicine:

"The traditional acupuncture points are no more real than the black spots a drunkard

sees in front of his eyes." (p. 14)

and...

"The meridians of acupuncture are no more real than the meridians of geography. If

someone were to get a spade and tried to dig up the Greenwich meridian, he might end

up in a lunatic asylum. Perhaps the same fate should await those doctors who believe in

[acupuncture] meridians." (p. 31)[8]

Felix Mann tried to join up his medical knowledge with that of Chinese theory. In spite

of his protestations about the theory, he was fascinated by it and trained many people

in the west with the parts of it he borrowed. He also wrote many books on this subject.His legacy is that there is now a college in London and a system of needling that is

known as "Medical Acupuncture". Today this college trains Doctors and western

medical professionals only.

Medical acupuncture has caused much controversy amongst traditional practitioners;

the British Acupuncture Council wished for it to be called 'treatment using needles',

and removing from it the title 'Acupuncture', as it is so different to traditional methods

but have had to retract this after pressure from the medical profession. Mann proposed

that the acupuncture points related to the nerve endings and he reassigned the pointsdifferent uses. He altered the theory so that the treatments given are no longer

individual to each client, a central premise of traditional theory. Traditionally the needle

combinations differ according to the age of the client, the length of time they had the

condition, the type of pain they experience and their health history. In medical

acupuncture none of this is addressed and the presenting symptom is treated using a

set group of points.

A report forCSICOP on pseudoscience in China written by Wallace Sampson

andBarry Beyersteinsaid:

"A few Chinese scientists we met maintained that although Qi is merely a metaphor, it is

still a useful physiological abstraction (e.g., that the related concepts ofYin and

Yangparallel modern scientific notions of endocrinologic [sic] and metabolic feedback

mechanisms). They see this as a useful way to unite Eastern and Western medicine.
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Their more hard-nosed colleagues quietly dismissed Qi as only a philosophy, bearing no

tangible relationship to modern physiology and medicine."[49]

George A. Ulett, MD, PhD, Clinical Professor of Psychiatry, University of Missouri

School of Medicine states:

"Devoid of metaphysical thinking, acupuncture becomes a rather simple technique that

can be useful as a nondrug method of pain control." He believes that the traditional

Chinese variety is primarily a placebo treatment, but electrical stimulation of about 80

acupuncture points has been proven useful for pain control." [50]

Ted J. Kaptchuk,[51] author ofThe Web That Has No Weaver, refers to

acupuncture as "prescientific." Regarding TCM theory, Kaptchuk states:

"These ideas are cultural and speculative constructs that provide orientation and direction

for the practical patient situation. There are few secrets of Oriental wisdom buried here.When presented outside the context of Chinese civilization, or of practical diagnosis and

therapeutics, these ideas are fragmented and without great significance. The "truth" of

these ideas lies in the way the physician can use them to treat real people with real

complaints." (1983, pp. 34-35)[52]

According to the 1997 NIHconsensus statement on acupuncture:

"Despite considerable efforts to understand the anatomy and physiology of the

"acupuncture points", the definition and characterization of these points remains

controversial. Even more elusive is the basis of some of the key traditional Easternmedical concepts such as the circulation ofQi, the meridian system, and the five phases

theory, which are difficult to reconcile with contemporary biomedical information but

continue to play an important role in the evaluation of patients and the formulation of

treatment in acupuncture."[11]

At least one study found that acupuncture "seems to alleviate

pain just barely better than sticking needles into nonspecified

parts of the body"[53] and concluded that some of acupuncture's

effects may be due to the placebo effect.

According toThe Straight Dope, a popular question-and-answer

newspaper column published in theChicago Reader:

"Traditional acupuncture theory is a quaint patchwork of folklore with about as much

relevance to current medical practice as medieval European notions about the four bodily
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humors. While it may be useful as a guide to future research, no scientist would regard it

as satisfactory as it stands.".[54]

[edit]Clinical practice

One type of acupuncture needle

Most modern acupuncturists use disposable stainless

steel needles of fine diameter(0.007 to 0.020 in (0.18 to

0.51 mm)), sterilized with ethylene oxideor byautoclave.

These needles are far smaller in diameter (and therefore

less painful) thanhypodermic injection needlessince they

do not have to be hollow for purposes of injection. The

upper third of these needles is wound with a thicker wire

(typically bronze), or covered in plastic, to stiffen the needle

and provide a handle for the acupuncturist to grasp while

inserting. The size and type of needle used, and the depth

of insertion, depend on the acupuncture style beingpracticed.

Warming an acupuncture point, typically

bymoxibustion (the burning of a combination of herbs,

primarilymugwort), is a different treatment than

acupuncture itself and is often, but not exclusively, used as

a supplemental treatment. The Chinese term zhn ju (

), commonly used to refer to acupuncture, comes

from zhen meaning "needle", andjiu meaning"moxibustion". Moxibustion is used to varying degrees

among current schools of oriental medicine. For example,

one well-known technique is to insert the needle at the

desired acupuncture point, attach dried moxa to the

external end of an acupuncture needle, and then ignite it.
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The moxa will then smolder for several minutes (depending

on the amount adhered to the needle) and conduct heat

through the needle to the tissue surrounding the needle in

the patient's body. Another common technique is to hold a

large glowing stick of moxa over the needles. Moxa is also

sometimes burned at the skin surface, usually by applying

an ointment to the skin to protect from burns, though

burning of the skin is general practice in China.

[edit]An example of acupuncture treatment

In Western medicine, vascular headaches (the kind that are

accompanied by throbbing veinsin thetemples) are

typically treated with analgesics such as aspirin and/or by

the use of agents such as niacin that dilate the affected

blood vessels in the scalp, but in acupuncture a common

treatment for such headaches is to stimulate the sensitive

points that are located roughly in the centers of the webs

between the thumbs and the palms of the patient's hands,

the h g points. These points are described by

acupuncture theory as "targeting the face and head" and

are considered to be the most important points when

treating disorders affecting the face and head. The patient

reclines, and the points on each hand are first sterilized

with alcohol, and then thin, disposable needles are inserted

to a depth of approximately 35 mm until a characteristic

"twinge" is felt by the patient, often accompanied by a slight

twitching of the area between the thumb and hand..

In the clinical practice of acupuncturists, patients frequently

report one or more of certain kinds of sensation that are

associated with this treatment:

1.Extreme sensitivity to pain at the points in the

webs of the thumbs.

2.In bad headaches, a feeling of nausea that

persists for roughly the same period as the
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stimulation being administered to the webs of the

thumbs.

3.Simultaneous relief of the headache.[55]

[edit]Indications according toacupuncturists in the West

The American Academy ofMedical Acupuncture (2004)

states: "In the United States, acupuncture has its greatest

success and acceptance in the treatment of

musculoskeletal pain.".[56]They say that acupuncture may

be considered as a complementary therapy for the

conditions in the list below, noting: "Most of these

indications are supported by textbooks or at least 1 journal

article. However, definitive conclusions based on research

findings are rare because the state of acupuncture

research is poor but improving."[56]

Abdominal distention/flatulence

Acute and chronic pain control

Allergic sinusitis

Anesthesia for high-risk patients

with previous adverse responses to anesthetics

Anorexia

Anxiety, fright, panic

Arthritis/arthrosis

Atypical chest pain (negative

workup)

Bursitis, tendinitis, carpal tunnel

syndrome

Certain functional gastrointestinal

disorders (nausea and vomiting,

esophageal spasm, hyperacidity,

irritable bowel) *

Cervical and lumbar spine

syndromes

Cough with

contraindications for

narcotics

Drug detoxification is

suggested[57] but evidence is

poor[58][59][60]

Dysmenorrhea, pelvic

pain

Frozen shoulder

Headache (migraine and

tension-type), vertigo

(Meniere disease), tinnitus

Idiopathic palpitations,

sinus tachycardia

In fractures, assisting in

pain control, edema, and

enhancing healing process

Muscle spasms, tremors,

tics, contractures

Plantar fasciitis

Post-traumatic and

post-operative ileus

Selected dermatoses

(urticaria, pruritus,

eczema, psoriasis)

Sequelae of stroke

syndrome (aphasia,

hemiplegia)

Seventh nerve palsy

Severe

hyperthermia

Sprains and

contusions

Temporo-

mandibular joint

derangement, bruxism

Urinary

incontinence, retention
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Constipation, diarrhea

Neuralgias (trigeminal,

herpes zoster, postherpetic

pain, other)

Paresthesias

Persistent hiccups

Phantom pain

(neurogenic, spastic,

adverse drug effect)

Weight Loss

[edit]Scientific theories andmechanisms of action

Many hypotheses have been proposed to address the

physiological mechanisms of action of acupuncture.[61]

[edit]Gate-control theory of pain

The gate control theory of pain (developed by Ronald

Melzack and Patrick Wall in 1962[62] and in 1965)

[63] proposed thatpain perception is not simply a direct

result of activatingpain fibers, but modulated by interplay

between excitation and inhibition of these pain pathways.

According to the theory, the gating of pain is controlled by

the inhibitory action on the pain pathways. That is,

the perceptionof pain can be altered (gated on or off) by a

number of means, via psychology, pharmacology, orphysiology. The gate-control theory was developed

inneuroscienceindependent of acupuncture, which later

was proposed as a mechanism to account for the

hypothesized analgesic action of acupuncture in thebrain

stemreticular formationby a German neuroscientist in

1976.[64]

This leads to the theory of central control of pain gating,

i.e., pain blockade at the brain (i.e., central to the brainrather than at the spinal cord or periphery) via the release

ofendogenousopioid neurohormones, such as the

endogenous opioid-binding polypeptides, classified as

eitherendorphinsorenkephalins.

[edit]Neurohormonal theory
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Modern acupuncture model.

Pain transmission can also be modulated at many otherlevels in the brain along the pain pathways, including

the periaqueductal gray,thalamus, and the feedback

pathways from thecerebral cortex back to the thalamus.

Pain blockade at these brain locations is often mediated

byneurohormones, especially those that bind to

the opioidreceptors (pain-blockade site).

Some studies suggest that the analgesicaction of

acupuncture is associated with the release of natural

endorphins in the brain. This effect can be inferred by

blocking the action of endorphins (or morphine) using a

drug called naloxone. When naloxone is administered to

the patient, the analgesic effects of morphine can be

reduced, causing the patient to feel a more appropriate

level of pain. When naloxone is administered to an

acupunctured patient, the analgesic effect of acupuncture

can also be reversed, causing the patient to report an

increased level of pain.[65][66][67][68] It should be noted,

however, that studies using similar procedures, including

the administration of naloxone, have suggested a role of

endogenous opioids in the placebo response,

demonstrating that this response is not unique to

acupuncture.[69]
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One study performed on monkeys by recording the neural

activity directly in the thalamus of the brain indicated that

acupuncture's analgesic effect lasted more than an hour.

[70] Furthermore, there is a large overlap between the

nervous system and acupuncture trigger points (points of

maximum tenderness) in myofascial pain syndrome.[71]

Evidence suggests that the sites of action

ofanalgesia associated with acupuncture include

the thalamususing fMRI (functional magnetic resonance

imaging)[72] and PET (positron emission tomography)

[73]brain imagingtechniques,[74] and via the feedback

pathway from thecerebral cortex usingelectrophysiological

recording of the nerve impulses of neurons directly in the

cortex, which shows inhibitory action when acupuncture

stimulus is applied.[75] Similar effects have been observed in

association with the placebo response. One study using

fMRI found that placebo analgesia was associated with

decreased activity in the thalamus, insula and anterior

cingulate cortex.[76]

Recently, acupuncture has been shown to increase

the nitric oxidelevels in treated regions, resulting inincreased local blood circulation.[77][78] Effects on local

inflammation and ischemia have also been reported. [79]

[edit]Scientific research into efficacy

This section mayrequire cleanupto meet

Wikipedia'squality

standards. Please improve this

section if you can. (May 2008)

[edit]Issues in study design

One of the major challenges in acupuncture research is in

the design of an appropriate placebocontrol group.[12] In

trials of new drugs, double blinding is the accepted

standard, but since acupuncture is a procedure rather than

a pill, it is difficult to design studies in which both the
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e&action=edit&section=18http://en.wikipedia.org/wiki/Placebohttp://en.wikipedia.org/wiki/Control_grouphttp://en.wikipedia.org/wiki/Acupuncture#cite_note-pmid12184353-11%23cite_note-pmid12184353-11http://en.wikipedia.org/wiki/Double_blinding


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acupuncturist and patient are blinded as to the treatment

being given. The same problem arises in double-blinding

procedures used in biomedicine, including virtually all

surgical procedures, dentistry, physical therapy, etc. As

the Institute of Medicine states:

Controlled trials of surgical procedures have been done less

frequently than studies of medications because it is much more

difficult to standardize the process of surgery. Surgery depends to

some degree on the skills and training of the surgeon and the

specific environment and support team available to the surgeon. A

surgical procedure in the hands of a highly skilled, experienced

surgeon is different from the same procedure in the hands of an

inexperienced and unskilled surgeon... For many CAM modalities,

it is similarly difficult to separate the effectiveness of the treatment

from the effectiveness of the person providing the treatment.[14]:126

Blinding of the practitioner in acupuncture remains

challenging. One proposed solution to blinding patients has

been the development of "sham acupuncture", i.e.,

needling performed superficially or at non-acupuncture

sites. Controversy remains over whether, and under what

conditions, sham acupuncture may function as a true

placebo, particularly in studies onpain, in which insertion of

needles anywhere near painful regions may elicit abeneficial response.[11][13]A review in 2007 noted several

issues confounding sham acupuncture:

Weak physiologic activity of superficial or sham needle

penetration is suggested by several lines of research,

including RCTs showing larger effects of a superficial needle

penetrating acupuncture than those of a nonpenetrating sham

control, positron emission tomography research indicating that

sham acupuncture can stimulate regions of the brain associated

with natural opiate production, and animal studies showing that

sham needle insertion can have nonspecific analgesic effectsthrough a postulated mechanism of diffuse noxious inhibitory

control. Indeed, superficial needle penetration is a common

technique in many authentic traditional Japanese acupuncture

styles.[80]

An analysis of 13 studies of pain treatment with

acupuncture, published in January 2009 in the journal BMJ,
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concluded there was little difference in the effect of real,

sham and no acupuncture.[81]

[edit]Evidence-based medicine

There is scientific agreement that an evidence-based

medicine (EBM) framework should be used to assess

health outcomes and that systematic reviews with strict

protocols are essential. Organizations such as

the Cochrane Collaboration and Bandolierpublish such

reviews. In practice, EBM is "about integrating individual

clinical expertise and the best external evidence" and thus

does not demand that doctors ignore research outside its

"top-tier" criteria.[82]

The development of the evidence base for acupuncture

was summarized in a review by researcherEdzard

Ernstand colleagues in 2007. They compared systematic

reviews conducted (with similar methodology) in 2000 and

2005:

The effectiveness of acupuncture remains a controversial

issue. ... The results indicate that the evidence base has

increased for 13 of the 26 conditions included in this comparison.

For 7 indications it has become more positive (i.e. favoring

acupuncture) and for 6 it had changed in the opposite direction. It

is concluded, that acupuncture research is active. The emerging

clinical evidence seems to imply that acupuncture is effective for

some but not all conditions.[10]

For acute low back pain there is insufficient evidence to

recommend for or against either acupuncture ordry

needling, though for chronic low back pain acupuncture is

more effective than sham treatment but no more effective

than conventional and alternative treatments for short-term

pain relief and improving function. However, when

combined with other conventional therapies, the

combination is slightly better than conventional therapy

alone.[17][83] A review for the American Pain

Society/American College of Physicians found fair evidence

that acupuncture is effective for chronic low back pain. [84]
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There are both positive[85] and negative[86] reviews regarding

the effectiveness of acupuncture when combined with in

vitro fertilisation.

A

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