Acupuncture

[[File:Acupuncture chart 300px.jpg|thumb|right|165px|[[Ming dynasty]] acupuncture chart.]]{{bronze}}{{Altmed}}
'''Acupuncture''' is a [[Traditional Chinese medicine|traditional Chinese therapy]] based on sticking needles into the dermis at [[Accuracy and precision|presumptively precise]] points along '[[meridians]]'. Acupuncture is often described as "gateway [[woo]]"<ref>[https://web.archive.org/web/20101205215259/http://scienceblogs.com/insolence/2008/11/thatll_teach_em_for_using_an_actual_vali.php That'll teach 'em for using an actual valid placebo control] by Orac (November 17, 2008 8:30 AM) ''Science Blogs'' (archived from December 5, 2010).</ref> because of the increasing number of scientists and medical centers accepting it as respectable treatment.

While many doctors don't believe in [[chi]] or meridians, it is widely believed that acupuncture is more effective than [[placebo|randomly stabbing someone with needles while telling them it helps]], despite a serious lack of quality [[Randomized controlled trial|randomized clinical trials]] (RCTs) and a nearly completely-unknown mechanism of action.<ref>[https://pubmed.ncbi.nlm.nih.gov/21611904/ Acupuncture for infertility: is it an effective therapy?] by Dong-mei Huang et al. (2011) ''Chin. J. Integr. Med.'' 2011;17(5):386-395. doi:10.1007/s11655-011-0611-8.</ref> This belief is apparently because needles have less of a "magic" vibe than other forms of woo. Despite spending considerable sums of [[money]], acupuncture researchers have yet to show consistent, [[statistically significant]], and relevant effects in proper clinical trials.<ref>[http://www.sciencebasedmedicine.org/index.php/acupuncture-for-migraine/ Acupuncture for Migraine] by Steven Novella (March 14, 2012) ''Science-Based Medicine''. "The best conclusion we can make today, based on all available evidence, is that acupuncture adds nothing to the non-specific effects of the attention from the practitioner."</ref> Although a few small-sample ([[Case-control study|case, or case series]]) studies including an n=57 randomized placebo-controlled study from 2009 suggest acupuncture can increase fertility in infertile patients,<ref>Dieterle S, Li C, Greb R, Bartzsch F, Hatzmann W, Huang D. A prospective randomized placebo-controlled study of the effect of acupuncture in infertile patients with severe oligoasthenozoospermia. ''Fertility and Sterility'' 2009;92(4):1340-1343. doi:10.1016/j.fertnstert.2009.02.041.</ref> as later editorials and papers asserted, these results, "should be considered preliminary awaiting further supporting evidence,"<ref>Niederberger C. A Prospective Randomized Placebo-Controlled Study of the Effect of Acupuncture in Infertile Patients With Severe Oligoasthenozoospermia Editorial Comment. ''The Journal of Urology'' 2010;183(5):1966-1966.</ref> and, "[t]he current evidence showing that acupuncture might improve poor semen quality is insufficient because of the small number of studies, inadequacy of procedures and/or insufficient information for semen analysis, high levels of heterogeneity, high risk of [[bias]], and poor quality of reporting. Further large, well-designed RCTs are required."<ref>Kwon O, Jerng U, Jo J-Y, Lee S, Lee J-M. The effectiveness and safety of acupuncture for poor semen quality in infertile males: a systematic review and meta-analysis. ''Asian Journal of Andrology'' 2014;16(6):884. doi:10.4103/1008-682X.129130.</ref>

==Technique==
[[File:Acupuncture for Skeptics.jpg|thumb|left|400px|Acupuncture can relieve anger, too.]]
Acupuncture's theoretical basis is that health and sickness are caused by the good or bad flow of [[chi]] through the body, in particular along the twelve major meridians of the body (though some authorities list fourteen or even more) which run from head to toe along the body, and which are associated with the bladder, gallbladder, heart, large intestine, small intestine, kidneys, liver, lungs, spleen, stomach, pericardium, and "triple heater" (三焦) also known as "triple burner" in English. "Triple heater" is by necessity a literal translation from the Chinese: as there is no such organ, there is no correct medical term for it.<ref group=note>Acupuncturists are aware of this, and say that this particular meridian does not associate with one organ, but instead three functions in the torso.</ref>

The acupuncturist treats the ailments of these various parts by inserting needles at points lying on these meridians, known simply as "acupuncture points" and manipulating the needles to increase or decrease the flow of chi along that meridian.

Variants on acupuncture include auricular acupuncture, which involves sticking needles into particular parts of the outer ear, which supposedly correspond to different body parts (essentially [[reflexology]] with ears instead of feet); electroacupuncture, in which the needle carries a small electric current; and moxibustion, in which moxa (the plant commonly known as [[mugwort]], ''Artemisia vulgaris'') is set smouldering on the appropriate acupuncture point. Acupuncture can also be used to perform [[bloodletting]].<ref name=acupuncture>[https://web.archive.org/web/20021003010203/http://www.itmonline.org/arts/bleeding.htm Bleeding Peripheral Points: An Acupuncture Technique] by Subhuti Dharmananda, ''Institute for Traditional Medicine'' (archived from October 3, 2002).</ref> This is supposed to be [[Panacea|good for a long list of unrelated diseases]]. Chinese bloodletting is banned in [[California]].<ref>[http://www.sciencebasedmedicine.org/index.php/california-reins-in-bloodletting/ ''California Forbids Chinese Bloodletting''] by Ben Kavoussi (December 16, 2010) ''Science-Based Medicine''.</ref>

==Origins==
[[File:Guo Xu album dated 1503 (2).jpg|thumb|right|165px|Shennong, eating a branch]]
[[File:Han Gold & Silver Acupuncture Needles (11867003425).jpg|thumb|right|165px|gold (top row) and silver needles from Han dynasty tombs]]
Unlike many remedies which appeal to the [[New Age]], acupuncture is genuinely [[Protoscience|pre-scientific]] and genuinely [[Asia]]n. The earliest surviving text dealing with acupuncture is the [[China|Chinese]] text ''The Yellow Emperor's Classic of Internal Medicine'', dating from rather uncertain origins ranging from 320 BCE to 220 CE.<ref>{{wpa|Huangdi Neijing|''Huangdi Neijing''}}</ref><ref name=lu>''Celestial Lancets: A History and Rationale of Acupuncture and Moxa'' by Lu Gwei-Djen & Joseph Needham (1980) Cambridge University Press. ISBN 0521215137.</ref>{{rp|69}} The transmission of acupuncture to [[Korea]] and [[Japan]] in the 6<sup>th</sup> century CE<ref>''Celestial Lancets: A History and Rationale of Acupuncture and Moxa.'' by Lu Gwei-Djen & Joseph Needham (1980) Cambridge University Press. ISBN 0700714588.</ref> though shows that it was in use well before any scientific understanding of disease, including [[germ theory]], [[cell theory]], and basic [[biology]] such as neurology. According to one [[myth]], acupuncture was invented by the Chinese [[god]] Shennong sometime around 3000 BCE.<ref>''Handbook of Chinese Mythology'' by Lihui Yang and Demming An (2008) Oxford University Press. ISBN 0195332636.</ref>{{rp|71-72,193}} Possible evidence of even earlier development of acupuncture exists in the form of neolithic period bone needles.<ref name=lu/>{{rp|72-73}} More convincing physical evidence in the form of gold needles came from the tomb of prince Liu Shêng {{lived||113 BCE}}.<ref name=lu/>{{rp|73-74}}

The origin of moxibustion is likely more recent than acupuncture, with the first possible references in lost books of the [[Han dynasty]] {{lived|202 BCE|220 CE}}, and the oldest definitive reference in the [[Imperial China#Three Kingdoms|Three Kingdoms period]] {{lived|220|280 CE}}.<ref name=lu/>{{rp|175-176}} Nonetheless, moxibustion and acupuncutre are closely intertwined, not just because of shared use of meridians but because of historical texts:
{{cquote|The ancients said that a man who understands drugs but does not know acupuncture, or one who knows acupuncture but does not know moxa, can never make a real physician (''shang i''). Truly moxibustion and acupunture are the most important of the techniques.|||Chin Li-Mêng, author of ''Chen Chiu Tsê Jih Pien (1447 CE).<ref name=lu/>{{rp|170}}}}

With the introduction of [[Evidence-based medicine|Western medical ideas]], acupuncture lost ground in China from the 17<sup>th</sup> century onwards. It regained some of its prestige, starting with [[Mao Zedong]] and the Chinese Communist Party advocating [[Traditional Chinese Medicine]] following the end of the [[Chinese Civil War]]. The publication in 1951 of ''The New Acupuncture'' by Zhu Lian<ref>''新针灸学'' (''Xin Zhenjiu Xue'') by 朱璉 (Zhu Lian) (1951) 人民出版社 (People's Publishers).</ref> was central to repopularizing acupuncture.<ref name=taylor>''Chinese Medicine in Early Communist China, 1945-1963: A Medicine of Revolution'' by Kim Taylor (2005). Routledge. ISBN 041534512X.</ref>{{rp|18}}

Although the basics of acupuncture have remained the same since ancient times, the system has suffered the inevitable mutations and accretions: the original system, for example, had as many as 365 acupuncture points, with classical texts (from 1600 CE and earlier) ranging from 295-667 named and bilateral points.<ref name=lu/>{{rp|100}} Notably, moxibustion has a mostly overlapping set of points but also includes different points.<ref name=lu/>{{rp|172-174}} Modern acupuncture systems catalog as many as 2000 points.<ref>[https://web.archive.org/web/20210124062059/https://acupuncturistseattle.com/acupuncture-learning-center/acupuncture-points/ What are Acupuncture Points? The Foundation of Acupuncture and the Triggers for Healing] by Derek Kirkham (archived from January 24, 2021).</ref> There is no [[science]] to support even one point, and inventing more of them just gets more patients to pay money.

==Efficacy==
[[File:Flickr - Official U.S. Navy Imagery - Cmdr. Yevsey Goldberg conducts an acupuncture procedure. (2).jpg|thumb|right|Your tax dollars at work of doing nothing at best, spreading disease at worst.]]
Sticking needles into people can cause the release into the bloodstream of endorphins and natural steroids such as cortisol. The medical version of this is called intramuscular stimulation and is of some use in the management of chronic [[pain]]. Acupuncture, to the extent it works, seems to do so in this manner. The pain relief from acupuncture seems to be mediated solely through the release of endorphins, as any perceived analgesic effect is reduced or eliminated when the patient has been pretreated with an opioid antagonist such as naloxone.<ref>[http://www.ncbi.nlm.nih.gov/pubmed/1654741 Interaction of diazepam and naloxone on acupuncture induced pain relief] by Eriksson SV, Lundeberg T, Lundeberg S. ''Am J Chin Med.'' (1991) 19(1):1-7. doi:10.1142/S0192415X91000028.</ref>

However, the few supposed studies that show efficacy have been criticized for poor design, poor analysis and poor results.<ref>[http://www.sciencebasedmedicine.org/index.php/another-overhyped-acupuncture-study-misinterpreted/ Another overhyped acupuncture study misinterpreted] by David Gorski (June 2, 2010) ''Science-Based Medicine''.</ref> In fact, if acupuncture were held to the same standards as all other medications and drugs, the poor quality of the studies would have prevented it from ever being approved for use by the [[FDA]].{{efn|"In summary, Ernst et al. have shown that the evidence for efficacy of acupuncture for the treatment of pain is questionable, to say the least, and of particular concern is that its use can be dangerous. If the 57 systematic reviews they surveyed had been for a prescription drug and a similar list of serious adverse effects had been reported for that drug, we would hesitate to prescribe that drug. Is there any reason not to hold acupuncture to the same standards?"<ref>[http://www.sciencebasedmedicine.org/index.php/acupuncture-revisited/#more-11765 Acupuncture Revisited] by Harriet Hall (March 29, 2011) ''Science-Based Medicine''.</ref>}} Many of the acupuncture trials that report positive results come from China, to such an extent that 99.8% of studies from the country were positive (in stark contrast to trials conducted in many other countries); some skeptics (both in China and abroad) speculated there could be a bias at play.<ref name="80pSBM">Mark Crislip (January 20, 2017). [https://sciencebasedmedicine.org/chinese-biomedical-research-sturgeons-law-in-action/ "Chinese BioMedical Research: Sturgeon’s Law In Action"]. ''Science-Based Medicine''.</ref><ref name="Ernst80p">Edzard Ernst (October 4, 2016). [https://edzardernst.com/2016/10/data-fabrication-in-china-is-an-open-secret/ "Data fabrication in China is an 'open secret'"].</ref> The results of an investigation by the Chinese government itself, reported in 2016, appeared to shed some light on the issue: over 80 percent of clinical trials in the country contained completely fabricated data, with "fraudulent behaviour at almost every level". This investigation did not examine trials for acupuncture or traditional Chinese medicine, but may cast further doubt on the integrity of mainland Chinese medical research, in general.<ref name="80pSBM"/><ref>Fiona MacDonald (September 30, 2016). [https://www.sciencealert.com/80-of-the-data-in-chinese-clinical-trial-is-fabricated "80% of Data in Chinese Clinical Trials Have Been Fabricated"]. ''ScienceAlert''.</ref><ref name="Ernst80p"/>{{efn|Though, the fact there was an investigation and exposure of the fraud may have indicated willingness by the government to improve the situation.}}

As to the wider claims of acupuncturists, it seems on the face of it unlikely, given the unscientific basis of their claims, that they can have much effect on a patient's physiology by manipulating the flow of a non-existent substance around imaginary meridians. The [[James Randi]] Educational Foundation noted that in studies using "no needles vs needles," the methodology of the study is an important consideration.<ref>[http://www.randi.org/site/index.php/swift-blog/673-does-chinese-acupuncture-affect-the-brains-ability-to-regulate-pain.html Does Chinese acupuncture affect the brain's ability to regulate pain?] by Christina Stephens (13 August 2009) ''James Randi Educational Foundation Swift Blog''.</ref>

===Acupuncture anesthesia===
The biggest publicity generator for TCM in [[the West]] was in the early 1970s with acupuncture analgesia allegedly used in surgery, which was publicized by James Reston, a ''[[New York Times]]'' reporter who accompanied then-Secretary of State [[Henry Kissinger]] to China in 1971, in preparation for President [[Richard Nixon]]'s visit in 1972. Reston had an emergency appendectomy while in China using conventional anesthesia,<ref name=taylor/>{{rp|138}} and received post-surgical acupuncture analgesia, which he described as causing diversionary pain.<ref>[https://web.archive.org/web/20140501205357/https://graphics8.nytimes.com/packages/pdf/health/1971acupuncture.pdf Now, About My Operation in Peking] by James Reston (July 26, 1971) ''The New York Times''. Pages 1 and 6. The acupuncture "sent ripples of pain racing through my limbs and, at least, had the effect of diverting my attention from the distress in my stomach."</ref> Acupuncture analgesia has been portrayed elsewhere as occurring ''during'' surgery,<ref name=taylor/>{{rp|138-140}} but this has largely been debunked: when acupuncture has been used during surgery, it has been used ''in addition to'' chemical sedatives.<ref>[https://journals.lww.com/anesthesia-analgesia/pages/articleviewer.aspx?year=2013&issue=06000&article=00025&type=Fulltext Acupuncture Is Theatrical Placebo] by David Colquhoun & Steven Novella (2013) ''Anesthesia & Analgesia'' 116(6):1360-1363.</ref><ref name=novella>[https://sciencebasedmedicine.org/acupuncture-doesnt-work/ Acupuncture Doesn't Work] by Steven Novella (June 19, 2013) ''Science-Based Medicine''.</ref><ref>"Acupuncture Anesthesia": A Proclamation from Chairman Mao: [https://sciencebasedmedicine.org/acupuncture-anesthesia-a-proclamation-of-chairman-mao-part-i/ Part I], [https://sciencebasedmedicine.org/acupuncture-anesthesia-a-proclamation-from-chairman-mao-part-ii/ Part II], [https://sciencebasedmedicine.org/acupuncture-anesthesia-a-proclamation-from-chairman-mao-part-iii/ Part III], and [[https://sciencebasedmedicine.org/acupuncture-anesthesia-a-proclamation-from-chairman-mao-part-iv/ Part IV] by Kimball Atwood (May 15, 2009 - June 26, 2009) ''Science-Based Medicine''.</ref><ref>[https://sciencebasedmedicine.org/acupuncture-anesthesia-redux-another-skeptic-and-an-unfortunate-misportrayal-at-the-nccam/ 'Acupuncture Anesthesia' Redux: another Skeptic and an Unfortunate Misportrayal at the NCCAM] by Kimball Atwood (July 24, 2009) ''Science-Based Medicine''.</ref>

===Intermittent diseases===
It is noticeable that acupuncturists tend chiefly to advertise their abilities to treat precisely those ailments which are chronic but intermittently better or worse (headaches, acne), or which often have a strong [[psychosomatic]] element (impotence, asthma), or which are guaranteed to clear up rapidly anyway (the common cold), and are therefore profiting from the [[placebo effect]] and [[regression to the mean]].<ref group=note>Probably unwittingly so.</ref>

===Death and disease===
It has also been found that far from curing disease, acupuncture has been a transmission agent for hepatitis C, [[Methicillin-resistant Staphylococcus aureus|Methicillin-resistant ''Staphylococcus aureus'']] and  acupuncture mycobacteriosis.<ref>[http://www.bmj.com/content/340/bmj.c1268.full Acupuncture transmitted infections] by Patrick C. Y. Woo et al. (2010) ''BMJ'' 340:c1268. doi:10.1136/bmj.c1268.</ref> In one prospective study of 190,924 acupuncture patients, the rate of "serious adverse events ([[death]], organ trauma or hospital admission)" was found to be 0.024%.<ref name="WHO2010">[https://pubmed.ncbi.nlm.nih.gov/21124716/ Acupuncture-related adverse events: a systematic review of the Chinese literature] by Junhua Zhang et al. ''Bulletin of the World Health Organization'' 2010;88:915-921C. doi:10.2471/BLT.10.076737</ref> In another prospective study of 229,230 patients, the rate of "adverse events requiring specific treatment" was found to be 2.2%.<ref name="WHO2010"/>

{{cquote|The final argument against acupuncture is the hardest to refute. Acupuncture needles are not without risk, having punctured hearts, lungs, and livers and transmitted viruses like [[HIV]], [[hepatitis B]], and hepatitis C. … At least eighty-six people have died from acupuncture."|||Paul A. Offit, MD<ref>''Do You Believe in Magic? Vitamins, Supplements, and All Things Natural: A Look Behind the Curtain'' by Paul A. Offit (2014) Harper. ISBN 0062222988.</ref>{{rp|233}}}}

Unfortunately, almost no reporting mechanism exists for acupuncture, and so the true harms are likely grossly underestimated.<ref>[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2951167/ Acupuncture – a treatment to die for?] by Edzard Ernst (2010) ''J. R. Soc. Med.'' 103(10):384–385. doi:10.1258/jrsm.2010.100181.</ref>

==Acupressure==
Acupressure is acupuncture without the needles.

Acupressure is part of the Western bundle of [[hypotheses]] and practices known as traditional Chinese medicine. You press on acupuncture pressure points to affect the meridian system and bring about relief by rebalancing [[Yin and yang|yin, yang]] and [[qi]]. Apparently.

===Effectiveness===
Considering the needles are the one bit of acupuncture that appears to do anything at all, with the rest of the [[bullshit|theory]] being [[woo]], acupressure is, unsurprisingly, not much good. Studies show<ref>[https://web.archive.org/web/20050924082237/http://consensus.nih.gov/1997/1997Acupuncture107html.htm Acupuncture: NIH Consensus Development Program (3–5 November 1997)] ''National Institutes of Health''.</ref> possible effects, such as interaction with the body's pain reduction systems, but at a level that is not statistically significant. [[WOMBAT|Studies are ongoing]]. At least it’s far less likely to spread blood-borne illnesses.

==See also==
*''[[Acupuncture Today]]''
*[[Acutonics]]
*[[Ear stapling]]
*[[Colorpuncture]]

==External links==
* [http://uk.news.yahoo.com/x-ray-reveals-hundreds-gold-needles-woman-39-143249373.html#lu5g3T6 X-Ray Reveals Hundreds of Gold Needles in Woman's Knees]

==Notes==
{{reflist|group=note}}

==References==
{{reflist|2|80%}}

{{altmedbox}}
[[Category:Alternative medicine]]
[[Category:Chinese medicine]]
[[Category:Energy therapy]]
[[Category:Manipulative therapy]]
[[Category:Orientalist woo]]

Categories: Alternative medicine, Chinese medicine, Energy therapy, Manipulative therapy, Orientalist woo