Antiquity The precise start date of acupuncture's use in China and how it evolved from early times are

uncertain. One explanation is that some soldiers wounded in battle by arrows were believed to have been cured of chronic afflictions that were otherwise untreated,[29] and there are variations on this idea.[30] Sharpened stones known as Bian shi have been found in China, suggesting the practice may date to the Neolithic[31] or possibly even earlier in the Stone Age.[32] Hieroglyphs andpictographs have been found dating from the Shang Dynasty (16001100 BCE) which suggest that acupuncture was practiced along with moxibustion.[33] It has also been suggested that acupuncture has its origins in bloodletting[34] or demonology.[35] Despite improvements in metallurgy over centuries, it was not until the 2nd century BCE during the Han Dynasty that stone and bone needles were replaced with metal.[31] The earliest examples of metal needles were found in a tomb dated to c. 113 BCE, though their use might not necessarily have been acupuncture. The earliest example of the unseen meridians used for diagnosis and treatment are dated to the second century BCE but these records do not mention needling, while the earliest reference to therapeutic needling occurs in the historical Shiji text (, English: Records of the Grand Historian) but does not mention the meridians and may be a reference to lancing rather than acupuncture.[36] The earliest written record of acupuncture is found in the Huangdi Neijing (; translated as The Yellow Emperor's Inner Canon), dated approximately 200 BCE.[35] It does not distinguish between acupuncture and moxibustion and gives the same indication for both treatments.[35] The Mawangdui texts, which also date from the 2nd century BCE (though antedating both the Shiji and Huangdi Neijing), mention the use of pointed stones to open abscesses, and moxibustion, but not acupuncture. However, by the 2nd

century BCE, acupuncture replaced moxibustion as the primary treatment of systemic conditions.[35] The practice of acupuncture expanded out of China into the areas now part of Japan, Korea and Taiwan, diverging from the narrower theory and practice of mainland TCM in the process.[37] A large number of contemporary practitioners outside of China follow these non-TCM practices, particularly in Europe.[38] In Europe, examinations of the 5,000-year-old mummified body of tzi the Iceman have identified 15 groups of tattoos on 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 early Bronze Age.[39] [edit]Middle history

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). Korea is believed to be the first country acupuncture spread to outside of China. Within Korea there is a legend that acupuncture was developed by the legendary emperor Dangun though it is more likely brought into Korea from a Chinese colonial prefecture.[40]

Around ninety works on acupuncture were written in China between the Han 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 lost status, and started to be seen as a technical profession, in comparison to the more scholarly profession of herbalism. It became rarer in the following centuries, and was associated with less prestigious practices like alchemy, shamanism, midwifery and moxibustion.[41] Portuguese missionaries in the 16th century were among the first to bring reports of acupuncture to the West.[42] Jacob de Bondt, a Dutch surgeon traveling 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.[43] In 1674, Hermann Buschoff, a Dutch priest in Batavia, published the first book on moxibustion (from Japanese mogusa) for the cure of arthritis. The first elaborate Western treatise on acupuncture was published in 1683 by Willem ten Rhijne, a Dutch physician who had worked at the Dutch trading post Dejima in Nagasakifor two years.[44] 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.[45] 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.[46] [edit]Modern era In the early years after the Chinese Civil War, Chinese Communist Party leaders ridiculed traditional Chinese

medicine, including acupuncture, as superstitious,irrational and backward, claiming that it conflicted with the Party's dedication to science as the way of progress. Communist Party Chairman Mao Zedong later reversed this position, saying that "Chinese medicine and pharmacology are a great treasure house and efforts should be made to explore them and raise them to a higher level."[47] Under Mao's leadership, in response to the lack of modern medical practitioners, acupuncture was revived and its theory rewritten to adhere to the political, economic and logistic necessities of providing for the medical needs of China's population. Despite Mao proclaiming the practice of Chinese medicine to be "scientific", the practice was based more on the materialist assumptions of Marxism in opposition to superstition rather than the Western practice of empirical investigation of nature. Later the 1950s TCM's theory was again rewritten at Mao's insistence as a political response to the lack of unity between scientific and traditional Chinese medicine, and to correct the supposed "bourgeois thought of Western doctors of medicine" (p. 109).[48] Acupuncture gained attention in the United States when President Richard Nixon visited China in 1972. During one part of the visit, the delegation was shown a patient undergoing major surgery while fully awake, ostensibly receiving acupuncture rather than anesthesia. Later it was found that the patients selected for the surgery had both a high pain tolerance and received heavy indoctrination before the operation; these demonstration cases were also frequently receiving morphine surreptitiously through an intravenous drip that observers were told contained only fluids and nutrients.[49] The greatest exposure in the West came when New York Times reporter James Reston, who accompanied Nixon during the visit, received acupuncture in China for post-operative pain after undergoing an emergency appendectomy under standard anesthesia. Reston experienced pain relief from the acupuncture and wrote it in The New York Times.[50] In 1973

the American Internal Revenue Serviceallowed acupuncture to be deducted as a medical expense.[51] In 2006, a BBC documentary Alternative Medicine filmed a patient undergoing open heart surgery allegedly under acupuncture-induced anesthesia. It was later revealed that the patient had been given a cocktail of weak anesthetics that in combination could have a much more powerful effect. The program was also criticized for its fanciful interpretation of the results of a brain scanning experiment.[52][53] The use of acupuncture as anesthesia for surgery has fallen out of favor with scientifically trained surgeons in China. A delegation of the Committee for Skeptical Inquiry reported in 1995: We were not shown acupuncture anesthesia for surgery, this apparently having fallen out of favor with scientifically trained surgeons. Dr. Han, for instance, had been emphatic that he and his colleagues see acupuncture only as an analgesic (pain reducer), not an anesthetic (an agent that blocks all conscious sensations).[49] [edit]Theory The general theory of acupuncture is based on the premise that bodily functions are regulated by an energy called qi which flows through the body; disruptions of this flow are believed to be responsible for disease.[1] Acupuncture describes a family of procedures aiming to correct imbalances in the flow of qi by stimulation of anatomical locations on or under the skin (usually called acupuncture points or acupoints), by a variety of techniques.[1] The most common mechanism of stimulation of acupuncture points employs penetration of the skin by thin metal needles, which are manipulated manually or by electrical stimulation.[1] [edit]Qi, meridians and acupuncture points Main articles: Qi, Traditional Chinese medicine#TCM model of the body, Meridian (Chinese medicine), and Acupuncture point

Old Chinese medical chart on acupuncture meridians Traditional Chinese medicine distinguishes not only one but several different kinds of qi ().[54] In a general sense, qi is something that is defined by five "cardinal functions":[54][55] 1. Actuation (, tudng) of all physical processes in the body, especially the circulation of all body fluids such as blood in their vessels. This includes actuation of the functions of the zang-fu organs and meridians. 2. Warming (, pinyin: wnx) the body, especially the limbs. 3. Defense (, pinyin: fngy) against Exogenous Pathogenic Factors 4. Containment (, pinyin: gsh) of body fluids, i.e. keeping blood, sweat, urine, semen etc. from leakage or excessive emission. 5. Transformation (, pinyin: qhu) of food, drink, and breath into qi, xue (blood), and jinye (fluids), and/or transformation of all of the latter into each other. To fulfill its functions, qi has to steadily flow from the inside of the body (where the zang-fu organs are located) to the "superficial" body tissues of the skin, muscles, tendons, bones, and joints. It is assisted in its flow by "channels" referred to

as meridians (, pinyin: jng-lu). TCM identifies 12 "regular" and 8 "extraordinary" meridians; the Chinese terms being (pinyin: sh-r jngmi, lit. "the Twelve Vessels") and (pinyin: q jng b mi) respectively.[56]There's also a number of less customary channels branching off from the "regular" meridians.[57] No contemporary research has supported the existence of qi or meridians.[12][58][3][4] The meridians are believed to connect to the bodily organs, of which those considered hollow organs (such as the stomach and intestines) were also considered yang while those considered solid (such as the liver and lungs) were considered yin. They were also symbolically linked to the rivers found in ancient China, such as the Yangtze, Wei and Yellow Rivers.[59] Acupuncture points are mainly (but not always) found at specified locations along the meridians. There also is a number of acupuncture points with specified locations outside of the meridians; these are called "extraordinary" points and often credited with special therapeutic properties. A third category of acupuncture points called "A-shi" points have no fixed location but represent tender or reflexive points appearing in the course of pain syndromes.[60] The actual number of points have varied considerably over time, initially they were considered to number 365, symbolically aligning with the number of days in the year (and in Han times, the number of bones thought to be in the body). The Huangdi Neijingmentioned only 160 and a further 135 could be deduced giving a total of 295. The modern total was once considered 670 but subsequently expanded due to more recent interest in auricular (ear) acupuncture and the treatment of further conditions. In addition, it is considered likely that some points used historically have since ceased being used.[61] [edit]TCM concept of disease Main article: Traditional Chinese medicine#Concept of disease In TCM, disease is generally perceived as a disharmony (or imbalance) in the functions or interactions of yin, yang, qi, xu, zng-f, meridians etc. and/or of the interaction between the

human body and the environment.[62] Therapy is based on which "pattern of disharmony" can be identified.[63][64] In the case of the meridians, typical disease patterns are invasions with wind, cold and damp Excesses.[65] In order to determine which pattern is at hand, practitioners will 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.[66][67] TCM and its concept of disease do not strongly differentiate between cause and effect.[68] In theory, however, endogenous, exogenous and miscellaneous causes of disease are recognized.[69] [edit]Traditional diagnosis 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.[70] Inspection focuses on the face and particularly on the tongue, including analysis of the tongue 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 A-shi 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). [edit]Tongue and pulse

Examination of the tongue and the pulse are among the principal diagnostic methods in traditional Chinese medicine. The surface of the tongue is believed to contain a map of the entire body, and is used to determine acupuncture points to manipulate. For example, teeth marks on one part of the tongue might indicate a problem with the heart, while teeth marks on another part of the tongue might indicate a problem with the liver.[66] TCM diagnosis also involves measuring for three superficial and three deep pulses at different locations on the radial artery of each arm, for a total of twelve pulses that are thought to correspond to twelve internal organs. The pulse is examined for several characteristics including rhythm, strength and volume, and described with terms like "floating, slippery, bolstering-like, feeble, thready and quick", which are used to ascribe a specific imbalance in the body. Learning TCM pulse diagnosis can take several years.[71] [edit]Clinical practice

One type of acupuncture needle In a modern acupuncture session, an initial consultation is followed by taking the pulse on both arms, and an inspection of the tongue. Classically, in clinical practice, acupuncture is highly individualized and based on philosophy and intuition, and not on controlled scientific research.[72] In the United States, acupuncture typically lasts from 10 to 60 minutes, with diagnosis and treatment for a single session ranging from $25 to $80 in 2011.[73] Sometimes needles are left in the ear for up to 3 days.[73] Clinical practice varies depending on the country.[18][74] A comparison of the average number of patients treated per hour found significant differences between China (10) and the United States (1.2).[75] Acupuncture is used to treat various type of

pain, neurological problems and stroke rehabilitation.[75][76][77] Studies conducted in China and Brazil found that the majority of patients were female,[77] though in one study the majority of Chinese patients using acupuncture for stroke rehabilitation were male.[75] [edit]Needles Acupuncture needles are typically made of stainless steel wire. They are usually disposable, but reusable needles are sometimes used as well, though they must be sterilized between uses.[78]Needles vary in length between 13 to 130 millimetres (0.51 to 5.1 in), with shorter needles used near the face and eyes, and longer needles in more fleshy areas; needle diameters vary from 0.16 mm (0.006 in) to 0.46 mm (0.018 in),[79] with thicker needles used on more robust patients. Thinner needles may be flexible and require tubes for insertion. The tip of the needle should not be made too sharp to prevent breakage, although blunt needles cause more pain.[80] Apart from the usual filiform needle, there are also other needle types which can be utilized, such as three-edged needles and the Nine Ancient Needles.[79] Japanese acupuncturists use extremely thin needles that are used superficially, sometimes without penetrating the skin, and surrounded by a guide tube (a technique adopted in China and the West). Korean acupuncture uses copper needles and has a greater focus on the hand.[74] [edit]Needling technique [edit]Insertion Since most pain is felt in the superficial layers of the skin, a quick insertion of the needle is recommended. If skilled enough, a practitioner purportedly can insert the needles without causing any pain.[81] Both peer-reviewed medical journals, and acupuncture journals reviewed by acupuncturists, have published on the painfulness of acupuncture treatments, in some cases within the context of reporting studies testing acupunctures

effectiveness.[82][83][84][85] A peer-reviewed medical journal on pain published an article stating that "acupuncture is a painful and unpleasant treatment".[85] There are other cases in which patients have found the insertion of needles in acupuncture too painful to endure.[83] An acupuncture journal, peer-reviewed by acupuncturists, published an article describing insertion of needles in TCM acupuncture and random needling acupuncture as painful stimulation.[86] In a peer-reviewed medical journal, one medical scientist published that Japanese acupuncture is far less painful than Chinese acupuncture, and that Japanese acupuncture needles are smaller than Chinese acupuncture needles.[82] [edit]De-qi sensation De-qi (Chinese: ; pinyin: d q; lit. "obtaining of qi", usually translated as "arrival of qi") refers to a sensation of numbness, distension, or electrical tingling at the needling site which might radiate along the corresponding meridian. If it can not be generated, inaccurate location of the acupoint, improper depth of needle insertion, inadequate manipulation, or a very weak constitution of the patient have to be considered, all of which decrease the likelihood of successful treatment. If de-qi sensation doesn't immediately occur upon needle insertion, various manipulation techniques can be applied to promote it (such as "plucking", "shaking" or "trembling"). Once it is achieved, further techniques might be utilized which aim to influence the de-qi; for example, by certain manipulation the de-qi sensation allegedly can be conducted from the needling site towards more distant sites of the body. Other techniques aim at "tonifying" (Chinese: ; pinyin: b) or "sedating" (Chinese: ; pinyin: xi) qi.[79] The former techniques are used in vacuity patterns, the latter in repletion patterns.[87] De qi is more important in Chinese acupuncture, while Western and Japanese patients may not consider it a necessary part of the treatment.[74]

"DOCTOR, WHAT'S THIS ACUPUNCTURE ALL ABOUT?" A Brief Explanation

ACUPUNCTURE: WHAT IS IT? Acupuncture is a method of encouraging the body to promote natural healing and to improve functioning. This is done by inserting needles and applying heat or electrical stimulation at very precise acupuncture points.

HOW DOES ACUPUNCTURE WORK? The classical Chinese explanation is that channels of energy run in regular patterns through the body and over its surface. These energy channels, called meridians, are like rivers flowing through the body to irrigate and nourish the tissues. An obstruction in the movement of these energy rivers is like a dam that backs up in others. The meridians can be influenced by needling the acupuncture points; the acupuncture needles unblock the obstructions at the dams, and reestablish the regular flow through the meridians. Acupuncture treatments can therefore help the body's internal organs to correct imbalances in their digestion, absorption, and energy production activities, and in the circulation of their energy through the meridians. The modern scientific explanation is that needling the acupuncture points stimulates the nervous system to release chemicals in the muscles, spinal cord, and brain. These chemicals will either change the experience of pain, or they will trigger the release of other chemicals and hormones which influence the body's own internal regulating system.

The improved energy and biochemical balance produced by acupuncture results in stimulating the body's natural healing abilities, and in promoting physical and emotional well-being.

WHAT IS MEDICAL ACUPUNCTURE? IS IT DIFFERENT FROM ORDINARY ACUPUNCTURE? Acupuncture is a very old medical art, and there are many approaches to learning and practicing it. Medical acupuncture is the term used to describe acupuncture performed by a doctor trained and licensed in Western medicine who has also had thorough training in acupuncture as a specialty practice. Such a doctor can use one or the other approach, or a combination of both as the need arises, to treat an illness.

WHAT IS THE SCOPE OF MEDICAL ACUPUNCTURE? Medical acupuncture is a system which can influence three areas of health care:

promotion of health and well-being, prevention of illness, treatment of various medical conditions.

While acupuncture is often associated with pain control, in the hands of a well-trained practitioner it has much broader applications. Acupuncture can be effective as the only treatment used, or as the support or adjunct to other medial treatment forms in many medical and surgical disorders.The World Health Organization recognizes the use of acupuncture in the treatment of a wide range of medical problems, including:

Digestive disorders: gastritis and hyperacidity, spastic colon, constipation, diarrhea.

Respiratory disorders: sinusitis, sore throat, bronchitis, asthma, recurrent chest infections. Neurological and muscular disorders: headaches, facial tics, neck pain, rib neuritis, frozen shoulder, tennis elbow, various forms of tendinitis, low back pain, sciatica, osteoarthritis. Urinary, menstrual, and reproductive problems.

Acupuncture is particularly useful in resolving physical problems related to tension andstress and emotional conditions. If you have questions about a specific illness or disorder not listed above, you can usually have your questions answered by medical acupuncturists practicing in your area.Click HERE to Find a Medical Acupuncturist. Also see the table: Conditions Appropriate to Acupuncture Therapy

HOW MANY TREATMENTS WILL I NEED? The number of treatments needed differs from person to person. For complex or long-standing conditions, one or two treatments a week for several months may be recommended. For acute problems, usually fewer visits are required, and for health ARE THERE ANY SIDE EFFECTS TO THE TREATMENT? Usually not. As energy is redirected in the body, internal chemicals and hormones are stimulated and healing begins to takeplace. Occasionally the original symptoms worsen for a few days, or other general changes in appetite, sleep, bowel or urination patterns, or emotional state may be triggered. These should not cause concern, as they are simply indications that the acupuncture is starting to work. It is quite common with the

first one or two treatments to have a sensation of deep relaxation or even mild disorientation immediately following the treatment. These pass within a short time, and never require anything more than a bit of rest to overcome.

WHAT ARE THE NEEDLES LIKE? DO THEY HURT?

People experience acupuncture needling differently. Most patients feel only minimal pain as the needles are inserted; some feel no pain at all. Once the needles are in place, there is no pain felt. Acupuncture needles are very thin and solid and are made from stainless steel. The point is smooth (not hollow with cuttingedges like a hypodermic needle) and insertion through the skin is not as painful as injections or blood sampling. The risk of bruising and skin irritation is less than when using a hollow needle. Because your doctor carefully sterilizes the needles using the same techniques as for surgical instruments, or uses disposable needles, there is no risk of infection from the treatments.

DOES ACUPUNCTURE REALLY WORK? Yes. In the past 2,000 years, more people have been successfully treated with acupuncture than with all other health modalities combined. Today acupuncture is practiced widely in Asia, the Soviet Union, and in Europe. It is now being used more and more in America by patients and physicians. Acupuncture treatments can be given at the same time other techniques are being used, such as conventional Western medicine,osteopathic or chiropractic adjustments, and homeopathic ornaturopathic prescriptions. It is important that

your physician-acupuncturist know everything that you are doing, so he or she can help you get the most benefit from all your treatments.

DO I HAVE TO BELIEVE IN ACUPUNCTURE FOR IT TO WORK? No. Acupuncture is used successfully on cats, dogs, horses and other animals. These animal patients do not understand or believein the process that helps them get better. A positive attitude toward wellness may reinforce the effects of the treatment received, just as a negative attitude may hinder the effects of acupuncture or any other treatment. A neutral attitude ("I don't know if I really believe in this.") will not block the treatment results.

ARE THERE ANY "DO'S AND DONT'S" FOR ME ON THE DAY OF A TREATMENT? Yes. To enhance the value of a treatment, the following guidelines are important:

Do not eat an unusually large meal immediately before or after your treatment. Do not over-exercise, engage in sexual activity, or consume alcoholic beverages within 6 hours before or after the treatment. Plan your activities so that after the treatment you can get some rest, or at least not have to be working at top performance. This is especially important for the first few visits. Continue to take any prescription medicines as directed by your regular doctor. Substance abuse (drugs and alcohol) especially in the week prior to treatment, will seriously interfere with the effectiveness of acupuncture reatments.

Remember to keep good mental or written notes of what your response is to the treatment. This is important for your doctor to know so that the follow-up treatments can be designed to best help you and your problem

IS ACUPUNCTURE COVERED BY HEALTH INSURANCE? Some insurance companies currently cover acupuncture costs, other companies do not yet recognize the value of acupuncture. Each health policy must be reviewed to determine acupuncture benefits. More and more insurance companies are recognizing the value of providing coverage for medical acupuncture services. You can help by insisting that your insurance company offer you reimbursement for medically indicated acupuncture treatments before you accept their policy.

Are there risks or side effects to acupuncture? Usually not. Acupuncture is a very safe method of encouraging the body to promote natural healing and improve function. Done properly, acupuncture rarely causes serious side effects. Many people feel a brief stinging sensation, like a pinprick, during insertion of the needles. Others experience a dull ache around the needle after it goes in. Other problems documented by researchers resulted from mistakes made by the acupuncturists. For example, some have failed to refer their patients for other kinds of treatment that might be more effective for their illness. Others have spread serious infections by using needles that weren't sterile. A handful have

injured patients by pushing a needle into a vital organ such as a lung. But overall, as the National Institutes of Health recently concluded, acupuncturists have an extremely good safety record. A side effect that I have seen in my own practice is the original symptoms worsening for a few days after an acupuncture treatment. Sometimes other general changes in appetite, sleep, bowel or urination patterns, or emotional state may be triggered. These should not cause concern, as they are simply indications that the acupuncture is starting to work. My teacher explained it to me like this: Acupuncture is smoothing out blocked Qi (energy) that is stuck in areas of your body. When a garden hose gets a kink in it, the water stops flowing. When you straighten the hose, the built up pressure makes the water burst out in the beginning. This is what can happen when you first have acupuncture. It is also common with the first one or two treatments to have a sensation of deep relaxation or even mild disorientation immediately following the treatment. These effects should wear off within 24-48 hours. Please discuss what you have been experiencing with your acupuncturist. Your comfort is a priority. The more you communicate with the practitioner, the more he or she will be able to help you. A few people have reported more serious reactions, such as dizziness, sweatiness, or nausea, according to a November 1999 issue of theArchives of Family Medicine. There have even been some cases reported where patients lost consciousness. However, these

problems usually clear up on their own within a few minutes, without lasting harm to the patient. While Acupuncture is an extremely safe form of physical medicine, here are some rarely seen contraindications and risks. Precautions & Contraindications: 1. It is contraindicated to needle the abdomen and lumbosacral areas of pregnant women 2. Avoid blood vessels to prevent bleeding 3. Points on the chest and back should be carefully needled to avoid injury to organs Risks: (Some of the risks mentioned below are EXTREMELY RARE!) 1. Bruising 2. Fainting 3. Muscle Spasms 4. Bleeding 5. Nerve Damage 6. Punctured Lung
Accidental Injury to organs (Brain, Spinal Cord, Heart, Liver, Spleen,