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~ A , ~ est|m~t~ t ~ ml||~e~consumptions ~y ~tl~ rsga~ acupuncture,~ke ~ y oth~ '~m~tive' ther~es, ~s an ~vero~res~ 1~ Nls ~ay, are ~ e re~t~r~ ae o ~ e e u ~ i N ~oge ~ the ~ y ' s respoe~ Acupt~~um is ~: ancient form of medicine that origiaa~edio CNoa. how iI aH sta~ed is unce~ain: oee s~g~estion is that ~ldie~ wom'~ded by ~ows i~ battle were subsequently ob~rved to recover from chm~ic i~lr,es~s ~hat ~ad plagued ~he~'~f~' years hombre.This m~l~d exN6mxmts into tN offers of panct~6eg Ne b~y surface ~iN needles, made originNty t~3ms b ~ e d {~gments of ~on4:o the Cni~se ~ga~ to use oeedtes made from tame ar~ ~am~o~ ~ , as metals were di~overed, needles made of imp, silver ~ o~er Acupuv~zt-~re s~ead to Et~rc~ dnri~g the ~Tth century and has times° ~D.,ecurreot revival of interest ~hmugho~tthe West originated k} ~ USA ia ~he 1970s after President Ni×ou's physiciaa aed the N ~he US Natier~N l~stitn.tesof Heahh visited Chieao h UK, despite an inNN Na~stili~ym acuNnctare, ~e medica! prc~ )7f~sion has recently s~ght m incor~rate NN f~,~ of Nerapy iete its orthodox medical repertoi~. Bu~ as ~7.ard Ems~ (Professor of Complementao' M~icine at E×e~r University, E×e~r, UK) ~ints ou~, 'desNte its long histo~, aad widesp~ad use, acnpu~ure has failed to demonstrateits cfinical effectiveoessconvincingly.' =~

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Aeapl~cta~s: as a l aad<:tl{ belief system @,~e of the cemr;t b<.loh; o~ whch ac pt,mc u~e .~ b a e d b, 9'~at @e ~£~y centa)~s tv~o opposh~g fo~ce~ el er~e~gy, ym u+~f }a~g l~:~gethe< 8o~e,.;efi>~w~,the CB'. or lili: %.>:e. o£ 9~e livng >> a ca g e~ct. A ~g m Chi~ese , a p~:rs{m"s ~ l t ! ~ delta ~qe t ba,/~£e bet.:e-on yi~ atoll yasg+ m'.,~{rely wig~i£ the {x~ly of ¢&e i~dividwaL but a/so k~ ~b:: wider uMverse. "t('~~ aml ya~g a e th{,~.@~ w flow a ~ m l (b,: ~ d y i~ sNs,ciaI cbmsels, or ~eridiar~s, are 26 mab~ me{idlass, roach as~ciated with a d}fferem ka~Iy fm~cti{m or o£r~ios of ~¢-adles d~rbg tlemp/y -- IRe acaNmctam {mints -- lie alo~g tb~ese ~,ridia~so Whim. so

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f f he i a s did ~"~o sco~: !i~h y rdca ~'~; tt~s ff>:~y wcse mos~y o ©w q~.ai}~ w t b >.s%~:~ctto :sseth./~w~s4 d~a~ c4 !.h,,~~ tr~ss K did score m<:~e ~h;m 50% 21q ;/rove resub.s 1,i'a;~ r:dc~mu ~i>.~. cu?,;.~cu#:e s~sd

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l~:~rar~ ex~ersaI dis4tase a ~ : : : d~erapists believe tha~ t e di~ca:~vito~dgisacs from as imbaf~ce is yin am:l 7=;~g tiow As a result of this imbah~c< ~ < t i c ac~pa~£t<¢ F<>mts i~ the }x~ty ae ff)}a~d to be m~ier whe~? ~#s>~d, allowisg a diagr~eqis to b: maie. The °comhtiOl' is rectified by pierch~g the skis at precise acup'~mct~,mtp<:@sts,so that the er~ecgy flow m tle affected b:y~y par< is either st)mdated or ca1 . The acup.~cmris~ hates los is @s ski~~ ~o va'ymg de~qs, a'cccdi~g m l m pc&t: a~d co~di@m beirut c ~ e a ~ a~d the are leR i= for a few see@ads a~4t ~£ve~aI mh> ~tes. N ceveml weeks... Several other comphm~e~mo~ therapies are closely m/deal to ac~@~tare~ E1 pa ira;oboes ~ v d s g aa dectfic c ~ e ~ t gh a~ acupw
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Ac~pa~ct~re has gai~ed i~ px?p@arity with the ge~aeral punic @m ~s~ 2.5 ; a ~g of ac~p~cm-m aloagside m~xe x ~reame~ts.~ A/harems of a~°e¢lNm fnat ff c ~ ~eat a of lh~es~s ~e, Ms, a~d digestive ~ s'ki~ ~k ba~d meta-ana~ysis of" al climcN tria~s eg that daze that i~ve ~he of c~ paim A~ e ve f ~v 5~ led diNcN s that were rev ~smg a IN of It a. Tc~ Riot a~d scored each ~ial y, awadi~g a ma,×imum of ll~} ~ i N s fee study @sigr~ N f ~ r mai~ try of prognosis, y of i el< y of of effbct a~d dam taio~. Di~p~iming~y, rf~w

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a ~fmite therapeutic effect, a~d 22% iedicaed that aeuga~=tnre ~ effect, Them ~ se~e~ ex for the ~ow quality of t~ eentro|~d tri~s. Fib.t, owing m ~e r~a~:~reof ~e ~ e d ~ e Nero is oa~increased N in bias aN therefore possNle mNinteoretali~ N data. SecoN, severn difL~ent forms of are ImP'fiscal and it is difficult m e ~ t e erie with a~o~ker. "third, the diagm~tic criteria of Ch.inese ac~nctnre a~e completely Nffe~nt to t t ~ of op~t~tox Western ~dic:ine, and can lead to conflict in d'mice of pafmnt groaps. F(r~nh, it is difficult m standardize acupuncture t~ea.,tment, ~ each eo~rse of treatment is dependent, to a gwat extent, ~ ~ ir~ividual paiem, Nil.h, axup~ncv.Nsts interpret the exact g~ifiea of' ~apu~eturc pants differently. Finally, it ix difficult m devise ~ ~ e ~ a t e ~am procedure f~r this ~rt N physical therapy, and m c o ~ & which tyN of ~ d u r e is being used from the ~ient and i~vestiKator, O ~ v a t t ~ r ~ of the effeet~ ~ acapm~cture AItNNg)~ the clinical ~als on acupuncture may r~)tbe conctasive~ many qualified p~cdtioners have observed that acupunc-

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twe can have an eft?or or~ the txydy.AIe×a~ter Ma~d<~a~d {a pfimay care physician based in Bfiaok UKL has practised ac~panct~r~ %r maw yeas and reN?rts tha it is effective fG paients wi~k chror~ic, a~d sometimes ~vere, Nin. The area of tenderness' may be some ~aance away from the site of referred pain i~ a patient He fisds tha inserting ~macupm~ct~re needle into this area %r anent ~wo seconds removes the tenderness, and the Ni~:~ k.seK is m a i n l y i~'~pre'.~ed within a few min~es, He d~s aot believe Nat meddia~s or ~'upeec~ tun points exist but acceNs that the Chi~ese n~ay hawe esed these ideas to ~ p l e m s ~ Doking for t~&~ regions a ,~me ~s~a~ce from areas of reread pai~o M~denald believes ~at the outcorre N the h~atment is t(mJty i of the paienfs ~r ~he ~ i t i o n e r ' s beliefs. The idea ~ a ~fidieas ca~ conre:~t tN tk~t m bead or chest may have been Chin£s int~*:>d~on m ~}e idea that the greater the dist~ce between the ~oxious sgmutas (i.e. the sire of ie~rtien of the ~ u D ~ t ~ m n~dle) aM the site of the pai~° the more likely is ~ ~atment to woN.

Neurochemica|exp|anat~s for acupuncturea n ~ g ~ [ a Scientific research into the nenrochemicJ basis of acupunctare amlgesia rea/~y began during the early DT0s° Ct~i~se ~ientists demonstrated that the anNgesic effect of acnpunctuN treatment could be Nocked by infiRration of procaine m acupm~cture points. and ob~r~'ed that it was imN~ssiNe to u~ agupu~:mm with any sa~ess in paraplegic or hemipIegic patients. The conch~sions from the~ ob~¢afiens were that acnp~nctare has an eft~ct cm afferent t~smission ~ nervoas impa[ses (Le. towards the central nervous system)~ ExNriments c ~ e d ot~t by Daniel le Ba~ and colleagues (NSERM Laboratories° Pros, Dance) in rat m~e|s have shown that acupuncture c ~ produce a cle~
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Me>cnkephaIff>l{ke n:ateda/ ln>r;~ hc ,p :~a c:,~'d. Ih ,;c,: '~ r'r>.~. renal>, of ear:~e~ qudie., theft mi>[icacd ~hc in'~:~':.~::,:~e}t o c:> d:>rphln>, i::~~cup~sc:u:'c by ,,h(wh"~g ~a ti-l.cc I~.c > :,' o..p:~c ~ 'c A key ~olc ~f 5.-~:},dr~%t }'p:;~r~ e 5...l.-{T: k ~(,,~;:>. ,<>u has a~a.~ ~:en estab:i'shed h? ~wa>.:~:~.e.~ ar~i:n ~..4~.die~.,, carted o~ i~ ~he late. 1970~ and earl}' ~980~<. '[v~o separate cer:m,:

5oHT pathwa}?, s£cm to he ffpa}s or ginadng i~ the midbrain.. Le Ba~s has conclu@d [ha~ acupuncture may ff:terfcr<: w:th d~e way that the bu~y and the braii.:~ rccehe and p: ~c~.:>. infi~:~r~atio~ coming from pairffu~ stim~E [n:emeu:ons in the spinal c<'d are FYtic:dar[y mW>rta~: a defi~ed gm~ap of i~:erneure~s [:~ ~he ~,pisa: cord resF~eds :o FAg ari:d~g in ~0ario:> part:°, of the N.:,d,~ ~,er",ed b,, fisat segment of the cord. Thi>,,, acthe group f f h-na:.r~>:u~q,...:end>0 ~o ~,spo. press the acthity of aH other i:?ter::e,~rons in tl:ecord. :oXsti:nuh>:ti~m of or:e group of neuron>< by. ~br exam[@, pats in the k:fi ~,hou:der° switd~es off the other group:4 of [n~e~x~earoe~:... If a ,,;of pain is the~ .%et up in another par: of thee N~dy. ~i~r e:~,:ampte b,~ :he insertion of ar~ acspg~cu~:e needle, a ~~ew ,,et o~ ir:{er::e:,~ro::%take> over° switching off {he f:r:,: gro~@ ar~i so darnpmg do:;~0n the origmaf Din. eno~s opiates {en{~p}'@> arid e:~kepha~h>} seem :o be [~vohed ie this 'switchir~g off ~mechanism Aeupm~c~Hre arid the f ~ u r e Research i~to the clinical effica~:y of acupuncture should be con.tinned to pro~e who:her the re~:>urces heir~g spem e:~ i: ave warranted. and to deferrable how :o target ~he~,~e ~:sources to ~ho~,e padee~a most ~[kely to ber:efi~ from the treatment. F)e~,pi~e a fl~l'iry {:}~7activity ie acupenct~re°rda~ed re,,earch dermg the 197{}~, and 19g0s. a:~d the gradua~ acceptance of ac:.~puecu~,re in "9,'k: ~:rn medicine, the imNms :o ff~vestiga:e i~s physidogfcaf mechanb~.ms b, fading, Anima~ studie~ ha~e [:ven ,, a::~able m ducidating the complex :nechao nisms ~hat explain the effects of acnptmct:~re, b:~ ~he%er~o,,v p~?ie: :o the need tier more m~asive studies [~ h:~mans. Hov,eve:. ~he poor methodology of clinica~ triab; and ~he e:hica~ di@cuhk>, of cart'}iron nu~ pafr~r{~,earch i~ h~mar~ st~ s comin~e ~o be a serioas s{icki~g point. (:on m~y. the g~:f Ntween the ~acdce d acu)~cmre arena a ~ien{ific exp/a~mSor~ of its ~:Nserved eflbcts seems ~et m wNen far, her.

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• Given the extensive evi@nce for the physie:egica| effects of acupuncture in ~:mats, shenN h into the |at s of pain in@a@ ~udy N a e tare? o is the image of are ~ ~ ° h:e ° tl~r~y preo venting serious ~ientific investigation of its efficacy? ® ~ n is a pe~istent in' ' medkine° ShouN ~ N ~tried' (m Ntiems win chronic pain, no what the. sdemific ev or u ing d its mok~alar nmchanisms?

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