194-441: Acupuncture is a form of alternative medicine and a component of traditional Chinese medicine (TCM) in which thin needles are inserted into the body. Acupuncture is a pseudoscience ; the theories and practices of TCM are not based on scientific knowledge , and it has been characterized as quackery . There is a range of acupuncture technological variants that originated in different philosophies, and techniques vary depending on
388-519: A gain medium , a mechanism to energize it, and something to provide optical feedback . The gain medium is a material with properties that allow it to amplify light by way of stimulated emission. Light of a specific wavelength that passes through the gain medium is amplified (power increases). Feedback enables stimulated emission to amplify predominantly the optical frequency at the peak of the gain-frequency curve. As stimulated emission grows, eventually one frequency dominates over all others, meaning that
582-471: A lens system, as is always included, for instance, in a laser pointer whose light originates from a laser diode . That is possible due to the light being of a single spatial mode. This unique property of laser light, spatial coherence , cannot be replicated using standard light sources (except by discarding most of the light) as can be appreciated by comparing the beam from a flashlight (torch) or spotlight to that of almost any laser. A laser beam profiler
776-402: A "borderlands science" lying between science and pseudoscience. It is a generally held belief within the acupuncture community that acupuncture points and meridians structures are special conduits for electrical signals, but no research has established any consistent anatomical structure or function for either acupuncture points or meridians. Human tests to determine whether electrical continuity
970-471: A 2018 interview with The BMJ , Edzard Ernst stated: "The present popularity of complementary and alternative medicine is also inviting criticism of what we are doing in mainstream medicine. It shows that we aren't fulfilling a certain need-we are not giving patients enough time, compassion, or empathy. These are things that complementary practitioners are very good at. Mainstream medicine could learn something from complementary medicine." Alternative medicine
1164-716: A body's "rhythm" on the effectiveness of treatment. Acupuncture fluctuated in popularity in China due to changes in the country's political leadership and the preferential use of rationalism or scientific medicine. Acupuncture spread first to Korea in the 6th century AD, then to Japan through medical missionaries, and then to Europe, beginning with France. In the 20th century, as it spread to the United States and Western countries, spiritual elements of acupuncture that conflicted with scientific knowledge were sometimes abandoned in favor of simply tapping needles into acupuncture points. Acupuncture
1358-464: A broad spectrum of light or emit different wavelengths of light simultaneously. Certain lasers are not single spatial mode and have light beams that diverge more than is required by the diffraction limit . All such devices are classified as "lasers" based on the method of producing light by stimulated emission. Lasers are employed where light of the required spatial or temporal coherence can not be produced using simpler technologies. A laser consists of
1552-504: A chain reaction. The materials chosen for lasers are the ones that have metastable states , which stay excited for a relatively long time. In laser physics , such a material is called an active laser medium . Combined with an energy source that continues to "pump" energy into the material, it is possible to have enough atoms or molecules in an excited state for a chain reaction to develop. Lasers are distinguished from other light sources by their coherence . Spatial (or transverse) coherence
1746-472: A classification system for branches of complementary and alternative medicine that divides them into five major groups. These groups have some overlap, and distinguish two types of energy medicine: veritable which involves scientifically observable energy (including magnet therapy , colorpuncture and light therapy ) and putative , which invokes physically undetectable or unverifiable energy. None of these energies have any evidence to support that they affect
1940-436: A coherent beam has been formed. The process of stimulated emission is analogous to that of an audio oscillator with positive feedback which can occur, for example, when the speaker in a public-address system is placed in proximity to the microphone. The screech one hears is audio oscillation at the peak of the gain-frequency curve for the amplifier. For the gain medium to amplify light, it needs to be supplied with energy in
2134-414: A corresponding increase in success of its treatments. In the 1970s, irregular practices were grouped with traditional practices of nonwestern cultures and with other unproven or disproven practices that were not part of biomedicine, with the entire group collectively marketed and promoted under the single expression "alternative medicine". Use of alternative medicine in the west began to rise following
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#17328844585382328-446: A culture which have existed since before the advent of medical science, Many TM practices are based on "holistic" approaches to disease and health, versus the scientific evidence-based methods in conventional medicine. The 2019 WHO report defines traditional medicine as "the sum total of the knowledge, skill and practices based on the theories, beliefs and experiences indigenous to different cultures, whether explicable or not, used in
2522-419: A device lacks the spatial and temporal coherence achievable with lasers. Such a device cannot be described as an oscillator but rather as a high-gain optical amplifier that amplifies its spontaneous emission. The same mechanism describes so-called astrophysical masers /lasers. The optical resonator is sometimes referred to as an "optical cavity", but this is a misnomer: lasers use open resonators as opposed to
2716-508: A gain medium must have a gain bandwidth sufficiently broad to amplify those frequencies. An example of a suitable material is titanium -doped, artificially grown sapphire ( Ti:sapphire ), which has a very wide gain bandwidth and can thus produce pulses of only a few femtoseconds duration. Such mode-locked lasers are a most versatile tool for researching processes occurring on extremely short time scales (known as femtosecond physics, femtosecond chemistry and ultrafast science ), for maximizing
2910-480: A given pulse energy, this requires creating pulses of the shortest possible duration utilizing techniques such as Q-switching . The optical bandwidth of a pulse cannot be narrower than the reciprocal of the pulse width. In the case of extremely short pulses, that implies lasing over a considerable bandwidth, quite contrary to the very narrow bandwidths typical of CW lasers. The lasing medium in some dye lasers and vibronic solid-state lasers produces optical gain over
3104-399: A higher energy level with energy difference ΔE, it will not stay that way forever. Eventually, a photon will be spontaneously created from the vacuum having energy ΔE. Conserving energy, the electron transitions to a lower energy level that is not occupied, with transitions to different levels having different time constants. This process is called spontaneous emission . Spontaneous emission is
3298-904: A laser beam to stay narrow over great distances ( collimation ), a feature used in applications such as laser pointers , lidar , and free-space optical communication . Lasers can also have high temporal coherence , which permits them to emit light with a very narrow frequency spectrum . Temporal coherence can also be used to produce ultrashort pulses of light with a broad spectrum but durations as short as an attosecond . Lasers are used in optical disc drives , laser printers , barcode scanners , DNA sequencing instruments , fiber-optic and free-space optical communications, semiconductor chip manufacturing ( photolithography , etching ), laser surgery and skin treatments, cutting and welding materials, military and law enforcement devices for marking targets and measuring range and speed, and in laser lighting displays for entertainment. Semiconductor lasers in
3492-471: A laser beam, it is highly collimated : the wavefronts are planar, normal to the direction of propagation, with no beam divergence at that point. However, due to diffraction , that can only remain true well within the Rayleigh range . The beam of a single transverse mode (gaussian beam) laser eventually diverges at an angle that varies inversely with the beam diameter, as required by diffraction theory. Thus,
3686-471: A laser is normally a material of controlled purity, size, concentration, and shape, which amplifies the beam by the process of stimulated emission described above. This material can be of any state : gas, liquid, solid, or plasma . The gain medium absorbs pump energy, which raises some electrons into higher energy (" excited ") quantum states . Particles can interact with light by either absorbing or emitting photons. Emission can be spontaneous or stimulated. In
3880-503: A life force energy called qi . Qi was believed to flow from the body's primary organs ( zang-fu organs) to the "superficial" body tissues of the skin, muscles, tendons, bones, and joints, through channels called meridians. Acupuncture points where needles are inserted are mainly (but not always) found at locations along the meridians. Acupuncture points not found along a meridian are called extraordinary points and those with no designated site are called A-shi points. In TCM, disease
4074-400: A medical diagnosis. Limited research has compared the contrasting acupuncture systems used in various countries for determining different acupuncture points, and thus there is no defined standard for acupuncture points. In traditional acupuncture, the acupuncturist decides which points to treat by observing and questioning the patient to make a diagnosis according to the tradition used. In TCM,
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#17328844585384268-435: A method is proven to work, it eventually ceases to be alternative and becomes mainstream medicine. Much of the perceived effect of an alternative practice arises from a belief that it will be effective, the placebo effect , or from the treated condition resolving on its own ( the natural course of disease ). This is further exacerbated by the tendency to turn to alternative therapies upon the failure of medicine, at which point
4462-418: A multi-level system as a method for obtaining the population inversion, later a main method of laser pumping. Townes reports that several eminent physicists—among them Niels Bohr , John von Neumann , and Llewellyn Thomas —argued the maser violated Heisenberg's uncertainty principle and hence could not work. Others such as Isidor Rabi and Polykarp Kusch expected that it would be impractical and not worth
4656-431: A non-drug approach to treating some health conditions. In addition to the social-cultural underpinnings of the popularity of alternative medicine, there are several psychological issues that are critical to its growth, notably psychological effects, such as the will to believe, cognitive biases that help maintain self-esteem and promote harmonious social functioning, and the post hoc, ergo propter hoc fallacy. In
4850-577: A particular culture, folk knowledge, superstition, spiritual beliefs, belief in supernatural energies (antiscience), pseudoscience, errors in reasoning, propaganda, fraud, new or different concepts of health and disease, and any bases other than being proven by scientific methods. Different cultures may have their own unique traditional or belief based practices developed recently or over thousands of years, and specific practices or entire systems of practices. Alternative medicine, such as using naturopathy or homeopathy in place of conventional medicine ,
5044-536: A patient's condition even though the objective effect is non-existent, or even harmful. David Gorski argues that alternative treatments should be treated as a placebo, rather than as medicine. Almost none have performed significantly better than a placebo in clinical trials. Furthermore, distrust of conventional medicine may lead to patients experiencing the nocebo effect when taking effective medication. A patient who receives an inert treatment may report improvements afterwards that it did not cause. Assuming it
5238-494: A person not diagnosed with science-based medicine may never originally have had a true illness diagnosed as an alternative disease category. Edzard Ernst , the first university professor of Complementary and Alternative Medicine, characterized the evidence for many alternative techniques as weak, nonexistent, or negative and in 2011 published his estimate that about 7.4% were based on "sound evidence", although he believes that may be an overestimate. Ernst has concluded that 95% of
5432-421: A person's skin containing mycobacterium, and reusing needles at various sites in the same person. Although acupuncture is generally considered a safe procedure, a 2013 review stated that the reports of infection transmission increased significantly in the prior decade, including those of mycobacterium. Although it is recommended that practitioners of acupuncture use disposable needles, the reuse of sterilized needles
5626-441: A process called pumping . The energy is typically supplied as an electric current or as light at a different wavelength. Pump light may be provided by a flash lamp or by another laser. The most common type of laser uses feedback from an optical cavity —a pair of mirrors on either end of the gain medium. Light bounces back and forth between the mirrors, passing through the gain medium and being amplified each time. Typically one of
5820-571: A project funded by the CDC identified 208 condition-treatment pairs, of which 58% had been studied by at least one randomized controlled trial (RCT), and 23% had been assessed with a meta-analysis . According to a 2005 book by a US Institute of Medicine panel, the number of RCTs focused on CAM has risen dramatically. As of 2005 , the Cochrane Library had 145 CAM-related Cochrane systematic reviews and 340 non-Cochrane systematic reviews. An analysis of
6014-462: A quantum-mechanical effect and a direct physical manifestation of the Heisenberg uncertainty principle . The emitted photon has a random direction, but its wavelength matches the absorption wavelength of the transition. This is the mechanism of fluorescence and thermal emission . A photon with the correct wavelength to be absorbed by a transition can also cause an electron to drop from the higher to
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6208-633: A research institute for integrative medicine (a member entity of the Cochrane Collaboration ). Medical schools are responsible for conferring medical degrees, but a physician typically may not legally practice medicine until licensed by the local government authority. Licensed physicians in the US who have attended one of the established medical schools there have usually graduated Doctor of Medicine (MD). All states require that applicants for MD licensure be graduates of an approved medical school and complete
6402-534: A result of reforms following the Flexner Report of 1910 medical education in established medical schools in the US has generally not included alternative medicine as a teaching topic. Typically, their teaching is based on current practice and scientific knowledge about: anatomy, physiology, histology, embryology, neuroanatomy, pathology, pharmacology, microbiology and immunology. Medical schools' teaching includes such topics as doctor-patient communication, ethics,
6596-447: A result of substandard practice. The incidence of serious adverse events was 5 per one million, which included children and adults. When used during pregnancy, the majority of adverse events caused by acupuncture were mild and transient, with few serious adverse events. The most frequent mild adverse event was needling or unspecified pain, followed by bleeding. Although two deaths (one stillbirth and one neonatal death) were reported, there
6790-432: A seminar on this idea, and Charles H. Townes asked him for a copy of the paper. In 1953, Charles H. Townes and graduate students James P. Gordon and Herbert J. Zeiger produced the first microwave amplifier, a device operating on similar principles to the laser, but amplifying microwave radiation rather than infrared or visible radiation. Townes's maser was incapable of continuous output. Meanwhile, in
6984-535: A single-minded focus on the pathophysiological had diverted much of mainstream American medicine from clinical conditions that were not well understood in mechanistic terms, and were not effectively treated by conventional therapies. By 2001 some form of CAM training was being offered by at least 75 out of 125 medical schools in the US. Exceptionally, the School of Medicine of the University of Maryland, Baltimore , includes
7178-431: A small volume of material at the surface of a workpiece can be evaporated if it is heated in a very short time, while supplying the energy gradually would allow for the heat to be absorbed into the bulk of the piece, never attaining a sufficiently high temperature at a particular point. Other applications rely on the peak pulse power (rather than the energy in the pulse), especially to obtain nonlinear optical effects. For
7372-955: A test which are not related to a patient's experience. These include patients reporting more favourable results than they really felt due to politeness or "experimental subordination", observer bias , and misleading wording of questions. In their 2010 systematic review of studies into placebos, Asbjørn Hróbjartsson and Peter C. Gøtzsche write that "even if there were no true effect of placebo, one would expect to record differences between placebo and no-treatment groups due to bias associated with lack of blinding ." Alternative therapies may also be credited for perceived improvement through decreased use or effect of medical treatment, and therefore either decreased side effects or nocebo effects towards standard treatment. Practitioners of complementary medicine usually discuss and advise patients as to available alternative therapies. Patients often express interest in mind-body complementary therapies because they offer
7566-496: A theoretical advantage of an inexpensive treatment without adverse reactions or interactions with drugs or other medications. As the evidence for most types of alternative medicine such as acupuncture is far from strong, the use of alternative medicine in regular healthcare can present an ethical question. Using the principles of evidence-based medicine to research acupuncture is controversial, and has produced different results. Some research suggests acupuncture can alleviate pain but
7760-624: A treatment to be harmful will perceive harmful effects after taking it. Placebos do not have a physical effect on diseases or improve overall outcomes, but patients may report improvements in subjective outcomes such as pain and nausea. A 1955 study suggested that a substantial part of a medicine's impact was due to the placebo effect. However, reassessments found the study to have flawed methodology. This and other modern reviews suggest that other factors like natural recovery and reporting bias should also be considered. All of these are reasons why alternative therapies may be credited for improving
7954-433: A variety of conditions. In 2008, a study determined that the use of acupuncture-needle treatment on children was "questionable" due to the possibility of adverse side-effects and the pain manifestation differences in children versus adults. The study also includes warnings against practicing acupuncture on infants, as well as on children who are over-fatigued, very weak, or have over-eaten. When used on children, acupuncture
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8148-430: A wide bandwidth, making a laser possible that can thus generate pulses of light as short as a few femtoseconds (10 s). In a Q-switched laser, the population inversion is allowed to build up by introducing loss inside the resonator which exceeds the gain of the medium; this can also be described as a reduction of the quality factor or 'Q' of the cavity. Then, after the pump energy stored in the laser medium has approached
8342-436: A wide range of health care practices, products, and therapies. The shared feature is a claim to heal that is not based on the scientific method. Alternative medicine practices are diverse in their foundations and methodologies. Alternative medicine practices may be classified by their cultural origins or by the types of beliefs upon which they are based. Methods may incorporate or be based on traditional medicinal practices of
8536-591: A wide range of other conditions. Acupuncture is typically used in combination with other forms of treatment. The global acupuncture market was worth US$ 24.55 billion in 2017. The market was led by Europe with a 32.7% share, followed by Asia-Pacific with a 29.4% share and the Americas with a 25.3% share. It was estimated in 2021 that the industry would reach a market size of US$ 55 billion by 2023. The conclusions of trials and systematic reviews of acupuncture generally provide no good evidence of benefit, which suggests that it
8730-492: A wide range of technologies addressing many different motivations. Some lasers are pulsed simply because they cannot be run in continuous mode. In other cases, the application requires the production of pulses having as large an energy as possible. Since the pulse energy is equal to the average power divided by the repetition rate, this goal can sometimes be satisfied by lowering the rate of pulses so that more energy can be built up between pulses. In laser ablation , for example,
8924-484: Is a form of alternative medicine. It is used most commonly for pain relief, though it is also used to treat a wide range of conditions. Acupuncture is generally only used in combination with other forms of treatment. For example, the American Society of Anesthesiologists states it may be considered in the treatment of nonspecific, noninflammatory low back pain only in conjunction with conventional therapy. Acupuncture
9118-498: Is a profitable industry with large media advertising expenditures. Accordingly, alternative practices are often portrayed positively and compared favorably to "big pharma" . Laser light A laser is a device that emits light through a process of optical amplification based on the stimulated emission of electromagnetic radiation . The word laser is an anacronym that originated as an acronym for light amplification by stimulated emission of radiation . The first laser
9312-404: Is a transition between energy levels that match the energy carried by the photon or phonon. For light, this means that any given transition will only absorb one particular wavelength of light. Photons with the correct wavelength can cause an electron to jump from the lower to the higher energy level. The photon is consumed in this process. When an electron is excited from one state to that at
9506-477: Is also required for three-level lasers in which the lower energy level rapidly becomes highly populated, preventing further lasing until those atoms relax to the ground state. These lasers, such as the excimer laser and the copper vapor laser, can never be operated in CW mode. In 1917, Albert Einstein established the theoretical foundations for the laser and the maser in the paper " Zur Quantentheorie der Strahlung " ("On
9700-667: Is at hand, practitioners 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. TCM and its concept of disease does not strongly differentiate between the cause and effect of symptoms. Many within the scientific community consider acupuncture to be quackery and pseudoscience, having no effect other than as "theatrical placebo". David Gorski has argued that of all forms of quackery, acupuncture has perhaps gained most acceptance among physicians and institutions. Academics Massimo Pigliucci and Maarten Boudry describe acupuncture as
9894-508: Is based on belief systems not grounded in science. Alternative medical systems may be based on traditional medicine practices, such as traditional Chinese medicine (TCM), Ayurveda in India, or practices of other cultures around the world. Some useful applications of traditional medicines have been researched and accepted within ordinary medicine, however the underlying belief systems are seldom scientific and are not accepted. Traditional medicine
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#173288445853810088-413: Is called an optical amplifier . When an optical amplifier is placed inside a resonant optical cavity, one obtains a laser. For lasing media with extremely high gain, so-called superluminescence , light can be sufficiently amplified in a single pass through the gain medium without requiring a resonator. Although often referred to as a laser (see, for example, nitrogen laser ), the light output from such
10282-406: Is considered alternative when it is used outside its home region; or when it is used together with or instead of known functional treatment; or when it can be reasonably expected that the patient or practitioner knows or should know that it will not work – such as knowing that the practice is based on superstition. Bases of belief may include belief in existence of supernatural energies undetected by
10476-598: Is considered safe when administered by well-trained, licensed practitioners using sterile needles; however, a 2011 review found there was limited research to draw definite conclusions about the overall safety of pediatric acupuncture. The same review found 279 adverse events, 25 of them serious. The adverse events were mostly mild in nature (e.g., bruising or bleeding). The prevalence of mild adverse events ranged from 10.1% to 13.5%, an estimated 168 incidences among 1,422 patients. On rare occasions adverse events were serious (e.g. cardiac rupture or hemoptysis ); many might have been
10670-462: Is defined loosely as a set of products, practices, and theories that are believed or perceived by their users to have the healing effects of medicine, but whose effectiveness has not been established using scientific methods , or whose theory and practice is not part of biomedicine , or whose theories or practices are directly contradicted by scientific evidence or scientific principles used in biomedicine. "Biomedicine" or "medicine"
10864-462: Is emitted by stimulated emission is identical to the photon that triggered its emission, and both photons can go on to trigger stimulated emission in other atoms, creating the possibility of a chain reaction . For this to happen, many of the atoms or molecules must be in the proper excited state so that the photons can trigger them. In most materials, atoms or molecules drop out of excited states fairly rapidly, making it difficult or impossible to produce
11058-421: Is formed by single-frequency quantum photon states distributed according to a Poisson distribution . As a result, the arrival rate of photons in a laser beam is described by Poisson statistics. Many lasers produce a beam that can be approximated as a Gaussian beam ; such beams have the minimum divergence possible for a given beam diameter. Some lasers, particularly high-power ones, produce multimode beams, with
11252-443: Is frequently used in the field, meaning "to give off coherent light," especially about the gain medium of a laser; when a laser is operating, it is said to be " lasing ". The terms laser and maser are also used for naturally occurring coherent emissions, as in astrophysical maser and atom laser . A laser that produces light by itself is technically an optical oscillator rather than an optical amplifier as suggested by
11446-404: Is generally perceived as a disharmony or imbalance in energies such as yin, yang , qi , xuĕ, zàng-fǔ, meridians , and of the interaction between the body and the environment. Therapy is based on which "pattern of disharmony" can be identified. For example, some diseases are believed to be caused by meridians being invaded with an excess of wind, cold, and damp. In order to determine which pattern
11640-414: Is important, as greater numbers improved the outcomes of acupuncture compared to non-acupuncture controls. There has been little systematic investigation of which components of an acupuncture session may be important for any therapeutic effect, including needle placement and depth, type and intensity of stimulation, and number of needles used. The research seems to suggest that needles do not need to stimulate
11834-421: Is impossible. In some other lasers, it would require pumping the laser at a very high continuous power level, which would be impractical, or destroying the laser by producing excessive heat. Such lasers cannot be run in CW mode. The pulsed operation of lasers refers to any laser not classified as a continuous wave so that the optical power appears in pulses of some duration at some repetition rate. This encompasses
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#173288445853812028-615: Is in the design of an appropriate placebo control group . For efficacy studies to determine whether acupuncture has specific effects, "sham" forms of acupuncture where the patient, practitioner, and analyst are blinded seem the most acceptable approach. Sham acupuncture uses non-penetrating needles or needling at non-acupuncture points, e.g. inserting needles on meridians not related to the specific condition being studied, or in places not associated with meridians. The under-performance of acupuncture in such trials may indicate that therapeutic effects are due entirely to non-specific effects, or that
12222-403: Is inappropriate for such therapies; it is time to assert that many alternative cancer therapies have been "disproven". Anything classified as alternative medicine by definition does not have a proven healing or medical effect. However, there are different mechanisms through which it can be perceived to "work". The common denominator of these mechanisms is that effects are mis-attributed to
12416-458: Is individualized and based on philosophy and intuition, and not on scientific research. There is also a non-invasive therapy developed in early 20th-century Japan using an elaborate set of instruments other than needles for the treatment of children ( shōnishin or shōnihari ). Clinical practice varies depending on the country. A comparison of the average number of patients treated per hour found significant differences between China (10) and
12610-515: Is not an effective method of healthcare. Acupuncture is generally safe when done by appropriately trained practitioners using clean needle techniques and single-use needles. When properly delivered, it has a low rate of mostly minor adverse effects . When accidents and infections do occur, they are associated with neglect on the part of the practitioner, particularly in the application of sterile techniques . A review conducted in 2013 stated that reports of infection transmission increased significantly in
12804-405: Is not the result of random thermal processes. Instead, the release of a photon is triggered by the nearby passage of another photon. This is called stimulated emission . For this process to work, the passing photon must be similar in energy, and thus wavelength, to the one that could be released by the atom or molecule, and the atom or molecule must be in the suitable excited state. The photon that
12998-428: Is observed, techniques might be used which attempt to "influence" the de-qi ; for example, by certain manipulation the de-qi can allegedly be conducted from the needling site towards more distant sites of the body. Other techniques aim at "tonifying" ( Chinese : 补 ; pinyin : bǔ ) or "sedating" ( Chinese : 泄 ; pinyin : xiè ) qi . The former techniques are used in deficiency patterns,
13192-525: Is really no such thing as alternative medicine, just medicine that works and medicine that doesn't", a notion later echoed by Paul Offit : "The truth is there's no such thing as conventional or alternative or complementary or integrative or holistic medicine. There's only medicine that works and medicine that doesn't. And the best way to sort it out is by carefully evaluating scientific studies—not by visiting Internet chat rooms, reading magazine articles, or talking to friends." Alternative medicine consists of
13386-480: Is sometimes derogatorily called " Big Pharma " by supporters of alternative medicine. Billions of dollars have been spent studying alternative medicine, with few or no positive results and many methods thoroughly disproven. The terms alternative medicine , complementary medicine , integrative medicine, holistic medicine , natural medicine , unorthodox medicine , fringe medicine , unconventional medicine , and new age medicine are used interchangeably as having
13580-493: Is still permitted. It is also recommended that thorough control practices for preventing infection be implemented and adapted. A 2013 systematic review of the English-language case reports found that serious adverse events associated with acupuncture are rare, but that acupuncture is not without risk. Between 2000 and 2011 the English-language literature from 25 countries and regions reported 294 adverse events. The majority of
13774-710: Is that part of medical science that applies principles of biology , physiology , molecular biology , biophysics , and other natural sciences to clinical practice , using scientific methods to establish the effectiveness of that practice. Unlike medicine, an alternative product or practice does not originate from using scientific methods, but may instead be based on hearsay , religion, tradition, superstition , belief in supernatural energies, pseudoscience , errors in reasoning , propaganda, fraud, or other unscientific sources. Some other definitions seek to specify alternative medicine in terms of its social and political marginality to mainstream healthcare. This can refer to
13968-476: Is the insertion of thin needles into the skin. According to the Mayo Foundation for Medical Education and Research (Mayo Clinic), a typical session entails lying still while approximately five to twenty needles are inserted; for the majority of cases, the needles will be left in place for ten to twenty minutes. It can be associated with the application of heat, pressure, or laser light . Classically, acupuncture
14162-489: Is to heat an object; some of the thermal energy being applied to the object will cause the molecules and electrons within the object to gain energy, which is then lost through thermal radiation , that we see as light. This is the process that causes a candle flame to give off light. Thermal radiation is a random process, and thus the photons emitted have a range of different wavelengths , travel in different directions, and are released at different times. The energy within
14356-504: Is to pump the laser material with a source that is itself pulsed, either through electronic charging in the case of flash lamps, or another laser that is already pulsed. Pulsed pumping was historically used with dye lasers where the inverted population lifetime of a dye molecule was so short that a high-energy, fast pump was needed. The way to overcome this problem was to charge up large capacitors which are then switched to discharge through flashlamps, producing an intense flash. Pulsed pumping
14550-441: Is typically expressed through the output being a narrow beam, which is diffraction-limited . Laser beams can be focused to very tiny spots, achieving a very high irradiance , or they can have a very low divergence to concentrate their power at a great distance. Temporal (or longitudinal) coherence implies a polarized wave at a single frequency, whose phase is correlated over a relatively great distance (the coherence length ) along
14744-430: Is used to measure the intensity profile, width, and divergence of laser beams. Diffuse reflection of a laser beam from a matte surface produces a speckle pattern with interesting properties. The mechanism of producing radiation in a laser relies on stimulated emission , where energy is extracted from a transition in an atom or molecule. This is a quantum phenomenon that was predicted by Albert Einstein , who derived
14938-612: Is when alternative medicine is used together with mainstream functional medical treatment in a belief that it improves the effect of treatments. For example, acupuncture (piercing the body with needles to influence the flow of a supernatural energy) might be believed to increase the effectiveness or "complement" science-based medicine when used at the same time. Significant drug interactions caused by alternative therapies may make treatments less effective, notably in cancer therapy . Several medical organizations differentiate between complementary and alternative medicine including
15132-519: The Neolithic era, near the end of the Stone Age , using sharpened stones called Bian shi . Many Chinese texts from later eras refer to sharp stones called "plen", which means "stone probe", that may have been used for acupuncture purposes. The ancient Chinese medical text, Huangdi Neijing, indicates that sharp stones were believed at-the-time to cure illnesses at or near the body's surface, perhaps because of
15326-643: The United States Medical Licensing Examination (USMLE). There is a general scientific consensus that alternative therapies lack the requisite scientific validation , and their effectiveness is either unproved or disproved. Many of the claims regarding the efficacy of alternative medicines are controversial, since research on them is frequently of low quality and methodologically flawed. Selective publication bias , marked differences in product quality and standardisation, and some companies making unsubstantiated claims call into question
15520-730: The abdominal region , should be avoided during pregnancy. Four adverse events associated with moxibustion were bruising, burns and cellulitis, spinal epidural abscess, and large superficial basal cell carcinoma. Ten adverse events were associated with cupping. The minor ones were keloid scarring, burns, and bullae ; the serious ones were acquired hemophilia A, stroke following cupping on the back and neck, factitious panniculitis , reversible cardiac hypertrophy, and iron deficiency anemia . As with other alternative medicines, unethical or naïve practitioners may induce patients to exhaust financial resources by pursuing ineffective treatment. Professional ethics codes set by accrediting organizations such as
15714-569: The counterculture movement of the 1960s, as part of the rising new age movement of the 1970s. This was due to misleading mass marketing of "alternative medicine" being an effective "alternative" to biomedicine, changing social attitudes about not using chemicals and challenging the establishment and authority of any kind, sensitivity to giving equal measure to beliefs and practices of other cultures ( cultural relativism ), and growing frustration and desperation by patients about limitations and side effects of science-based medicine. At
15908-410: The phase of the emitted light is 90 degrees in lead of the stimulating light. This, combined with the filtering effect of the optical resonator gives laser light its characteristic coherence, and may give it uniform polarization and monochromaticity, depending on the resonator's design. The fundamental laser linewidth of light emitted from the lasing resonator can be orders of magnitude narrower than
16102-512: The pulse and other parts of the body and examining the tongue. Traditional acupuncture involves the belief that a "life force" ( qi ) circulates within the body in lines called meridians. The main methods practiced in the UK are TCM and Western medical acupuncture. The term Western medical acupuncture is used to indicate an adaptation of TCM-based acupuncture which focuses less on TCM. The Western medical acupuncture approach involves using acupuncture after
16296-798: The scientific method to test plausible therapies by way of responsible and ethical clinical trials , producing repeatable evidence of either effect or of no effect, alternative therapies reside outside of mainstream medicine and do not originate from using the scientific method, but instead rely on testimonials , anecdotes , religion, tradition, superstition , belief in supernatural " energies ", pseudoscience , errors in reasoning , propaganda, fraud, or other unscientific sources. Frequently used terms for relevant practices are New Age medicine , pseudo-medicine , unorthodox medicine , holistic medicine , fringe medicine , and unconventional medicine , with little distinction from quackery . Some alternative practices are based on theories that contradict
16490-421: The transverse modes often approximated using Hermite – Gaussian or Laguerre -Gaussian functions. Some high-power lasers use a flat-topped profile known as a " tophat beam ". Unstable laser resonators (not used in most lasers) produce fractal-shaped beams. Specialized optical systems can produce more complex beam geometries, such as Bessel beams and optical vortexes . Near the "waist" (or focal region ) of
16684-497: The "pencil beam" directly generated by a common helium–neon laser would spread out to a size of perhaps 500 kilometers when shone on the Moon (from the distance of the Earth). On the other hand, the light from a semiconductor laser typically exits the tiny crystal with a large divergence: up to 50°. However even such a divergent beam can be transformed into a similarly collimated beam employing
16878-400: The "seven inquiries": chills and fever; perspiration; appetite, thirst and taste; defecation and urination; pain; sleep; and menses and leukorrhea . Palpation is focusing on feeling the body for tender A-shi points and feeling the pulse. The most common mechanism of stimulation of acupuncture points employs penetration of the skin by thin metal needles, which are manipulated manually or
17072-520: The "whole" person, in contrast to the supposed reductionism of medicine. Prominent members of the science and biomedical science community say that it is not meaningful to define an alternative medicine that is separate from a conventional medicine because the expressions "conventional medicine", "alternative medicine", "complementary medicine", "integrative medicine", and "holistic medicine" do not refer to any medicine at all. Others say that alternative medicine cannot be precisely defined because of
17266-675: The 1980s and 2002, the Japanese-language literature contained reports of 150 adverse events. Although acupuncture has been practiced for thousands of years in China, its use in pediatrics in the United States did not become common until the early 2000s. In 2007, the National Health Interview Survey (NHIS) conducted by the National Center For Health Statistics (NCHS) estimated that approximately 150,000 children had received acupuncture treatment for
17460-544: The CAM review used the more developed 2004 Cochrane database, while the conventional review used the initial 1998 Cochrane database. Alternative therapies do not "complement" (improve the effect of, or mitigate the side effects of) functional medical treatment. Significant drug interactions caused by alternative therapies may instead negatively impact functional treatment by making prescription drugs less effective, such as interference by herbal preparations with warfarin . In
17654-453: The NHS organizations. The adverse events recorded included retained needles (31%), dizziness (30%), loss of consciousness/unresponsive (19%), falls (4%), bruising or soreness at needle site (2%), pneumothorax (1%) and other adverse side effects (12%). Acupuncture practitioners should know, and be prepared to be responsible for, any substantial harm from treatments. Some acupuncture proponents argue that
17848-637: The National Certification Commission for Acupuncture and Oriental Medicine require practitioners to make "timely referrals to other health care professionals as may be appropriate." Stephen Barrett states that there is a "risk that an acupuncturist whose approach to diagnosis is not based on scientific concepts will fail to diagnose a dangerous condition". Acupuncture is a substantial part of traditional Chinese medicine (TCM). Early acupuncture beliefs relied on concepts that are common in TCM, such as
18042-670: The Quantum Theory of Radiation") via a re-derivation of Max Planck 's law of radiation, conceptually based upon probability coefficients ( Einstein coefficients ) for the absorption, spontaneous emission, and stimulated emission of electromagnetic radiation. In 1928, Rudolf W. Ladenburg confirmed the existence of the phenomena of stimulated emission and negative absorption. In 1939, Valentin A. Fabrikant predicted using stimulated emission to amplify "short" waves. In 1947, Willis E. Lamb and R. C. Retherford found apparent stimulated emission in hydrogen spectra and effected
18236-503: The Soviet Union, Nikolay Basov and Aleksandr Prokhorov were independently working on the quantum oscillator and solved the problem of continuous-output systems by using more than two energy levels. These gain media could release stimulated emissions between an excited state and a lower excited state, not the ground state, facilitating the maintenance of a population inversion . In 1955, Prokhorov and Basov suggested optical pumping of
18430-472: The State of California, USA. Needles vary in length between 13 and 130 millimetres (0.51 and 5.12 in), with shorter needles used near the face and eyes, and longer needles in areas with thicker tissues; needle diameters vary from 0.16 mm (0.006 in) to 0.46 mm (0.018 in), with thicker needles used on more robust patients. Thinner needles may be flexible and require tubes for insertion. The tip of
18624-728: The UK National Health Service (NHS), Cancer Research UK , and the US Center for Disease Control and Prevention (CDC), the latter of which states that " Complementary medicine is used in addition to standard treatments" whereas " Alternative medicine is used instead of standard treatments." Complementary and integrative interventions are used to improve fatigue in adult cancer patients. David Gorski has described integrative medicine as an attempt to bring pseudoscience into academic science-based medicine with skeptics such as Gorski and David Colquhoun referring to this with
18818-565: The UK than other countries. Reports included 38 cases of infections and 42 cases of organ trauma. The most frequent adverse events included pneumothorax , and bacterial and viral infections . A 2013 review found (without restrictions regarding publication date, study type or language) 295 cases of infections; mycobacterium was the pathogen in at least 96%. Likely sources of infection include towels, hot packs or boiling tank water, and reusing reprocessed needles. Possible sources of infection include contaminated needles, reusing personal needles,
19012-467: The United States (1.2). Chinese herbs are often used. There is a diverse range of acupuncture approaches, involving different philosophies. Although various different techniques of acupuncture practice have emerged, the method used in traditional Chinese medicine (TCM) seems to be the most widely adopted in the US. Traditional acupuncture involves needle insertion, moxibustion , and cupping therapy , and may be accompanied by other procedures such as feeling
19206-457: The West). Korean acupuncture uses copper needles and has a greater focus on the hand. The skin is sterilized and needles are inserted, frequently with a plastic guide tube. Needles may be manipulated in various ways, including spinning, flicking, or moving up and down relative to the skin. Since most pain is felt in the superficial layers of the skin, a quick insertion of the needle is recommended. Often
19400-614: The acronym. It has been humorously noted that the acronym LOSER, for "light oscillation by stimulated emission of radiation", would have been more correct. With the widespread use of the original acronym as a common noun, optical amplifiers have come to be referred to as laser amplifiers . Modern physics describes light and other forms of electromagnetic radiation as the group behavior of fundamental particles known as photons . Photons are released and absorbed through electromagnetic interactions with other fundamental particles that carry electric charge . A common way to release photons
19594-531: The adverse events cardiac arrest, pyknolepsy, shock, fever, cough, thirst, aphonia, leg numbness, and sexual dysfunction remains uncertain. The same review concluded that acupuncture can be considered inherently safe when practiced by properly trained practitioners, but the review also stated there is a need to find effective strategies to minimize the health risks. Between 1999 and 2010, the Korean-language literature contained reports of 1104 adverse events. Between
19788-417: The alternative therapies he and his team studied, including acupuncture, herbal medicine, homeopathy, and reflexology , are "statistically indistinguishable from placebo treatments", but he also believes there is something that conventional doctors can usefully learn from the chiropractors and homeopath: this is the therapeutic value of the placebo effect, one of the strangest phenomena in medicine. In 2003,
19982-408: The alternative treatment. A placebo is a treatment with no intended therapeutic value. An example of a placebo is an inert pill, but it can include more dramatic interventions like sham surgery . The placebo effect is the concept that patients will perceive an improvement after being treated with an inert treatment. The opposite of the placebo effect is the nocebo effect , when patients who expect
20176-442: The ancient Chinese belief that illnesses were caused by demons within the body that could be killed or released. It is likely bloodletting was an antecedent to acupuncture. Alternative medicine Alternative medicine is any practice that aims to achieve the healing effects of medicine despite lacking biological plausibility , testability , repeatability or evidence of effectiveness. Unlike modern medicine , which employs
20370-491: The art of medicine, and engaging in complex clinical reasoning (medical decision-making). Writing in 2002, Snyderman and Weil remarked that by the early twentieth century the Flexner model had helped to create the 20th-century academic health center, in which education, research, and practice were inseparable. While this had much improved medical practice by defining with increasing certainty the pathophysiological basis of disease,
20564-476: The beam. A beam produced by a thermal or other incoherent light source has an instantaneous amplitude and phase that vary randomly with respect to time and position, thus having a short coherence length. Lasers are characterized according to their wavelength in a vacuum . Most "single wavelength" lasers produce radiation in several modes with slightly different wavelengths. Although temporal coherence implies some degree of monochromaticity , some lasers emit
20758-425: The blue to near-UV have also been used in place of light-emitting diodes (LEDs) to excite fluorescence as a white light source; this permits a much smaller emitting area due to the much greater radiance of a laser and avoids the droop suffered by LEDs; such devices are already used in some car headlamps . The first device using amplification by stimulated emission operated at microwave frequencies, and
20952-445: The body in any positive or health promoting way. The history of alternative medicine may refer to the history of a group of diverse medical practices that were collectively promoted as "alternative medicine" beginning in the 1970s, to the collection of individual histories of members of that group, or to the history of western medical practices that were labeled "irregular practices" by the western medical establishment. It includes
21146-508: The body of knowledge related to health, disease, and health care that has been widely accepted by the scientific community. TCM practitioners disagree among themselves about how to diagnose patients and which treatments should go with which diagnoses. Even if they could agree, the TCM theories are so nebulous that no amount of scientific study will enable TCM to offer rational care." Academic discussions of acupuncture still make reference to pseudoscientific concepts such as qi and meridians despite
21340-505: The body suggests Ötzi had these conditions. This has been cited as evidence that practices similar to acupuncture may have been practised elsewhere in Eurasia during the early Bronze Age ; however, The Oxford Handbook of the History of Medicine calls this theory "speculative". It is considered unlikely that acupuncture was practised before 2000 BC. Acupuncture may have been practised during
21534-496: The cervical, thoracic and lumbar spine), chylothorax, injuries of abdominal organs and tissues, injuries in the neck region, injuries to the eyes, including orbital hemorrhage, traumatic cataract, injury of the oculomotor nerve and retinal puncture, hemorrhage to the cheeks and the hypoglottis, peripheral motor-nerve injuries and subsequent motor dysfunction, local allergic reactions to metal needles, stroke, and cerebral hemorrhage after acupuncture. A causal link between acupuncture and
21728-482: The claims of efficacy of isolated examples where there is evidence for alternative therapies. The Scientific Review of Alternative Medicine points to confusions in the general population – a person may attribute symptomatic relief to an otherwise-ineffective therapy just because they are taking something (the placebo effect); the natural recovery from or the cyclical nature of an illness (the regression fallacy ) gets misattributed to an alternative medicine being taken;
21922-637: The conclusions of only the 145 Cochrane reviews was done by two readers. In 83% of the cases, the readers agreed. In the 17% in which they disagreed, a third reader agreed with one of the initial readers to set a rating. These studies found that, for CAM, 38.4% concluded positive effect or possibly positive (12.4%), 4.8% concluded no effect, 0.7% concluded harmful effect, and 56.6% concluded insufficient evidence. An assessment of conventional treatments found that 41.3% concluded positive or possibly positive effect, 20% concluded no effect, 8.1% concluded net harmful effects, and 21.3% concluded insufficient evidence. However,
22116-477: The condition will be at its worst and most likely to spontaneously improve. In the absence of this bias, especially for diseases that are not expected to get better by themselves such as cancer or HIV infection , multiple studies have shown significantly worse outcomes if patients turn to alternative therapies. While this may be because these patients avoid effective treatment, some alternative therapies are actively harmful (e.g. cyanide poisoning from amygdalin , or
22310-510: The country in which it is performed. However, it can be divided into two main foundational philosophical applications and approaches; the first being the modern standardized form called eight principles TCM and the second being an older system that is based on the ancient Daoist wuxing , better known as the five elements or phases in the West. Acupuncture is most often used to attempt pain relief, though acupuncturists say that it can also be used for
22504-539: The diversity of theories and practices it includes, and because the boundaries between alternative and conventional medicine overlap, are porous, and change. Healthcare practices categorized as alternative may differ in their historical origin, theoretical basis, diagnostic technique , therapeutic practice and in their relationship to the medical mainstream. Under a definition of alternative medicine as "non-mainstream", treatments considered alternative in one location may be considered conventional in another. Critics say
22698-628: The dominant health care system. They are used interchangeably with traditional medicine in some countries." The Integrative Medicine Exam by the American Board of Physician Specialties includes the following subjects: Manual Therapies , Biofield Therapies , Acupuncture , Movement Therapies, Expressive Arts, Traditional Chinese Medicine , Ayurveda , Indigenous Medical Systems , Homeopathic Medicine , Naturopathic Medicine , Osteopathic Medicine , Chiropractic , and Functional Medicine . Traditional medicine (TM) refers to certain practices within
22892-619: The earliest known historical record of acupuncture is the Shiji ("Records of the Grand Historian"), written by a historian around 100 BC. It is believed that this text was documenting what was established practice at that time. The 5,000-year-old mummified body of Ötzi the Iceman was found with 15 groups of tattoos, many of which were located at points on the body where acupuncture needles are used for abdominal or lower back problems. Evidence from
23086-561: The effect of nonlinearity in optical materials (e.g. in second-harmonic generation , parametric down-conversion , optical parametric oscillators and the like). Unlike the giant pulse of a Q-switched laser, consecutive pulses from a mode-locked laser are phase-coherent; that is, the pulses (and not just their envelopes ) are identical and perfectly periodic. For this reason, and the extremely large peak powers attained by such short pulses, such lasers are invaluable in certain areas of research. Another method of achieving pulsed laser operation
23280-482: The established science of how the human body works; others appeal to the supernatural or superstitious to explain their effect or lack thereof. In others, the practice has plausibility but lacks a positive risk–benefit outcome probability. Research into alternative therapies often fails to follow proper research protocols (such as placebo -controlled trials, blind experiments and calculation of prior probability ), providing invalid results. History has shown that if
23474-554: The exact date acupuncture was founded depends on the extent to which dating of ancient texts can be trusted and the interpretation of what constitutes acupuncture. Acupressure therapy was prevalent in India. Once Buddhism spread to China , the acupressure therapy was also integrated into common medical practice in China and it came to be known as acupuncture. The major points of Indian acupressure and Chinese acupuncture are similar to each other. According to an article in Rheumatology ,
23668-447: The existence of qi or meridians, which was a major part of early belief systems. Acupuncture is believed to have originated around 100 BC in China, around the time The Inner Classic of Huang Di ( Huangdi Neijing ) was published, though some experts suggest it could have been practiced earlier. Over time, conflicting claims and belief systems emerged about the effect of lunar, celestial and earthly cycles, yin and yang energies, and
23862-424: The expression is deceptive because it implies there is an effective alternative to science-based medicine, and that complementary is deceptive because it implies that the treatment increases the effectiveness of (complements) science-based medicine, while alternative medicines that have been tested nearly always have no measurable positive effect compared to a placebo . Journalist John Diamond wrote that "there
24056-595: The first demonstration of stimulated emission. In 1950, Alfred Kastler (Nobel Prize for Physics 1966) proposed the method of optical pumping , which was experimentally demonstrated two years later by Brossel, Kastler, and Winter. In 1951, Joseph Weber submitted a paper on using stimulated emissions to make a microwave amplifier to the June 1952 Institute of Radio Engineers Vacuum Tube Research Conference in Ottawa , Ontario, Canada. After this presentation, RCA asked Weber to give
24250-458: The first documentation of an "organized system of diagnosis and treatment" for acupuncture was in Inner Classic of Huang Di ( Huangdi Neijing ) from about 100 BC. Gold and silver needles found in the tomb of Liu Sheng from around 100 BC are believed to be the earliest archaeological evidence of acupuncture, though it is unclear if that was their purpose. According to Plinio Prioreschi,
24444-437: The four diagnostic methods are: inspection, auscultation and olfaction, inquiring, and palpation. 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 involve listening for particular sounds, such as wheezing, and observing body odor. Inquiring involves focusing on
24638-509: The histories of complementary medicine and of integrative medicine . Before the 1970s, western practitioners that were not part of the increasingly science-based medical establishment were referred to "irregular practitioners", and were dismissed by the medical establishment as unscientific and as practicing quackery. Until the 1970s, irregular practice became increasingly marginalized as quackery and fraud, as western medicine increasingly incorporated scientific methods and discoveries, and had
24832-781: The intentional ingestion of hydrogen peroxide ) or actively interfere with effective treatments. The alternative medicine sector is a highly profitable industry with a strong lobby, and faces far less regulation over the use and marketing of unproven treatments. Complementary medicine ( CM ), complementary and alternative medicine ( CAM ), integrated medicine or integrative medicine ( IM ), and holistic medicine attempt to combine alternative practices with those of mainstream medicine. Traditional medicine practices become "alternative" when used outside their original settings and without proper scientific explanation and evidence. Alternative methods are often marketed as more " natural " or " holistic " than methods offered by medical science, that
25026-425: The lack of scientific evidence. Some modern practitioners support the use of acupuncture to treat pain, but have abandoned the use of qi , meridians, yin , yang and other mystical energies as an explanatory frameworks. The use of qi as an explanatory framework has been decreasing in China, even as it becomes more prominent during discussions of acupuncture in the US. Many acupuncturists attribute pain relief to
25220-542: The lack of support that alternative therapies receive from medical scientists regarding access to research funding , sympathetic coverage in the medical press , or inclusion in the standard medical curriculum . For example, a widely used definition devised by the US NCCIH calls it "a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine" . However, these descriptive definitions are inadequate in
25414-518: The large number of treatments performed there or a relatively higher number of poorly trained Asian acupuncturists. Many serious adverse events were reported from developed countries. These included Australia, Austria, Canada, Croatia, France, Germany, Ireland, the Netherlands, New Zealand, Spain, Sweden, Switzerland, the UK, and the US. The number of adverse effects reported from the UK appears particularly unusual, which may indicate less under-reporting in
25608-422: The laser power inside the cavity; this equilibrium determines the operating point of the laser. If the applied pump power is too small, the gain will never be sufficient to overcome the cavity losses, and laser light will not be produced. The minimum pump power needed to begin laser action is called the lasing threshold . The gain medium will amplify any photons passing through it, regardless of direction; but only
25802-501: The lasing medium or pumping mechanism, then it is still classified as a "modulated" or "pulsed" continuous wave laser. Most laser diodes used in communication systems fall into that category. Some applications of lasers depend on a beam whose output power is constant over time. Such a laser is known as a continuous-wave ( CW ) laser. Many types of lasers can be made to operate in continuous-wave mode to satisfy such an application. Many of these lasers lase in several longitudinal modes at
25996-414: The latter case, the photon is emitted in the same direction as the light that is passing by. When the number of particles in one excited state exceeds the number of particles in some lower-energy state, population inversion is achieved. In this state, the rate of stimulated emission is larger than the rate of absorption of light in the medium, and therefore the light is amplified. A system with this property
26190-530: The latter in excess patterns. De qi is more important in Chinese acupuncture, while Western and Japanese patients may not consider it a necessary part of the treatment. As of 2021, many thousands of papers had been published on the efficacy of acupuncture for the treatment of various adult health conditions, but there was no robust evidence it was beneficial for anything, except shoulder pain and fibromyalgia . For Science-Based Medicine , Steven Novella wrote that
26384-503: The linewidth of light emitted from the passive resonator. Some lasers use a separate injection seeder to start the process off with a beam that is already highly coherent. This can produce beams with a narrower spectrum than would otherwise be possible. In 1963, Roy J. Glauber showed that coherent states are formed from combinations of photon number states, for which he was awarded the Nobel Prize in physics . A coherent beam of light
26578-402: The literal cavity that would be employed at microwave frequencies in a maser . The resonator typically consists of two mirrors between which a coherent beam of light travels in both directions, reflecting on itself so that an average photon will pass through the gain medium repeatedly before it is emitted from the output aperture or lost to diffraction or absorption. If the gain (amplification) in
26772-569: The long history of acupuncture suggests it is safe. However, there is an increasing literature on adverse events (e.g. spinal-cord injury). Acupuncture seems to be safe in people getting anticoagulants , assuming needles are used at the correct location and depth, but studies are required to verify these findings. A 2010 systematic review of the Chinese-language literature found numerous acupuncture-related adverse events, including pneumothorax, fainting, subarachnoid hemorrhage , and infection as
26966-564: The loose terminology to give the appearance of effectiveness). Loose terminology may also be used to suggest meaning that a dichotomy exists when it does not (e.g., the use of the expressions "Western medicine" and "Eastern medicine" to suggest that the difference is a cultural difference between the Asian east and the European west, rather than that the difference is between evidence-based medicine and treatments that do not work). Alternative medicine
27160-522: The lower level, emitting a new photon. The emitted photon exactly matches the original photon in wavelength, phase, and direction. This process is called stimulated emission. The gain medium is put into an excited state by an external source of energy. In most lasers, this medium consists of a population of atoms that have been excited into such a state using an outside light source, or an electrical field that supplies energy for atoms to absorb and be transformed into their excited states. The gain medium of
27354-492: The maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness." When used outside the original setting and in the absence of scientific evidence, TM practices are typically referred to as "alternative medicine". Holistic medicine is another rebranding of alternative medicine. In this case, the words balance and holism are often used alongside complementary or integrative , claiming to take into fuller account
27548-1028: The majority of infections were bacterial in nature, caused by skin contact at the needling site. Infection has also resulted from skin contact with unsterilized equipment or with dirty towels in an unhygienic clinical setting. Other adverse complications included five reported cases of spinal cord injuries (e.g. migrating broken needles or needling too deeply), four brain injuries, four peripheral nerve injuries, five heart injuries, seven other organ and tissue injuries, bilateral hand edema , epithelioid granuloma , pseudolymphoma , argyria , pustules, pancytopenia , and scarring due to hot-needle technique. Adverse reactions from acupuncture, which are unusual and uncommon in typical acupuncture practice, included syncope, galactorrhoea, bilateral nystagmus, pyoderma gangrenosum, hepatotoxicity, eruptive lichen planus, and spontaneous needle migration. A 2013 systematic review found 31 cases of vascular injuries caused by acupuncture, three causing death. Two died from pericardial tamponade and one
27742-451: The majority of research suggests that acupuncture's effects are mainly due to placebo. Evidence suggests that any benefits of acupuncture are short-lasting. There is insufficient evidence to support use of acupuncture compared to mainstream medical treatments . Acupuncture is not better than mainstream treatment in the long term. The use of acupuncture has been criticized owing to there being little scientific evidence for explicit effects, or
27936-400: The majority of these reviews were published in journals with impact factors of zero. A 2015 study comparing pre-registered records of acupuncture trials with their published results found that it was uncommon for such trials to be registered before the trial began. This study also found that selective reporting of results and changing outcome measures to obtain statistically significant results
28130-412: The maximum possible level, the introduced loss mechanism (often an electro- or acousto-optical element) is rapidly removed (or that occurs by itself in a passive device), allowing lasing to begin which rapidly obtains the stored energy in the gain medium. This results in a short pulse incorporating that energy, and thus a high peak power. A mode-locked laser is capable of emitting extremely short pulses on
28324-731: The mechanisms for its supposed effectiveness, for any condition that is discernible from placebo. Acupuncture has been called "theatrical placebo", and David Gorski argues that when acupuncture proponents advocate "harnessing of placebo effects" or work on developing "meaningful placebos", they essentially concede it is little more than that. Publication bias is cited as a concern in the reviews of randomized controlled trials of acupuncture. A 1998 review of studies on acupuncture found that trials originating in China, Japan, Hong Kong, and Taiwan were uniformly favourable to acupuncture, as were ten out of eleven studies conducted in Russia. A 2011 assessment of
28518-498: The medium is larger than the resonator losses, then the power of the recirculating light can rise exponentially . But each stimulated emission event returns an atom from its excited state to the ground state, reducing the gain of the medium. With increasing beam power, the net gain (gain minus loss) reduces to unity and the gain medium is said to be saturated. In a continuous wave (CW) laser, the balance of pump power against gain saturation and cavity losses produces an equilibrium value of
28712-417: The most frequent, and cardiovascular injuries, subarachnoid hemorrhage, pneumothorax, and recurrent cerebral hemorrhage as the most serious, most of which were due to improper technique. Between 1980 and 2009, the Chinese-language literature reported 479 adverse events. Prospective surveys show that mild, transient acupuncture-associated adverse events ranged from 6.71% to 15%. In a study with 190,924 patients,
28906-436: The needle may be further stimulated by electrical stimulation (electroacupuncture). Acupuncture needles are typically made of stainless steel, making them flexible and preventing them from rusting or breaking. Needles are usually disposed of after each use to prevent contamination. Reusable needles when used should be sterilized between applications. In many areas, only sterile, single-use acupuncture needles are allowed, including
29100-478: The needle should not be made too sharp to prevent breakage, although blunt needles cause more pain. Apart from the usual filiform needle, other needle types include three-edged needles and the Nine Ancient Needles. Japanese acupuncturists use extremely thin needles that are used superficially, sometimes without penetrating the skin, and surrounded by a guide tube (a 17th-century invention adopted in China and
29294-427: The needles are stimulated by hand in order to cause a dull, localized, aching sensation that is called de qi , as well as "needle grasp," a tugging feeling felt by the acupuncturist and generated by a mechanical interaction between the needle and skin. Acupuncture can be painful. The acupuncturist's skill level may influence the painfulness of the needle insertion; a sufficiently skilled practitioner may be able to insert
29488-576: The needles without causing any pain. De-qi ( Chinese : 得气 ; pinyin : dé qì ; "arrival of qi") refers to a claimed sensation of numbness, distension, or electrical tingling at the needling site. If these sensations are not observed then inaccurate location of the acupoint , improper depth of needle insertion, inadequate manual manipulation, are blamed. If de-qi is not immediately observed upon needle insertion, various manual manipulation techniques are often applied to promote it (such as "plucking", "shaking" or "trembling"). Once de-qi
29682-404: The object is not random, however: it is stored by atoms and molecules in " excited states ", which release photons with distinct wavelengths. This gives rise to the science of spectroscopy , which allows materials to be determined through the specific wavelengths that they emit. The underlying physical process creating photons in a laser is the same as in thermal radiation, but the actual emission
29876-451: The order of tens of picoseconds down to less than 10 femtoseconds . These pulses repeat at the round-trip time, that is, the time that it takes light to complete one round trip between the mirrors comprising the resonator. Due to the Fourier limit (also known as energy–time uncertainty ), a pulse of such short temporal length has a spectrum spread over a considerable bandwidth. Thus such
30070-435: The overall pattern of evidence was reminiscent of that for homeopathy , compatible with the hypothesis that most, if not all, benefits were due to the placebo effect , and strongly suggestive that acupuncture had no beneficial therapeutic effects at all. It is difficult but not impossible to design rigorous research trials for acupuncture. Due to acupuncture's invasive nature, one of the major challenges in efficacy research
30264-679: The part of the practitioner. To reduce the risk of serious adverse events after acupuncture, acupuncturists should be trained sufficiently. A 2009 overview of Cochrane reviews found acupuncture is not effective for a wide range of conditions. People with serious spinal disease, such as cancer or infection, are not good candidates for acupuncture. Contraindications to acupuncture (conditions that should not be treated with acupuncture) include coagulopathy disorders (e.g. hemophilia and advanced liver disease), warfarin use, severe psychiatric disorders (e.g. psychosis), and skin infections or skin trauma (e.g. burns). Further, electroacupuncture should be avoided at
30458-435: The pejorative term " quackademia ". Robert Todd Carroll described Integrative medicine as "a synonym for 'alternative' medicine that, at its worst, integrates sense with nonsense. At its best, integrative medicine supports both consensus treatments of science-based medicine and treatments that the science, while promising perhaps, does not justify" Rose Shapiro has criticized the field of alternative medicine for rebranding
30652-638: The period of reorganization within medicine (1965–1999) was reported as showing that the medical profession had responded to the growth of CAM in three phases, and that in each phase, changes in the medical marketplace had influenced the type of response in the journals. Changes included relaxed medical licensing, the development of managed care , rising consumerism, and the establishment of the USA Office of Alternative Medicine (later National Center for Complementary and Alternative Medicine, currently National Center for Complementary and Integrative Health). Mainly as
30846-418: The photons in a spatial mode supported by the resonator will pass more than once through the medium and receive substantial amplification. In most lasers, lasing begins with spontaneous emission into the lasing mode. This initial light is then amplified by stimulated emission in the gain medium. Stimulated emission produces light that matches the input signal in direction, wavelength, and polarization, whereas
31040-409: The power output is essentially continuous over time or whether its output takes the form of pulses of light on one or another time scale. Of course, even a laser whose output is normally continuous can be intentionally turned on and off at some rate to create pulses of light. When the modulation rate is on time scales much slower than the cavity lifetime and the period over which energy can be stored in
31234-459: The preceding decade. The most frequently reported adverse events were pneumothorax and infections. Since serious adverse events continue to be reported, it is recommended that acupuncturists be trained sufficiently to reduce the risk. Scientific investigation has not found any histological or physiological evidence for traditional Chinese concepts such as qi , meridians , and acupuncture points, and many modern practitioners no longer support
31428-427: The present-day when some conventional doctors offer alternative medical treatments and introductory courses or modules can be offered as part of standard undergraduate medical training; alternative medicine is taught in more than half of US medical schools and US health insurers are increasingly willing to provide reimbursement for alternative therapies. Complementary medicine (CM) or integrative medicine (IM)
31622-571: The prevalence of serious adverse events was roughly 0.024%. Another study showed a rate of adverse events requiring specific treatment of 2.2%, 4,963 incidences among 229,230 patients. Infections, mainly hepatitis , after acupuncture are reported often in English-language research, though are rarely reported in Chinese-language research, making it plausible that acupuncture-associated infections have been underreported in China. Infections were mostly caused by poor sterilization of acupuncture needles. Other adverse events included spinal epidural hematoma (in
31816-662: The properties of the emitted light, such as the polarization, wavelength, and shape of the beam. Electrons and how they interact with electromagnetic fields are important in our understanding of chemistry and physics . In the classical view , the energy of an electron orbiting an atomic nucleus is larger for orbits further from the nucleus of an atom . However, quantum mechanical effects force electrons to take on discrete positions in orbitals . Thus, electrons are found in specific energy levels of an atom, two of which are shown below: An electron in an atom can absorb energy from light ( photons ) or heat ( phonons ) only if there
32010-785: The quality of randomized controlled trials on traditional Chinese medicine, including acupuncture, concluded that the methodological quality of most such trials (including randomization, experimental control, and blinding) was generally poor, particularly for trials published in Chinese journals (though the quality of acupuncture trials was better than the trials testing traditional Chinese medicine remedies). The study also found that trials published in non-Chinese journals tended to be of higher quality. Chinese authors use more Chinese studies, which have been demonstrated to be uniformly positive. A 2012 review of 88 systematic reviews of acupuncture published in Chinese journals found that less than half of these reviews reported testing for publication bias, and that
32204-457: The relationship between the A coefficient , describing spontaneous emission, and the B coefficient which applies to absorption and stimulated emission. In the case of the free electron laser , atomic energy levels are not involved; it appears that the operation of this rather exotic device can be explained without reference to quantum mechanics . A laser can be classified as operating in either continuous or pulsed mode, depending on whether
32398-482: The release of adenosine . The anti-nociceptive effect of acupuncture may be mediated by the adenosine A1 receptor . A 2014 review in Nature Reviews Cancer analyzed mouse studies that suggested acupuncture relieves pain via the local release of adenosine, which then triggered nearby A1 receptors. The review found that in those studies, because acupuncture "caused more tissue damage and inflammation relative to
32592-402: The release of endorphins when needles penetrate, but no longer support the idea that acupuncture can affect a disease. Some studies suggest acupuncture causes a series of events within the central nervous system , and that it is possible to inhibit acupuncture's analgesic effects with the opioid antagonist naloxone . Mechanical deformation of the skin by acupuncture needles appears to result in
32786-433: The reported adverse events were relatively minor, and the incidences were low. For example, a prospective survey of 34,000 acupuncture treatments found no serious adverse events and 43 minor ones, a rate of 1.3 per 1000 interventions. Another survey found there were 7.1% minor adverse events, of which 5 were serious, amid 97,733 acupuncture patients. The most common adverse effect observed was infection (e.g. mycobacterium), and
32980-416: The same effects as "real" acupuncture and, in some cases, does better." A 2013 meta-analysis found little evidence that the effectiveness of acupuncture on pain (compared to sham) was modified by the location of the needles, the number of needles used, the experience or technique of the practitioner, or by the circumstances of the sessions. The same analysis also suggested that the number of needles and sessions
33174-591: The same meaning and are almost synonymous in most contexts. Terminology has shifted over time, reflecting the preferred branding of practitioners. For example, the United States National Institutes of Health department studying alternative medicine, currently named the National Center for Complementary and Integrative Health (NCCIH), was established as the Office of Alternative Medicine (OAM) and
33368-446: The same practices as integrative medicine. CAM is an abbreviation of the phrase complementary and alternative medicine . The 2019 World Health Organization (WHO) Global Report on Traditional and Complementary Medicine states that the terms complementary and alternative medicine "refer to a broad set of health care practices that are not part of that country's own traditional or conventional medicine and are not fully integrated into
33562-410: The same time, and beats between the slightly different optical frequencies of those oscillations will produce amplitude variations on time scales shorter than the round-trip time (the reciprocal of the frequency spacing between modes), typically a few nanoseconds or less. In most cases, these lasers are still termed "continuous-wave" as their output power is steady when averaged over longer periods, with
33756-569: The same time, in 1975, the American Medical Association , which played the central role in fighting quackery in the United States, abolished its quackery committee and closed down its Department of Investigation. By the early to mid 1970s the expression "alternative medicine" came into widespread use, and the expression became mass marketed as a collection of "natural" and effective treatment "alternatives" to science-based biomedicine. By 1983, mass marketing of "alternative medicine"
33950-823: The same way as for conventional therapies, drugs, and interventions, it can be difficult to test the efficacy of alternative medicine in clinical trials . In instances where an established, effective, treatment for a condition is already available, the Helsinki Declaration states that withholding such treatment is unethical in most circumstances. Use of standard-of-care treatment in addition to an alternative technique being tested may produce confounded or difficult-to-interpret results. Cancer researcher Andrew J. Vickers has stated: Contrary to much popular and scientific writing, many alternative cancer treatments have been investigated in good-quality clinical trials, and they have been shown to be ineffective. The label "unproven"
34144-649: The science of physics, as in biofields, or in belief in properties of the energies of physics that are inconsistent with the laws of physics, as in energy medicine. Substance based practices use substances found in nature such as herbs, foods, non-vitamin supplements and megavitamins, animal and fungal products, and minerals, including use of these products in traditional medical practices that may also incorporate other methods. Examples include healing claims for non-vitamin supplements, fish oil , Omega-3 fatty acid , glucosamine , echinacea , flaxseed oil , and ginseng . Herbal medicine , or phytotherapy, includes not just
34338-562: The sham treatments are not inert, or that systematic protocols yield less than optimal treatment. A 2014 review in Nature Reviews Cancer found that "contrary to the claimed mechanism of redirecting the flow of qi through meridians, researchers usually find that it generally does not matter where the needles are inserted, how often (that is, no dose-response effect is observed), or even if needles are actually inserted. In other words, "sham" or "placebo" acupuncture generally produces
34532-421: The short depth a stone could penetrate. However, it is more likely that stones were used for other medical purposes, such as puncturing a growth to drain its pus . The Mawangdui texts, which are believed to be from the 2nd century BC, mention the use of pointed stones to open abscesses , and moxibustion, but not for acupuncture. It is also speculated that these stones may have been used for bloodletting, due to
34726-452: The size of the animal in mice than in humans, such studies unnecessarily muddled a finding that local inflammation can result in the local release of adenosine with analgesic effect." Acupuncture, along with moxibustion , is one of the oldest practices of traditional Chinese medicine. Most historians believe the practice began in China, though there are some conflicting narratives on when it originated. Academics David Ramey and Paul Buell said
34920-616: The spot of implanted electrical devices (such as pacemakers). A 2011 systematic review of systematic reviews (internationally and without language restrictions) found that serious complications following acupuncture continue to be reported. Between 2000 and 2009, ninety-five cases of serious adverse events , including five deaths , were reported. Many such events are not inherent to acupuncture but are due to malpractice of acupuncturists. This might be why such complications have not been reported in surveys of adequately trained acupuncturists. Most such reports originate from Asia, which may reflect
35114-411: The traditionally specified acupuncture points or penetrate the skin to attain an anticipated effect (e.g. psychosocial factors). A response to "sham" acupuncture in osteoarthritis may be used in the elderly, but placebos have usually been regarded as deception and thus unethical. However, some physicians and ethicists have suggested circumstances for applicable uses for placebos such as it might present
35308-425: The two mirrors, the output coupler , is partially transparent. Some of the light escapes through this mirror. Depending on the design of the cavity (whether the mirrors are flat or curved ), the light coming out of the laser may spread out or form a narrow beam . In analogy to electronic oscillators , this device is sometimes called a laser oscillator . Most practical lasers contain additional elements that affect
35502-518: The use of plant products, but may also include the use of animal and mineral products. It is among the most commercially successful branches of alternative medicine, and includes the tablets, powders and elixirs that are sold as "nutritional supplements". Only a very small percentage of these have been shown to have any efficacy, and there is little regulation as to standards and safety of their contents. The United States agency National Center for Complementary and Integrative Health (NCCIH) has created
35696-410: The very high-frequency power variations having little or no impact on the intended application. (However, the term is not applied to mode-locked lasers, where the intention is to create very short pulses at the rate of the round-trip time.) For continuous-wave operation, the population inversion of the gain medium needs to be continually replenished by a steady pump source. In some lasing media, this
35890-412: Was a lack of acupuncture-associated maternal mortality. Limiting the evidence as certain, probable or possible in the causality evaluation, the estimated incidence of adverse events following acupuncture in pregnant women was 131 per 10,000. Although acupuncture is not contraindicated in pregnant women, some specific acupuncture points are particularly sensitive to needle insertion; these spots, as well as
36084-448: Was a serious, usually fatal, though theoretically avoidable complication following acupuncture, and urged training to minimize risk. A 2012 review found that a number of adverse events were reported after acupuncture in the UK's National Health Service (NHS), 95% of which were not severe, though miscategorization and under-reporting may alter the total figures. From January 2009 to December 2011, 468 safety incidents were recognized within
36278-421: Was built in 1960 by Theodore Maiman at Hughes Research Laboratories , based on theoretical work by Charles H. Townes and Arthur Leonard Schawlow . A laser differs from other sources of light in that it emits light that is coherent . Spatial coherence allows a laser to be focused to a tight spot, enabling applications such as optical communication, laser cutting , and lithography . It also allows
36472-598: Was called a maser , for "microwave amplification by stimulated emission of radiation". When similar optical devices were developed they were first called optical masers , until "microwave" was replaced by "light" in the acronym, to become laser . Today, all such devices operating at frequencies higher than microwaves (approximately above 300 GHz ) are called lasers (e.g. infrared lasers , ultraviolet lasers , X-ray lasers , gamma-ray lasers ), whereas devices operating at microwave or lower radio frequencies are called masers. The back-formed verb " to lase "
36666-673: Was common in this literature. Scientist and journalist Steven Salzberg identifies acupuncture and Chinese medicine generally as a focus for "fake medical journals" such as the Journal of Acupuncture and Meridian Studies and Acupuncture in Medicine . Acupuncture is generally safe when administered by an experienced, appropriately trained practitioner using clean-needle technique and sterile single-use needles. When improperly delivered it can cause adverse effects. Accidents and infections are associated with infractions of sterile technique or neglect on
36860-425: Was from an aortoduodenal fistula. The same review found vascular injuries were rare, bleeding and pseudoaneurysm were most prevalent. A 2011 systematic review (without restriction in time or language), aiming to summarize all reported case of cardiac tamponade after acupuncture, found 26 cases resulting in 14 deaths, with little doubt about cause in most fatal instances. The same review concluded that cardiac tamponade
37054-482: Was renamed the National Center for Complementary and Alternative Medicine (NCCAM) before obtaining its current name. Therapies are often framed as "natural" or "holistic", implicitly and intentionally suggesting that conventional medicine is "artificial" and "narrow in scope". The meaning of the term "alternative" in the expression "alternative medicine", is not that it is an effective alternative to medical science (though some alternative medicine promoters may use
37248-401: Was significantly different near meridians than other places in the body have been inconclusive. Scientific research has not supported the existence of qi , meridians, or yin and yang. A Nature editorial described TCM as "fraught with pseudoscience", with the majority of its treatments having no logical mechanism of action . Quackwatch states that "TCM theory and practice are not based upon
37442-513: Was so pervasive that the British Medical Journal ( BMJ ) pointed to "an apparently endless stream of books, articles, and radio and television programmes urge on the public the virtues of (alternative medicine) treatments ranging from meditation to drilling a hole in the skull to let in more oxygen". An analysis of trends in the criticism of complementary and alternative medicine (CAM) in five prestigious American medical journals during
37636-414: Was the cause without evidence is an example of the regression fallacy. This may be due to a natural recovery from the illness, or a fluctuation in the symptoms of a long-term condition. The concept of regression toward the mean implies that an extreme result is more likely to be followed by a less extreme result. There are also reasons why a placebo treatment group may outperform a "no-treatment" group in
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