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. 2015 Aug 3;2015:432467. doi: 10.1155/2015/432467

Systematic Review of Adverse Effects: A Further Step towards Modernization of Acupuncture in China

Junyi Wu 1, Yanmei Hu 1, Yin Zhu 2, Ping Yin 1, Gerhard Litscher 3, Shifen Xu 1,*
PMCID: PMC4538973  PMID: 26339265

Abstract

As a further step towards the modernization of acupuncture, the objective of this review was to figure out the frequency and severity of adverse complications and events in acupuncture treatment reported from 1980 to 2013 in China. All first-hand case reports of acupuncture-related complications and adverse events that could be identified in the scientific literature were reviewed and classified according to the type of complication and adverse event, circumstance of the event, and long-term patient outcome. The selected case reports were published between 1980 and 2013 in 3 databases. Relevant papers were collected and analyzed by 2 reviewers. Over the 33 years, 182 incidents were identified in 133 relevant papers. Internal organ, tissue, or nerve injury is the main complications of acupuncture especially for pneumothorax and central nervous system injury. Adverse effects also included syncope, infections, hemorrhage, allergy, burn, aphonia, hysteria, cough, thirst, fever, somnolence, and broken needles. Qualifying training of acupuncturists should be systemized and the clinical acupuncture operations should be standardized in order to effectively prevent the occurrence of acupuncture accidents, enhance the influence of acupuncture, and further popularize acupuncture to the rest of the world.

1. Introduction

Complications and adverse effects in medical practice are always of concern to the public and the medical profession. While being widely used in current medical treatment, especially in the area of intertrochanteric hip fractures, the cephalomedullary devices (CMN), however, led to a considerably high complication rate of 41.9% according to Pui et al. [1]. Faunø et al. [2] conducted a study on the medical records of 997 patients who were suffering from stoma closure, which revealed 131 cases of early complications and 187 late ones, accounting for 13.1% and 18.8% of the total subject pool, respectively. Umuroglu et al. [3] identified that the nuss procedure showed an overall complication rate of 18.7% through a retrospective analysis. Fortunately, with the increasing attention from the society on medical care safety and the further standardization of doctor's qualifications, such medical incidents have been decreasing. As acupuncture and moxibustion (A&M) are increasingly used in world, their widening acceptance necessitates continual safety assessment. This review, a sequel to two previous reviews from our team [4, 5], is an evaluation of the frequency and severity of adverse events (AEs) for acupuncture reported between 1980 and 2013 in China. These two reviews reported the AEs of A&M in the West, reported from 1965 to 1999 and from 2000 to 2011, respectively. In the first review, the main source of infection was found to be hepatitis caused by reused needles. In the second review, the majority of infections were bacterial, caused by skin contact at acupoint sites, without cases of hepatitis. For these two reviews, we just searched English articles, without Chinese reports, so it is unclear which AE happens in China. Since acupuncture is widely used in China, it is necessary to make sure what is happening about AE. In this review, we found internal organ, tissue, or nerve injuries were the main complications of acupuncture in China from 1980 to 2013. Clearly, guidelines must be followed in order to minimize acupuncture-related AEs and to modernize acupuncture and make it safer to apply.

2. Materials and Methods

2.1. Inclusion Criteria

All case reports concerning acupuncture-related complications or AEs in China published from 1980 to 2013 were identified. Only firsthand reports were included to avoid multiple reports of the same event. Thus, reviews, comments, or case-control studies were excluded from this review.

Complications, defined as “an added difficulty: a complex state, a disease, or an accident superimposed upon another without specific relation,” include infections, internal organ or tissue injuries, and other severe consequences. AEs and adverse reactions were defined as “development of an undesired side effect or toxicity” and include less severe consequences, such as contact dermatitis. Side effects, defined as “the action or effect other than that desired,” are included within the discussion of AEs [4, 5].

2.2. Search Strategy

The following databases were searched for case reports published from 1980 to 2013: VIP science and technology periodical database (CQVIP), China National Knowledge Infrastructure (CNKI), and Wanfang Database (WF). Search terms included “acupuncture, electro-acupuncture, acupuncture points, ear acupuncture, needling.” These terms were combined with “safe, safety, adverse event, adverse reaction, side effects, side events, complications, and risk.”

2.3. Data Extraction

A total of 739 papers were found; 133 were relevant (Figure 1). Information pertaining to the author, year of publication, number of patients, patient's age, sex, original treatment, the punctured site, circumstances of the complication or AE, and long-term patient outcome when available was extracted from each case. These data were then organized according to the type of complication or AE.

Figure 1.

Figure 1

Flow chart of the screening process.

3. Results

A total of 133 papers published from 1980 to 2013 were reviewed, and 182 cases of complications or AEs were identified to be associated with pneumothorax (n = 30), central nervous system injury (37), peripheral nerve injury (8), organ injury (22), other tissue injury(18), syncope (18), infections (17), hemorrhage (10), complications caused by broken needles (7), and others (15). Pneumothorax and central nervous system injury were the major complications.

3.1. Complications of Acupuncture: Internal Organ, Tissue, or Nerve Injury

A total of 115 cases of internal organ, tissue, or nerve injuries were reported, including pneumothorax (n = 30), central nervous system injury (37), peripheral nerve injury (8), organ injury (22), and other tissue injury (18).

3.2. Pneumothorax (Table 1)

Table 1.

Pneumothorax associated with acupuncture.

Author/year (reference) Cases Age/sex Disease treated Punctured site Practitioner Follow-up
Jiang, 1980 [117] 1 54/F Gastroptosis RN15 Not specified Recovered
Cai and Wang, 1982 [118] 1 41/M Numbness and pain of shoulders and chest Shoulder and back Not specified Recovered (1 mo)
Zheng and Pang, 1983 [119] 1 21/M Stiff neck GB21 Not specified Recovered after surgery (1 mo)
Gao, 1984 [120] 1 50/F Chest and back pain Back Factory doctor Recovered (12 d)
Duan and Wang, 1984 [29] 2 26/F Bronchitis GB21, BL13, EX-B2 Not specified Recovered (3 d)
50/F Bronchitis GB21, BL13 Not specified Recovered (7 d)
Chang, 1984 [121] 1 33/M Back pain Back Country doctor Recovered (19 d)
Yan, 1985 [122] 1 55/F Chronic bronchitis RN22 Health center Recovered (16 d)
Hu, 1986 [123] 1 58/F Pulmonary heart disease BL13 Not specified Recovered (13 d)
Zhang, 1986 [124] 1 52/M Cervical pain Left shoulder Factory doctor Recovered (20 d)
Yang, 1986 [6] 1 57/F Chronic asthmatic disease BL12 Not specified Dead
Jin, 1987 [125] 1 26/F Shoulder pain SI13 Acupuncturist Recovered (9 d)
Song and Xu, 1987 [126] 1 60/F Shoulder pain GB21 Not specified Not specified
Ruan et al., 1992 [127] 1 35/F Hysteria Supraclavicular fossa Acupuncturist Recovered (10 d)
Zhang et al., 1992 [38] 3 53/F Chronic bronchitis and emphysema BL18 Not specified Recovered (1 wk)
65/F Cough RN22 Recovered (1 mo)
21/M Spasmodic torticollis LI17 Recovered (2 wk)
Lu, 1993 [128] 1 60/M Cough, chest, and back pain Back Acupuncturist Recovered (1 wk)
Xia, 1993 [129] 1 60/M Back pain caused by hyperplastic spondylitis BL18, BL23 Acupuncturist Recovered (10 d)
Li and Chen, 1997 [130] 1 65/F Shoulder pain Scapular region Clinic Recovered (5 d)
Ma and Zhang, 1997 [131] 1 48/M Neck and shoulder pain Shoulder and back Clinic Recovered (1 wk)
Wang, 1999 [7] 1 47/F Shoulder and leg pain LI17 Not specified Dead
Song and Wu, 2001 [9] 1 45/F Scapulohumeral periarthritis GB21, SI11 Hospital Recovered (1 wk)
Qin and Ao, 2003 [132] 1 55/M Intercostal neuralgia The sixth intercostal space on the anterior axillary line Factory doctor Recovered (2 wk)
Zha, 2006 [133] 1 32/M Chronic hepatitis B Chest and back Itinerant doctor Recovered (14 d)
Gan et al., 2006 [134] 1 30/M Neck and back pain Back Individual clinic Not specified
Huo et al., 2007 [135] 1 39/M Chest and back pain Not specified Not specified Recovered after surgery (7 d)
Liu, 2007 [136] 1 50/M Cervical and back pain Back Individual clinic Not specified
Ma, 2007 [137] 1 35/F Shoulder pain Not specified Individual clinic Recovered
Zhang and Zhao, 2012 [138] 1 65/F Cervical spondylopathy GB21 Acupuncturist Recovered (10 d)

Between 1980 and 2013, pneumothorax was the most common complication of acupuncture treatment, as 30 cases in 27 papers were noted to be possibly associated with acupuncture (Table 1). Among the 30 cases presented, 25 recovered through thoracocentesis, thoracic closed drainage, anti-infection treatment, and clinical observation; 2 patients died; and the outcomes of the other 3 cases were not stated or unknown. More than half of them were reported by doctors in emergency rooms or departments of internal medicine, but the practitioner's training background was not reported. The punctured sites were mostly in the chest, supraclavicular fossa, and the back. The patients' major complaints were chest stuffy, chest pain, and dyspnea. One pneumothorax patient did not receive timely treatment and died [6]. Another case died because of a tension pneumothorax after acupuncture treatment [7].

3.3. Central Nervous System Injury (Table 2)

Table 2.

Central nervous system injury associated with acupuncture.

Author/Year (reference) Cases Age/Sex Disease treated Punctured site Complication Onset after acupuncture Follow-up
Liu, 1980 [139] 1 19/F Impaired vision GB20 Subarachnoid hemorrhage 1 h Recovered (20 d)
Liu, 1981 [14]  3 16/M  Schizophrenia DU16 Subdural hematoma  Immediately Dead
30/F DU14 Cervical and thoracic cord injury
30/M GB20 Subarachnoid hemorrhage 1 h Recovered (47 d)
Bao and Gao, 1983 [140] 3 30/F Eyelid muscle twitch GB20 Subarachnoid hemorrhage Immediately Recovered (14 d)
27/M Bulbar palsy DU15 Recovered (20 d)
40/F Headache GB20 Recovered (19 d)
Chen and Wu, 1985 [141] 1 30/F Hysteria Ex-HN18 Subarachnoid hemorrhage and medulla oblongata hemorrhage 1 d Dead
Yang et al., 1985 [8] 1 15/M Chronic tracheitis Between 2 and 3 thoracic spinous process Subarachnoid hemorrhage Immediately Recovered (1 mo)
Chen and Huang, 1985 [142] 1 57/M Facial Spasm Neck Subarachnoid hemorrhage Immediately Recovered (3 wk)
Su et al., 1985 [143] 1 11/F Deaf-mute DU15 Subarachnoid hemorrhage At night Recovered (1 wk)
Yu, 1986 [144] 7 42/M Psychosis DU15 Subarachnoid hemorrhage Several hours Recovered (1 mo)
4.5/M Cerebral agenesis with aphasia DU15 Immediately Recovered (20 d)
29/M Weakness of limbs DU15, DU16 Minutes after treatment Recovered (1 mo)
22/M Acid swells of the neck Back neck Immediately Recovered (40 d)
55/F Aural vertigo Back neck Recovered (20 d)
24/F Stuffy head GB20 Recovered (1 mo)
22/M Facial paralysis Ex-HN21 Recovered
Chen, 1987 [145] 1 37/F Neck pain DU15 Subarachnoid hemorrhage 1 min Recovered (1 mo)
Jiang and Chen, 1987 [146] 1 77/F Stiff neck GB20 The cerebellopontine and subarachnoid hemorrhage After treatment Dead
Zhou, 1988 [147] 1 15/M Cold GB20 Subarachnoid hemorrhage During the treatment Dead
Mi et al., 1989 [148] 1 28/F Neurosis DU15 Subarachnoid hemorrhage 2 d Recovered (27 d)
Wu and Xu, 1990 [149] 1 57/M Stroke Ashi points near C3 Subarachnoid hemorrhage 1 h Dead (10 d)
Liu, 1992 [150] 1 28/M Insomnia GB20 Acute subdural hematoma 3 hours Recovered after surgery
Mi, 1993 [12] 1 73/M Cerebral hemorrhage LI11, LI4, GB30, ST36, GB39, GB14, ST2 Cerebral hemorrhage reformulation 10 min Dead
Jiang et al., 1996 [151] 2 45/M Cervical spondylopathy GB20 Subarachnoid hemorrhage Immediately Recovered (30 d)
54/M Neck Recovered (1 mo)
Liu et al., 1996 [152] 1 35/M Ankylosing Spondylitis DU16 Medulla oblongata hemorrhage 5 hours Dead
Bian et al., 1997 [153] 1 29/F Headache caused by pesticide poisoning GB20 Subarachnoid hemorrhage 3 min Recovered (1 mo)
Wang, 1999 [10] 1 54/M Low back pain BL37 Acute subarachnoid hemorrhage Immediately Recovered
Wang, 1999 [154] 1 39/F Neurosis GB20 Cervical cord injury Immediately Dead
Song and Wu, 2001 [9] 1 58/M Hypertensive cerebral hemorrhage KI01 Cerebral hemorrhage reformulation Immediately Dead
Li et al., 2003 [155] 1 55/M Neck and back pain Neck and back Cervical spinal epidural hematoma Immediately Recovered
Niu and Zhang, 2006 [156] 1 42/M Headache Neck Cisterna magna hemorrhage Not specified Recovered after surgery
Li et al., 2008 [157] 1 36/F Migraine DU16 Subarachnoid hemorrhage At night Recovered (3 wk)
Chen, 2009 [11] 1 43/F Lumbago pain Waist Subarachnoid hemorrhage Immediately Recovered (1 mo)
Li et al., 2011 [13] 1 45/F Toothache RN16, RN10, RN9, RN4 Leukemia acute intracerebral hemorrhage Immediately Dead (2 d)

There were 37 cases of central nervous system injury associated with acupuncture (Table 2). The 37 patients suffered subarachnoid hemorrhage (n = 27), subdural hematoma (2), spinal cord injury (2), cerebral hemorrhage reformulation (2), cervical spinal epidural hematoma (1), medulla oblongata hemorrhage (1), cisterna magna hemorrhage (1), and leukemia acute intracerebral hemorrhage (1). The causes were acupuncture of cervical acupoints (n = 31), acupoints between the second and third thoracic spinal process [8], acupoints KI01 (Yongquan) [9] and BL37 (Yinmen) [10], waist acupoint [11] (each n = 1), and body acupuncture (n = 2) [12, 13]. Among the 37 cases, 26 recovered and 11 died.

Because of insufficient compliance and protected observation, accidents occurred in 3 schizophrenia patients, of whom 2 died and 1 recovered [14]. Two cerebral hemorrhage patients after receiving body acupuncture died from recurrence, and the authors speculated the reason might be that acupuncture had irritated the parasympathetic nerve, causing vascular contraction and increasing blood pressure and thus cerebral hemorrhage recurred before the original cerebrovascular fracture could be fully restored [9, 12]. Two patients suffered from dizziness and vomiting during treatment, but the acupuncturists did not pay high attention; the symptoms did not improve significantly after treatment, but the acupuncturists did not realize the severity and even allowed the patients to go home. One patient was treated the next day after onset and was diagnosed as subarachnoid hemorrhage; he recovered and left hospital [11]. The other patient died the next day [13].

3.4. Peripheral Nerve Injury (Table 3)

Table 3.

Peripheral nerve injury.

Author/Year (reference) Cases Age/Sex Disease treated Punctured site Complication Practitioner Follow-up
Tang and Fang, 1986 [15] 1 Not specified Facial paralysis Not specified Aggravated facial paralysis Not specified Recovered
Nie and Zhou, 1990 [16] 1 26/M Left eye pain SJ17 Cardiac arrest Acupuncturist Recovered (1 min)
Yan, 1994 [17] 1 57/M Cervical dislocation Bitong point Phrenic nerve injury Acupuncturist Recovered (1 wk)
Yang and Wang, 1996 [18] 1 62/M Lateral rectus paralysis Ex-HN07 Optic atrophy Acupuncturist Blind
Xu and Liu, 1997 [19] 1 48/M Tinnitus and hearing loss ST1, ST2, BL2, LI20, SJ21, SI19 Oculomotorius injury Not specified Recovered (17 d)
Huang and Wei, 1997 [20] 1 53/F Trigeminal nerve pain Around the mandible Trigeminal nerve injury Acupuncturist in the stomatological hospital Improved (3 mo)
Wang, 1999 [10] 1 54/F Lumbago GB30 Sciatic nerve injury Private practitioner Unrecovered
Ruan et al., 2009 [21] 1 67/F Lumbago GB34 Peroneus nerve injury Not specified Recovered (3 wk)

There were 8 cases of acupuncture-induced peripheral nerve injury (Table 3). They include aggravated facial paralysis [15], mistakenly hitting the vagus [16], phrenic nerve injury [17], optic atrophy [18], oculomotorius injury [19], right trigeminal nerve injury [20], sciatic nerve injury [10], and peroneus nerve injury [21], respectively. The patient with optic atrophy lost sight [18], the patient with right trigeminal anchor injury improved after 3 days [20], the patient with sciatic nerve injury did not recover [10], and the other 5 patients recovered.

3.5. Organ Injury (Table 4)

Table 4.

Organ injury associated with acupuncture.

Author/year (reference) Cases Age/sex Disease treated Punctured site Complication Follow-up
Liu, 1981 [14] 1 19/F Schizophrenia RN15 Cardiac tamponade Dead
Zhu, 1990 [22] 1 64/M Chest stiffness and rib pain LR14 Aortoclasia Dead
Shi, 1993 [23] 1 42/F Witchcraft Limbs, chest, abdomen, back Aortoclasia Dead
Xie and Lin, 2003 [24] 1 35/F Intercostal neuralgia Right breast Cardiac trauma Dead
Luo et al., 2006 [25] 1 40/M Chronic esophagitis RN15 Cardiac tamponade Recovered
Zhang and Dong, 2006 [26] 1 37/M Chest tightness, asthma Chest and back Cardiac tamponade Dead
Zhu et al., 2008 [27] 1 44/F Diabetes Chest Cardiac tamponade Dead
Yang, 1991 [28] 1 21/M Bad cold BL13 Chylothorax Recovered (2 wk)
Zheng and Zhao, 1983 [30] 1 31/F Stomachache ST25, LR14, RN12 Gallbladder perforation and biliary peritonitis Recovered after surgery
1 59/M Cervical spondylopathy RN12, RN13, ST25
Deng, 1985 [31] 1 45/F Acute attack of chronic cholecystitis ST21 Gallbladder perforation Not specified
Bai, 1991 [32] 1 32/F Paralytic ileus Upper abdomen Gallbladder perforation and biliary peritonitis Recovered after surgery
Duan and Wang, 1984 [29] 1 42/M Intestinal spasm RN8, RN12, ST25 Intestinal perforation and suppurative peritonitis Recovered after surgery (14 d)
Zhang, 1997 [33] 4 51/M Paroxysmal abdominal pain Abdomen  Localized peritonitis Recovered  after surgery
47/F Right lower abdominal pain
53/F Abdominal pain, diarrhea
37/F Periumbilical pain
Xiao, 1985 [34] 1 20/M Abdominal discomfort RN12 Gastric perforation Recovered after surgery (11 d)
Huang, 1999 [35] 1 54/M Gastric ulcer ST36 Gastric ulcer with perforation Recovered after surgery (10 d)
Tang et al., 2006 [36] 1 61/M RA ST34, ST40, SP6, SP10, GB33, GB34 Gastric stress ulcer and hemorrhagic shock Recovered (2 mo)
Liu et al., 1992 [37] 1 2/M Diarrhea RN12, ST25, DU1 Complete intestinal obstruction Recovered after surgery
Zhang et al., 1992 [38] 1 45/F Chronic bronchitis, coronary disease GB21, BL13, BL23 Multiple organ injury Dead

Twenty-two cases were reported to have organ injury associated with acupuncture treatment (Table 4). There was cardiovascular injury (n = 7) [14, 2227], thoracic duct injury (1) [28], peritonitis induced by abdominal system (9) [2933], gastric perforation (3) [3436], intestinal obstruction (1) [37], and multiple organ injury (1) [38]. Of them, 14 recovered, 7 died, and 1 did not recover. Most of them were caused by too deep puncture and incorrect acupoint location.

One patient received treatment following gastric abscess induced by gastric ulcer. He was treated by electroacupuncture (EA) at ST36 (Zusanli) and the acupoint was located without violation, but the state of illness was not relieved and gastric perforation occurred. The doctor was puzzled and put forward this case for discussion [35]. One patient with a history of stomach bleeding received treatment following knee pains induced by rheumatoid arthritis and took anti-inflammatory analgesic drugs for a long time. The lower limb acupoint was selected, but the excessive EA irritation during treatment caused an irritable gastric ulcer and then hemorrhagic shock and the patient recovered after timely rescue [36].

3.6. Other Tissue Injuries (Table 5)

Table 5.

Other tissue injury.

Author/year (reference) Cases Age/sex Disease treated Punctured site Complication Practitioner Follow-up
Chen, 1980 [39] 1 33/F Sore throat Neck Cervical common carotid aneurysm Not specified Recovered after surgery (3 mo)
Wang, 1987 [40] 1 42/F Thyroid cancer (anaesthesia for thyroidectomy) SJ17 Sinus caroticus syndrome, shock Not specified Recovered
Zhang et al., 1992 [38] 1 39/M Asthma BL13 Pleural shock Not specified Recovered (2 d)
Zhu, 1986 [41] 1 56/M Chest distress RN22 Asphyxia Acupuncturist Dead
Gao, 1989 [42] 1 73/M Cough LI18 Dyspnea Not specified Recovered (3 d)
Liu et al., 1988 [43] 1 53/M Blepharospasm The lateral upper eyelid Retinal detachment Health worker Recovered after surgery
Yang and Wang, 1996 [18] 1 63/F Left eye ptosis Periocular Traumatic cataract Acupuncturist Blind
Wang, 1982 [44] 2 20/M Traumatic mydriasis EX-HN5 The orbicularis oculi muscle tremor Not specified Recovered (3 d)
35/F Right migraine Speech and swallowing difficulties Recovered (2 h)
Li and Zhou, 1980 [45] 1 40/M Schizophrenia EX-HN5 Femoral neck fracture Acupuncturist Not specified
Liang and Song, 1984 [46] 1 23/M Cramp BL57 Flexor hallucis muscle and digitorum longus muscle scar contracture Health worker Recovered after surgery
Chen, 1992 [47] 1 17/F Shortsightedness GB20, EX-HN17 Nape spasm Acupuncturist Recovered (6 d)
Wang, 1994 [48] 1 65/F Stroke LI4, SJ5, LI15 Subluxation of wrist Intern Recovered (1 wk)
Shi and Chen, 1994 [49] 1 52/M Facioplegia LI11 Elbow pain Acupuncturist Recovered (2wk)
1 61/F Scapulohumeral periarthritis Not specified Shoulder pain Recovered (20 d)
Wang, 1999 [10] 1 53/M Cough, epistaxis LU6 Amyotrophy Private practitioner Unrecovered
Luo and Huang, 2006 [50] 2 42/M Amyotrophic lateral sclerosis Upper limb Fasciculation Not specified Improved
63/M Upper limb Improved

In addition to injuries of the organs in thorax and abdomen, 18 cases of other tissue injuries were reported (Table 5), including cervical common carotid aneurysm [39], shock [38, 40], asphyxia [41], dyspnea [42], eye injury [18, 43, 44], and the locomotor system injury [10, 4450]. Among the 18 cases, 12 recovered, 2 improved, 2 did not recover, 1 died, and the outcome of 1 was not stated.

One patient suffered from retinal detachment, and eyesight was corrected to 0.2 after treatment [43]. One patient lost eyesight because of traumatic cataract [18]. One patient experienced femoral neck fracture after strong stimulation to myospasm [45]. One patient suffered from subluxation in right wrist joint due to excessive EA intensity [48].

3.7. Syncope (Table 6)

Table 6.

Syncope associated with acupuncture.

Author/year (reference) Cases Age/sex Disease treated Punctured sites Position Start time Causes Practitioner Follow-up
Yang, 1986 [6] 1 32/M Facioplegia GB14, ST 6, ST4, SJ 17, LI20, LI4 Sitting 5 min after inserting needle Limosis Acupuncturist Recovered
Shao, 1989 [51] 1 53/M Myotenositis of long head of biceps brachii LI15, LI11, ashi Not specified After inserting needle After drinking Acupuncturist Recovered (20 m)
Shi and Chen, 1994 [49] 1 57/F Stomachache LI3, ST 36, PC6 Not specified Finish needling Limosis Acupuncturist Recovered (30 min)
Guo, 1995 [158]  2 65/F Scapulohumeral periarthritis Ex-UE01, GB21, LI14, LI11, SJ5, LI4 Clinostatism Finish needling Weakness Acupuncturist Recovered
24/F Waist sprain BL40, ashi point and acupoint of bladder meridian Finish needling Nervous Acupuncturist Recovered (10 min)
Wu et al., 2001 [56] 1 24/F Insomnia PC6, ST 36, HT7 Not specified At night Not specified Acupuncturist Recovered (2 d)
Liu, 2001 [52] 3 45/F Lumbago pain BL23, BL40, DU3, GB30, KI7 Not specified Finish needling After drinking Acupuncturist Recovered
34/F Shoulder pain LI11, LI14, LI15, SJ5, SJ14 Sitting After inserting needle Tiredness Acupuncturist
56/F Right thumb pain LI4, LI5, LI11, ashi point Not specified On the way home Limosis Acupuncturist
Ma, 2005 [54] 1 28/M Prosopalgia EX-HN5, LI4, ST6, SJ5 Sitting 5 min after inserting needle Not specified Acupuncturist Recovered (30 s)
Long et al., 2006 [55] 3 72/M Stroke LI11, SJ5, ST36, SP6, EX-UE17, EX-LE11 Clinostatism 10 min after inserting needle Nervous Acupuncturist Recovered (2 min)
41/F Cervical spondylopathy BL10, GB20 Sitting 1 min after inserting needle Not specified Acupuncturist Recovered (30 min)
42/F Lumbago pain ST36 Clinostatism After inserting needle Heavy stimulus Acupuncturist Recovered (2 min)
Liu, 2007 [159] 1 42/F Scapulohumeral periarthritis Ex-UE01, LI14, Ashi point, SJ3 Sitting 10 min after inserting needle Not specified Acupuncturist Recovered (30 min)
Chen, 2009
[11]
1 42/M Acute lumbar sprain EX-B5, BL40 Not specified Finish needling Not specified Acupuncturist Recovered (10 min)
Liao and Guo, 2009 [160] 1 57/F Gouty arthritis GB20 Clinostatism After inserting needle Limosis Acupuncturist Recovered (10 min)
Li et al., 2009 [53] 2 48/M Cervical spondylopathy radiculaire GB21, LI11, SJ5, Ex-B5 Not specified 6 h after treatment Not specified Acupuncturist Recovered after stop treatment
68/F Facial paralysis GB14, ST2, ST4, ST6, SJ17, LI4, Ex-HN16 12 h after treatment Not specified Acupuncturist Recovered after stop treatment

A total of 18 cases of acupuncture-associated syncope were reported (Table 6). Syncope occurred during the treatment in 9 cases, several minutes after the treatment in 5 cases, and several hours later in 4 patients. Two patients fainted after taking liquors [51, 52]. The positions were sitting (n = 5), lying (5), and not specified (8). Most patients recovered with rest and drinking sugar water, while 2 patients recovered after injection of metoclopramide via ST36 [53]. Two cases suffered from sudden cardiac arrest and were cured after first aid [54, 55]. One patient recovered after massaging an ear acupoint [56].

3.8. Infection (Table 7)

Table 7.

Infection associated with acupuncture.

Author/year (reference) Cases Age/sex Disease treated Punctured site Diagnosis Practitioner Follow-up
Zhang, 1980 [161] 1 5/F Heat, cough Ex-UE19 Infection Not specified Middle finger disability
Xie and Zong, 1983 [62] 1 38/F Right upper abdominal mass and discomfort Ashi points Abdominal metastatic hepatic hydatid Local hospital Recovered after surgery
Gao and Qi, 1989 [65] 1 54/M Right leg pain Local points Third-degree burns with infection Clinic Not specified
Xu, 1990 [162] 1 19/M Migraine EX-HN5, GB14, DU20 Head abscess, intracranial infection Health worker in the army Recovered
Xia, 1993 [129] 1 37/F Facioplegia ST5 Right cheek hematoma with infection Not specified Recovered (1 wk)
Chen and Gao, 1995 [63] 1 30/M Insomnia Head Encephalopyosis Not specified Recovered after surgery
Zhou, 1999 [64] 3 From 22 to 28/M (1); F (2) Lumbar muscle strain Loin Tuberculous abscess on the body surface Not specified Recovered (3–6 mo)
Song and Wu, 2001 [9] 1 38/M Rheumatic arthritis EX-LE4, EX-LE5, GB34, SP9 Pyogenic arthritis Individual clinic in the country Recovered (2 wk)
Ding et al., 2008 [112] 1 60/F Scapulohumeral periarthritis ST38 Diabetes foot Not specified Remission after 3 days
Yang et al., 1990 [57] 1 2/F Malnutritional stagnation Ex-UE19 Tetanus Illegal treatment Dead
Liu, 1991 [58] 1 52/F Headache Ex-HN05, DU20, GB20, LI4 Tetanus Village acupuncturist Recovered (2 wk)
Liu, 1992 [59] 1 52/F Leg pain Not specified Tetanus Private practitioner Recovered (1 mo)
Sun and Hu, 1997 [60] 1 23/M Facioplegia Not specified Tetanus Health-center Remission after 3 days
Wang, 1999 [10] 1 60/M Headache and fever GB20, GB21, SJ5 Tetanus Not specified Dead
Chen et al., 2008 [61] 1 62/F RA Knee Tetanus Illegal treatment Dead

A total of 17 cases were infections associated with acupuncture (Table 7). Among them, 10 recovered, 3 died, 2 improved after 3 days, 1 was disabled, and 1 was not stated. The infection was caused by tetanus bacillus (n = 6) [10, 5761], hydatid (1) [62], Escherichia coli (1) [63], and Mycobacterium tuberculosis (3) [64]. One patient was infected after deep 3-degree burning [65] while others were not stated.

In one patient, the right epigastric mass due to acupunctured liver hydatid caused extensive metastasis in hydatid abdominal cavity; the patient recovered after operation [62]. One diabetic patient without controlling blood glucose suffered from diabetic feet because of infection and recovered after hypoglycemic and anti-infection treatments.

3.9. Hemorrhage (Table 8)

Table 8.

Hemorrhage.

Author/year (reference) Cases Age/sex Disease treated Punctured site Complication Practitioner Follow-up
Yang, 1986 [6] 1 28/F Chronic conjunctivitis BL1 Eye hematoma Acupuncturist Recovered (14 f)
Li, 1989 [67] 1 62/F Teratoma of ovary Hypogastrium Extraperitoneal hematoma Roving doctor Recovered after surgery
Cai, 1991 [68] 1 47/M Neck mass Neck Thyroid intracapsular hemorrhage with apnea Not specified Recovered after surgery (10 d)
Han, 1994 [69] 1 56/M Stroke RN23 Sublingual hematoma Not specified Recovered (1 wk)
Zeng and Liu, 1996 [71] 1 50/M Cough ST9 Hematoma compression tracheal cause apnea Unauthorized
acupuncturist
Dead
Wang, 1996 [70] 1 72/M Cerebral infarction Ex-HN20 Sublingual hematoma Not specified Recovered (2 d)
Gan, 2000 [66] 1 46/F Cold headache Ex-HN05 Orbital hemorrhage Not specified Recovered (1 mo)
Jiang, 2001 [72] 1 68/M Hypertension, stroke LI4 Hand hematoma Acupuncturist Recovered (7 d)
Duan, 2007 [73] 1 65/F Neck, waist, and leg pain Hip Buttock hematoma Not specified Improved
H. Liu and X. H. Liu, 2007 [74] 1 61/M Cerebral thrombosis SP6 Lower extremity hematoma Acupuncturist Recovered (1 d)

Among 10 cases of acupuncture-induced local hemorrhage (Table 8), 8 patients recovered, 1 improved, but 1 died. The positions of hemorrhage included eyes (n = 2) [6, 66], extraperitoneal (1) [67], thyroid (1) [68], hypoglossus (2) [69, 70], suffocated death from hematoma compressed trachea (1) [71], hand (1) [72], 1 case of buttock hematoma due to acquired hemophilia B which improved after treatment [73], and lower limb (1) [74].

3.10. Complications Caused by Broken Needles (Table 9)

Table 9.

Complications caused by broken needles.

Author/year (reference) Cases Age/sex Disease treated Punctured site Complication Practitioner Follow-up
Yang, 1986 [6] 1 45/M Flaccid paralysis ST36, LI11 Bent needle Acupuncturist Recovered
Lu and Teng, 1994 [75] 1 39/M Scapulohumeral periarthritis Supraclavicular fossa Hemopneumothorax caused by broken needle Country doctor Recovered after surgery
Wang, 2000 [80] 1 54/M The left upper limb dysfunction Upperlimb Sticking of needle Not specified Recovered
Geng, 2005 [76] 1 58/M Chronic bronchitis and emphysema LU1 Damage of arteria coronaria and cardiac tamponade caused by embedded needle Self Recovered after surgery
Quan, 2008 [77] 1 43/F Gastric disease Xiphoid Palpitation and paroxysmal pricking pain caused by broken needle Not specified Recovered after surgery
Liu and Yu, 2010 [78] 1 45/F Multiple injuries by traffic RN23 Pulmonary bulla caused by embedded needle Not specified Recovered after surgery
Cheng, 2010 [79] 1 55/M Lumbago Lower limb Broken needle Not specified Recovered after surgery

Seven cases of accidents due to broken or bent needles were identified (Table 9). Five recovered after the surgery [7579], and 2 cases of bent needles were slowly pushed out by acupuncturists [6, 80].

3.11. Other Complications Associated with Acupuncture (Table 10)

Table 10.

Other complications associated with acupuncture.

Author/year (reference) Cases Age/sex Disease treated Acupoint Complication Practitioner Follow-up
Wang and Lan, 1980 [81]  2 46/F Intercostal neuralgia PC6 Aphonia Not specified Recovered  (3 d)
36/F Obstinate hiccup
Zhou et al., 2005
[82]
1 43/F Neck pain Ex-B05 Hoarseness Acupuncturist Recovered (10 min)
Peng, 1982 [83] 1 54/not specified Scapulohumeral periarthritis Ex-UE01, GB21, LI11, SJ5 Allergy to electroacupuncture Acupuncturist Recovered (10 min)
Gao and Zheng, 2008 [84]  2 72/M Nerve root cervical spondylopathy EX-B2 Allergy to metal Not specified Recovered (1 wk)
49/F Cervical type cervical spondylopathy EX-B2 Recovered (5 d)
Wang, 2004 [85] 1 35/M Soft tissue injury Ashi point Epilepsy Acupuncturist Recovered
Dai, 2012 [86]  2 45/M Epilepsy Not specified Epilepsy Acupuncturist Recovered (2 min)
53/M Cervical spondylosis Recovered (1 min)
Li, 2000 [87] 1 52/M Cerebral concussion DU20, GB20, GB30, GB39, LI4, LI11, ST36 Fever Acupuncturist Recovered
Shang, 2006 [88]  2 65/F Facial neuritis GB14, BL2, ST2, SI18, RN24, LI4, ST36, LR3 Cough Acupuncturist Recovered (2 min)
46/F Obesity ST25, ST36, SP15, RN6, LI11, SJ6, SP9, ST40 Thirsty Acupuncturist Recovered
Quan and Jiang, 2008 [89] 1 45/F RA Local points Infusion reaction Acupuncturist Recovered (2 h)
Fang, 2010 [90] 1 35/F Cervical pain GB20, EX-B2 Hyperventilation syndrome Acupuncturist Recovered (15 min)
Wang, 2010 [91] 1 46/F Nasopharyngeal carcinoma radiation sequela with fatigue LI11, LI4, ST36, SP6, KI3; LU7, SI6, SJ3 Aggravation of fatigue Acupuncturist Improved

A total of 15 other complications associated with acupuncture were reported (Table 10): aphonia [81], hoarseness [82], allergy to electroacupuncture [83] and metal [84], epilepsy [85, 86], fever [87], cough [88], thirst [88], infusion reaction [89], hyperventilation syndrome [90], and aggravation of fatigue [91]. Of them, 14 cases recovered completely and 1 improved.

One patient was not allergic after several acupuncture treatments, but systemic allergy occurred after EA treatment [65]. Among three patients with acupuncture-induced epilepsy, only one had a history of epilepsy [85, 86].

4. Discussion

The studies about safety of acupuncture are gradually increasing. One study protocol of a randomized controlled trial is efficacy and safety of acupuncture for chronic dizziness [92]. This trial's aim is to get result that acupuncture has good efficacy and without adverse effect for chronic dizziness. We hope it is success.

Some studies that researched acupuncture as an alternative means for pediatric diseases found that it is safe, feasible, and acceptable [9399]. One study explored acupuncture as an effective therapy of pain relief for children and adolescents after tonsillectomy [100]. Severe throat pain can result from tonsillectomy and last up to 10 days in children. Codeine elixir has long been used for pain relief but has recently been banned by the Food and Drug Administration due to a recently recognized risk of death. This study suggested that acupuncture decreases perceived pain in children and adolescents after tonsillectomy. These data, combined with the cost effectiveness, safety, and ease of administering acupuncture, suggest that further studies exploring the effectiveness of acupuncture in juveniles after tonsillectomy are merited.

One research evaluated the feasibility of delivering acupuncture in an emergency department (ED) to patients presenting with pain and/or nausea [101]. The acupuncture group comprised 200 patients who received usual medical care and acupuncture; the usual care group comprised 200 patients with retrospective data closely matched from ED electronic health records. The results confirmed that acupuncture in the ED appears safe and acceptable for patients with pain and/or nausea. Further high-quality, sufficiently powered randomized studies evaluating the cost-effectiveness and efficacy of the add-on effect of acupuncture are recommended.

Some reports confirmed that acupuncture for pregnant women is safe and effective [102109]. For example, one reported a complete recovery from Bell's palsy (BP) of a 27-year-old woman, 27-week pregnant, after 2 weeks of acupuncture treatment. Prior to treatment, her House-Brackmann facial nerve grading system (HBS) was II, Nottingham facial nerve grading system was 50.88%, and the Facial Disability Indexes (FDI) were 90. After 2 weeks, her symptoms had disappeared, her face was restored to normal, HBS was I, Nottingham was 96.46%, and FDIP was 100. These results suggest that acupuncture may be a safe, alternative treatment for BP in pregnancy [110]. Another study described patients' experience of acupuncture treatment in low back and pelvic pain during pregnancy. Women received acupuncture treatment from gestational week 20 or week 26, for a period of 6 weeks divided into eight sessions of 30 minutes each. The results of Pain-O-Meter and visual analogue scale (POM-VAS), Short-Form McGill Questionnaire (SF-MPQ), and Short-form-36 health survey (SF-36) showed a relief of pain. Telephone interviews confirmed that expectations of treatment were fulfilled. The authors suggested that it may be advantageous to begin acupuncture therapy later in pregnancy to maximize pain relief [111].

However, complications and adverse effects in medical practice always concern the public and the medical profession. Acupuncture has been used for several thousand years in China. Although it has been deemed a safe and reliable therapy, the rare adverse effects and complications should arouse concerns. During the 33 years from 1980 to 2013, about 182 cases of acupuncture-associated complications and adverse effects were reported in China, including 25 fatal cases. The frequency of acupuncture associated complications reported in China appears to be steady over time (see Figure 2).

Figure 2.

Figure 2

Distribution of cases of acupuncture-associated complications reported from 1980 to 2013.

As indicated in Table 1, the most frequent complication of acupuncture treatment is internal organ, tissue, or nerve injury. Of the 115 reported cases involving internal organ, tissue, or nerve injury, 30 (26.08%) were pneumothorax, 37 concerned the central nervous system (32.17%), others included injury in peripheral nerve, organ, and other tissues. Based on our research, one major cause of direct thrusted injuries to organ, tissue, or nerve is the lack of knowledge about anatomy and other systems. In 1980s, the acupuncturists or individuals in many country grassroot regions performed acupuncture because of low cost and convenience, but the deficient knowledge on anatomy led to many cases of pneumothorax and subarachnoid hemorrhage, as well as injuries to abdomen organs, heart, and peripheral nerves. With the increasing requirement for acupuncturists, these accidents decreased from the 1990s. Particularly, the frequency of pneumothorax and central nervous system injury appears to be on the decline since the 2000s (see Figure 3). This may be because the government has demanded that the acupuncturists should have licenses and formal education background if they practice in clinic in recent years. They should also undergo short time training every year. All these make the acupuncture technique become more and more standardized so that the accidents of pneumothorax and central nervous system injury are reduced. However, there is a possibility that we lack the accident reporting system so that the incidences were underreported.

Figure 3.

Figure 3

Distribution of cases of pneumothorax and central nervous system injury from 1980 to 2013.

We put forward suggestions for the medical system in order to avoid more accidental injury on organ, such as enhancing training on anatomy for acupuncturists; setting up more continuation courses on the safety of acupuncture practice for acupuncturists; establishing a reporting system on the incidents of acupuncture adverse effect; and safety courses and certificates should be required in order to obtain the license of acupuncture in China.

The acupuncturists (1) should avoid important organs and tissues during selection of acupoints and reposition if the patient changes body position; (2) do not distract attention during treatment and do not move the patient after acupuncture so as to avoid accidents; for unconscious patients unable to cooperate, shallow needling or not retaining needle is preferred, and the process of treatment should be strictly monitored; (3) inquire detailed medical history and carefully determine the needling depth for patients with emphysema or hemorrhagic disease. Moreover, traditional medicine holds that acupuncture should be performed to bring about the desired sensations of “sour, numb, heavy, and swelling.” Many acupuncturists and patients think that a stronger sensation of needling will bring about better therapeutic effects, but excessively violent operation will also cause accidents. The 2 cases of irritable stomach bleeding due to excessive irritation [35, 36] and the 1 case of femoral neck fracture due to myospasm [45] are typical examples and should alert clinicians. In case of suspected acupuncture-induced injury, the doctor should prolong the time of observation and warn for prompt treatment.

Syncope is also a common acupuncture-induced accident. The hungry, thirsty, drunken, or nervous patients should be asked to eat, drink, or rest for half an hour before treatment and calm down. They should be observed for a moment during and after treatment to avoid syncope. Once syncope occurs, needles should be pulled out immediately, sugar water should be provided, and the patient should lie down with head low; if the symptom becomes severe, take appropriate treatment. Two patients had severe adverse reaction like shock, with the clinical manifestation, including loss of consciousness, respiratory arrest, and carotid pulselessness. After doing CPR, both of them recovered [54, 55]. Reviewing medical history, one was found to have the similar experience several years ago [55]. Therefore, acupuncturists are required to inquire patients' medical history carefully and learn to deal with emergencies.

Acupuncture infection usually occurs in rural grassroot health centers with low awareness of hygiene, but accidents will be largely controlled along with the use of disposable needles and the popularization of health knowledge. Moreover, tetanus is still an adverse event that should be strictly prevented, and once it occurs, it will cause a high mortality rate. Along with the increasing incidence of diabetes, for patients with poorly controlled blood glucose [112], careful operation is required to avoid infection due to disunion of acupuncture-caused wounds.

The acupuncture-induced bleeding and hematoma are unavoidable; thus to reduce their incidence rates, acupuncturists should (1) get familiar with the anatomy of acupoints and avoid blood vessels during needle manipulation; (2) avoid manipulation methods such as lifting and thrusting when acupuncturing intraorbital acupoints; (3) appropriately extend the time of compression for patients with hypertension, arteriosclerosis, or inclination to hemorrhage and for women during the menstrual period. The acupuncture-induced hematoma is usually cold compressed within 24 hours and hot compressed after 24 hours. H. Liu and X. H. Liu [74] suggested pressing the local hematoma site heavily for a long time, which could immediately disperse the swelling, without leaving bruises. This method is recommended for other acupuncturists.

With a long history in China, acupuncture has been widely accepted and applied in people's daily life due to its exceptional therapeutic effects and low side effects. As early as 1980, WHO unveiled 43 kinds of diseases that can be treated with acupuncture. The number had increased to 107 in 2002 [113], from which we can see that acupuncture has been recognized by an increasing number of people and more research in this field is being undertaken. In countries where acupuncture is widely used, it is inevitable to encounter the occurrence of some side reactions in acupuncture therapies. However, the accident rate in acupuncture is relatively low. Although existing reports in China show no statistical data about acupuncture accidents, some studies conducted in large subject pools in Germany reveal some relevant information. It has been reported that Endres et al. [114] conducted a study about accidents in acupuncture therapies on 190,924 patients. The study showed an occurrence of 14,449 acupuncture accidents, which accounted for 7.57% of the total subject pool. According to statistics conducted by Witt et al. [115] on 229,230 clinical acupuncture cases, there were 19,726 accidents, which occupied 8.6% of the total subject pool. Chinese literatures show that most of the acupuncture accidents are caused by acupuncturist's lack of corresponding techniques and nonstandard operations. Since 2005, the Chinese National Administration of Quality Supervision, Inspection and Quarantine and the Chinese National Standardization Management Committee have issued a total of 18 acupuncture technical operation specifications in two batches, including terms and definitions, operating procedures and requirements, operating methods, attentions, and contraindications. Among them, operating procedures and requirements specifically include the selection of needles, acupuncture points and acupuncture positions, environmental requirements, the disinfection of needles, selected acupuncture points and acupuncturist's hands, specific operation techniques, and after-treatments of wounds [116]. The acupuncture technical operation specification series covers a wide area and contains comprehensive and specific contents, but it still shows some deficiency in the popularization and implementation of acupuncture.

In conclusion, we recommend that the qualifying training of acupuncturists should be systemized and the clinical acupuncture operations be standardized in order to effectively prevent the occurrence of acupuncture accidents, enhance the influence of acupuncture, and further popularize acupuncture to the rest of the world. All this would mean a huge step towards modernization of acupuncture.

Acknowledgments

This work was supported partially by Grant no. 81102636 from the National Natural Science Foundation (NSFC) in China. In Austria, the work was supported by the Federal Ministries of Science, Research and Economy and of Health (project title “Evidence-Based High-Tech Acupuncture and Integrative Laser Medicine for Prevention and Early Intervention of Chronic Diseases”). The authors would like to thank Ms Ingrid Gaischek, M.S. (Medical University of Graz) for her valuable help concerning this paper.

Conflict of Interests

The authors declare that there is no conflict of interests regarding the publication of this paper.

References

  • 1.Pui C. M., Bostrom M. P., Westrich G. H., et al. Increased complication rate following conversion total hip arthroplasty after cephalomedullary fixation for intertrochanteric hip fractures. A Multi-center Study. Journal of Arthroplasty. 2013;28(8):45–47. doi: 10.1016/j.arth.2013.04.048. [DOI] [PubMed] [Google Scholar]
  • 2.Faunø L., Rasmussen C., Sloth K. K., Sloth A. M., Tøttrup A. Low complication rate after stoma closure. Consultants attended 90% of the operations. Colorectal Disease. 2012;14(8):e499–e505. doi: 10.1111/j.1463-1318.2012.02991.x. [DOI] [PubMed] [Google Scholar]
  • 3.Umuroglu T., Bostanci K., Thomas D. T., Yuksel M., Yilmaz Gogus F. Perioperative anesthetic and surgical complications of the nuss procedure. Journal of Cardiothoracic and Vascular Anesthesia. 2013;27(3):436–440. doi: 10.1053/j.jvca.2012.10.016. [DOI] [PubMed] [Google Scholar]
  • 4.Lao L., Hamilton G. R., Fu J., Berman B. M. Is acupuncture safe? A systematic review of case reports. Alternative Therapies in Health and Medicine. 2003;9(1):72–83. [PubMed] [Google Scholar]
  • 5.Xu S. F., Wang L. Z., Cooper E., et al. Adverse events of acupuncture: a systematic review of case reports. Evidence-Based Complementary and Alternative Medicine. 2013;2013:15. doi: 10.1155/2013/581203.581203 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6.Yang Y. D. Clinical examples of adverse events of acupuncture. Shanxi Journal of Traditional Chinese Medicine. 1986;7(7):p. 319. [Google Scholar]
  • 7.Wang Y. L. A case about death because of pneumothorax caused by needling LI17-tianding. Journal of Forensic Medicine. 1999;15(1):47–48. [Google Scholar]
  • 8.Yang Y. D., Shi R., Ge S. H. Presentation about one case of subarachnoid hemorrhage caused by needling. Liaoning Journal of Traditional Chinese Medicine. 1985;8:p. 37. [Google Scholar]
  • 9.Song Q. L., Wu T. Y. Report of three cases about malpractice of acupuncture. Clinical Misdiagnosis & Mistherapy. 2001;14(1):p. 73. [Google Scholar]
  • 10.Wang K. F. Some thoughts about acupuncture accidents. Journal of Clinical Acupuncture and Moxibustion. 1999;15(5):57–58. [Google Scholar]
  • 11.Chen A. Analysis on four cases about acupuncture accident. Shanghai Journal of Acupuncture and Moxibustion. 2009;28(2):112–113. [Google Scholar]
  • 12.Mi J. A case about cerebral hemorrhage caused by acupuncture. Heilongjiang Journal of Traditional Chinese Medicine. 1993;(2):p. 34. [Google Scholar]
  • 13.Li S. X., Wen H., Yao X. H. A case about death caused by leukemia acute intracerebral hemorrhage with acupuncture damage. Chinese Journal of Forensic Medicine. 2011;26(4):334–335. [Google Scholar]
  • 14.Liu X. J. Four cases accidents of schizophrenia treating by acupuncture. Chinese Journal of Nervous and Mental Diseases. 1981;5:p. 317. [Google Scholar]
  • 15.Tang X. L., Fang Q. P. Aggravation of infranuclear facial palsy induced by strong stimulation of electro-acupuncture. People's Military Surgeon. 1986;(6):p. 69. [Google Scholar]
  • 16.Nie X. F., Zhou A. J. Analysis on the reason of respiratory and cardiac arrest induced by needling in SJ17-yifeng. Hubei Journal of Traditional Chinese Medicine. 1990;5:p. 39. [Google Scholar]
  • 17.Yan B. X. One case of phrenic nerve damage caused by needling in brachial plexus. Shaanxi Journal of Traditional Chinese Medicine. 1994;15(11):p. 513. [Google Scholar]
  • 18.Yang G., Wang S. L. Two reports about blindness caused by acupuncture. Tianjin Journal of Traditional Chinese Medicine. 1996;13(1):p. 6. [Google Scholar]
  • 19.Xu L. H., Liu A. H. One case about oculomotor nerve damage caused by acupuncture. Journal of Injuries and Occupational Diseases of the Eye with Ophthalmic Surgeries. 1997;19(3, article 226) [Google Scholar]
  • 20.Huang R. H., Wei S. H. A case of eye damage in treating trigeminal nerve pain with electro-acupuncture. Chinese Journal of Ocular Trauma and Occupational Eye Disease (with Ophthalmic Surgery) 1997;19(4):p. 307. [Google Scholar]
  • 21.Ruan J. W., Li S. M., Wen M., Rao Z. D., Hu Y. H. Analysis on adverse effects of acupuncture in clinical practices. Chinese Acupuncture & Moxibustion. 2009;29(11):939–942. [PubMed] [Google Scholar]
  • 22.Zhu J. A case about death caused by thoracic aorta hemorrhage through needling in LR14-qimen. Shanghai Journal of Acupuncture and Moxibustion. 1990;(2):p. 31. [Google Scholar]
  • 23.Shi G. W. A case about death caused by aortic rupture through needling in the chest. Chinese Journal of Forensic Medicine. 1993;8(4):237–242. [Google Scholar]
  • 24.Xie J. Z., Lin W. Z. A case about death because of cardiac trauma caused by acupuncture. Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care. 2003;10(1):p. 51. [Google Scholar]
  • 25.Luo Y. Z., Dong L., Yuan H. S., Xiang Q. L. A case about delayed cardiac tamponade caused by acupuncture. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery. 2006;13(5):p. 343. [Google Scholar]
  • 26.Zhang J. H., Dong X. R. A case about death because of cardiac rupture caused by acupuncture. Journal of Forensic Medicine. 2006;(2):p. 49. [Google Scholar]
  • 27.Zhu W. T., Li X. S., Zhang Y. T., Li W. A case about death because of cardiac rupture caused by acupuncture. Chinese Journal of Forensic Medicine. 2008;24(4):p. 312. [Google Scholar]
  • 28.Yang S. T. A case about chylothorax caused by needling in BL 13-Feishu. Journal of Clinical Acupuncture and Moxibustion. 1991;(4):p. 19. [Google Scholar]
  • 29.Duan Q. L., Wang S. R. Lesson learn from three cases about severe complications caused by acupuncture. Hebei Journal of Traditional Chinese Medicine. 1984;(1):36–37. [Google Scholar]
  • 30.Zheng B. S., Zhao M. L. Lessons learn from two cases about perforation of gallbladder and biliary peritonitis caused by acupuncture. Chinese Journal for Clinicians. 1983;(3):p. 44. [Google Scholar]
  • 31.Deng M. H. Report of one case about gallbladder perforation caused by needling in ST21-liangmen. Journal of Sichuan of Traditional Chinese Medicine. 1985;4:p. 13. [Google Scholar]
  • 32.Bai X. F. One case about perforation of gallbladder and biliary peritonitis caused by acupuncture. Inner Mongolia Medical Journal. 1991;11(2, article 80) [Google Scholar]
  • 33.Zhang J. H. Four reports of peritonitis caused by needling in the abdomen. Chinese Journal of Rural Medicine and Pharmacy. 1997;4(6):20–21. [Google Scholar]
  • 34.Xiao X. T. Lessons learned from one case about gastric perforation caused by acupuncture. Chinese Journal for Clinicians. 1985;(1):p. 9. [Google Scholar]
  • 35.Huang L. H. A case of gastric ulcer with perforation caused by needling in ST36-zusanli. Journal of Clinical Acupuncture and Moxibustion. 1999;15(10):p. 43. [Google Scholar]
  • 36.Tang T., Li Q., Gao J. X. A case about clinical acupuncture accident. Chinese Acupuncture & Moxibustion. 2006;26(6):459–460. [Google Scholar]
  • 37.Liu W. G., Duan L. J., Sun D. T. Report of one case about intestinal obstruction caused by needling in ST25-tianshu. Chinese Journal of Integrated Traditional and Western Medicine. 1992;2(3):p. 147. [Google Scholar]
  • 38.Zhang C. Y., Zhen S. M., Pei Y. F. Report of five cases about visceral injury caused by acupuncture. Heilongjiang Journal of Traditional Chinese Medicine. 1992;(1):p. 38. [Google Scholar]
  • 39.Chen S. M. One case about cervical common carotid aneurysm caused by acupuncture. Journal of Traditional Chinese Medicine. 1980;(7):p. 49. [Google Scholar]
  • 40.Wang Z. Z. A case of shock induced by acupuncturing in carotid sinus. Chinese Journal of Practical Surgery. 1987;7(2):p. 66. [Google Scholar]
  • 41.Zhu J. A case about death because of asphyxia caused by needling in RN 22-tiantu. Jiangsu Journal of Traditional Chinese Medicine. 1986;2, article 28 [Google Scholar]
  • 42.Gao L. W. A case about dyspnea caused by needling LI18-futu. China Journal of Traditional Chinese Medicine and Pharmacy. 1989;(2):p. 50. [Google Scholar]
  • 43.Liu B. S., Li Z. X., Lei F. A case about amotio retinae caused by acupuncture. Chinese Journal of Ocular Trauma and Occupational Eye Disease(With Ophthalmic Surgery) 1988;1:43–44. [Google Scholar]
  • 44.Wang S. F. Adverse reaction about two cases caused by needling in Ex-HN5-taiyang with improper technique. Chinese Journal of Practical Meicine. 1982;(3):p. 135. [Google Scholar]
  • 45.Li Y. M., Zhou Z. Q. Report of one case about femoral neck fracture induced by electro-acupuncture. Chinese Journal of Nervous and Mental Diseases. 1980;3:p. 153. [Google Scholar]
  • 46.Liang Y. T., Song L. F. One case of flexor hallucis muscle and digitorum longus muscle scar contracture caused by repeated acupuncture. People's Military Surgeon. 1984;(5):79–80. [Google Scholar]
  • 47.Chen Y. Z. Analysis on one case of nape spasm induced by electro-acupuncturing in GB20-fengchi and Ex-HN17-yiming. Journal of Clinical Acupuncture and Moxibustion. 1992;1, article 50 [Google Scholar]
  • 48.Wang J. H. A case of subluxation of wrist caused by improper electro-acupuncture. Guangxi Journal of Traditional Chinese Medicine. 1994;(1):p. 45. [Google Scholar]
  • 49.Shi G. P., Chen Z. M. Analysis on three cases of adverse events caused by acupuncture. Journal of Clinical Acupuncture and Moxibustion. 1994;10(5):p. 38. [Google Scholar]
  • 50.Luo C. Y., Huang H. Y. Two cases of fasciculation induced by acupuncture. Chinese Acupuncture and Moxibustion. 2006;26(6):p. 460. [Google Scholar]
  • 51.Shao W. L. Report of one case about syncope after drink. Journal of Nanjing University of Traditional Chinese Medicine. 1989;(4):p. 41. [Google Scholar]
  • 52.Liu C. B. Report of four case about syncope induced by acupuncture. Journal of Clinical Acupuncture and Moxibustion. 2001;17(3, article 51) [Google Scholar]
  • 53.Li L., Huang J. Y., Lu G. M. Two cases of lag syncope induced by acupuncture. Chinese Acupuncture and Moxibustion. 2009;29(9):p. 732. [Google Scholar]
  • 54.Ma Z. H. A case of sudden cardiac arrest induced by acupuncture. Hebei Journal of Traditional Chinese Medicine. 2005;27(8):p. 589. [Google Scholar]
  • 55.Long Z. Y., Chen D. S., Chen L. P. Analysis on cases of severe syncope during acupuncture treatment. Hubei Journal of Traditional Chinese Medicine. 2006;28(9):p. 52. [Google Scholar]
  • 56.Wu Z. Q., Lv J. C., Ma H. F. A case about ear-acupuncture treatment of abnormal sense after needling. Journal of Hebei Traditional Chinese Medicine and Pharmacology. 2001;16(4):p. 32. [Google Scholar]
  • 57.Yang B. S., Wu Y., Wang L. Y., Xu Y. X. One case about tetanus caused by needling in Ex-UE19. Chinese Community Doctors. 1990;(2):p. 31. [Google Scholar]
  • 58.Liu G. X. One case about tetanus caused by acupuncture. The Journal of Medical Theory and Practice. 1991;4(3, article 30) [Google Scholar]
  • 59.Liu C. R. One case about tetanus caused by acupuncture. Chinese Community Doctors. 1992;(4):p. 30. [Google Scholar]
  • 60.Sun Y. E., Hu Q. G. A case about tetanus caused by acupuncture during the treatment for Facioplegia. Journal of Oral and Maxillofacial Surgery. 1997;7(2):p. 108. [Google Scholar]
  • 61.Chen Z. G., Zhang J., Li J. J., Jia D. Z. One case about death because of tetanus caused by acupuncture. Forensic Science and Technology. 2008;(2):p. 74. [Google Scholar]
  • 62.Xie D. X., Zong S. W. One lesson about abdominal metastatic hepatic hydatid caused by acupuncture. Chinese Journal for Clinicians. 1983;(3):p. 45. [Google Scholar]
  • 63.Chen Y. S., Gao L. One case about encephalopyosis caused by needling on the head. People's Military Surgeon. 1995;4, article 58 [Google Scholar]
  • 64.Zhou Z. Report of three cases about tuberculous abscess on the body surface caused by acupuncture and moxibustion. Journal of Jiujiang University. 1999;(1):p. 47. [Google Scholar]
  • 65.Gao F., Qi Y. Z. Report of one case about locally burn caused by electro-acupuncture. Shanghai Journal of Acupuncture and Moxibustion. 1989;4:p. 15. [Google Scholar]
  • 66.Gan Z. Z. A case about massive orbital hemorrhage caused by neeldling in Ex-HN05. Chinese Journal of Ocular Trauma and Occupational Eye Disease. 2000;22(3):p. 246. [Google Scholar]
  • 67.Li D. P. One case report of extraperitoneal hematoma casued by needling in the abdomen. Shaanxi Medical Journal. 1989;18(11):53–54. [Google Scholar]
  • 68.Cai X. J. One case about apnea caused by thyroid intracapsular hemorrhage because of needling. Medical Journal of Chinese People's Liberation Army. 1991;(6):p. 494. [Google Scholar]
  • 69.Han L. X. One case of sublingual fold hematoma caused by needling RN23-lianquan. Shanghai Journal of Acupuncture and Moxibustion. 1994;13(3):p. 107. [Google Scholar]
  • 70.Wang N. R. A case about sublingual hematoma caused by needling in Ex-HN20. Journal of Clinical Acupuncture and Moxibustion. 1996;1(8):p. 8. [Google Scholar]
  • 71.Zeng X. F., Liu Z. Y. A case about death caused by needling in ST 9-renying. Proceedings of the 5th National Clinical Forensic Medicine Symposium of Chinese forensic Medicine Association; 1996; p. p. 408. [Google Scholar]
  • 72.Jiang Y. Analysis on one case of hematoma induced by hegu-stimulate in LI4-hegu. Journal of Clinical Acupuncture and Moxibustion. 2001;17(5):p. 46. [Google Scholar]
  • 73.Duan H. One case report of hematoma after acupuncture in acquired hemophilia B. Practical Journal of Clinical Medicine. 2007;4(2):p. 32. [Google Scholar]
  • 74.Liu H., Liu X. H. Prevention and treatment of haematoma in acupuncture. Chinese Journal of Misdiagnostics. 2007;7(29):p. 71. [Google Scholar]
  • 75.Lu Y. D., Teng Q. S. A case about hemopneumothorax caused by breaking needle in the chest during acupuncture. Medical Journal of Chinese People's Liberation Army. 1994;19(5, article 381) [Google Scholar]
  • 76.Geng J. Q. A case about successful rescue of acute pericardial tamponade caused by acupuncturing coronary artery. Journal of Clinical Cardiology. 2005;21(7):p. 392. [Google Scholar]
  • 77.Quan S. S. A case of metal foreign body in the heart. Journal of Medical Science Yanbian University. 2008;31(4):p. 304. [Google Scholar]
  • 78.Liu W. H., Yu G. X. A case about pulmonary bulla caused by acupuncture. Chinese Acupuncture and Moxibustion. 2010;30(8):p. 674. [Google Scholar]
  • 79.Cheng R. S. One case about broken needle caused by wrist-ankle acupuncture. Shanghai Journal of Acupuncture and Moxibustion. 2010;29(7):p. 463. [Google Scholar]
  • 80.Wang H. F. One case of sticking and damage of needles in acupuncture treatment of trauma patient. Journal of Clinical Acupuncture and Moxibustion. 2000;16(11):p. 42. [Google Scholar]
  • 81.Wang S. F., Lan Y. H. Acute aphonia caused by acupuncture in PC6-neiguan. New Chinese Medicine. 1980;11(11):587–588. [Google Scholar]
  • 82.Zhou L. Z., Zhao D. G., Peng L. Some thoughts of hoarseness casued by acupuncture. Shanghai Journal of Acupuncture and Moxibustion. 2005;24(1):p. 27. [Google Scholar]
  • 83.Peng Y. G. Report of one case about allergy induced by electro-acupuncture. Jiangxi Journal of Traditional Chinese Medicine. 1982;3, article 19 [Google Scholar]
  • 84.Gao Q. S., Zheng Y. J. Two cases about acupuncture allergy. Chinese Acupuncture and Moxibustion. 2008;28(11):p. 818. [Google Scholar]
  • 85.Wang L. One case of epilepsy seizures caused by acupuncture. Chinese Acupuncture Moxibustion. 2004;24:p. 96. [Google Scholar]
  • 86.Dai S. Two cases of epilepsy caused by acupuncture. Jiangxi Journal of Traditional Chinese Medicine. 2012;43(6):p. 38. [Google Scholar]
  • 87.Li J. S. A case about fever induced by acupuncture. Chinese Acupuncture and Moxibustion. 2000;20(10):p. 639. [Google Scholar]
  • 88.Shang Y. T. Two adverse reactions induced by acupuncture. Journal of New Chinese Medicine. 2006;38(11, article 76) [Google Scholar]
  • 89.Quan G. S., Jiang L. One case report of infusion reaction caused by acupuncture. Jilin Medical Journal. 2008;29(1):p. 79. [Google Scholar]
  • 90.Fang W. Case report of hyperventilation syndrome induced by acupuncture. Journal of Emergency in Traditional Chinese Medicine. 2010;19(3):486–488. [Google Scholar]
  • 91.Wang C. H. A case of adverse reaction induced by acupuncture when treating sequelae of radiotherapy in nasopharyngeal carcinoma. Shanghai Journal of Acupuncture and Moxibustion. 2010;29(8):536–537. [Google Scholar]
  • 92.Xue Z., Liu C. Z., Shi G. X., et al. Efficacy and safety of acupuncture for chronic dizziness: study protocol for a randomized controlled trial. Trials. 2013;14:p. 429. doi: 10.1186/1745-6215-14-429. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 93.Ferreira D. C. A., De Rossi A., Torres C. P., et al. Effect of laser acupuncture and auricular acupressure in a child with trismus as a sequela of medulloblastoma. Acupuncture in Medicine. 2014;32(2):190–193. doi: 10.1136/acupmed-2013-010484. [DOI] [PubMed] [Google Scholar]
  • 94.Karlson G., Bennicke P. Acupuncture in asthmatic children: a prospective, randomized, controlled clinical trial of efficacy. Alternative Therapies in Health and Medicine. 2013;19(4):13–19. [PubMed] [Google Scholar]
  • 95.Elseify M. Y., Mohammed N. H., Alsharkawy A. A., Elseoudy M. E. Laser acupuncture in treatment of childhood bronchial asthma. Journal of Complementary and Integrative Medicine. 2013;10(1):199–203. doi: 10.1515/jcim-2012-0006. [DOI] [PubMed] [Google Scholar]
  • 96.Moustafa Y., Kassab A. N., el Sharnoubi J., Yehia H. Comparative study in the management of allergic rhinitis in children using LED phototherapy and laser acupuncture. International Journal of Pediatric Otorhinolaryngology. 2013;77(5):658–665. doi: 10.1016/j.ijporl.2013.01.006. [DOI] [PubMed] [Google Scholar]
  • 97.Anders E. F., Findeisen A., Nowak A., Rüdiger M., Usichenko T. I. Acupuncture for treatment of hospital-induced constipation in children: a retrospective case series study. Acupuncture in Medicine. 2012;30(4):258–260. doi: 10.1136/acupmed-2012-010192. [DOI] [PubMed] [Google Scholar]
  • 98.Ni X. L., Xie Y. N., Wang Q., et al. Cardioprotective effect of transcutaneous electric acupoint stimulation in the pediatric cardiac patients: a randomized controlled clinical trial. Paediatric Anaesthesia. 2012;22(8):805–811. doi: 10.1111/j.1460-9592.2012.03822.x. [DOI] [PubMed] [Google Scholar]
  • 99.Reinthal M., Lund I., Ullman D., Lundeberg T. Gastrointestinal symptoms of infantile colic and their change after light needling of acupuncture: a case series study of 913 infants. Chinese Medicine. 2011;6(1, article 28) doi: 10.1186/1749-8546-6-28. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 100.Ochi J. W. Acupuncture instead of codeine for tonsillectomy pain in children. International Journal of Pediatric Otorhinolaryngology. 2013;77(12):2058–2062. doi: 10.1016/j.ijporl.2013.10.008. [DOI] [PubMed] [Google Scholar]
  • 101.Zhang A. L., Parker S. J., Taylor D. M., Xue C. C. Acupuncture and standard emergency department care for pain and/or nausea and its impact on emergency care delivery: a feasibility study. Acupuncture in Medicine. 2014 doi: 10.1136/acupmed-2013-010501. [DOI] [PubMed] [Google Scholar]
  • 102.Gribel G. P. C., Coca-Velarde L. G., Moreira de Sá R. A. Electroacupuncture for cervical ripening prior to labor induction: a randomized clinical trial. Archives of Gynecology and Obstetrics. 2011;283(6):1233–1238. doi: 10.1007/s00404-010-1526-x. [DOI] [PubMed] [Google Scholar]
  • 103.da Silva J. B. G., Nakamura M. U., Cordeiro J. A., Kulay L., Saidah R. Acupuncture for dyspepsia in pregnancy: a prospective, randomised, controlled study. Acupuncture in Medicine. 2009;27(2):50–53. doi: 10.1136/aim.2009.000497. [DOI] [PubMed] [Google Scholar]
  • 104.Da Silva J. B. G. Acupuncture for mild to moderate emotional complaints in pregnancy—a prospective, quasi-randomised, controlled study. Acupuncture in Medicine. 2007;25(3):65–71. doi: 10.1136/aim.25.3.65. [DOI] [PubMed] [Google Scholar]
  • 105.Guerreiro Da Silva J. B., Nakamura M. U., Cordeiro J. A., Kulay L., Jr. Acupuncture for insomnia in pregnancy—a prospective, quasi-randomised, controlled study. Acupuncture in Medicine. 2005;23(2):47–51. doi: 10.1136/aim.23.2.47. [DOI] [PubMed] [Google Scholar]
  • 106.Guerreiro da Silva J. B., Nakamura M. U., Cordeiro J. A., Kulay L., Jr. Acupuncture for low back pain in pregnancy—a prospective, quasi-randomised, controlled study. Acupuncture in Medicine. 2004;22(2):60–67. doi: 10.1136/aim.22.2.60. [DOI] [PubMed] [Google Scholar]
  • 107.Kvorning N., Holmberg C., Grennert L., Aberg A., Akeson J. Acupuncture relieves pelvic and low-back pain in late pregnancy. Acta Obstetricia et Gynecologica Scandinavica. 2004;83(3):246–250. doi: 10.1111/j.0001-6349.2004.0215.x. [DOI] [PubMed] [Google Scholar]
  • 108.Wedenberg K., Moen B., Norling Å. A prospective randomized study comparing acupuncture with physiotherapy for low-back and pelvic pain in pregnancy. Acta Obstetricia et Gynecologica Scandinavica. 2000;79(5):331–335. doi: 10.1034/j.1600-0412.2000.079005331.x. [DOI] [PubMed] [Google Scholar]
  • 109.Rosen T., de Veciana M., Miller H. S., Stewart L., Rebarber A., Slotnick R. N. A randomized controlled trial of nerve stimulation for relief of nausea and vomiting in pregnancy. Obstetrics and Gynecology. 2003;102(1):129–135. doi: 10.1016/S0029-7844(03)00375-2. [DOI] [PubMed] [Google Scholar]
  • 110.Lei H., Wang W., Huang G. Acupuncture benefits a pregnant patient who has Bell’s palsy: a case study. The Journal of Alternative and Complementary Medicine. 2010;16(9):1011–1014. doi: 10.1089/acm.2009.0180. [DOI] [PubMed] [Google Scholar]
  • 111.Ekdahl L., Petersson K. Acupuncture treatment of pregnant women with low back and pelvic pain—an intervention study. Scandinavian Journal of Caring Sciences. 2010;24(1):175–182. doi: 10.1111/j.1471-6712.2009.00704.x. [DOI] [PubMed] [Google Scholar]
  • 112.Ding X. Y., Liu S. Y., Zhu J. One case about clinical acupuncture accident. Chinese Acupuncture & Moxibustion. 2008;28(11):817–818. [Google Scholar]
  • 113.World Health Organization. Acupuncture: Review and Analysis of Reports on Controlled Clinical Trials. World Health; 2002. [Google Scholar]
  • 114.Endres H. G., Molsberger A., Lungenhausen M., Trampisch H. J. An internal standard for verifying the accuracy of serious adverse event reporting: the example of an acupuncture study of 190,924 patients. European Journal of Medical Research. 2004;9(12):545–551. [PubMed] [Google Scholar]
  • 115.Witt C. M., Pach D., Brinkhaus B., et al. Safety of acupuncture: results of a prospective observational study with 229,230 patients and introduction of a medical information and consent form. Research in Complementary Medicine. 2009;16(2):91–97. doi: 10.1159/000209315. [DOI] [PubMed] [Google Scholar]
  • 116.He W. J., Li Y. Q., Zhao X., et al. Overview of the acupuncture safety standards at home and abroad. Proceedings of Chinese Acupuncture Association Annual Meeting; 2011; pp. 62–67. [Google Scholar]
  • 117.Jiang D. G. Report of one case about pneumothorax caused by needling in RN15-jiuwei. Chongqing Medicine. 1980;(6):p. 47. [Google Scholar]
  • 118.Cai Y. Z., Wang Q. L. A case about large hemothorax caused by deep needling. Chinese Journal of Medicine. 1982;(6):p. 54. [Google Scholar]
  • 119.Zheng P. D., Pang S. H. One case about severe hemopneumothorax caused by acupuncture. Journal of Traditional Chinese Medicine. 1983;5, article 32 [Google Scholar]
  • 120.Gao C. G. Report of two cases about pneumothorax caused by acupuncture. The Journal of Practical Medicine. 1984;3:38–39. [Google Scholar]
  • 121.Chang J. Y. A case about large hemopneumothorax caused by needling in the back. Hebei Journal of Traditional Chinese Medicine. 1984;(3):p. 48. [Google Scholar]
  • 122.Yan Z. C. A case about severe pneumothorax caused by needling RN22-tiantu. New Chinese Medicine. 1985;16(12):p. 655. [Google Scholar]
  • 123.Hu Q. X. A case about pneumothorax caused by improper acupuncture. Shanghai Journal of Acupuncture and Moxibustion. 1986;3:p. 34. [Google Scholar]
  • 124.Zhang S. P. A case about large hemopneumothorax caused by acupuncture. Shanghai Journal of Acupuncture and Moxibustion. 1986;6(4):p. 21. [Google Scholar]
  • 125.Jin B. R. A case about pneumothorax caused by needling SI13-quyuan. Shanghai Journal of Acupuncture and Moxibustion. 1987;(3):p. 45. [Google Scholar]
  • 126.Song B. Z., Xu J. S. Report of one case about hemothorax caused by needling left GB21-jianjing. Journal of Anhui Traditional Chinese Medical College. 1987;6(3):p. 45. [Google Scholar]
  • 127.Ruan K. Y., Qi K. J., Mou Z. C. A case about hydropneumothorax caused by needling supraclavicular fossae. Journal of New Chinese Medicine. 1992;4:p. 33. [Google Scholar]
  • 128.Lu B. Report of one case about traumatic pneumothorax caused by needling too deep. Guizhou Medicine Journal. 1993;17(2):p. 125. [Google Scholar]
  • 129.Xia C. Handling method and experience of accident occurred during acupuncture. Journal of Clinical Acupuncture and Moxibustion. 1993;(2-3):75–76. [Google Scholar]
  • 130.Li Y. W., Chen X. L. A case about pneumothorax caused by acupuncture. Journal of Handan Medical College. 1997;10(3):72–73. [Google Scholar]
  • 131.Ma L., Zhang C. J. Clinical analysis of pneumothorax caused by acupuncture. Journal of Clinical Acupuncture and Moxibustion. 1997;13(2):p. 40. [Google Scholar]
  • 132.Qin M. X., Ao W. H. Pneumothorax caused by improper acupuncture and moxibustion. Clinical Misdiagnosis & Mistherapy. 2003;16(1, article 76) [Google Scholar]
  • 133.Zha C. H. Injury identification of one case about hemopneumothorax caused by acupuncturing left lung. Chinese Journal of Forensic Medicine. 2006;(21):75–76. [Google Scholar]
  • 134.Gan J. Y., Lei G. Q., Zhu J. S. One case about hemopneumothorax and dyspnea caused by acupuncture. Proceedings of the 9th National Clinical Forensic Medicine Symposium of Chinese forensic Medicine Association; 2006; pp. 58–59. [Google Scholar]
  • 135.Huo S. H., Tian Y. P., Ma Q. L., et al. One case about cardiac trauma and pneumothorax caused by acupuncture. Chinese Journal of Critical Care Medicine. 2007;27(10):p. 908. [Google Scholar]
  • 136.Liu L. Y. Analysis on one case of hemopneumothorax induced by acupuncture. Journal of Changchun University of Traditional Chinese Medicine. 2007;23(3):p. 58. [Google Scholar]
  • 137.Ma B. Z. Report of one case about traumatic pneumothorax caused by acupuncture and moxibustion. Qinghai Medical Journal. 2007;37(2):p. 41. [Google Scholar]
  • 138.Zhang J., Zhao L. Analysis and treatment of pneumothorax caused by needling GB21-jianjing. Hubei Journal of Traditional Chinese Medicine. 2012;34(11):60–61. [Google Scholar]
  • 139.Liu S. X. Subarachnoid hemorrhage caused by needling in GB20-fengchi. Shanxi Medical Journal. 1980;9(6, article 53) [Google Scholar]
  • 140.Bao L. P., Gao C. T. Report of three cases about subarachnoid hemorrhage induced by needling GB20-fengchi and DU15-yamen. Jilin Medical Journal. 1983;4(3):45–53. [Google Scholar]
  • 141.Chen Q. T., Wu L. J. Case about subarachnoid hemorrhage and medulla oblogata hemorrhage caused by needling in anmian point. Journal of Apoplexy and Nervous Diseases. 1985;2(3):158–159. [Google Scholar]
  • 142.Chen Y. Z., Huang W. C. One case of subarachnoid hemorrhage caused by needling in the nape. Shanxi Journal of Traditional Chinese Medicine. 1985;1(1):47–48. [Google Scholar]
  • 143.Su Y., Chen H. X., Chen C. C., Yang Z. J. One case of subarachnoid hemorrhage caused by needling in Du15-yamen. Shanghai Journal of Acupuncture and Moxibustion. 1985;3:p. 22. [Google Scholar]
  • 144.Yu B. R. Subarachnoid hemorrhage caused by needling in the nape—with report of seven cases. Journal of Apoplexy and Nervous Diseases. 1986;3(2):74–75. [Google Scholar]
  • 145.Chen M. X. One case of subarachnoid hemorrhage caused by needling in Du15-yamen. Chinese Journal of Practical Internal Medicine. 1987;7(7):p. 355. [Google Scholar]
  • 146.Jiang S. C., Chen X. Q. A case about death caused by needling in GB20-fengchi. Chinese Journal of Forensic Medicine. 1987;2(2):116–117. [Google Scholar]
  • 147.Zhou J. W. A case about death caused by needling in GB20-fengchi. Journal of Sichuan of Traditional Chinese Medicine. 1988;(10):p. 52. [Google Scholar]
  • 148.Mi X. H., Li S. K., Jia S. K. One case of subarachnoid hemorrhage caused by needling in Du15-yamen. Shandong Journal of Traditional Chinese Medicine. 1989;8(2):p. 22. [Google Scholar]
  • 149.Wu B. C., Xu Q. Z. Report of one case about death caused by spinal cord injury through acupuncturing in acupoint near C3. Chinese Journal of Forensic Medicine. 1990;5(1):32–33. [Google Scholar]
  • 150.Liu F. Y. One case of posterior fossa acute subdural hematoma caused by needling in GB20-fengchi. Medical Journal of Liaoning. 1992;6(1):p. 25. [Google Scholar]
  • 151.Jiang T. Z., Chen W. D., Zhang B., Yang R. M. Report of two cases about subarachnoid hemorrhage caused by needling in the nape. Journal of Anhui Traditional Chinese Medicine College. 1996;15(1):p. 48. [Google Scholar]
  • 152.Liu M., Shen S. P., Tong H., Wang T. Autopsy report of medulla oblongata hemorrhage caused by needling in DU16-fengfu. Proceedings of the 5th National Clinical Forensic Medicine Symposium of Chinese Forensic Medicine Association; 1996; p. p. 85. [Google Scholar]
  • 153.Bian F., Zhang X. L., Tian S. P. A case about subarachnoid hemorrhage caused by needling in GB20-fengchi. Journal of Hebei North University (Medical Edition) 1997;14(6, article 73) [Google Scholar]
  • 154.Wang L. A case about death caused by needling in cervical spinal cord. Forensic Science and Technology. 1999;(4):p. 20. [Google Scholar]
  • 155.Li Y. Q., Chen G. W., Zeng X. C. A case about cervical spinal cord epidural hematoma caused by acupuncture. Chinese Journal of Rural Medicine and Pharmacy. 2003;10(3):p. 20. [Google Scholar]
  • 156.Niu L. J., Zhang R. W. A case about cisterna magna hemorrhage caused by acupuncture. Practical Journal of Medicine & Pharmacy. 2006;23(8):p. 932. [Google Scholar]
  • 157.Li L. F., Cong X., Jin Q. W. Subarachnoid hemorrhage caused by needling in DU16-fengfu. Chinese Acupuncture & Moxibustion. 2008;28(4):p. 292. [Google Scholar]
  • 158.Guo Y. C. Lag syncope cannot be ignored. Shanghai Journal of Acupuncture and Moxibustion. 1995;14(6, article 254) [Google Scholar]
  • 159.Liu Y. Z. Analysis on two cases about abnormal condition induced by improper position during acupuncture. Lishizhen Medicine and Materia Medica Research. 2007;18(7):p. 1756. [Google Scholar]
  • 160.Liao Y., Guo Y. Q. Report of one case about syncope induced by acupuncture. Journal of Clinical Acupuncture and Moxibustion. 2009;25(8, article 21) [Google Scholar]
  • 161.Zhang J. P. Disinfection must be done when needling in Ex-UE19. Chinese Journal for Clinicians. 1980;2, article 14 [Google Scholar]
  • 162.Xu C. Z. One case about intracranial infection caused by acupuncture. Nei Mongol Journal of Traditional Chinese Medicine. 1990;(1):p. 12. [Google Scholar]

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