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8201 | reports originate from Asia, which may reflect 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 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 | Acupuncture | [
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8202 | 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, 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 | Acupuncture | [
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8203 | practitioners of acupuncture use disposable needles, the reuse of sterilized needles 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 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 | Acupuncture | [
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8204 | 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 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 | Acupuncture | [
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8205 | 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 resulting in death. Two died from pericardial tamponade and one was from an aortoduodenal fistula. The same review found vascular injuries were rare, bleeding and pseudoaneurysm were most prevalent. A 2011 systematic review | Acupuncture | [
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8206 | (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 causality in most fatal instances. The same review concluded cardiac tamponade was a serious, usually fatal, though theoretically avoidable complication following acupuncture, and urged training to minimize risk. A 2012 review found a number of adverse events were reported after acupuncture in the UK's National Health Service (NHS) but most (95%) were not severe, though miscategorization and under-reporting may alter the total figures. From January 2009 to December 2011, 468 safety incidents | Acupuncture | [
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8207 | were recognized within 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 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. Studies are | Acupuncture | [
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8208 | required to verify these findings. The evidence suggests that acupuncture might be a safe option for people with allergic rhinitis. A 2010 systematic review of the Chinese-language literature found numerous acupuncture-related adverse events, including pneumothorax, fainting, subarachnoid hemorrhage, and infection as 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, the prevalence of | Acupuncture | [
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8209 | 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 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 | Acupuncture | [
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8210 | 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 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 Republic of Korean-literature contained | Acupuncture | [
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8211 | reports of 1104 adverse events. Between 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 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 | Acupuncture | [
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8212 | 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 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% | Acupuncture | [
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8213 | 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 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 was a lack of acupuncture-associated maternal mortality. | Acupuncture | [
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8214 | 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 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 | Acupuncture | [
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8215 | A, stroke following cupping on the back and neck, factitious panniculitis, reversible cardiac hypertrophy, and iron deficiency anemia. A 2013 meta-analysis found that acupuncture for chronic low back pain was cost-effective as a complement to standard care, but not as a substitute for standard care except in cases where comorbid depression presented. The same meta-analysis found there was no difference between sham and non-sham acupuncture. A 2011 systematic review found insufficient evidence for the cost-effectiveness of acupuncture in the treatment of chronic low back pain. A 2010 systematic review found that the cost-effectiveness of acupuncture could not be concluded. A | Acupuncture | [
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8216 | 2012 review found that acupuncture seems to be cost-effective for some pain conditions. 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 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 | Acupuncture | [
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8217 | traditional Chinese medicine (TCM). Early acupuncture beliefs relied on concepts that are common in TCM, such as 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 is generally perceived as a disharmony or | Acupuncture | [
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8218 | 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 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 | Acupuncture | [
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8219 | not strongly differentiate between the cause and effect of symptoms. 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 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 | Acupuncture | [
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8220 | TCM theories are so nebulous that no amount of scientific study will enable TCM to offer rational care." Some modern practitioners support the use of acupuncture to treat pain, but have abandoned the use of "qi", meridians, "yin", "yang" and other energies based in mysticism as 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. Academic discussions of acupuncture still make reference to pseudoscientific concepts such as "qi" and meridians despite the lack of scientific evidence. Many within the scientific community | Acupuncture | [
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8221 | consider attempts to rationalize acupuncture in science to be quackery, pseudoscience and "theatrical placebo". Academics Massimo Pigliucci and Maarten Boudry describe it as a "borderlands science" lying between science and pseudoscience. Many acupuncturists attribute pain relief to the release of endorphins when needles penetrate, but no longer support the idea that acupuncture can affect a disease. 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 | Acupuncture | [
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8222 | electrical continuity was significantly different near meridians than other places in the body have been inconclusive. 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 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" found that since the key mouse studies that suggested acupuncture relieves pain via the local release of adenosine, which | Acupuncture | [
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8223 | then triggered nearby A1 receptors "caused more tissue damage and inflammation relative to 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." It has been proposed that acupuncture's effects in gastrointestinal disorders may relate to its effects on the parasympathetic and sympathetic nervous system, which have been said to be the "Western medicine" equivalent of "yin and yang". Another mechanism whereby acupuncture may be effective for gastrointestinal dysfunction involves the promotion of gastric peristalsis in subjects with low initial | Acupuncture | [
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8224 | gastric motility, and suppressing peristalsis in subjects with active initial motility. Acupuncture has also been found to exert anti-inflammatory effects, which may be mediated by the activation of the vagus nerve and deactivation of inflammatory macrophages. Neuroimaging studies suggest that acupuncture stimulation results in deactivation of the limbic brain areas and the default mode network. 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 the exact date acupuncture was founded | Acupuncture | [
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8225 | depends on the extent dating of ancient texts can be trusted and the interpretation of what constitutes acupuncture. According to an article in "Rheumatology", the first documentation of an "organized system of diagnosis and treatment" for acupuncture was in "The Yellow Emperor's Classic of Internal Medicine" (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 archeological evidence of acupuncture, though it is unclear if that was their purpose. According to Plinio Prioreschi, the earliest known historical record of acupuncture is the Shih-Chi | Acupuncture | [
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8226 | ("Record of History"), 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 the body suggests Otzi suffered from these conditions. This has been cited as evidence that practices similar to acupuncture may have been practiced elsewhere in Eurasia during the early Bronze Age; however, "The Oxford Handbook of the | Acupuncture | [
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8227 | History of Medicine" calls this theory "speculative". It is considered unlikely that acupuncture was practiced before 2000 BC. The Ötzi the Iceman's tattoo marks suggest to some experts that an acupuncture-like treatment was previously used in Europe 5 millennia ago. Acupuncture may have been practiced during 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 | Acupuncture | [
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8228 | to cure illnesses at or near the body's surface, perhaps because of 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 the ancient Chinese belief that illnesses were caused by demons within the body that could be | Acupuncture | [
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8229 | killed or released. It is likely bloodletting was an antecedent to acupuncture. According to historians Lu Gwei-djen and Joseph Needham, there is substantial evidence that acupuncture may have begun around 600 BC. Some hieroglyphs and pictographs from that era suggests acupuncture and moxibustion were practiced. However, historians Gwei-djen and Needham said it was unlikely a needle could be made out of the materials available in China during this time period. It is possible that bronze was used for early acupuncture needles. Tin, copper, gold and silver are also possibilities, though they are considered less likely, or to have been used | Acupuncture | [
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8230 | in fewer cases. If acupuncture was practiced during the Shang dynasty (1766 to 1122 BC), organic materials like thorns, sharpened bones, or bamboo may have been used. Once methods for producing steel were discovered, it would replace all other materials, since it could be used to create a very fine, but sturdy needles. Gwei-djen and Needham noted that all the ancient materials that could have been used for acupuncture and which often produce archeological evidence, such as sharpened bones, bamboo or stones, were also used for other purposes. An article in "Rheumatology" said that the absence of any mention of | Acupuncture | [
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8231 | acupuncture in documents found in the tomb of Ma-Wang-Dui from 198 BC suggest that acupuncture was not practiced by that time. Several different and sometimes conflicting belief systems emerged regarding acupuncture. This may have been the result of competing schools of thought. Some ancient texts referred to using acupuncture to cause bleeding, while others mixed the ideas of blood-letting and spiritual ch'i energy. Over time, the focus shifted from blood to the concept of puncturing specific points on the body, and eventually to balancing Yin and Yang energies as well. According to David Ramey, no single "method or theory" was | Acupuncture | [
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8232 | ever predominantly adopted as the standard. At the time, scientific knowledge of medicine was not yet developed, especially because in China dissection of the deceased was forbidden, preventing the development of basic anatomical knowledge. It is not certain when specific acupuncture points were introduced, but the autobiography of Pien Chhio from around 400–500 BC references inserting needles at designated areas. Bian Que believed there was a single acupuncture point at the top of one's skull that he called the point "of the hundred meetings." Texts dated to be from 156–186 BC document early beliefs in channels of life force energy | Acupuncture | [
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8233 | called meridians that would later be an element in early acupuncture beliefs. Ramey and Buell said the "practice and theoretical underpinnings" of modern acupuncture were introduced in "The Yellow Emperor's Classic" (Huangdi Neijing) around 100 BC. It introduced the concept of using acupuncture to manipulate the flow of life energy ("qi") in a network of meridian (channels) in the body. The network concept was made up of acu-tracts, such as a line down the arms, where it said acupoints were located. Some of the sites acupuncturists use needles at today still have the same names as those given to them | Acupuncture | [
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8234 | by the "Yellow Emperor's Classic". Numerous additional documents were published over the centuries introducing new acupoints. By the 4th century AD, most of the acupuncture sites in use today had been named and identified. In the first half of the 1st century AD, acupuncturists began promoting the belief that acupuncture's effectiveness was influenced by the time of day or night, the lunar cycle, and the season. The Science of the Yin-Yang Cycles ("Yün Chhi Hsüeh") was a set of beliefs that curing diseases relied on the alignment of both heavenly (thien) and earthly (ti) forces that were attuned to cycles | Acupuncture | [
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8235 | like that of the sun and moon. There were several different belief systems that relied on a number of celestial and earthly bodies or elements that rotated and only became aligned at certain times. According to Needham and Gwei-djen, these "arbitrary predictions" were depicted by acupuncturists in complex charts and through a set of special terminology. Acupuncture needles during this period were much thicker than most modern ones and often resulted in infection. Infection is caused by a lack of sterilization, but at that time it was believed to be caused by use of the wrong needle, or needling in | Acupuncture | [
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8236 | the wrong place, or at the wrong time. Later, many needles were heated in boiling water, or in a flame. Sometimes needles were used while they were still hot, creating a cauterizing effect at the injection site. Nine needles were recommended in the "Chen Chiu Ta Chheng" from 1601, which may have been because of an ancient Chinese belief that nine was a magic number. Other belief systems were based on the idea that the human body operated on a rhythm and acupuncture had to be applied at the right point in the rhythm to be effective. In some cases | Acupuncture | [
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8237 | a lack of balance between Yin and Yang were believed to be the cause of disease. In the 1st century AD, many of the first books about acupuncture were published and recognized acupuncturist experts began to emerge. The "Zhen Jiu Jia Yi Jing", which was published in the mid-3rd century, became the oldest acupuncture book that is still in existence in the modern era. Other books like the "Yu Kuei Chen Ching", written by the Director of Medical Services for China, were also influential during this period, but were not preserved. In the mid 7th century, Sun Simiao published acupuncture-related | Acupuncture | [
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8238 | diagrams and charts that established standardized methods for finding acupuncture sites on people of different sizes and categorized acupuncture sites in a set of modules. Acupuncture became more established in China as improvements in paper led to the publication of more acupuncture books. The Imperial Medical Service and the Imperial Medical College, which both supported acupuncture, became more established and created medical colleges in every province. The public was also exposed to stories about royal figures being cured of their diseases by prominent acupuncturists. By time "The Great Compendium of Acupuncture and Moxibustion" was published during the Ming dynasty (1368–1644 | Acupuncture | [
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8239 | AD), most of the acupuncture practices used in the modern era had been established. By the end of the Song dynasty (1279 AD), acupuncture had lost much of its status in China. It became rarer in the following centuries, and was associated with less prestigious professions like alchemy, shamanism, midwifery and moxibustion. Additionally, by the 18th century, scientific rationality was becoming more popular than traditional superstitious beliefs. By 1757 a book documenting the history of Chinese medicine called acupuncture a "lost art". Its decline was attributed in part to the popularity of prescriptions and medications, as well as its association | Acupuncture | [
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8240 | with the lower classes. In 1822, the Chinese Emperor signed a decree excluding the practice of acupuncture from the Imperial Medical Institute. He said it was unfit for practice by gentlemen-scholars. In China acupuncture was increasingly associated with lower-class, illiterate practitioners. It was restored for a time, but banned again in 1929 in favor of science-based Western medicine. Although acupuncture declined in China during this time period, it was also growing in popularity in other countries. Korea is believed to be the first country in Asia that acupuncture spread to outside of China. Within Korea there is a legend that | Acupuncture | [
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8241 | acupuncture was developed by emperor Dangun, though it is more likely to have been brought into Korea from a Chinese colonial prefecture in 514 AD. Acupuncture use was commonplace in Korea by the 6th century. It spread to Vietnam in the 8th and 9th centuries. As Vietnam began trading with Japan and China around the 9th century, it was influenced by their acupuncture practices as well. China and Korea sent "medical missionaries" that spread traditional Chinese medicine to Japan, starting around 219 AD. In 553, several Korean and Chinese citizens were appointed to re-organize medical education in Japan and they | Acupuncture | [
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8242 | incorporated acupuncture as part of that system. Japan later sent students back to China and established acupuncture as one of five divisions of the Chinese State Medical Administration System. Acupuncture began to spread to Europe in the second half of the 17th century. Around this time the surgeon-general of the Dutch East India Company met Japanese and Chinese acupuncture practitioners and later encouraged Europeans to further investigate it. He published the first in-depth description of acupuncture for the European audience and created the term "acupuncture" in his 1683 work "De Acupunctura". France was an early adopter among the West due | Acupuncture | [
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8243 | to the influence of Jesuit missionaries, who brought the practice to French clinics in the 16th century. The French doctor Louis Berlioz (the father of the composer Hector Berlioz) is usually credited with being the first to experiment with the procedure in Europe in 1810, before publishing his findings in 1816. By the 19th century, acupuncture had become commonplace in many areas of the world. Americans and Britons began showing interest in acupuncture in the early 19th century but interest waned by mid century. Western practitioners abandoned acupuncture's traditional beliefs in spiritual energy, pulse diagnosis, and the cycles of the | Acupuncture | [
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8244 | moon, sun or the body's rhythm. Diagrams of the flow of spiritual energy, for example, conflicted with the West's own anatomical diagrams. It adopted a new set of ideas for acupuncture based on tapping needles into nerves. In Europe it was speculated that acupuncture may allow or prevent the flow of electricity in the body, as electrical pulses were found to make a frog's leg twitch after death. The West eventually created a belief system based on Travell trigger points that were believed to inhibit pain. They were in the same locations as China's spiritually identified acupuncture points, but under | Acupuncture | [
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8245 | a different nomenclature. The first elaborate Western treatise on acupuncture was published in 1683 by Willem ten Rhijne. In China, the popularity of acupuncture rebounded in 1949 when Mao Zedong took power and sought to unite China behind traditional cultural values. It was also during this time that many Eastern medical practices were consolidated under the name traditional Chinese medicine (TCM). New practices were adopted in the 20th century, such as using a cluster of needles, electrified needles, or leaving needles inserted for up to a week. A lot of emphasis developed on using acupuncture on the ear. Acupuncture research | Acupuncture | [
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8246 | organizations were founded in the 1950s and acupuncture services became available in modern hospitals. China, where acupuncture was believed to have originated, was increasingly influenced by Western medicine. Meanwhile, acupuncture grew in popularity in the US. The US Congress created the Office of Alternative Medicine in 1992 and the National Institutes of Health (NIH) declared support for acupuncture for some conditions in November 1997. In 1999, the National Center for Complementary and Alternative Medicine was created within the NIH. Acupuncture became the most popular alternative medicine in the US. Politicians from the Chinese Communist Party said acupuncture was superstitious and | Acupuncture | [
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8247 | conflicted with the party's commitment to science. Communist Party Chairman Mao Zedong later reversed this position, arguing that the practice was based on scientific principles. In 1971, a "New York Times" reporter published an article on his acupuncture experiences in China, which led to more investigation of and support for acupuncture. The US President Richard Nixon visited China in 1972. During one part of the visit, the delegation was shown a patient undergoing major surgery while fully awake, ostensibly receiving acupuncture rather than anesthesia. Later it was found that the patients selected for the surgery had both a high pain | Acupuncture | [
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8248 | tolerance and received heavy indoctrination before the operation; these demonstration cases were also frequently receiving morphine surreptitiously through an intravenous drip that observers were told contained only fluids and nutrients. One patient receiving open heart surgery while awake was ultimately found to have received a combination of three powerful sedatives as well as large injections of a local anesthetic into the wound. After the National Institute of Health expressed support for acupuncture for a limited number of conditions, adoption in the US grew further. In 1972 the first legal acupuncture center in the US was established in Washington DC and | Acupuncture | [
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8249 | in 1973 the American Internal Revenue Service allowed acupuncture to be deducted as a medical expense. In 2006, a BBC documentary "Alternative Medicine" filmed a patient undergoing open heart surgery allegedly under acupuncture-induced anesthesia. It was later revealed that the patient had been given a cocktail of anesthetics. In 2010, UNESCO inscribed "acupuncture and moxibustion of traditional Chinese medicine" on the UNESCO Intangible Cultural Heritage List following China's nomination. Acupuncture is popular in China, the US, Australia, and Europe including all five Nordic countries, though less so in Finland. It is most heavily practiced in China and is one of | Acupuncture | [
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8250 | the most common alternative medicine practices in Europe. In Switzerland, acupuncture has become the most frequently used alternative medicine since 2004. In the United Kingdom, a total of 4 million acupuncture treatments were administered in 2009. Acupuncture is used in most pain clinics and hospices in the UK. An estimated 1 in 10 adults in Australia used acupuncture in 2004. In Japan, it is estimated that 25 percent of the population will try acupuncture at some point, though in most cases it is not covered by public health insurance. Users of acupuncture in Japan are more likely to be elderly | Acupuncture | [
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8251 | and to have a limited education. Approximately half of users surveyed indicated a likelihood to seek such remedies in the future, while 37% did not. Less than one percent of the US population reported having used acupuncture in the early 1990s. By the early 2010s, more than 14 million Americans reported having used acupuncture as part of their health care. In the US, acupuncture is increasingly () used at academic medical centers, and is usually offered through CAM centers or anesthesia and pain management services. Examples include those at Harvard University, Stanford University, Johns Hopkins University, and UCLA. The Joint | Acupuncture | [
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8252 | Commission recommends acupuncture for pain management. The American College of Occupational and Environmental Medicine recommends acupuncture . The American Academy of Family Physicians recommends acupuncture for chronic pain. The use of acupuncture in Germany increased by 20% in 2007, after the German acupuncture trials supported its efficacy for certain uses. In 2011, there were more than one million users, and insurance companies have estimated that two-thirds of German users are women. As a result of the trials, German public health insurers began to cover acupuncture for chronic low back pain and osteoarthritis of the knee, but not tension headache or | Acupuncture | [
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8253 | migraine. This decision was based in part on socio-political reasons. Some insurers in Germany chose to stop reimbursement of acupuncture because of the trials. For other conditions, insurers in Germany were not convinced that acupuncture had adequate benefits over usual care or sham treatments. Highlighting the results of the placebo group, researchers refused to accept a placebo therapy as efficient. There are various government and trade association regulatory bodies for acupuncture in the United Kingdom, the United States, Saudi Arabia, Australia, Japan, Canada, and in European countries and elsewhere. The World Health Organization recommends that before being licensed or certified, | Acupuncture | [
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8254 | an acupuncturist receive 200 hours of specialized training if they are a physician and 2,500 hours for non-physicians; many governments have adopted similar standards. In China, the practice of acupuncture is regulated by the Chinese Medicine Council that was formed in 1999 by the Legislative Council. It includes a licensing exam and registration, as well as degree courses approved by the board. Canada has acupuncture licensing programs in the provinces of British Columbia, Ontario, Alberta and Quebec; standards set by the Chinese Medicine and Acupuncture Association of Canada are used in provinces without government regulation. Regulation in the US began | Acupuncture | [
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8255 | in the 1970s in California, which was eventually followed by every state but Wyoming and Idaho. Licensing requirements vary greatly from state to state. The needles used in acupuncture are regulated in the US by the Food and Drug Administration. In some states acupuncture is regulated by a board of medical examiners, while in others by the board of licensing, health or education. In Japan, acupuncturists are licensed by the Minister of Health, Labour and Welfare after passing an examination and graduating from a technical school or university. Australia regulates Chinese medical traditions through the Chinese Medicine Board of Australia | Acupuncture | [
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8256 | and the Public Health (Skin Penetration) Regulation of 2000. It restricts the use of words like "Acupuncture" and "Registered Acupuncturist". At least 28 countries in Europe have professional associations for acupuncturists. In France, the Académie Nationale de Médecine (National Academy of Medicine) has regulated acupuncture since 1955. Acupuncture Acupuncture is a form of alternative medicine in which thin needles are inserted into the body. It is a key component of traditional Chinese medicine (TCM). The theories and practices of TCM are not based upon scientific knowledge, and acupuncture is a pseudoscience. There are a diverse range of acupuncture theories based | Acupuncture | [
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8257 | Aeneas In Greco-Roman mythology, Aeneas (; Greek: Αἰνείας, "Aineías", possibly derived from Greek meaning "praised") was a Trojan hero, the son of the prince Anchises and the goddess Aphrodite (Venus). His father was a first cousin of King Priam of Troy (both being grandsons of Ilus, founder of Troy), making Aeneas a second cousin to Priam's children (such as Hector and Paris). He is a character in Greek mythology and is mentioned in Homer's "Iliad". Aeneas receives full treatment in Roman mythology, most extensively in Virgil's "Aeneid," where he is cast as an ancestor of Romulus and Remus. He became | Aeneas | [
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8258 | the first true hero of Rome. Snorri Sturluson identifies him with the Norse Æsir Vidarr. Aeneas is the Latin spelling of Greek Αἰνείας ("Aineías"). In the Homeric Hymn to Aphrodite, Aeneas is first introduced with Aphrodite naming him Αἰνείας ("Aineías") for the αὶνóν ἄχος ("terrible grief") he caused her, where "Aineías" derives from the adjective αὶνóν ("ainon", meaning "terrible"). It is a popular etymology for the name, apparently exploited by Homer in the Iliad. Later in the Medieval period there were writers who held that, because the Aeneid was written by a philosopher it is meant to be read philosophically. | Aeneas | [
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8259 | As such, in the "natural order", the meaning of Aeneas' name combines Greek "ennos" ("dweller") and "demas" ("body"), which becomes "ennaios", meaning "in-dweller" (i.e. as a god inhabiting a mortal body). However, there is no certainty regarding the origin of his name. In imitation of the "Iliad", Virgil borrows epithets of Homer, including; Anchisiades, "magnanimum", "magnus", "heros", and "bonus". Though he borrows many, Virgil gives Aeneas two epithets of his own in the "Aeneid:" "pater" and "pius". The epithets applied by Virgil are an example of an attitude different from that of Homer, for whilst Odysseus is "poikilios" ("wily"), Aeneas | Aeneas | [
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8260 | is described as "pius" ("pious"), which conveys a strong moral tone. The purpose of these epithets seems to enforce the notion of Aeneas' divine hand as father and founder of the Roman race, and their use seem circumstantial: when Aeneas is praying he refers to himself as pius, and is referred to as such by the author only when the character is acting on behalf of the gods to fulfill his divine mission. Likewise, Aeneas is called "pater" when acting in the interest of his men. The story of the birth of Aeneas is told in the "Hymn to Aphrodite", | Aeneas | [
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8261 | one of the major Homeric Hymns. Aphrodite has caused Zeus to fall in love with mortal women. In retaliation, Zeus puts desire in her heart for Anchises, who is tending his cattle among the hills near Mount Ida. When Aphrodite sees him she is smitten. She adorns herself as if for a wedding among the gods and appears before him. He is overcome by her beauty, believing that she is a goddess, but Aphrodite identifies herself as a Phrygian princess. After they make love, Aphrodite reveals her true identity to him and Anchises fears what might happen to him as | Aeneas | [
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8262 | a result of their liaison. Aphrodite assures him that he will be protected, and tells him that she will bear him a son to be called Aeneas. However, she warns him that he must never tell anyone that he has lain with a goddess. When Aeneas is born, Aphrodite takes him to the nymphs of Mount Ida. She directs them to raise the child to age five, then take him to Anchises. According to other sources, Anchises later brags about his encounter with Aphrodite, and as a result is struck in the foot with a thunderbolt by Zeus. Thereafter he | Aeneas | [
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8263 | is lame in that foot, so that Aeneas has to carry him from the flames of Troy. Aeneas is a minor character in the "Iliad", where he is twice saved from death by the gods as if for an as-yet-unknown destiny, but is an honorable warrior in his own right. Having held back from the fighting, aggrieved with Priam because in spite of his brave deeds he was not given his due share of honour, he leads an attack against Idomeneus to recover the body of his brother-in-law Alcathous at the urging of Deiphobus. He is the leader of the | Aeneas | [
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8264 | Trojans' Dardanian allies, as well as a second cousin and principal lieutenant of Hector, son of the Trojan king Priam. Aeneas's mother Aphrodite frequently comes to his aid on the battlefield, and he is a favorite of Apollo. Aphrodite and Apollo rescue Aeneas from combat with Diomedes of Argos, who nearly kills him, and carry him away to Pergamos for healing. Even Poseidon, who normally favors the Greeks, comes to Aeneas's rescue after he falls under the assault of Achilles, noting that Aeneas, though from a junior branch of the royal family, is destined to become king of the Trojan | Aeneas | [
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8265 | people. Bruce Louden presents Aeneas as a "type" in the tradition of Utnapishtim, Baucis and Philemon, and Lot; the just man spared the general destruction. Apollodorus explains that "...the Greeks let him alone on account of his piety". The Roman mythographer Gaius Julius Hyginus (c. 64 BCE – CE 17) in his "Fabulae" credits Aeneas with killing 28 enemies in the Trojan War. Aeneas also appears in the Trojan narratives attributed to Dares Phrygius and Dictys of Crete The history of Aeneas was continued by Roman authors. One influential source was the account of Rome's founding in Cato the Elder's | Aeneas | [
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8266 | "Origines". The Aeneas legend was well known in Virgil's day and appeared in various historical works, including the "Roman Antiquities" of the Greek historian Dionysius of Halicarnassus (relying on Marcus Terentius Varro), "Ab Urbe Condita" by Livy (probably dependent on Quintus Fabius Pictor, fl. 200 BCE), and Gnaeus Pompeius Trogus (now extant only in an epitome by Justin). The "Aeneid" explains that Aeneas is one of the few Trojans who were not killed or enslaved when Troy fell. Aeneas, after being commanded by the gods to flee, gathered a group, collectively known as the Aeneads, who then traveled to Italy | Aeneas | [
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8267 | and became progenitors of Romans. The Aeneads included Aeneas's trumpeter Misenus, his father Anchises, his friends Achates, Sergestus, and Acmon, the healer Iapyx, the helmsman Palinurus, and his son Ascanius (also known as Iulus, Julus, or Ascanius Julius). He carried with him the Lares and Penates, the statues of the household gods of Troy, and transplanted them to Italy. Several attempts to find a new home failed; one such stop was on Sicily, where in Drepanum, on the island's western coast, his father, Anchises, died peacefully. After a brief but fierce storm sent up against the group at Juno's request, | Aeneas | [
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8268 | Aeneas and his fleet made landfall at Carthage after six years of wanderings. Aeneas had a year-long affair with the Carthaginian queen Dido (also known as Elissa), who proposed that the Trojans settle in her land and that she and Aeneas reign jointly over their peoples. A marriage of sorts was arranged between Dido and Aeneas at the instigation of Juno, who was told that her favorite city would eventually be defeated by the Trojans' descendants. Aeneas's mother Venus (the Roman adaptation of Aphrodite) realized that her son and his company needed a temporary respite to reinforce themselves for the | Aeneas | [
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8269 | journey to come. However, the messenger god Mercury was sent by Jupiter and Venus to remind Aeneas of his journey and his purpose, compelling him to leave secretly. When Dido learned of this, she uttered a curse that would forever pit Carthage against Rome, an enmity that would culminate in the Punic Wars. She then committed suicide by stabbing herself with the same sword she gave Aeneas when they first met. After the sojourn in Carthage, the Trojans returned to Sicily where Aeneas organized funeral games to honor his father, who had died a year before. The company traveled on | Aeneas | [
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8270 | and landed on the western coast of Italy. Aeneas descended into the underworld where he met Dido (who turned away from him to return to her husband) and his father, who showed him the future of his descendants and thus the history of Rome. Latinus, king of the Latins, welcomed Aeneas's army of exiled Trojans and let them reorganize their lives in Latium. His daughter Lavinia had been promised to Turnus, king of the Rutuli, but Latinus received a prophecy that Lavinia would be betrothed to one from another land — namely, Aeneas. Latinus heeded the prophecy, and Turnus consequently | Aeneas | [
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8271 | declared war on Aeneas at the urging of Juno, who was aligned with King Mezentius of the Etruscans and Queen Amata of the Latins. Aeneas's forces prevailed. Turnus was killed, and Virgil's account ends abruptly. The rest of Aeneas's biography is gleaned from other ancient sources, including Livy and Ovid's "Metamorphoses". According to Livy, Aeneas was victorious but Latinus died in the war. Aeneas founded the city of Lavinium, named after his wife. He later welcomed Dido's sister, Anna Perenna, who then committed suicide after learning of Lavinia's jealousy. After Aeneas's death, Venus asked Jupiter to make her son immortal. | Aeneas | [
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8272 | Jupiter agreed. The river god Numicus cleansed Aeneas of all his mortal parts and Venus anointed him with ambrosia and nectar, making him a god. Aeneas was recognized as the god Jupiter Indiges. Snorri Sturlason in the Prologue of The Edda, tells of the world as parted in three continents: Africa, Asia and the third part called Europe or Enea . Snorri also tells of a Trojan named Munon or Menon, who marries the daughter of the High King (Yfirkonungr) Priam called Troan and travels to distant lands, marries the Sybil and got a son, Tror, who, as Snorri tells, | Aeneas | [
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8273 | is identical to Thor. This tale resemble some episodes of the Aeneid . Continuations of Trojan matter in the Middle Ages had their effects on the character of Aeneas as well. The 12th-century French "Roman d'Enéas" addresses Aeneas's sexuality. Though Virgil appears to deflect all homoeroticism onto Nisus and Euryalus, making his Aeneas a purely heterosexual character, in the Middle Ages there was at least a suspicion of homoeroticism in Aeneas. The "Roman d'Enéas" addresses that charge, when Queen Amata opposes Aeneas's marrying Lavinia, claiming that Aeneas loved boys. Medieval interpretations of Aeneas were greatly influenced by both Virgil and | Aeneas | [
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8274 | other Latin sources. Specifically, the accounts by Dares and Dictys, which were reworked by 13th-century Italian writer Guido delle Colonne (in "Historia destructionis Troiae"), colored many later readings. From Guido, for instance, the Pearl Poet and other English writers get the suggestion that Aeneas's safe departure from Troy with his possessions and family was a reward for treason, for which he was chastised by Hecuba. In "Sir Gawain and the Green Knight" (late 14th century) the Pearl Poet, like many other English writers, employed Aeneas to establish a genealogy for the foundation of Britain, and explains that Aeneas was "impeached | Aeneas | [
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8275 | for his perfidy, proven most true" (line 4). Aeneas had an extensive family tree. His wet-nurse was Caieta, and he is the father of Ascanius with Creusa, and of Silvius with Lavinia. Ascanius, also known as Iulus (or Julius), founded Alba Longa and was the first in a long series of kings. According to the mythology outlined by Virgil in the "Aeneid," Romulus and Remus were both descendants of Aeneas through their mother Rhea Silvia, making Aeneas the progenitor of the Roman people. Some early sources call him their father or grandfather, but considering the commonly accepted dates of the | Aeneas | [
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8276 | fall of Troy (1184 BC) and the founding of Rome (753 BC), this seems unlikely. The Julian family of Rome, most notably Julius Cæsar and Augustus, traced their lineage to Ascanius and Aeneas, thus to the goddess Venus. Through the Julians, the Palemonids make this claim. The legendary kings of Britain – including King Arthur – trace their family through a grandson of Aeneas, Brutus. Aeneas's consistent epithet in Virgil and other Latin authors is "pius", a term that connotes reverence toward the gods and familial dutifulness. In the "Aeneid", Aeneas is described as strong and handsome, but neither his | Aeneas | [
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8277 | hair colour nor complexion are described. In late antiquity however sources add further physical descriptions. The "De excidio Troiae" of Dares Phrygius describes Aeneas as ‘‘auburn-haired, stocky, eloquent, courteous, prudent, pious, and charming.’’ There is also a brief physical description found in 6th century AD John Malalas' "Chronographia": ‘‘Aeneas: short, fat, with a good chest, powerful, with a ruddy complexion, a broad face, a good nose, fair skin, bald on the forehead, a good beard, grey eyes.’’ Aeneas and Dido are the main characters of a 17th-century broadside ballad called "The Wandering Prince of Troy." The ballad ultimately alters Aeneas's | Aeneas | [
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8278 | fate from traveling on years after Dido's death to joining her as a spirit soon after her suicide. In modern literature, Aeneas is the speaker in two poems by Allen Tate, "Aeneas at Washington" and "Aeneas at New York." He is a main character in Ursula K. Le Guin's "Lavinia", a re-telling of the last six books of the "Aeneid" told from the point of view of Lavinia, daughter of King Latinus of Latium. Aeneas appears in David Gemmell's "Troy" series as a main heroic character who goes by the name Helikaon. In Rick Riordan's book series, "The Heroes of | Aeneas | [
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8279 | Olympus", Aeneas is regarded as the first Roman demigod, son of Venus rather than Aphrodite. Aeneas is a title character in Henry Purcell's opera "Dido and Aeneas" (c. 1688), and one of the principal roles in Hector Berlioz' opera "Les Troyens" (c. 1857). Canadian composer James Rolfe composed his opera "Aeneas and Dido" (2007; to a libretto by André Alexis) as a companion piece to Purcell's opera. Despite its many dramatic elements, Aeneas's story has generated little interest from the film industry. Portrayed by Steve Reeves, he was the main character in the 1961 sword and sandal film "Guerra di | Aeneas | [
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8280 | Troia" ("The Trojan War"). Reeves reprised the role the following year in the film "The Avenger", about Aeneas's arrival in Latium and his conflicts with local tribes as he tries to settle his fellow Trojan refugees there. The most recent cinematic portrayal of Aeneas was in the film "Troy", in which he appears as a youth charged by Paris to protect the Trojan refugees, and to continue the ideals of the city and its people. Paris gives Aeneas Priam's sword, in order to give legitimacy and continuity to the royal line of Troy – and lay the foundations of Roman | Aeneas | [
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8281 | culture. In this film, he is not a member of the royal family and does not appear to fight in the war. In the role-playing game "" by White Wolf Game Studios, Aeneas figures as one of the mythical founders of the Ventrue Clan. in the action game "", Aeneas is a playable character. The game ends with him and the Aeneans fleeing Troy's destruction and, spurned by the words of a prophetess thought crazed, goes to a new country (Italy) where he will start an empire greater than Greece and Troy combined that shall rule the world for 1000 | Aeneas | [
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8282 | years, never to be outdone in the tale of men (The Roman Empire). In the 2018 TV miniseries "", Aeneas is portrayed by Alfred Enoch. Scenes depicting Aeneas, especially from the Aeneid, have been the focus of study for centuries. They have been the frequent subject of art and literature since their debut in the 1st century. The artist Giovanni Battista Tiepolo was commissioned by Gaetano Valmarana in 1757 to fresco several rooms in the Villa Valmarana, the family villa situated outside Vicenza. Tiepolo decorated the "palazzina" with scenes from epics such as Homer's "Iliad" and Virgil's "Aeneid". Aeneas In | Aeneas | [
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8283 | Amphibian Amphibians are ectothermic, tetrapod vertebrates of the class Amphibia. Modern amphibians are all Lissamphibia. They inhabit a wide variety of habitats, with most species living within terrestrial, fossorial, arboreal or freshwater aquatic ecosystems. Thus amphibians typically start out as larvae living in water, but some species have developed behavioural adaptations to bypass this. The young generally undergo metamorphosis from larva with gills to an adult air-breathing form with lungs. Amphibians use their skin as a secondary respiratory surface and some small terrestrial salamanders and frogs lack lungs and rely entirely on their skin. They are superficially similar to lizards | Amphibian | [
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8284 | but, along with mammals and birds, reptiles are amniotes and do not require water bodies in which to breed. With their complex reproductive needs and permeable skins, amphibians are often ecological indicators; in recent decades there has been a dramatic decline in amphibian populations for many species around the globe. The earliest amphibians evolved in the Devonian period from sarcopterygian fish with lungs and bony-limbed fins, features that were helpful in adapting to dry land. They diversified and became dominant during the Carboniferous and Permian periods, but were later displaced by reptiles and other vertebrates. Over time, amphibians shrank in | Amphibian | [
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8285 | size and decreased in diversity, leaving only the modern subclass Lissamphibia. The three modern orders of amphibians are Anura (the frogs and toads), Urodela (the salamanders), and Apoda (the caecilians). The number of known amphibian species is approximately 7,000, of which nearly 90% are frogs. The smallest amphibian (and vertebrate) in the world is a frog from New Guinea ("Paedophryne amauensis") with a length of just . The largest living amphibian is the Chinese giant salamander ("Andrias davidianus"), but this is dwarfed by the extinct "Prionosuchus" from the middle Permian of Brazil. The study of amphibians is called batrachology, while | Amphibian | [
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8286 | the study of both reptiles and amphibians is called herpetology. The word "amphibian" is derived from the Ancient Greek term ἀμφίβιος ("amphíbios"), which means "both kinds of life", "ἀμφί" meaning "of both kinds" and "βιος" meaning "life". The term was initially used as a general adjective for animals that could live on land or in water, including seals and otters. Traditionally, the class Amphibia includes all tetrapod vertebrates that are not amniotes. Amphibia in its widest sense ("sensu lato") was divided into three subclasses, two of which are extinct: The actual number of species in each group depends on the | Amphibian | [
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8287 | taxonomic classification followed. The two most common systems are the classification adopted by the website AmphibiaWeb, University of California, Berkeley and the classification by herpetologist Darrel Frost and the American Museum of Natural History, available as the online reference database "Amphibian Species of the World". The numbers of species cited above follows Frost and the total number of known amphibian species is over 7,000, of which nearly 90% are frogs. With the phylogenetic classification, the taxon Labyrinthodontia has been discarded as it is a polyparaphyletic group without unique defining features apart from shared primitive characteristics. Classification varies according to the | Amphibian | [
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8288 | preferred phylogeny of the author and whether they use a stem-based or a node-based classification. Traditionally, amphibians as a class are defined as all tetrapods with a larval stage, while the group that includes the common ancestors of all living amphibians (frogs, salamanders and caecilians) and all their descendants is called Lissamphibia. The phylogeny of Paleozoic amphibians is uncertain, and Lissamphibia may possibly fall within extinct groups, like the Temnospondyli (traditionally placed in the subclass Labyrinthodontia) or the Lepospondyli, and in some analyses even in the amniotes. This means that advocates of phylogenetic nomenclature have removed a large number of | Amphibian | [
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8289 | basal Devonian and Carboniferous amphibian-type tetrapod groups that were formerly placed in Amphibia in Linnaean taxonomy, and included them elsewhere under cladistic taxonomy. If the common ancestor of amphibians and amniotes is included in Amphibia, it becomes a paraphyletic group. All modern amphibians are included in the subclass Lissamphibia, which is usually considered a clade, a group of species that have evolved from a common ancestor. The three modern orders are Anura (the frogs and toads), Caudata (or Urodela, the salamanders), and Gymnophiona (or Apoda, the caecilians). It has been suggested that salamanders arose separately from a Temnospondyl-like ancestor, and | Amphibian | [
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8290 | even that caecilians are the sister group of the advanced reptiliomorph amphibians, and thus of amniotes. Although the fossils of several older proto-frogs with primitive characteristics are known, the oldest "true frog" is "Prosalirus bitis", from the Early Jurassic Kayenta Formation of Arizona. It is anatomically very similar to modern frogs. The oldest known caecilian is another Early Jurassic species, "Eocaecilia micropodia", also from Arizona. The earliest salamander is "Beiyanerpeton jianpingensis" from the Late Jurassic of northeastern China. Authorities disagree as to whether Salientia is a superorder that includes the order Anura, or whether Anura is a sub-order of the | Amphibian | [
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8291 | order Salientia. The Lissamphibia are traditionally divided into three orders, but an extinct salamander-like family, the Albanerpetontidae, is now considered part of Lissamphibia alongside the superorder Salientia. Furthermore, Salientia includes all three recent orders plus the Triassic proto-frog, "Triadobatrachus". The first major groups of amphibians developed in the Devonian period, around 370 million years ago, from lobe-finned fish which were similar to the modern coelacanth and lungfish. These ancient lobe-finned fish had evolved multi-jointed leg-like fins with digits that enabled them to crawl along the sea bottom. Some fish had developed primitive lungs to help them breathe air when the | Amphibian | [
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8292 | stagnant pools of the Devonian swamps were low in oxygen. They could also use their strong fins to hoist themselves out of the water and onto dry land if circumstances so required. Eventually, their bony fins would evolve into limbs and they would become the ancestors to all tetrapods, including modern amphibians, reptiles, birds, and mammals. Despite being able to crawl on land, many of these prehistoric tetrapodomorph fish still spent most of their time in the water. They had started to develop lungs, but still breathed predominantly with gills. Many examples of species showing transitional features have been discovered. | Amphibian | [
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8293 | "Ichthyostega" was one of the first primitive amphibians, with nostrils and more efficient lungs. It had four sturdy limbs, a neck, a tail with fins and a skull very similar to that of the lobe-finned fish, "Eusthenopteron". Amphibians evolved adaptations that allowed them to stay out of the water for longer periods. Their lungs improved and their skeletons became heavier and stronger, better able to support the weight of their bodies on land. They developed "hands" and "feet" with five or more digits; the skin became more capable of retaining body fluids and resisting desiccation. The fish's hyomandibula bone in | Amphibian | [
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8294 | the hyoid region behind the gills diminished in size and became the stapes of the amphibian ear, an adaptation necessary for hearing on dry land. An affinity between the amphibians and the teleost fish is the multi-folded structure of the teeth and the paired supra-occipital bones at the back of the head, neither of these features being found elsewhere in the animal kingdom. At the end of the Devonian period (360 million years ago), the seas, rivers and lakes were teeming with life while the land was the realm of early plants and devoid of vertebrates, though some, such as | Amphibian | [
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8295 | "Ichthyostega", may have sometimes hauled themselves out of the water. It is thought they may have propelled themselves with their forelimbs, dragging their hindquarters in a similar manner to that used by the elephant seal. In the early Carboniferous (360 to 345 million years ago), the climate became wet and warm. Extensive swamps developed with mosses, ferns, horsetails and calamites. Air-breathing arthropods evolved and invaded the land where they provided food for the carnivorous amphibians that began to adapt to the terrestrial environment. There were no other tetrapods on the land and the amphibians were at the top of the | Amphibian | [
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8296 | food chain, occupying the ecological position currently held by the crocodile. Though equipped with limbs and the ability to breathe air, most still had a long tapering body and strong tail. They were the top land predators, sometimes reaching several metres in length, preying on the large insects of the period and the many types of fish in the water. They still needed to return to water to lay their shell-less eggs, and even most modern amphibians have a fully aquatic larval stage with gills like their fish ancestors. It was the development of the amniotic egg, which prevents the | Amphibian | [
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8297 | developing embryo from drying out, that enabled the reptiles to reproduce on land and which led to their dominance in the period that followed. After the Carboniferous rainforest collapse amphibian dominance gave way to reptiles, and amphibians were further devastated by the Permian–Triassic extinction event. During the Triassic Period (250 to 200 million years ago), the reptiles continued to out-compete the amphibians, leading to a reduction in both the amphibians' size and their importance in the biosphere. According to the fossil record, Lissamphibia, which includes all modern amphibians and is the only surviving lineage, may have branched off from the | Amphibian | [
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8298 | extinct groups Temnospondyli and Lepospondyli at some period between the Late Carboniferous and the Early Triassic. The relative scarcity of fossil evidence precludes precise dating, but the most recent molecular study, based on multilocus sequence typing, suggests a Late Carboniferous/Early Permian origin for extant amphibians. The origins and evolutionary relationships between the three main groups of amphibians is a matter of debate. A 2005 molecular phylogeny, based on rDNA analysis, suggests that salamanders and caecilians are more closely related to each other than they are to frogs. It also appears that the divergence of the three groups took place in | Amphibian | [
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8299 | the Paleozoic or early Mesozoic (around 250 million years ago), before the breakup of the supercontinent Pangaea and soon after their divergence from the lobe-finned fish. The briefness of this period, and the swiftness with which radiation took place, would help account for the relative scarcity of primitive amphibian fossils. There are large gaps in the fossil record, but the discovery of a Gerobatrachus hottoni from the Early Permian in Texas in 2008 provided a missing link with many of the characteristics of modern frogs. Molecular analysis suggests that the frog–salamander divergence took place considerably earlier than the palaeontological evidence | Amphibian | [
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8300 | indicates. Newer research indicates that the common ancestor of all Lissamphibians lived about 315 million years ago, and that stereospondyls are the closest relatives to the caecilians. As they evolved from lunged fish, amphibians had to make certain adaptations for living on land, including the need to develop new means of locomotion. In the water, the sideways thrusts of their tails had propelled them forward, but on land, quite different mechanisms were required. Their vertebral columns, limbs, limb girdles and musculature needed to be strong enough to raise them off the ground for locomotion and feeding. Terrestrial adults discarded their | Amphibian | [
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