“…The 2012 review by Zhang [14] showed illustrations of anatomical structures that can be influenced by needling and documented evidence of at least 17 possible pathways involved in needling. Additionally, effects have been described related to touch and pressure to the skin [43][44][45][46], physiological effects of shallow insertion needling [47][48][49][50][51], non-inserted needling [44,52], deeper needling with varying forms of manipulation [14,42] including electrical stimulation of the needles [40,42,53,54]. Other studies demonstrate that acupuncture can also create effects due to modulation of the somato-sensory system [55], autonomic nervous system [51,[56][57][58], and microcirculatory [48,59], antiinflammatory [60,61] and immunological effects [62][63][64].…”