Reflexology, or zone therapy, is an alternative medicine involving the physical act of applying pressure to the feet, hands, or ears with specific thumb, finger, and hand techniques without the use of oil or lotion. It is based on what reflexologists claim to be a system of zones and reflex areas that they say reflect an image of the body on the feet and hands, with the premise that such work effects a physical change to the body.[1] A 2009 systematic review of randomised controlled trials concludes that "The best evidence available to date does not demonstrate convincingly that reflexology is an effective treatment for any medical condition."[2] There is no consensus among reflexologists on how reflexology is supposed to work; a unifying theme is the idea that areas on the foot correspond to areas of the body, and that by manipulating these one can improve health through one's qi.[3] Reflexologists divide the body into ten equal vertical zones, five on the right and five on the left.[4] Concerns have been raised by medical professionals that treating potentially serious illnesses with reflexology, which has no proven efficacy, could delay the seeking of appropriate medical treatment. The Reflexology Association of Canada defines reflexology as: "A natural healing art based on the principle that there are reflexes in the feet, hands and ears and their referral areas within zone related areas, which correspond to every part, gland and organ of the body. Through application of pressure on these reflexes without the use of tools, cremes or lotions, the feet being the primary area of application, reflexology relieves tension, improves circulation and helps promote the

atural function of the related areas of the body."[6] Reflexologists posit that the blockage of an energy field, invisible life force, or Qi, can prevent healing.[3] Another tenet of reflexology is the belief that practitioners can relieve stress and pain in other parts of the body through the manipulation of the feet. One claimed explanation is that the pressure received in the feet may send signals that 'balance' the nervous system or release chemicals such as endorphins that reduce stress and pain.[7] These hypotheses are rejected by the general medical community, who cite a lack of scientific evidence and the well-tested germ theory of disease.[4] Common criticisms of reflexology are the lack of evidence for its claimed effects, or of a scientific or demonstrated basis for its theories, of central regulation, accreditation and licensing, or of medical training provided to reflexologists, and the short duration of training programmes. As with other pseudosciences without any proven effect beyond placebo, if patients rely on them and delay or even reject effective medical treatment there can be significant health risks. Reflexology's claim to manipulate energy (Qi) has been highly controversial, as there is no scientific evidence for the existence of life energy (Qi), 'energy balance', 'crystalline structures,' or 'pathways' in the body.[8] In Trick or Treatment? Alternative Medicine on Trial, Simon Singh argues that if indeed the hands and feet "reflect" the internal organs, reflexology might be expected to explain how such "reflection" was derived from the process of Darwinian natural selection; but Singh observes that no argument or evidence has been adduced.