Challenging the Skeptics - The Truth about Acupuncture Part 2

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Challenging the Skeptics - The Truth about Acupuncture Part 2

 

 

Biomedical Mechanisms of Acupuncture

 

* 1997 NIH statement: " Many studies in animals and humans have demonstrated that

acupuncture can cause multiple biological responses. These responses can occur

locally, i.e., at or close to the site of application, or at a distance,

mediated mainly by sensory neurons to many structures within the central nervous

system. This can lead to activation of pathways affecting various physiological

systems in the brain as well as in the periphery. A focus of attention has been

the role of endogenous opioids in acupuncture analgesia. Considerable evidence

supports the claim that opioid peptides are released during acupuncture and that

the analgesic effects of acupuncture are at least partially explained by their

actions. That opioid antagonists such as naloxone reverse the analgesic effects

of acupuncture further strengthens this hypothesis. Stimulation by acupuncture

may also

 

activate the hypothalamus and the pituitary gland, resulting in a broad

spectrum of systemic effects

Alteration in the secretion of neurotransmitters and neurohormones and

changes in the regulation of blood flow, both centrally and peripherally, have

been documented.

There is also evidence of alterations in immune functions produced by

acupuncture. Which of these and other physiological changes mediate clinical

effects is at present unclear. "

 

* From the same source: " Findings from basic research have begun to elucidate

the mechanisms of action of acupuncture, including the release of opioids and

other peptides in the central nervous system and the periphery and changes in

neuroendocrine function. Although much needs to be accomplished, the emergence

of plausible mechanisms for the therapeutic effects of acupuncture is

encouraging. "

 

* One of the studies cited by the NIH was conducted by Abass Alavi, M.D., chief

of nuclear medicine at the University of Pennsylvania Medical Center, who showed

that acupuncture affects the flow of blood in the brain. He used SPECT (single

photon emission computed tomography) to view the brains of four people with pain

and five pain-free people who served as the control group. Dr. Alavi found that

after acupuncture needles were inserted, all of the patients had increased blood

flow to the thalamus, the area of the brain that relays pain and other sensory

messages. Because the brains of the pain-free group showed the same reactions as

those with pain, the changes in blood flow couldn't be attributed to placebo.

 

* " The phenomenon of acupuncture is both complex and dynamic. Recent information

demonstrates that acupuncture may exert its actions on pain and immune

processes. The coupling of these two systems occurs via common signaling

molecules, i.e., opioid peptides. In this regard, we surmise that

 

opioid activation leads to the processing of opioid peptides from their

precursor, proenkephalin, and

the simultaneous release of antibacterial peptides contained within the

precursor as well. Thus,

central nervous system pain circuits may be coupled to immune enhancement.

Furthermore, acupuncture needle manipulation elicited signal increases

bilaterally in the region of the primary and secondary somatosensory corticies

in human brain as determined by magnetic resonance imaging.

The maps reveal marked signal decreases bilaterally in multiple limbic and

deep gray structures including the nucleus accumbens, amygdala, hypothalamus,

hippocampus, and ventral tegmental area.

Taken together, we surmise a major central nervous system pathway as well as

local pain and immune modulation during acupuncture. " - 1999 Review

 

* " In recent years, more and more laboratory proof has accumulated that

acupuncture can

 

change the charge and potential of neurons,

the concentrations of K(+), Na(+), Ca(++) and

the content of neuro-transmitters such as aspartate, and taurine and

the quantities of neuro-peptides such as beta-endorphin and leu-enkephalin.

All these phenomena are directly related to nerve cells. " - source

 

SKEPTIC: It should be remembered that the placebo effect accounts for 30% or

more for a person feeling better.

 

RESPONSE: Only 1/3 of people respond to placebo treatment, but " Both animal and

human laboratory and clinical experience suggest that the majority (more than

half) of subjects respond to acupuncture, with a minority not responding " -

source

 

* One primary reason for doing RCT's is to eliminate the influence of the

placebo effect. Again, I refer you to the published RCT's on acupuncture

mentioned above.

 

* I challenge you to explain how the placebo effect is working in a dog or cat

who is healed by acupuncture- we can't tell them what to expect, etc. Here is an

RCT that shows significant success with hind-limb paralysis in dogs

 

SKEPTIC: (1) Proponents of alternative medicine are often hostile to the medical

establishment and/or (2) what is called " western thinking, " that is, rational

thinking. There is often a bias against science or (3) belief in a conspiracy

amongst physicians. (4) This prejudice prevents them from objectively viewing

the evidence against alternative healing.

 

RESPONSE: Some of this language (the words chosen: hostile, rational,

conspiracy, prejudice) is quite inflammatory. I will address these point by

point.

 

1. Hostility is ill-will; do acupuncturists have ill-will toward the medical

establishment? And what is the medical establishment? According to some MD's, it

would not include chiropractic. It depends upon who you talk to. And if you talk

to other MD's, you will find that they are themselves hostile to the current

economic climate in medicine. Also, there are alternative medicine programs at

highly-regarded medical universities, such as Harvard (the top medical school in

the U.S.). Back in July 11, 2000, Harvard Medical School established the

Division for Research and Education in Complementary and Integrative Medical

Therapies. One of the best known names in acupuncture, Ted Kaptchuk, is

Associate Director of the Center for Alternative Medicine Research at Harvard

Medical School, and an Assistant Professor of Medicine at Harvard Medical

School. For a study by Harvard Medical Researchers that shows that CAM is here

to stay. My point is that there is no homogenous medical establishment against

which to hold ill-will, and given the acceptance of CAM by leaders within the

various sectors of health care (education, insurance, journalism, clinical),

there is no need for such ill-will. The current healthcare model is called

cooperative care, in which practitioners of various types of medicine cooperate

around a primary care provider in the care of individual patients.

 

2. This is an interesting claim, that alternative medicine practitioners are

irrational, and can't or don't want to think logically. I almost would rather

not answer it until the critic gives me some indication of their source for this

idea. But I will anyway:

 

* There are people in every profession who have varying degrees of logical and

critical-thinking ability. M.D. programs, with their rigorous scientific and

mathematic requirements and education, do tend to produce more logical,

critically-thinking practitioners. The national requirements for graduation and

licensure in OM are: " graduation from a formal full-time acupuncture program

that can document at least 1,725 hours of entry-level acupuncture education.

Education must consist of a minimum of 1000 didactic and 500 clinical hours. "

The educational standards have been raised quite a bit in the last 5 years. In

fact, newly graduated acupuncturists and those who have been in practice for

5-10 years are almost different breeds. In the same way that MD programs are

including CAM programs, schools like the Pacific College of Oriental Medicine

(San Diego, CA) are integrating biomedicine into their curriculae. One aspect of

PCOM's curriculum is the 10-class Oriental Medicine series, which is divided by

specialty (e.g. gynecology, psychology, neurology) and in which 25% of the

material is biomedical. Acupuncturists are taught what conditions to treat and

what not to treat, when to refer out, and when to send a patient to the ER. The

profession currently developing a Ph.D. track which will include specialization

and research. This will increase the education from 4 graduate years to 6

graduate and post-graduate years.

 

* My personal experience of acupuncturists is that although some of them are

pretty right-brained, there are a lot of very smart, analytical, critical

thinkers in oriental medicine- some of these are are doing or planning to do

research.

 

* There are is also a sub-population of acupuncture academicians (for example,

Nigel Wiseman, Bob Flaws, Min Fan, Bob Damone) who focus on translating and

studying both classical chinese medical texts and current research from chinese

medical journals. Translation requires a high level of academic proficiency,

intelligence, and rational and critical thinking. Inherent to all understanding

and practice of chinese medicine are the skills of inquiry, observation,

analysis, comparison, and synthesis (the latter 3 of which require

rational/critical thinking).

 

* What is the essence of science? The scientific method is: look at the

situation, come up with a theory, test it, then assess whether you got it right

or you need a new theory. The history of chinese medicine is the application of

the scientific method to real life situations- as I have said, there was no RCT

for thousands of years - either it worked clinically (and the socio-economic

climate for doctors was such that their welfare and very lives depended upon

success), or it didn't. Only in the last 50-100 years, has western medicine has

become so technology based, and CM has been present in the western world for a

century or less. The standards of biotechnology now require the justification,

integration and reinterpretion oriental medicine from a biomedical point of

view. And it's a good thing, because no medicine is perfect- they learn from one

another- many pharmaceuticals, such as aspirin, come from herbs utilized

historically in traditional medicines- and the RCT, as long as the funds are

available, will help oriental medicine clarify some of its areas of internal

disagreement.

 

3. One must be very careful in their response to an accusation of belief in

conspiracies. This kind of accusation is a powerful way to discredit your

opponent by making them appear paranoid and irrational. In responding to this,

anything I would say about physicians disagreeing with any aspect of CAM would

confirm the suspicion of paranoia. After reviewing some of the information on

the web about conspiracies and medicine, I would rather not get into the topic.

It is not my desire, nor in the acupuncture profession's or the patients'

interests for us to get into wildly speculative discussions. Let's stick with

RCT's, retrospective studies and reviews, and study of chinese classical and

modern sources.

 

4. As far as the evidence against alternative medicine, I'm not sure what you

mean. It is true that some studies are showing minimal or only short-term

efficacy (as in neck pain), but I still need to review the quality of the study

designs (although in the neck pain study, the design was good). For the most

part the criticisms leveled are based upon our lack of proof not that it works,

because more and more of that has been proven, but in terms of how it works in

biomedical terms. As I mentioned, there has been no need for that kind of

justification or argument for thousands of years, and only in the last 5 years

have we been given the kind of funding necessary to gather that data. There are

trials that show acupuncture now to be effective for one condition or another;

this is a complex issue, because all RCT's need to be reviewed and designed to

be true to chinese medical diagnosis and treatment. One trial I reviewed of

acupuncture for Rheumatoid Arthritis concluded that " Acupuncture of this type

cannot be considered as a useful adjunct to therapy in patients with RA, " but

" acupuncture of this type " is " Single-point (Liver 3) acupuncture. " There is,

among some acupuncturists, a belief that the superior acupuncturist could choose

the one most appropriate point for a patient, but this point would be selected

on an individual basis and never in such a general way as in this study (only

one specific point for a western disease). In addition, Liver 3 is a poor choice

for one point to use for RA. In discussion of related problems in the classical

literature (see list of acupuncture reference texts at end of document), many of

the 360+ acupuncture points are mentioned, but never Liver 3. To be faithful to

CM, patients would have to be divided in to diagnostic sub-groups (divided by

criteria such as the location of the RA), and then treated. So this study is

correct in saying that that type of acupuncture is not useful, but it does not

prove whether or not proper classical acupuncture would be effect for RA. As

mentioned above, the 1998 Bensoussan study may have been the first RCT to be

true to .

 

History of

 

Chinese medicine was almost destroyed by the communists in the 1950's (who

wanted to modernize medicine in their country), but Mao Tse-tung developed

bell's palsy (a sometimes self-limiting, sometimes permanent neurological facial

paralysis with which acupuncture has a high cure rate); being cured by

acupuncture convinced him to keep CM- he ordered that it be systematized and

simplified into what is known as TCM (Traditional ). As we know,

the communists are atheists; in creating the TCM version of CM, they stripped

away any remaining metaphysical aspects. Isn't it ironic that the atheistic

communist chinese did Christians a service by eliminating any potentially

contradictory metaphysical beliefs from this traditional medicine?

 

* It only came to the U.S., really, in the 1970's, about the time when western

medicine was discovering the immune system- CM has dealt with its own conception

of the immune system for thousands of years. In fact, the western science of

psychoneuroimmunology is the closest one to explaining and being informed by the

theories and mechanisms of acupuncture.

 

SKEPTIC: More doctors are now allowing or advocating these treatments because of

patient demand so they can stay in business. But remember, doctors can be

deceived, too.

 

RESPONSE: There is patient demand because for many illnesses, there are not

great western medical treatments; either

 

the pharmaceuticals have too many or too severe side effects, or

the risks of tx with pharm or surgery are too high and 'nothing can be done,'

or

there are only palliative (symptom-relieving) or

no known effective western treatments (e.g. IBS)

 

* In some of these conditions, chinese medicine is effective even if just in

relieving symptoms without causing side-effects (generally the only serious risk

of acupuncture is a pneumothorax, which are quite rare and basically impossible

if the acu has been trained and licensed in accordance with state and national

laws, and proper herbal treatments are personalized to prevent side-effects- see

the safety section)

 

* Anyone can be deceived- not sure what to say about that- that is probably

true... but so what? That doesn't prove that there is a deception here. I will

again refer you back to the RCT's and reviews above.

 

SKEPTIC: Many of the new healing techniques are being called energy medicine

since there is an assumption that one is dealing with channeling, transferring

or altering energy. This energy is not measurable or biological; it is believed

to be the energy of a universal force/life force pervading all. The belief in

this type of energy is foundational for sorcery, pantheism, monism, some Eastern

religions, many New Age-related beliefs, and most of the occult. Sometimes this

energy is seen as being an impersonal God, a god-force, or an innate divine

intelligence which infuses all parts of the universe and our bodies. These are

spiritual, not medical, views.

 

RESPONSE: Skeptical views of OM and acupuncture often focus on whether or not

yin and yang and qi actually exist. Let's end that debate right here - the truth

is, they do not. That is not central to Chinese medicine. Those concepts are

parts of theories (a la scientific method) that attempt to explain why

acupuncture and chinese herbal medicine work, and how they can work better- it

is clear that the system is not complete or perfect, or else it would always

work... like many things in this world, it is a work in progress. Theories can

be discarded for new ones. The entire system of chinese medical theory may one

day be discarded once an integrated biomedical understanding of these mechanisms

is assembled.

 

The Reason for All the Confusion? It is possible that the heterogenous,

multi-traditional, overlapping, organic, complex nature of chinese medical

theory, which leads to disagreements between and different representations from

CM practitioners, confuses both the public and other medical practitioners.

 

* Some scholars of oriental medicine now believe that the translation of 'qi' as

'energy' (which came from Morant in the 1930's) is inaccurate. It is also

translated as 'breaths,' or 'vital air.' It must be remembered that this all

comes from the chinese language which is composed of characters that are

basically simplified drawings of real objects- so the character for 'qi' is the

steam coming off a pot of rice. How we interpret that, whether it is properly

interpreted or not, is still up for grabs. Reading the Bible is similar- the

original was written in Greek and Hebrew, and often, the words are translated

differently in different versions (KJV, NIV, RSV).

 

* We do know from MRI studies that the nervous system is activated by

acupuncture- but in biomedical terms, qi could be related to so many things

(oxygen, carbohydrates, proteins, synaptic transmission), that it becomes clear

that oriental medicine, like the Chinese language itself, is largely

metaphorical (symbolic, like the analogies called parables that Christ used to

teach)- it is to some degree mechanical, but nowhere near as much as biomedicine

is, and how could it be, without microscopes, autopsies, MRI's, and lab tests?

None of those tests were available for thousands of years of CM.

 

The Christian Medical Fellowship: " When CMF's Medical Study Group investigated

acupuncture in the mid-1980s, we quizzed Dr Felix Mann, then Britain's best

known practitioner and the person chiefly responsible for introducing

acupuncture into clinical practice in the UK. He denied holding a religious

faith himself, and he put no weight on the claims of Yin-Yang theories. Dr Mann

believes the ancients stumbled upon something that worked empirically, needed

(as human beings always do) an explanation for this, and therefore expressed

their understanding in the terms of their own cultural beliefs. He sees the

methodology as having limited but definite benefit (and he was refreshingly

sceptical about how close you have to get the needle to the 'acupuncture

points') and sees no need to invoke any mystical or spiritual explanations. I

found his healthy common sense convincing. Conclusion: the methodology works,

sometimes. We do not need to invoke spiritual principles. " - Andrew Fergusson is

the General Secretary of Christian Medical Fellowship

 

* " Does the therapy involve the occult? I should by now have made clear that the

therapy itself need not involve the occult, but let me now emphasise the most

important warning in this article: while the therapy might not involve the

occult, the therapist might! As with most if not all alternative practices the

question is not so much about the nature of the therapy, but about the nature of

the therapist. Who is this person I am about to place myself under? In all

therapeutic relationships, there is a power imbalance and the patient, the

client, the counsellee, is potentially submitting to a lot when they place

themselves 'under' the therapist. I am therefore in general more concerned about

the acupuncturist in question than about the acupuncture. Let me give you an

example. As General Secretary of CMF, I spoke once on the phone to a lay

Christian, an ordinary person without any training or expertise in health

matters. He told me how he had visited an acupuncturist in his village, and

after half a dozen treatments he had indeed achieved relief of the chronic

painful condition he'd first gone with. He put this down to the therapy (though

I must say I wondered if the condition had got better anyway over the two month

period in question!). But what he went on to say was concerning. He told me that

while the acupuncturist was twiddling the needles he was always muttering

something inaudible under his breath, in what sounded like an incantation. He

noticed too that progressively over that two month period his own spiritual life

had begun to dry up. He found it hard to pray, he lost interest in going to

church, he lost some of his love for the Lord. Eventually he came to realise

that perhaps he'd come under some harmful spiritual influence from the

acupuncturist. Simple repentance and prayer was immediately completely effective

in restoring his spiritual life. I have heard a few other anecdotes like that. I

don't necessarily believe every element, but I take them seriously. Conclusion:

acupuncture need not involve the occult, but the acupuncturist might! " - Andrew

Fergusson is the General Secretary of Christian Medical Fellowship

 

Is CM a medicine (are its views medical or spiritual?): Definition: med·i·cine

(md-sn) n. 1. a. The science of diagnosing, treating, or preventing disease and

other damage to the body or mind. b. The branch of this science encompassing

treatment by drugs, diet, exercise, and other nonsurgical means. 2. The practice

of medicine. 3. An agent, such as a drug, used to treat disease or injury. 4.

Something that serves as a remedy or corrective: medicine for rebuilding the

economy; measures that were harsh medicine.

 

* CM does diagnose (see Bensoussan's 1998 study of IBS), treat, and prevent

disease and damage to the body and mind. And thousands of years of anecdotal

evidence, and recent scientific research supports this. Herbs are agents used to

treat disease and injury, so they are medicines. So the system of medicine that

applies acupuncture and herbal medicine does have medical views.

 

BUT has spiritual views, too, and that is where it gets tricky

to reconcile with Christianity. This is a broad topic that I am still

researching, and it will probably take me a couple years to get through all the

classical chinese medical literature and the Bible and related commentaries, but

one thing I have found already might serve as an example of where they agree: In

Biblical language, according to my NIV study bible, the word 'heart' means the

center of one's being including mind, will, and emotions. Now, in western

medicine, the heart is just an organ that pumps the blood through the body. But

in CM, the heart is the central authority and consciousness in terms of mind,

emotion, and being. It is our connection to heaven. In CM, also, the 'sprout' of

the heart is the tongue and expresses our consciousness, much as Jesus said in

Mat 12:34, " out of the overflow of the heart, the mouth speaks, " and 15:18, " the

things that come out of the mouth come from the heart. " Unlike western medicine,

CM never separated mind, emotion, body, and spirit in its theory, diagnosis, and

treatment. There is much more that can be said about the Heart, but that is

another topic. Untangling the complex meanings of statements about the spiritual

from many classic CM sources and reconciling them with Christian Biblical truth

is a huge project- I cannot say much more at this point.

 

Good and Evil: It is interesting to note that the earliest acupuncture grew out

of a tradition of shamanistic attempts to get rid of evil spirits. Early

acupuncture utilized some points and herbs to expel demons. Whether the problem

was actually a demon, or a neurochemical imbalance, or something else is an

academic point which needs further study, but it places chinese medical

tradition spiritually on the same side of the fence with Christianity as a

viewpoint that, as opposed to New-Age thought, acknowledge both good and evil in

the universe. Many techniques such as acupuncture, acupressure, tai chi (not a

medicine but often prescribed for people recovering from illness) are based on

the belief that a universal force called chi (also spelled as qi, ki or ji)

which pervades everything and everyone must be flowing to achieve good health.

 

More About Qi: As stated above, understanding qi is a matter of interpretation

of the Chinese characters. This is a metaphorical language; please re-read that

section above. As far as whether qi pervades everything, I do not believe that

is an accurate representation of chinese medical theory. Qi can mean many

different things in different contexts; air, gas, vapor, flatus, smell,

environmental influences, character, breath, circumstance, activity, defense,

containment, strength, transformation, disease; but I believe the idea that qi

pervades everything is actually a non-traditional new-age idea grafted onto

chinese medicine. (There are actually quite specific ways in which qi enters the

body or is formed (through food or air intake), and how it moves to defend the

body from attack (the wei qi or immune system)). This is the kind of thing that

disturbs me. No matter what additional research should be done in regard to

acupuncture, and what questions can be raised, it's clear that it has many good

effects and insights, and not only should we not allow the new-agers to claim it

as their own, but also we should keep it pure, we should be clear about what

really is oriental medicine and what isn't.

 

* As far as qi goes, in CM metaphorical terms, yes, if qi does not flow, there

is stagnation, and that often causes symptoms like pain, intestinal gas, anger,

etc. There can also be qi deficiency, which manifests as fatigue, loose stool,

low appetite, etc. There is also the belief in two universal energies, yin and

yang, which must be balanced. If anything is blocking the chi or unbalancing the

yin and yang, then illness results. The chi is believed to flow through

invisible channels in the body called meridians.

 

More About Yin and Yang: Yin and yang are not energies or forces. They are

descriptors ... more like adjectives than nouns (although they are used as nouns

when speaking metaphorically about physical or mental tendencies, activities, or

potentials). I knew I was going to have to write an article about this one for

Christians. Misunderstanding yin and yang, qi and meridians as real forces is

akin to the disciples' and others' frequent literal/material misunderstanding of

Jesus' parables. They are used to categorize things into their opposites. For

example, cold is more yin than heat is. Heat is more yang than cold is. We can

say that yin is evil because it is associated with darkness, but that would be

inaccurate- the darkness referred to is what we see with our eyes, not a

spiritual or emotional 'darkness.' Neither yin nor yang are essentially

anything, except in comparison to one another. Good and bad, active or passive,

male or female... there are many things that happen normally in the body

(physiology) described by CM in terms of yin and yang. For example, qi is

relatively yang compared to substance which is more yin. So when you move one of

your muscles, you have activated (yang) the nerves in your muscles (yin) by way

of your desire (yang) to move (yang) them. Hope that helps explain that we don't

really believe there are independent forces or entities called yin or yang- we

don't think we'll see them on an MRI... but we could say that an MRI is a yang

method of seeing internal activities (yang) and substances (yin).

 

Invisible channels/meridians: Again, I must emphasize the metaphorical nature of

chinese medical theory. And refer to the work of Dr. Zang-he Cho, which proves

via MRI, a credible, objective biomedical visual imaging technique that

acupuncture points can stimulate aspects of the CNS without direct neural

connection- this implies that the nervous system is more complex than we know

and that acupuncture works via some computer-like code interpretted by the

brain. It would mean that the map of the body described by CM's system of

meridians probably is accurate in terms of the correspondences it suggests-

that, e.g., the points on the foot from the discover article are on a meridian

connected with the eye, telling us that altho there may be no neural connection

between the foot and the eye, there is a relationship that the CNS can

understand and act upon.

 

SKEPTIC: (1) In this case, treatment is based on a spiritual belief system, not

on medicine or scientific fact. (2) So far (as of 3/2000), no medical or

biological basis as been discovered for acupuncture. (3) There are theories that

the needles trigger the release of endorphins, causing a temporary relief of

pain.

 

RESPONSE: (1) At this point in the article, it should be well-established by now

that CM is medical, not spiritual

 

(2) Untrue back then, and certainly untrue in the light of subsequent research.

The biomedical mechanisms of acupuncture according to scientific research are

reviewed above.

 

(3) Endorphins: Actually, the mechanism of pain relief is much more complex, and

is discussed above under the biomedical mechanisms of acupuncture.

All information herein provided is for educational use only and not meant

to substitute for the advice of a local Oriental or Biomedical Doctor.

Copyright 1999-2001, PULSE of OM Ltd.

 

 

 

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