Guest guest Posted May 4, 2007 Report Share Posted May 4, 2007 shocking. in 13 years of practice, I never saw any sustained decrease in BP from the typical regimen of any form of acupuncture plus patent meds that could not be explained by other concurrent changes such as diet and exercise. Not just talking about myself, but also the patients seen by dozens of others supposedly skilled px in school clinics. Even high does herbs are not very effective and I was always dismayed to learn how many senior herbalists from China took BP meds as they aged as a result. sadly, I predict controlled evidence will ultimately show that acupuncture is good for some musculoskeletal problems and herbs for a wide range of minor complaints. But this medicine is not going to turn out to be the salvation of the world. If you really could cure things like hepatitis or lupus with TCM, the chinese would be making hay out of it instead of racing headlong into their embrace of modern science and cutting edge therapies like stem cells. Chinese med is a nice safe alternat ive to the drugstore for many of the minor things that ail people. no miracle cures hiding anywhere. -------------- Original message ---------------------- " " < > Hi All, > > Bad news: the SHARP trial reported no benefit from AP over sham AP in > treating hypertension (BP: systolic 140-179mm Hg; diastolic 90-109mm Hg). > > I have not been able to access the full text but the abstract is below: > > Hypertension. 2006;48:838.) � 2006 American Heart Association, Inc. > Original Articles Stop Hypertension With the Acupuncture Research > Program (SHARP) Results of a Randomized, Controlled Clinical Trial Eric A. > Macklin; Peter M. Wayne; Leslie A. Kalish; Peter Valaskatgis; James > Thompson; May C.M. Pian-Smith; Qunhao Zhang; Stephanie Stevens; > Christine Goertz; Ronald J. Prineas; Beverly Buczynski; Randall M. Zusman > From the New England Research Institutes (E.A.M., L.A.K., S.S.), > Watertown, Mass; New England School of Acupuncture (P.M.W., P.V.), > Watertown, Mass; Children�s Hospital Boston (L.A.K.), Boston, Mass; > Massachusetts General Hospital (J.T., M.C.M.P.-S., Q.Z., B.B., R.M.Z.), > Harvard Medical School, Boston, Mass; Samueli Institute (C.G.), Alexandria, > Va; and the School of Medicine (R.J.P.), Wake Forest University, Winston- > Salem, NC. Correspondence to Eric A. Macklin, New England Research > Institutes, Inc, 9 Galen St, Watertown, MA 02472. E-mail > EMacklin Case studies and small trials suggest that > acupuncture may effectively treat hypertension, but no large randomized > trials have been reported. The Stop Hypertension with the Acupuncture > Research Program pilot trial enrolled 192 participants with untreated blood > pressure (BP) in the range of 140/90 to 179/109 mm Hg. The design of the > trial combined rigorous methodology and adherence to principles of > traditional Chinese medicine. Participants were weaned off > antihypertensives before enrollment and were then randomly assigned to 3 > treatments: individualized traditional Chinese acupuncture, standardized > acupuncture at preselected points, or invasive sham acupuncture. > Participants received 12 acupuncture treatments over 6 to 8 weeks. During > the first 10 weeks after random assignment, BP was monitored every 14 > days, and antihypertensives were prescribed if BP exceeded 180/110 mm > Hg. The mean BP decrease from baseline to 10 weeks, the primary end > point, did not differ significantly between participants randomly assigned to > active (individualized and standardized) versus sham acupuncture (systolic > BP: -3.56 versus -3.84 mm Hg, respectively; 95% CI for the difference: -4.0 > to 4.6 mm Hg; P=0.90; diastolic BP: -4.32 versus -2.81 mm Hg, 95% CI for > the difference: -3.6 to 0.6 mm Hg; P=0.16). Categorizing participants by > age, race, gender, baseline BP, history of antihypertensive use, obesity, or > primary traditional Chinese medicine diagnosis did not reveal any subgroups > for which the benefits of active acupuncture differed significantly from sham > acupuncture. Active acupuncture provided no greater benefit than invasive > sham acupuncture in reducing systolic or diastolic BP. Key Words: > acupuncture o blood pressure o hypertension o randomized clinical trial o > traditional Chinese medicine > > Best regards, > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 4, 2007 Report Share Posted May 4, 2007 Ah, that's too bad, I guess I'll have to tell my patients I've helped with hypertension over the years that it didn't really work. Also, I'll have to tell all the patients I've treated over twenty-five years with menstrual disorders, insomnia, digestive problems, and other conditions that acupuncture only treats musculoskeletal disorders. On May 4, 2007, at 2:28 PM, wrote: > shocking. in 13 years of practice, I never saw any sustained > decrease in BP from the typical regimen of any form of acupuncture > plus patent meds that could not be explained by other concurrent > changes such as diet and exercise. Not just talking about myself, > but also the patients seen by dozens of others supposedly skilled > px in school clinics. Even high does herbs are not very effective > and I was always dismayed to learn how many senior herbalists from > China took BP meds as they aged as a result. sadly, I predict > controlled evidence will ultimately show that acupuncture is good > for some musculoskeletal problems and herbs for a wide range of > minor complaints. But this medicine is not going to turn out to be > the salvation of the world. If you really could cure things like > hepatitis or lupus with TCM, the chinese would be making hay out of > it instead of racing headlong into their embrace of modern science > and cutting edge therapies like stem cells. Chinese med is a nice > safe alternat > ive to the drugstore for many of the minor things that ail people. > no miracle cures hiding anywhere. > > -------------- Original message ---------------------- > " " < >> Hi All, >> >> Bad news: the SHARP trial reported no benefit from AP over sham AP in >> treating hypertension (BP: systolic 140-179mm Hg; diastolic >> 90-109mm Hg). >> >> I have not been able to access the full text but the abstract is >> below: >> >> Hypertension. 2006;48:838.) � 2006 American Heart Association, Inc. >> Original Articles Stop Hypertension With the Acupuncture Research >> Program (SHARP) Results of a Randomized, Controlled Clinical Trial >> Eric A. >> Macklin; Peter M. Wayne; Leslie A. Kalish; Peter Valaskatgis; James >> Thompson; May C.M. Pian-Smith; Qunhao Zhang; Stephanie Stevens; >> Christine Goertz; Ronald J. Prineas; Beverly Buczynski; Randall M. >> Zusman >> From the New England Research Institutes (E.A.M., L.A.K., S.S.), >> Watertown, Mass; New England School of Acupuncture (P.M.W., P.V.), >> Watertown, Mass; Children�s Hospital Boston (L.A.K.), Boston, Mass; >> Massachusetts General Hospital (J.T., M.C.M.P.-S., Q.Z., B.B., >> R.M.Z.), >> Harvard Medical School, Boston, Mass; Samueli Institute (C.G.), >> Alexandria, >> Va; and the School of Medicine (R.J.P.), Wake Forest University, >> Winston- >> Salem, NC. Correspondence to Eric A. Macklin, New England Research >> Institutes, Inc, 9 Galen St, Watertown, MA 02472. E-mail >> EMacklin Case studies and small trials suggest that >> acupuncture may effectively treat hypertension, but no large >> randomized >> trials have been reported. The Stop Hypertension with the Acupuncture >> Research Program pilot trial enrolled 192 participants with >> untreated blood >> pressure (BP) in the range of 140/90 to 179/109 mm Hg. The design >> of the >> trial combined rigorous methodology and adherence to principles of >> traditional Chinese medicine. Participants were weaned off >> antihypertensives before enrollment and were then randomly >> assigned to 3 >> treatments: individualized traditional Chinese acupuncture, >> standardized >> acupuncture at preselected points, or invasive sham acupuncture. >> Participants received 12 acupuncture treatments over 6 to 8 weeks. >> During >> the first 10 weeks after random assignment, BP was monitored every 14 >> days, and antihypertensives were prescribed if BP exceeded 180/110 mm >> Hg. The mean BP decrease from baseline to 10 weeks, the primary end >> point, did not differ significantly between participants randomly >> assigned to >> active (individualized and standardized) versus sham acupuncture >> (systolic >> BP: -3.56 versus -3.84 mm Hg, respectively; 95% CI for the >> difference: -4.0 >> to 4.6 mm Hg; P=0.90; diastolic BP: -4.32 versus -2.81 mm Hg, 95% >> CI for >> the difference: -3.6 to 0.6 mm Hg; P=0.16). Categorizing >> participants by >> age, race, gender, baseline BP, history of antihypertensive use, >> obesity, or >> primary traditional Chinese medicine diagnosis did not reveal any >> subgroups >> for which the benefits of active acupuncture differed >> significantly from sham >> acupuncture. Active acupuncture provided no greater benefit than >> invasive >> sham acupuncture in reducing systolic or diastolic BP. Key Words: >> acupuncture o blood pressure o hypertension o randomized clinical >> trial o >> traditional Chinese medicine >> >> Best regards, >> >> >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 4, 2007 Report Share Posted May 4, 2007 I agree with Z’ev here 100%. There is no doubt CM has the ability to work (for HBP and many other conditions). Just because a modern cookbook style TCM approach may be found ineffective in some research, does not mean that CM cannot treat that disease. Do you know how many approaches one could find for any given complaint / condition. This is just with herbs. But in regard to acupuncture, just putting a needle in IMO is far from “real†acupuncture, therefore any standardized point (or herbal) prescription is a crap shoot either way (if it will work or not). We love to jump up and down when it does work and laugh (or cry) when it doesn’t. But clearly no one practices this way, or at least the practitioners that I respect and the ones that I see get bomber results. So why perform research in a way that the medicine is not practiced? IMO there is only one way to research CM, the way it is practiced (with placebos and all) – Put it as a whole, straight up against what ever your testing. IMO, “True†CM in practice literally relies on its ability to see the individual and customize treatments. This is not some cliché holistic mumbo jumbo, but clearly demonstrated in the CM literature by anyone who has spent time reading pre-modern or modern case studies. Clearly it is my experience, and doctors that I have followed, that it can effectively treat the very difficult diseases. Not just musculoskeletal. To judge CM with some base sample prescription (with some mods) is just not how the great doctors (that I have observed or read about) practice. It is comparing apples and oranges. Over simplification? Just because the current trend in China is to modernize and simplify the medicine with standardize protocols etc does not mean that practicing in an (opposite) individualized fashion doesn’t work, X does not negate Y. Quite frankly it is very hard to practice at the level that really makes use of all information (past and present) and writes individualized formulas, essentially practicing CM the way it is designed to. So why is China doing what they are doing? This is a complicated question and answer. But China is currently teaching to the masses, never before done like this. One school I recently visited (ZheJiang) had over 10,000 students enrolled. (BTW- only around 33% of them end up practicing, most looked like they for 18-20 years old, oh, they were). This western modernization has little to do with effectiveness, there are many factors, including economics (as always). Why are McDonalds popping up all over China? Training in China has many problems like we do. To put thing in perspective, one has to look where much of the research, that for example Bob has extensively published, comes from. For example, for a PHD thesis many students decide to do some easy research project, taking some base prescription with mods etc and putting it to the test for a given disease. Just like what we commonly read in the journals. When I was talking with the students they said, yes it is easy, you can be done in a few months. This is great for the many who just want there PHD and be out. The alternative is doing some classical literature research (or whatever) which can take years. Granted this (former) type of research can result in the newest and greatest patent for disease X, which does happen, but come on, this is not the in the trenches medicine. Granted there are all levels of doctors, there are those that just give xiao yao san over and over, but again let the results speak for themselves. Judging the medicine on its lowest common denominator makes little sense to me. Not to toally bash the Chinese, because they have 1 distinct advantage. The student who does want to break out of the box has almost unlimited resources compared to us. There are old doctors to study with, TCM libraries that I estimate are over 1000x bigger than the average school US TCM library to access material. There are young doctors that are totally rebelling against this modern trend and are very vocal about it! Addressing Todd’s 15 year observations: Do you think it is fair to gauge how well the medicine performs by years of watching students in a western school clinic? I have much respect for Todd and his herbal abilities, but in the three school clinics I have been in, I can only laugh at the level of medicine. I am not saying I am any better and I was at one time one of those fumbling students. But putting a 75 year old Chinese doctor to the test makes much more sense then concluding that CM doesn’t work from meager observations, especially with the relatively poor level of practice that goes on in the states (at least herbal medicine). Even supervisors prescriptions in the school clinic are not a fair judge, they rarely spend much time with patients and rely many times of the students observations and perspectives. There are many levels and CM has a black hole of knowledge if one desires to access it. It is not easy, but testing simflied approaches (the way that is happening) is just Western medicine testing CM’s tools, not CM’s thinking! Finally, because of all of this, I think standardization is a double edged sword, and the many Chinese I have spoke with agree. It is a complex arena and many differing opinions. There are many ideas and articles on the subject. - _____ On Behalf Of Friday, May 04, 2007 5:31 PM Re: Acupuncture no better than sham in hypertension - SHARP Trial Ah, that's too bad, I guess I'll have to tell my patients I've helped with hypertension over the years that it didn't really work. Also, I'll have to tell all the patients I've treated over twenty-five years with menstrual disorders, insomnia, digestive problems, and other conditions that acupuncture only treats musculoskeletal disorders. On May 4, 2007, at 2:28 PM, (AT) comcast (DOT) <%40comcast.net> net wrote: > shocking. in 13 years of practice, I never saw any sustained > decrease in BP from the typical regimen of any form of acupuncture > plus patent meds that could not be explained by other concurrent > changes such as diet and exercise. Not just talking about myself, > but also the patients seen by dozens of others supposedly skilled > px in school clinics. Even high does herbs are not very effective > and I was always dismayed to learn how many senior herbalists from > China took BP meds as they aged as a result. sadly, I predict > controlled evidence will ultimately show that acupuncture is good > for some musculoskeletal problems and herbs for a wide range of > minor complaints. But this medicine is not going to turn out to be > the salvation of the world. If you really could cure things like > hepatitis or lupus with TCM, the chinese would be making hay out of > it instead of racing headlong into their embrace of modern science > and cutting edge therapies like stem cells. Chinese med is a nice > safe alternat > ive to the drugstore for many of the minor things that ail people. > no miracle cures hiding anywhere. > > -------------- Original message ---------------------- > " " < (AT) tinet (DOT) <%40tinet.ie> ie> >> Hi All, >> >> Bad news: the SHARP trial reported no benefit from AP over sham AP in >> treating hypertension (BP: systolic 140-179mm Hg; diastolic >> 90-109mm Hg). >> >> I have not been able to access the full text but the abstract is >> below: >> >> Hypertension. 2006;48:838.) � 2006 American Heart Association, Inc. >> Original Articles Stop Hypertension With the Acupuncture Research >> Program (SHARP) Results of a Randomized, Controlled Clinical Trial >> Eric A. >> Macklin; Peter M. Wayne; Leslie A. Kalish; Peter Valaskatgis; James >> Thompson; May C.M. Pian-Smith; Qunhao Zhang; Stephanie Stevens; >> Christine Goertz; Ronald J. Prineas; Beverly Buczynski; Randall M. >> Zusman >> From the New England Research Institutes (E.A.M., L.A.K., S.S.), >> Watertown, Mass; New England School of Acupuncture (P.M.W., P.V.), >> Watertown, Mass; Children�s Hospital Boston (L.A.K.), Boston, Mass; >> Massachusetts General Hospital (J.T., M.C.M.P.-S., Q.Z., B.B., >> R.M.Z.), >> Harvard Medical School, Boston, Mass; Samueli Institute (C.G.), >> Alexandria, >> Va; and the School of Medicine (R.J.P.), Wake Forest University, >> Winston- >> Salem, NC. Correspondence to Eric A. Macklin, New England Research >> Institutes, Inc, 9 Galen St, Watertown, MA 02472. E-mail >> EMacklin@NERIScienc <EMacklin%40NERIScience.com> e.com Case studies and small trials suggest that >> acupuncture may effectively treat hypertension, but no large >> randomized >> trials have been reported. The Stop Hypertension with the Acupuncture >> Research Program pilot trial enrolled 192 participants with >> untreated blood >> pressure (BP) in the range of 140/90 to 179/109 mm Hg. The design >> of the >> trial combined rigorous methodology and adherence to principles of >> traditional Chinese medicine. Participants were weaned off >> antihypertensives before enrollment and were then randomly >> assigned to 3 >> treatments: individualized traditional Chinese acupuncture, >> standardized >> acupuncture at preselected points, or invasive sham acupuncture. >> Participants received 12 acupuncture treatments over 6 to 8 weeks. >> During >> the first 10 weeks after random assignment, BP was monitored every 14 >> days, and antihypertensives were prescribed if BP exceeded 180/110 mm >> Hg. The mean BP decrease from baseline to 10 weeks, the primary end >> point, did not differ significantly between participants randomly >> assigned to >> active (individualized and standardized) versus sham acupuncture >> (systolic >> BP: -3.56 versus -3.84 mm Hg, respectively; 95% CI for the >> difference: -4.0 >> to 4.6 mm Hg; P=0.90; diastolic BP: -4.32 versus -2.81 mm Hg, 95% >> CI for >> the difference: -3.6 to 0.6 mm Hg; P=0.16). Categorizing >> participants by >> age, race, gender, baseline BP, history of antihypertensive use, >> obesity, or >> primary traditional Chinese medicine diagnosis did not reveal any >> subgroups >> for which the benefits of active acupuncture differed >> significantly from sham >> acupuncture. Active acupuncture provided no greater benefit than >> invasive >> sham acupuncture in reducing systolic or diastolic BP. Key Words: >> acupuncture o blood pressure o hypertension o randomized clinical >> trial o >> traditional Chinese medicine >> >> Best regards, >> >> >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 4, 2007 Report Share Posted May 4, 2007 Hi All, Bad news: the SHARP trial reported no benefit from AP over sham AP in treating hypertension (BP: systolic 140-179mm Hg; diastolic 90-109mm Hg). I have not been able to access the full text but the abstract is below: Hypertension. 2006;48:838.) © 2006 American Heart Association, Inc. Original Articles Stop Hypertension With the Acupuncture Research Program (SHARP) Results of a Randomized, Controlled Clinical Trial Eric A. Macklin; Peter M. Wayne; Leslie A. Kalish; Peter Valaskatgis; James Thompson; May C.M. Pian-Smith; Qunhao Zhang; Stephanie Stevens; Christine Goertz; Ronald J. Prineas; Beverly Buczynski; Randall M. Zusman From the New England Research Institutes (E.A.M., L.A.K., S.S.), Watertown, Mass; New England School of Acupuncture (P.M.W., P.V.), Watertown, Mass; Children´s Hospital Boston (L.A.K.), Boston, Mass; Massachusetts General Hospital (J.T., M.C.M.P.-S., Q.Z., B.B., R.M.Z.), Harvard Medical School, Boston, Mass; Samueli Institute (C.G.), Alexandria, Va; and the School of Medicine (R.J.P.), Wake Forest University, Winston- Salem, NC. Correspondence to Eric A. Macklin, New England Research Institutes, Inc, 9 Galen St, Watertown, MA 02472. E-mail EMacklin Case studies and small trials suggest that acupuncture may effectively treat hypertension, but no large randomized trials have been reported. The Stop Hypertension with the Acupuncture Research Program pilot trial enrolled 192 participants with untreated blood pressure (BP) in the range of 140/90 to 179/109 mm Hg. The design of the trial combined rigorous methodology and adherence to principles of traditional Chinese medicine. Participants were weaned off antihypertensives before enrollment and were then randomly assigned to 3 treatments: individualized traditional Chinese acupuncture, standardized acupuncture at preselected points, or invasive sham acupuncture. Participants received 12 acupuncture treatments over 6 to 8 weeks. During the first 10 weeks after random assignment, BP was monitored every 14 days, and antihypertensives were prescribed if BP exceeded 180/110 mm Hg. The mean BP decrease from baseline to 10 weeks, the primary end point, did not differ significantly between participants randomly assigned to active (individualized and standardized) versus sham acupuncture (systolic BP: -3.56 versus -3.84 mm Hg, respectively; 95% CI for the difference: -4.0 to 4.6 mm Hg; P=0.90; diastolic BP: -4.32 versus -2.81 mm Hg, 95% CI for the difference: -3.6 to 0.6 mm Hg; P=0.16). Categorizing participants by age, race, gender, baseline BP, history of antihypertensive use, obesity, or primary traditional Chinese medicine diagnosis did not reveal any subgroups for which the benefits of active acupuncture differed significantly from sham acupuncture. Active acupuncture provided no greater benefit than invasive sham acupuncture in reducing systolic or diastolic BP. Key Words: acupuncture o blood pressure o hypertension o randomized clinical trial o traditional Chinese medicine Best regards, Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 4, 2007 Report Share Posted May 4, 2007 Jason Out of curiosity how many pt with essential hypertension have you treated successfully? - Friday, May 04, 2007 8:58 PM RE: Acupuncture no better than sham in hypertension - SHARP Trial I agree with Z’ev here 100%. There is no doubt CM has the ability to work (for HBP and many other conditions). Just because a modern cookbook style TCM approach may be found ineffective in some research, does not mean that CM cannot treat that disease. Do you know how many approaches one could find for any given complaint / condition. This is just with herbs. But in regard to acupuncture, just putting a needle in IMO is far from “real†acupuncture, therefore any standardized point (or herbal) prescription is a crap shoot either way (if it will work or not). We love to jump up and down when it does work and laugh (or cry) when it doesn’t. But clearly no one practices this way, or at least the practitioners that I respect and the ones that I see get bomber results. So why perform research in a way that the medicine is not practiced? IMO there is only one way to research CM, the way it is practiced (with placebos and all) – Put it as a whole, straight up against what ever your testing. IMO, “True†CM in practice literally relies on its ability to see the individual and customize treatments. This is not some cliché holistic mumbo jumbo, but clearly demonstrated in the CM literature by anyone who has spent time reading pre-modern or modern case studies. Clearly it is my experience, and doctors that I have followed, that it can effectively treat the very difficult diseases. Not just musculoskeletal. To judge CM with some base sample prescription (with some mods) is just not how the great doctors (that I have observed or read about) practice. It is comparing apples and oranges. Over simplification? Just because the current trend in China is to modernize and simplify the medicine with standardize protocols etc does not mean that practicing in an (opposite) individualized fashion doesn’t work, X does not negate Y. Quite frankly it is very hard to practice at the level that really makes use of all information (past and present) and writes individualized formulas, essentially practicing CM the way it is designed to. So why is China doing what they are doing? This is a complicated question and answer. But China is currently teaching to the masses, never before done like this. One school I recently visited (ZheJiang) had over 10,000 students enrolled. (BTW- only around 33% of them end up practicing, most looked like they for 18-20 years old, oh, they were). This western modernization has little to do with effectiveness, there are many factors, including economics (as always). Why are McDonalds popping up all over China? Training in China has many problems like we do. To put thing in perspective, one has to look where much of the research, that for example Bob has extensively published, comes from. For example, for a PHD thesis many students decide to do some easy research project, taking some base prescription with mods etc and putting it to the test for a given disease. Just like what we commonly read in the journals. When I was talking with the students they said, yes it is easy, you can be done in a few months. This is great for the many who just want there PHD and be out. The alternative is doing some classical literature research (or whatever) which can take years. Granted this (former) type of research can result in the newest and greatest patent for disease X, which does happen, but come on, this is not the in the trenches medicine. Granted there are all levels of doctors, there are those that just give xiao yao san over and over, but again let the results speak for themselves. Judging the medicine on its lowest common denominator makes little sense to me. Not to toally bash the Chinese, because they have 1 distinct advantage. The student who does want to break out of the box has almost unlimited resources compared to us. There are old doctors to study with, TCM libraries that I estimate are over 1000x bigger than the average school US TCM library to access material. There are young doctors that are totally rebelling against this modern trend and are very vocal about it! Addressing Todd’s 15 year observations: Do you think it is fair to gauge how well the medicine performs by years of watching students in a western school clinic? I have much respect for Todd and his herbal abilities, but in the three school clinics I have been in, I can only laugh at the level of medicine. I am not saying I am any better and I was at one time one of those fumbling students. But putting a 75 year old Chinese doctor to the test makes much more sense then concluding that CM doesn’t work from meager observations, especially with the relatively poor level of practice that goes on in the states (at least herbal medicine). Even supervisors prescriptions in the school clinic are not a fair judge, they rarely spend much time with patients and rely many times of the students observations and perspectives. There are many levels and CM has a black hole of knowledge if one desires to access it. It is not easy, but testing simflied approaches (the way that is happening) is just Western medicine testing CM’s tools, not CM’s thinking! Finally, because of all of this, I think standardization is a double edged sword, and the many Chinese I have spoke with agree. It is a complex arena and many differing opinions. There are many ideas and articles on the subject. - _____ On Behalf Of Friday, May 04, 2007 5:31 PM Re: Acupuncture no better than sham in hypertension - SHARP Trial Ah, that's too bad, I guess I'll have to tell my patients I've helped with hypertension over the years that it didn't really work. Also, I'll have to tell all the patients I've treated over twenty-five years with menstrual disorders, insomnia, digestive problems, and other conditions that acupuncture only treats musculoskeletal disorders. On May 4, 2007, at 2:28 PM, (AT) comcast (DOT) <%40comcast.net> net wrote: > shocking. in 13 years of practice, I never saw any sustained > decrease in BP from the typical regimen of any form of acupuncture > plus patent meds that could not be explained by other concurrent > changes such as diet and exercise. Not just talking about myself, > but also the patients seen by dozens of others supposedly skilled > px in school clinics. Even high does herbs are not very effective > and I was always dismayed to learn how many senior herbalists from > China took BP meds as they aged as a result. sadly, I predict > controlled evidence will ultimately show that acupuncture is good > for some musculoskeletal problems and herbs for a wide range of > minor complaints. But this medicine is not going to turn out to be > the salvation of the world. If you really could cure things like > hepatitis or lupus with TCM, the chinese would be making hay out of > it instead of racing headlong into their embrace of modern science > and cutting edge therapies like stem cells. Chinese med is a nice > safe alternat > ive to the drugstore for many of the minor things that ail people. > no miracle cures hiding anywhere. > > -------------- Original message ---------------------- > " " < (AT) tinet (DOT) <%40tinet.ie> ie> >> Hi All, >> >> Bad news: the SHARP trial reported no benefit from AP over sham AP in >> treating hypertension (BP: systolic 140-179mm Hg; diastolic >> 90-109mm Hg). >> >> I have not been able to access the full text but the abstract is >> below: >> >> Hypertension. 2006;48:838.) � 2006 American Heart Association, Inc. >> Original Articles Stop Hypertension With the Acupuncture Research >> Program (SHARP) Results of a Randomized, Controlled Clinical Trial >> Eric A. >> Macklin; Peter M. Wayne; Leslie A. Kalish; Peter Valaskatgis; James >> Thompson; May C.M. Pian-Smith; Qunhao Zhang; Stephanie Stevens; >> Christine Goertz; Ronald J. Prineas; Beverly Buczynski; Randall M. >> Zusman >> From the New England Research Institutes (E.A.M., L.A.K., S.S.), >> Watertown, Mass; New England School of Acupuncture (P.M.W., P.V.), >> Watertown, Mass; Children�s Hospital Boston (L.A.K.), Boston, Mass; >> Massachusetts General Hospital (J.T., M.C.M.P.-S., Q.Z., B.B., >> R.M.Z.), >> Harvard Medical School, Boston, Mass; Samueli Institute (C.G.), >> Alexandria, >> Va; and the School of Medicine (R.J.P.), Wake Forest University, >> Winston- >> Salem, NC. Correspondence to Eric A. Macklin, New England Research >> Institutes, Inc, 9 Galen St, Watertown, MA 02472. E-mail >> EMacklin@NERIScienc <EMacklin%40NERIScience.com> e.com Case studies and small trials suggest that >> acupuncture may effectively treat hypertension, but no large >> randomized >> trials have been reported. The Stop Hypertension with the Acupuncture >> Research Program pilot trial enrolled 192 participants with >> untreated blood >> pressure (BP) in the range of 140/90 to 179/109 mm Hg. The design >> of the >> trial combined rigorous methodology and adherence to principles of >> traditional Chinese medicine. Participants were weaned off >> antihypertensives before enrollment and were then randomly >> assigned to 3 >> treatments: individualized traditional Chinese acupuncture, >> standardized >> acupuncture at preselected points, or invasive sham acupuncture. >> Participants received 12 acupuncture treatments over 6 to 8 weeks. >> During >> the first 10 weeks after random assignment, BP was monitored every 14 >> days, and antihypertensives were prescribed if BP exceeded 180/110 mm >> Hg. The mean BP decrease from baseline to 10 weeks, the primary end >> point, did not differ significantly between participants randomly >> assigned to >> active (individualized and standardized) versus sham acupuncture >> (systolic >> BP: -3.56 versus -3.84 mm Hg, respectively; 95% CI for the >> difference: -4.0 >> to 4.6 mm Hg; P=0.90; diastolic BP: -4.32 versus -2.81 mm Hg, 95% >> CI for >> the difference: -3.6 to 0.6 mm Hg; P=0.16). Categorizing >> participants by >> age, race, gender, baseline BP, history of antihypertensive use, >> obesity, or >> primary traditional Chinese medicine diagnosis did not reveal any >> subgroups >> for which the benefits of active acupuncture differed >> significantly from sham >> acupuncture. Active acupuncture provided no greater benefit than >> invasive >> sham acupuncture in reducing systolic or diastolic BP. Key Words: >> acupuncture o blood pressure o hypertension o randomized clinical >> trial o >> traditional Chinese medicine >> >> Best regards, >> >> >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 4, 2007 Report Share Posted May 4, 2007 Todd as i said in the past i have not seen essential hypertension treated successfully when i was in China. Those cases that did improve did so because of dietary changes based on WM. I also met a lady at bioessence that did her PhD in TCM on hypertension. Her conclusion was that TCM is not effective unless WM style life style changes are incorporated. - < Friday, May 04, 2007 2:28 PM Re: Acupuncture no better than sham in hypertension - SHARP Trial shocking. in 13 years of practice, I never saw any sustained decrease in BP from the typical regimen of any form of acupuncture plus patent meds that could not be explained by other concurrent changes such as diet and exercise. Not just talking about myself, but also the patients seen by dozens of others supposedly skilled px in school clinics. Even high does herbs are not very effective and I was always dismayed to learn how many senior herbalists from China took BP meds as they aged as a result. sadly, I predict controlled evidence will ultimately show that acupuncture is good for some musculoskeletal problems and herbs for a wide range of minor complaints. But this medicine is not going to turn out to be the salvation of the world. If you really could cure things like hepatitis or lupus with TCM, the chinese would be making hay out of it instead of racing headlong into their embrace of modern science and cutting edge therapies like stem cells. Chinese med is a nice safe alternat ive to the drugstore for many of the minor things that ail people. no miracle cures hiding anywhere. -------------- Original message ---------------------- " " < > Hi All, > > Bad news: the SHARP trial reported no benefit from AP over sham AP in > treating hypertension (BP: systolic 140-179mm Hg; diastolic 90-109mm Hg). > > I have not been able to access the full text but the abstract is below: > > Hypertension. 2006;48:838.) � 2006 American Heart Association, Inc. > Original Articles Stop Hypertension With the Acupuncture Research > Program (SHARP) Results of a Randomized, Controlled Clinical Trial Eric A. > Macklin; Peter M. Wayne; Leslie A. Kalish; Peter Valaskatgis; James > Thompson; May C.M. Pian-Smith; Qunhao Zhang; Stephanie Stevens; > Christine Goertz; Ronald J. Prineas; Beverly Buczynski; Randall M. Zusman > From the New England Research Institutes (E.A.M., L.A.K., S.S.), > Watertown, Mass; New England School of Acupuncture (P.M.W., P.V.), > Watertown, Mass; Children�s Hospital Boston (L.A.K.), Boston, Mass; > Massachusetts General Hospital (J.T., M.C.M.P.-S., Q.Z., B.B., R.M.Z.), > Harvard Medical School, Boston, Mass; Samueli Institute (C.G.), > Alexandria, > Va; and the School of Medicine (R.J.P.), Wake Forest University, Winston- > Salem, NC. Correspondence to Eric A. Macklin, New England Research > Institutes, Inc, 9 Galen St, Watertown, MA 02472. E-mail > EMacklin Case studies and small trials suggest that > acupuncture may effectively treat hypertension, but no large randomized > trials have been reported. The Stop Hypertension with the Acupuncture > Research Program pilot trial enrolled 192 participants with untreated > blood > pressure (BP) in the range of 140/90 to 179/109 mm Hg. The design of the > trial combined rigorous methodology and adherence to principles of > traditional Chinese medicine. Participants were weaned off > antihypertensives before enrollment and were then randomly assigned to 3 > treatments: individualized traditional Chinese acupuncture, standardized > acupuncture at preselected points, or invasive sham acupuncture. > Participants received 12 acupuncture treatments over 6 to 8 weeks. During > the first 10 weeks after random assignment, BP was monitored every 14 > days, and antihypertensives were prescribed if BP exceeded 180/110 mm > Hg. The mean BP decrease from baseline to 10 weeks, the primary end > point, did not differ significantly between participants randomly assigned > to > active (individualized and standardized) versus sham acupuncture (systolic > BP: -3.56 versus -3.84 mm Hg, respectively; 95% CI for the > difference: -4.0 > to 4.6 mm Hg; P=0.90; diastolic BP: -4.32 versus -2.81 mm Hg, 95% CI for > the difference: -3.6 to 0.6 mm Hg; P=0.16). Categorizing participants by > age, race, gender, baseline BP, history of antihypertensive use, obesity, > or > primary traditional Chinese medicine diagnosis did not reveal any > subgroups > for which the benefits of active acupuncture differed significantly from > sham > acupuncture. Active acupuncture provided no greater benefit than invasive > sham acupuncture in reducing systolic or diastolic BP. Key Words: > acupuncture o blood pressure o hypertension o randomized clinical trial o > traditional Chinese medicine > > Best regards, > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 5, 2007 Report Share Posted May 5, 2007 " individualized traditional Chinese acupuncture, standardized acupuncture at preselected points " Looks like, yet another " sham vs sham " acupuncture study. Nothing to worry about. Kelvin Chinese Medicine , " " < wrote: > > Hi All, > > Bad news: the SHARP trial reported no benefit from AP over sham AP in > treating hypertension (BP: systolic 140-179mm Hg; diastolic 90- 109mm Hg). > > I have not been able to access the full text but the abstract is below: > > Hypertension. 2006;48:838.) © 2006 American Heart Association, Inc. > Original Articles Stop Hypertension With the Acupuncture Research > Program (SHARP) Results of a Randomized, Controlled Clinical Trial Eric A. > Macklin; Peter M. Wayne; Leslie A. Kalish; Peter Valaskatgis; James > Thompson; May C.M. Pian-Smith; Qunhao Zhang; Stephanie Stevens; > Christine Goertz; Ronald J. Prineas; Beverly Buczynski; Randall M. Zusman > From the New England Research Institutes (E.A.M., L.A.K., S.S.), > Watertown, Mass; New England School of Acupuncture (P.M.W., P.V.), > Watertown, Mass; Children´s Hospital Boston (L.A.K.), Boston, Mass; > Massachusetts General Hospital (J.T., M.C.M.P.-S., Q.Z., B.B., R.M.Z.), > Harvard Medical School, Boston, Mass; Samueli Institute (C.G.), Alexandria, > Va; and the School of Medicine (R.J.P.), Wake Forest University, Winston- > Salem, NC. Correspondence to Eric A. Macklin, New England Research > Institutes, Inc, 9 Galen St, Watertown, MA 02472. E-mail > EMacklin Case studies and small trials suggest that > acupuncture may effectively treat hypertension, but no large randomized > trials have been reported. The Stop Hypertension with the Acupuncture > Research Program pilot trial enrolled 192 participants with untreated blood > pressure (BP) in the range of 140/90 to 179/109 mm Hg. The design of the > trial combined rigorous methodology and adherence to principles of > traditional Chinese medicine. Participants were weaned off > antihypertensives before enrollment and were then randomly assigned to 3 > treatments: individualized traditional Chinese acupuncture, standardized > acupuncture at preselected points, or invasive sham acupuncture. > Participants received 12 acupuncture treatments over 6 to 8 weeks. During > the first 10 weeks after random assignment, BP was monitored every 14 > days, and antihypertensives were prescribed if BP exceeded 180/110 mm > Hg. The mean BP decrease from baseline to 10 weeks, the primary end > point, did not differ significantly between participants randomly assigned to > active (individualized and standardized) versus sham acupuncture (systolic > BP: -3.56 versus -3.84 mm Hg, respectively; 95% CI for the difference: -4.0 > to 4.6 mm Hg; P=0.90; diastolic BP: -4.32 versus -2.81 mm Hg, 95% CI for > the difference: -3.6 to 0.6 mm Hg; P=0.16). Categorizing participants by > age, race, gender, baseline BP, history of antihypertensive use, obesity, or > primary traditional Chinese medicine diagnosis did not reveal any subgroups > for which the benefits of active acupuncture differed significantly from sham > acupuncture. Active acupuncture provided no greater benefit than invasive > sham acupuncture in reducing systolic or diastolic BP. Key Words: > acupuncture o blood pressure o hypertension o randomized clinical trial o > traditional Chinese medicine > > Best regards, > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 5, 2007 Report Share Posted May 5, 2007 >>>...enrolled 192 participants with UNTREATED (my emphasis) blood pressure (BP) in the range of 140/90 to 179/109 mm Hg. The design of the trial combined rigorous methodology and adherence to principles of traditional Chinese medicine. PARTICIPANTS WERE WEANED OFF ANTIHYPERTENSIVES BEFORE ENROLLMENT (my emphasis)<<< That is a glaring contradiction. Besides, I thought everyone with a day or two of clinic time knew that needles alone could only be expected to give a very temporary lowering in refractory cases. The difference between an acupuncture technician and a skilled practitioner of oriental-derived-medicine is that we have ALWAYS addressed hypertension with breathing, exercise, diet, and dietary modification including herbs. Joe Reid, OMD Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 5, 2007 Report Share Posted May 5, 2007 Yes, I agree emphatically. While I understand studies trying to zero in on one modality, the reality of treatment of conditions such as hypertension essentially involves all of the tools of Chinese medicine. On May 4, 2007, at 4:52 PM, jreidomd wrote: > That is a glaring contradiction. Besides, I thought everyone with a > day or two of clinic time knew that needles alone could only be > expected to give a very temporary lowering in refractory cases. The > difference between an acupuncture technician and a skilled > practitioner of oriental-derived-medicine is that we have ALWAYS > addressed hypertension with breathing, exercise, diet, and dietary > modification including herbs. > > Joe Reid, OMD Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 5, 2007 Report Share Posted May 5, 2007 Well, look who performed this study! The white coat doctors! WHITE COATS & BLOOD PRESSURE The 'white coat effect' describes the false high reading that may occur when a GP takes a patient's blood pressure. A study has now confirmed this phenomenon and states " It is time to stop using high blood pressure readings by general practitioners to make decisions about treatment " . Instead blood pressure should be assessed by home measurements by the patient or repeated measurements by a nurse. (BMJ 2002;325:254). Well, we can't win 'em all. But I prefer to tell of this study to prospects: ACUPUNCTURE HELPS HEART PATIENTS Research carried out at the University of California Los Angeles School of Medicine has shown that acupuncture can dramatically reduce the pressure on the heart in patients with severe heart failure.....The researchers divided 14 critically ill chronic heart failure patients referred for heart transplantation evaluation into three groups. One group received acupuncture at traditional acupuncture sites, the second received " non-acupoint " acupuncture in which needles were placed at sites not traditionally believed to be useful in acupuncture, and the third group had a " no-needle " simulation of the treatment, in which a needle holder was tapped onto the back of their neck, but no needle was inserted. Blood pressure, heart rate and sympathetic nerve activity were measured in all the patients following a four-minute mental stress test. There was a 25% increase in sympathetic nerve activity after the mental stress tests without active acupuncture, while with a single session of real acupuncture, sympathetic nerve activation was significantly reduced and was similar to what it had been before the patients underwent the stress test (Middlekauf HR et.al., Proceedings of the American Heart Association 2001 Scientific Sessions conference, Anaheim, 14/11/2001). Elie Directory http://www.tcmdirectory.com Chinese Medicine , " " < wrote: > > Hi All, > > Bad news: the SHARP trial reported no benefit from AP over sham AP in > treating hypertension (BP: systolic 140-179mm Hg; diastolic 90-109mm Hg). > > I have not been able to access the full text but the abstract is below: > > Hypertension. 2006;48:838.) © 2006 American Heart Association, Inc. > Original Articles Stop Hypertension With the Acupuncture Research > Program (SHARP) Results of a Randomized, Controlled Clinical Trial Eric A. > Macklin; Peter M. Wayne; Leslie A. Kalish; Peter Valaskatgis; James > Thompson; May C.M. Pian-Smith; Qunhao Zhang; Stephanie Stevens; > Christine Goertz; Ronald J. Prineas; Beverly Buczynski; Randall M. Zusman > From the New England Research Institutes (E.A.M., L.A.K., S.S.), > Watertown, Mass; New England School of Acupuncture (P.M.W., P.V.), > Watertown, Mass; Children´s Hospital Boston (L.A.K.), Boston, Mass; > Massachusetts General Hospital (J.T., M.C.M.P.-S., Q.Z., B.B., R.M.Z.), > Harvard Medical School, Boston, Mass; Samueli Institute (C.G.), Alexandria, > Va; and the School of Medicine (R.J.P.), Wake Forest University, Winston- > Salem, NC. Correspondence to Eric A. Macklin, New England Research > Institutes, Inc, 9 Galen St, Watertown, MA 02472. E-mail > EMacklin Case studies and small trials suggest that > acupuncture may effectively treat hypertension, but no large randomized > trials have been reported. The Stop Hypertension with the Acupuncture > Research Program pilot trial enrolled 192 participants with untreated blood > pressure (BP) in the range of 140/90 to 179/109 mm Hg. The design of the > trial combined rigorous methodology and adherence to principles of > traditional Chinese medicine. Participants were weaned off > antihypertensives before enrollment and were then randomly assigned to 3 > treatments: individualized traditional Chinese acupuncture, standardized > acupuncture at preselected points, or invasive sham acupuncture. > Participants received 12 acupuncture treatments over 6 to 8 weeks. During > the first 10 weeks after random assignment, BP was monitored every 14 > days, and antihypertensives were prescribed if BP exceeded 180/110 mm > Hg. The mean BP decrease from baseline to 10 weeks, the primary end > point, did not differ significantly between participants randomly assigned to > active (individualized and standardized) versus sham acupuncture (systolic > BP: -3.56 versus -3.84 mm Hg, respectively; 95% CI for the difference: -4.0 > to 4.6 mm Hg; P=0.90; diastolic BP: -4.32 versus -2.81 mm Hg, 95% CI for > the difference: -3.6 to 0.6 mm Hg; P=0.16). Categorizing participants by > age, race, gender, baseline BP, history of antihypertensive use, obesity, or > primary traditional Chinese medicine diagnosis did not reveal any subgroups > for which the benefits of active acupuncture differed significantly from sham > acupuncture. Active acupuncture provided no greater benefit than invasive > sham acupuncture in reducing systolic or diastolic BP. Key Words: > acupuncture o blood pressure o hypertension o randomized clinical trial o > traditional Chinese medicine > > Best regards, > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 5, 2007 Report Share Posted May 5, 2007 Alon, Not sure, quite a few. But I guess we must clarify things, many must continue taking herbs / receive acupuncture. Most are on custom formulas, but I actually have 2 patients that are completely managed with Tian Ma Gou Teng Yin (pre-made granules). One of them needs only 6 capsules a day. (That is 3 grams or 3 scoops) in addition to her custom herb formula (osteoarthritis of the knee – which is completely managed) (6 caps a day) - it took 1 week for it to start working. Another I am thinking of was interesting because due to my poor intake I had no idea they had HBP and just treated the CC (GI). They reported back a couple months later and said that their BP had gone down dramatically (this was a modified bulk san ren tang). I myself had essential hypertension years ago, did raw herbs steady for 6 months and it has now been gone for years. I have a family history, so we will see with time… It seems like in most people, with a little tweaking you can get things under control. If the BP is too high already, you can get a reduction of meds but these people usually have many other problems as well. What are other’s experiences? - _____ On Behalf Of Alon Marcus Friday, May 04, 2007 10:09 PM Re: Acupuncture no better than sham in hypertension - SHARP Trial Jason Out of curiosity how many pt with essential hypertension have you treated successfully? - @ <%40> Friday, May 04, 2007 8:58 PM RE: Acupuncture no better than sham in hypertension - SHARP Trial I agree with Z’ev here 100%. There is no doubt CM has the ability to work (for HBP and many other conditions). Just because a modern cookbook style TCM approach may be found ineffective in some research, does not mean that CM cannot treat that disease. Do you know how many approaches one could find for any given complaint / condition. This is just with herbs. But in regard to acupuncture, just putting a needle in IMO is far from “real†acupuncture, therefore any standardized point (or herbal) prescription is a crap shoot either way (if it will work or not). We love to jump up and down when it does work and laugh (or cry) when it doesn’t. But clearly no one practices this way, or at least the practitioners that I respect and the ones that I see get bomber results. So why perform research in a way that the medicine is not practiced? IMO there is only one way to research CM, the way it is practiced (with placebos and all) – Put it as a whole, straight up against what ever your testing. IMO, “True†CM in practice literally relies on its ability to see the individual and customize treatments. This is not some cliché holistic mumbo jumbo, but clearly demonstrated in the CM literature by anyone who has spent time reading pre-modern or modern case studies. Clearly it is my experience, and doctors that I have followed, that it can effectively treat the very difficult diseases. Not just musculoskeletal. To judge CM with some base sample prescription (with some mods) is just not how the great doctors (that I have observed or read about) practice. It is comparing apples and oranges. Over simplification? Just because the current trend in China is to modernize and simplify the medicine with standardize protocols etc does not mean that practicing in an (opposite) individualized fashion doesn’t work, X does not negate Y. Quite frankly it is very hard to practice at the level that really makes use of all information (past and present) and writes individualized formulas, essentially practicing CM the way it is designed to. So why is China doing what they are doing? This is a complicated question and answer. But China is currently teaching to the masses, never before done like this. One school I recently visited (ZheJiang) had over 10,000 students enrolled. (BTW- only around 33% of them end up practicing, most looked like they for 18-20 years old, oh, they were). This western modernization has little to do with effectiveness, there are many factors, including economics (as always). Why are McDonalds popping up all over China? Training in China has many problems like we do. To put thing in perspective, one has to look where much of the research, that for example Bob has extensively published, comes from. For example, for a PHD thesis many students decide to do some easy research project, taking some base prescription with mods etc and putting it to the test for a given disease. Just like what we commonly read in the journals. When I was talking with the students they said, yes it is easy, you can be done in a few months. This is great for the many who just want there PHD and be out. The alternative is doing some classical literature research (or whatever) which can take years. Granted this (former) type of research can result in the newest and greatest patent for disease X, which does happen, but come on, this is not the in the trenches medicine. Granted there are all levels of doctors, there are those that just give xiao yao san over and over, but again let the results speak for themselves. Judging the medicine on its lowest common denominator makes little sense to me. Not to toally bash the Chinese, because they have 1 distinct advantage. The student who does want to break out of the box has almost unlimited resources compared to us. There are old doctors to study with, TCM libraries that I estimate are over 1000x bigger than the average school US TCM library to access material. There are young doctors that are totally rebelling against this modern trend and are very vocal about it! Addressing Todd’s 15 year observations: Do you think it is fair to gauge how well the medicine performs by years of watching students in a western school clinic? I have much respect for Todd and his herbal abilities, but in the three school clinics I have been in, I can only laugh at the level of medicine. I am not saying I am any better and I was at one time one of those fumbling students. But putting a 75 year old Chinese doctor to the test makes much more sense then concluding that CM doesn’t work from meager observations, especially with the relatively poor level of practice that goes on in the states (at least herbal medicine). Even supervisors prescriptions in the school clinic are not a fair judge, they rarely spend much time with patients and rely many times of the students observations and perspectives. There are many levels and CM has a black hole of knowledge if one desires to access it. It is not easy, but testing simflied approaches (the way that is happening) is just Western medicine testing CM’s tools, not CM’s thinking! Finally, because of all of this, I think standardization is a double edged sword, and the many Chinese I have spoke with agree. It is a complex arena and many differing opinions. There are many ideas and articles on the subject. - _____ @ <%40> [@ <%40> ] On Behalf Of Z'ev Rosenberg Friday, May 04, 2007 5:31 PM @ <%40> Re: Acupuncture no better than sham in hypertension - SHARP Trial Ah, that's too bad, I guess I'll have to tell my patients I've helped with hypertension over the years that it didn't really work. Also, I'll have to tell all the patients I've treated over twenty-five years with menstrual disorders, insomnia, digestive problems, and other conditions that acupuncture only treats musculoskeletal disorders. On May 4, 2007, at 2:28 PM, (AT) comcast (DOT) <%40comcast.net> net wrote: > shocking. in 13 years of practice, I never saw any sustained > decrease in BP from the typical regimen of any form of acupuncture > plus patent meds that could not be explained by other concurrent > changes such as diet and exercise. Not just talking about myself, > but also the patients seen by dozens of others supposedly skilled > px in school clinics. Even high does herbs are not very effective > and I was always dismayed to learn how many senior herbalists from > China took BP meds as they aged as a result. sadly, I predict > controlled evidence will ultimately show that acupuncture is good > for some musculoskeletal problems and herbs for a wide range of > minor complaints. But this medicine is not going to turn out to be > the salvation of the world. If you really could cure things like > hepatitis or lupus with TCM, the chinese would be making hay out of > it instead of racing headlong into their embrace of modern science > and cutting edge therapies like stem cells. Chinese med is a nice > safe alternat > ive to the drugstore for many of the minor things that ail people. > no miracle cures hiding anywhere. > > -------------- Original message ---------------------- > " " < (AT) tinet (DOT) <%40tinet.ie> ie> >> Hi All, >> >> Bad news: the SHARP trial reported no benefit from AP over sham AP in >> treating hypertension (BP: systolic 140-179mm Hg; diastolic >> 90-109mm Hg). >> >> I have not been able to access the full text but the abstract is >> below: >> >> Hypertension. 2006;48:838.) � 2006 American Heart Association, Inc. >> Original Articles Stop Hypertension With the Acupuncture Research >> Program (SHARP) Results of a Randomized, Controlled Clinical Trial >> Eric A. >> Macklin; Peter M. Wayne; Leslie A. Kalish; Peter Valaskatgis; James >> Thompson; May C.M. Pian-Smith; Qunhao Zhang; Stephanie Stevens; >> Christine Goertz; Ronald J. Prineas; Beverly Buczynski; Randall M. >> Zusman >> From the New England Research Institutes (E.A.M., L.A.K., S.S.), >> Watertown, Mass; New England School of Acupuncture (P.M.W., P.V.), >> Watertown, Mass; Children�s Hospital Boston (L.A.K.), Boston, Mass; >> Massachusetts General Hospital (J.T., M.C.M.P.-S., Q.Z., B.B., >> R.M.Z.), >> Harvard Medical School, Boston, Mass; Samueli Institute (C.G.), >> Alexandria, >> Va; and the School of Medicine (R.J.P.), Wake Forest University, >> Winston- >> Salem, NC. Correspondence to Eric A. Macklin, New England Research >> Institutes, Inc, 9 Galen St, Watertown, MA 02472. E-mail >> EMacklin@NERIScienc <EMacklin%40NERIScience.com> e.com Case studies and small trials suggest that >> acupuncture may effectively treat hypertension, but no large >> randomized >> trials have been reported. The Stop Hypertension with the Acupuncture >> Research Program pilot trial enrolled 192 participants with >> untreated blood >> pressure (BP) in the range of 140/90 to 179/109 mm Hg. The design >> of the >> trial combined rigorous methodology and adherence to principles of >> traditional Chinese medicine. Participants were weaned off >> antihypertensives before enrollment and were then randomly >> assigned to 3 >> treatments: individualized traditional Chinese acupuncture, >> standardized >> acupuncture at preselected points, or invasive sham acupuncture. >> Participants received 12 acupuncture treatments over 6 to 8 weeks. >> During >> the first 10 weeks after random assignment, BP was monitored every 14 >> days, and antihypertensives were prescribed if BP exceeded 180/110 mm >> Hg. The mean BP decrease from baseline to 10 weeks, the primary end >> point, did not differ significantly between participants randomly >> assigned to >> active (individualized and standardized) versus sham acupuncture >> (systolic >> BP: -3.56 versus -3.84 mm Hg, respectively; 95% CI for the >> difference: -4.0 >> to 4.6 mm Hg; P=0.90; diastolic BP: -4.32 versus -2.81 mm Hg, 95% >> CI for >> the difference: -3.6 to 0.6 mm Hg; P=0.16). Categorizing >> participants by >> age, race, gender, baseline BP, history of antihypertensive use, >> obesity, or >> primary traditional Chinese medicine diagnosis did not reveal any >> subgroups >> for which the benefits of active acupuncture differed >> significantly from sham >> acupuncture. Active acupuncture provided no greater benefit than >> invasive >> sham acupuncture in reducing systolic or diastolic BP. Key Words: >> acupuncture o blood pressure o hypertension o randomized clinical >> trial o >> traditional Chinese medicine >> >> Best regards, >> >> >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 5, 2007 Report Share Posted May 5, 2007 Jason That would have been my next question, what was the BP to start with. I have not treated to many BP pt but i have not seen much reduction in pt with pressures about 150/100 i have seen changes in mild cases. In china i have followed some 100 cases with high BP and i cant say i saw one pt that had such BPs manage them with herbs alone - Saturday, May 05, 2007 7:12 AM RE: Acupuncture no better than sham in hypertension - SHARP Trial Alon, Not sure, quite a few. But I guess we must clarify things, many must continue taking herbs / receive acupuncture. Most are on custom formulas, but I actually have 2 patients that are completely managed with Tian Ma Gou Teng Yin (pre-made granules). One of them needs only 6 capsules a day. (That is 3 grams or 3 scoops) in addition to her custom herb formula (osteoarthritis of the knee – which is completely managed) (6 caps a day) - it took 1 week for it to start working. Another I am thinking of was interesting because due to my poor intake I had no idea they had HBP and just treated the CC (GI). They reported back a couple months later and said that their BP had gone down dramatically (this was a modified bulk san ren tang). I myself had essential hypertension years ago, did raw herbs steady for 6 months and it has now been gone for years. I have a family history, so we will see with time… It seems like in most people, with a little tweaking you can get things under control. If the BP is too high already, you can get a reduction of meds but these people usually have many other problems as well. What are other’s experiences? - _____ On Behalf Of Alon Marcus Friday, May 04, 2007 10:09 PM Re: Acupuncture no better than sham in hypertension - SHARP Trial Jason Out of curiosity how many pt with essential hypertension have you treated successfully? - @ <%40> Friday, May 04, 2007 8:58 PM RE: Acupuncture no better than sham in hypertension - SHARP Trial I agree with Z’ev here 100%. There is no doubt CM has the ability to work (for HBP and many other conditions). Just because a modern cookbook style TCM approach may be found ineffective in some research, does not mean that CM cannot treat that disease. Do you know how many approaches one could find for any given complaint / condition. This is just with herbs. But in regard to acupuncture, just putting a needle in IMO is far from “real†acupuncture, therefore any standardized point (or herbal) prescription is a crap shoot either way (if it will work or not). We love to jump up and down when it does work and laugh (or cry) when it doesn’t. But clearly no one practices this way, or at least the practitioners that I respect and the ones that I see get bomber results. So why perform research in a way that the medicine is not practiced? IMO there is only one way to research CM, the way it is practiced (with placebos and all) – Put it as a whole, straight up against what ever your testing. IMO, “True†CM in practice literally relies on its ability to see the individual and customize treatments. This is not some cliché holistic mumbo jumbo, but clearly demonstrated in the CM literature by anyone who has spent time reading pre-modern or modern case studies. Clearly it is my experience, and doctors that I have followed, that it can effectively treat the very difficult diseases. Not just musculoskeletal. To judge CM with some base sample prescription (with some mods) is just not how the great doctors (that I have observed or read about) practice. It is comparing apples and oranges. Over simplification? Just because the current trend in China is to modernize and simplify the medicine with standardize protocols etc does not mean that practicing in an (opposite) individualized fashion doesn’t work, X does not negate Y. Quite frankly it is very hard to practice at the level that really makes use of all information (past and present) and writes individualized formulas, essentially practicing CM the way it is designed to. So why is China doing what they are doing? This is a complicated question and answer. But China is currently teaching to the masses, never before done like this. One school I recently visited (ZheJiang) had over 10,000 students enrolled. (BTW- only around 33% of them end up practicing, most looked like they for 18-20 years old, oh, they were). This western modernization has little to do with effectiveness, there are many factors, including economics (as always). Why are McDonalds popping up all over China? Training in China has many problems like we do. To put thing in perspective, one has to look where much of the research, that for example Bob has extensively published, comes from. For example, for a PHD thesis many students decide to do some easy research project, taking some base prescription with mods etc and putting it to the test for a given disease. Just like what we commonly read in the journals. When I was talking with the students they said, yes it is easy, you can be done in a few months. This is great for the many who just want there PHD and be out. The alternative is doing some classical literature research (or whatever) which can take years. Granted this (former) type of research can result in the newest and greatest patent for disease X, which does happen, but come on, this is not the in the trenches medicine. Granted there are all levels of doctors, there are those that just give xiao yao san over and over, but again let the results speak for themselves. Judging the medicine on its lowest common denominator makes little sense to me. Not to toally bash the Chinese, because they have 1 distinct advantage. The student who does want to break out of the box has almost unlimited resources compared to us. There are old doctors to study with, TCM libraries that I estimate are over 1000x bigger than the average school US TCM library to access material. There are young doctors that are totally rebelling against this modern trend and are very vocal about it! Addressing Todd’s 15 year observations: Do you think it is fair to gauge how well the medicine performs by years of watching students in a western school clinic? I have much respect for Todd and his herbal abilities, but in the three school clinics I have been in, I can only laugh at the level of medicine. I am not saying I am any better and I was at one time one of those fumbling students. But putting a 75 year old Chinese doctor to the test makes much more sense then concluding that CM doesn’t work from meager observations, especially with the relatively poor level of practice that goes on in the states (at least herbal medicine). Even supervisors prescriptions in the school clinic are not a fair judge, they rarely spend much time with patients and rely many times of the students observations and perspectives. There are many levels and CM has a black hole of knowledge if one desires to access it. It is not easy, but testing simflied approaches (the way that is happening) is just Western medicine testing CM’s tools, not CM’s thinking! Finally, because of all of this, I think standardization is a double edged sword, and the many Chinese I have spoke with agree. It is a complex arena and many differing opinions. There are many ideas and articles on the subject. - _____ @ <%40> [@ <%40> ] On Behalf Of Z'ev Rosenberg Friday, May 04, 2007 5:31 PM @ <%40> Re: Acupuncture no better than sham in hypertension - SHARP Trial Ah, that's too bad, I guess I'll have to tell my patients I've helped with hypertension over the years that it didn't really work. Also, I'll have to tell all the patients I've treated over twenty-five years with menstrual disorders, insomnia, digestive problems, and other conditions that acupuncture only treats musculoskeletal disorders. On May 4, 2007, at 2:28 PM, (AT) comcast (DOT) <%40comcast.net> net wrote: > shocking. in 13 years of practice, I never saw any sustained > decrease in BP from the typical regimen of any form of acupuncture > plus patent meds that could not be explained by other concurrent > changes such as diet and exercise. Not just talking about myself, > but also the patients seen by dozens of others supposedly skilled > px in school clinics. Even high does herbs are not very effective > and I was always dismayed to learn how many senior herbalists from > China took BP meds as they aged as a result. sadly, I predict > controlled evidence will ultimately show that acupuncture is good > for some musculoskeletal problems and herbs for a wide range of > minor complaints. But this medicine is not going to turn out to be > the salvation of the world. If you really could cure things like > hepatitis or lupus with TCM, the chinese would be making hay out of > it instead of racing headlong into their embrace of modern science > and cutting edge therapies like stem cells. Chinese med is a nice > safe alternat > ive to the drugstore for many of the minor things that ail people. > no miracle cures hiding anywhere. > > -------------- Original message ---------------------- > " " < (AT) tinet (DOT) <%40tinet.ie> ie> >> Hi All, >> >> Bad news: the SHARP trial reported no benefit from AP over sham AP in >> treating hypertension (BP: systolic 140-179mm Hg; diastolic >> 90-109mm Hg). >> >> I have not been able to access the full text but the abstract is >> below: >> >> Hypertension. 2006;48:838.) � 2006 American Heart Association, Inc. >> Original Articles Stop Hypertension With the Acupuncture Research >> Program (SHARP) Results of a Randomized, Controlled Clinical Trial >> Eric A. >> Macklin; Peter M. Wayne; Leslie A. Kalish; Peter Valaskatgis; James >> Thompson; May C.M. Pian-Smith; Qunhao Zhang; Stephanie Stevens; >> Christine Goertz; Ronald J. Prineas; Beverly Buczynski; Randall M. >> Zusman >> From the New England Research Institutes (E.A.M., L.A.K., S.S.), >> Watertown, Mass; New England School of Acupuncture (P.M.W., P.V.), >> Watertown, Mass; Children�s Hospital Boston (L.A.K.), Boston, Mass; >> Massachusetts General Hospital (J.T., M.C.M.P.-S., Q.Z., B.B., >> R.M.Z.), >> Harvard Medical School, Boston, Mass; Samueli Institute (C.G.), >> Alexandria, >> Va; and the School of Medicine (R.J.P.), Wake Forest University, >> Winston- >> Salem, NC. Correspondence to Eric A. Macklin, New England Research >> Institutes, Inc, 9 Galen St, Watertown, MA 02472. E-mail >> EMacklin@NERIScienc <EMacklin%40NERIScience.com> e.com Case studies and small trials suggest that >> acupuncture may effectively treat hypertension, but no large >> randomized >> trials have been reported. The Stop Hypertension with the Acupuncture >> Research Program pilot trial enrolled 192 participants with >> untreated blood >> pressure (BP) in the range of 140/90 to 179/109 mm Hg. The design >> of the >> trial combined rigorous methodology and adherence to principles of >> traditional Chinese medicine. Participants were weaned off >> antihypertensives before enrollment and were then randomly >> assigned to 3 >> treatments: individualized traditional Chinese acupuncture, >> standardized >> acupuncture at preselected points, or invasive sham acupuncture. >> Participants received 12 acupuncture treatments over 6 to 8 weeks. >> During >> the first 10 weeks after random assignment, BP was monitored every 14 >> days, and antihypertensives were prescribed if BP exceeded 180/110 mm >> Hg. The mean BP decrease from baseline to 10 weeks, the primary end >> point, did not differ significantly between participants randomly >> assigned to >> active (individualized and standardized) versus sham acupuncture >> (systolic >> BP: -3.56 versus -3.84 mm Hg, respectively; 95% CI for the >> difference: -4.0 >> to 4.6 mm Hg; P=0.90; diastolic BP: -4.32 versus -2.81 mm Hg, 95% >> CI for >> the difference: -3.6 to 0.6 mm Hg; P=0.16). Categorizing >> participants by >> age, race, gender, baseline BP, history of antihypertensive use, >> obesity, or >> primary traditional Chinese medicine diagnosis did not reveal any >> subgroups >> for which the benefits of active acupuncture differed >> significantly from sham >> acupuncture. Active acupuncture provided no greater benefit than >> invasive >> sham acupuncture in reducing systolic or diastolic BP. Key Words: >> acupuncture o blood pressure o hypertension o randomized clinical >> trial o >> traditional Chinese medicine >> >> Best regards, >> >> >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 5, 2007 Report Share Posted May 5, 2007 There is another issue here and where I think the current attacks are being based from biomedicine: the use of " sham acupuncture. " After looking at dozens of papers that compare acupuncture to sham acupuncture, here is the general scenario: let's get a valid acupuncture protocol with TCM practitioner input which invariably includes big, popular points such as LI 4, St 36, Sp 6. Then for a control, we will use sham acupuncture. When you read the methodology these " shams " are usually placed 1-2 cm from the actual acupuncture points. Of course, in these big points a centimeter or two is probably still on the actual point, not taking into account angle of insertion or depth (which are rarely mentioned in the methods despite the excellent STRICTA protocols). So we have a situation where the actual acupuncture points are essentially the same as the sham points. So if the study shows positive impact then the headline reads, as it did 6 months ago, " Migraines helped by acupuncture, sham acupuncture equally helpful. " This gives ammo to critics who simply say it obviously doesn't matter which point is chosen and therefore the " system " doesn't work. Or in the case of this paper, which doesn't have a non-treatment control, even though there was a reduction of blood pressure (which may or may not be statistically valid), the treatment was essentially the same as the control and therefore the treatment is invalid. As acupuncturists we have to be very careful of this new trend for research to use " sham " acupuncture as a control. No matter the results, they are interpreted to be against acupuncture. The best design is probably a comparison of best practices where acupuncture is compared with the standard biomedical practice and may the best intervention win. Of course this is open to often heated debate. ************************************************************************** Dr. Greg Sperber, BMBS, DAOM, MBA, L.Ac. California Licensed Acupuncturist Diplomate in Oriental Medicine (NCCAOM) Greg *************************************************************************** > Hi All, >Bad news: the SHARP trial reported no benefit from AP over sham AP in >treating hypertension (BP: systolic 140-179mm Hg; diastolic 90-109mm Hg). >I have not been able to access the full text but the abstract is below: >Hypertension. 2006;48:838.) C 2006 American Heart Association, Inc. >Original Articles Stop Hypertension With the Acupuncture Research >Program (SHARP) Results of a Randomized, Controlled Clinical Trial Eric A. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 5, 2007 Report Share Posted May 5, 2007 Thanks Greg for the excellent points; Acupuncture alone, Allopathic intervention alone and a comparison with a protocol that includes both modalities simultaneously (complementary care) is useful to understand the efficacies of all methodologies. I agree that these " sham " studies are wasting time and money, because acupuncture points have already been categorically and scientifically proven to be effective. That was over 10 years ago. Researchers should be spending resources in understanding the ways that traditional acupuncture treatment formulas are to what extent useful in complementing allopathic medicine, especially in syndromes where " western " medicine has been deemed to be more or less ineffective. I'm wondering how much of these kind of " sham " studies are based on ignorance, hidden agendas or the like. On 5/5/07, Dr. Greg Sperber <greg wrote: > > There is another issue here and where I think the current attacks are > being > based from biomedicine: the use of " sham acupuncture. " After looking at > dozens of papers that compare acupuncture to sham acupuncture, here is the > general scenario: let's get a valid acupuncture protocol with TCM > practitioner input which invariably includes big, popular points such as > LI > 4, St 36, Sp 6. Then for a control, we will use sham acupuncture. When you > read the methodology these " shams " are usually placed 1-2 cm from the > actual > acupuncture points. Of course, in these big points a centimeter or two is > probably still on the actual point, not taking into account angle of > insertion or depth (which are rarely mentioned in the methods despite the > excellent STRICTA protocols). So we have a situation where the actual > acupuncture points are essentially the same as the sham points. So if the > study shows positive impact then the headline reads, as it did 6 months > ago, > " Migraines helped by acupuncture, sham acupuncture equally helpful. " This > gives ammo to critics who simply say it obviously doesn't matter which > point > is chosen and therefore the " system " doesn't work. Or in the case of this > paper, which doesn't have a non-treatment control, even though there was a > reduction of blood pressure (which may or may not be statistically valid), > the treatment was essentially the same as the control and therefore the > treatment is invalid. > > As acupuncturists we have to be very careful of this new trend for > research > to use " sham " acupuncture as a control. No matter the results, they are > interpreted to be against acupuncture. The best design is probably a > comparison of best practices where acupuncture is compared with the > standard > biomedical practice and may the best intervention win. Of course this is > open to often heated debate. > > ************************************************************************** > > Dr. Greg Sperber, BMBS, DAOM, MBA, L.Ac. > > California Licensed Acupuncturist > > Diplomate in Oriental Medicine (NCCAOM) > > Greg <Greg%40SperbsHerbs.com> > > > *************************************************************************** > > > Hi All, > > >Bad news: the SHARP trial reported no benefit from AP over sham AP in > >treating hypertension (BP: systolic 140-179mm Hg; diastolic 90-109mm Hg). > > >I have not been able to access the full text but the abstract is below: > > >Hypertension. 2006;48:838.) C 2006 American Heart Association, Inc. > >Original Articles Stop Hypertension With the Acupuncture Research > >Program (SHARP) Results of a Randomized, Controlled Clinical Trial Eric > A. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 5, 2007 Report Share Posted May 5, 2007 Alon, Several teachers in China have told me that CM doesn't treat HBP very well. However, that may be in part due to the fact that the contemporary Chinese reframing of hypertension into the traditional Chinese disease categories of headache and dizziness is not correct in the majority of cases, and, therefore, most patients are not getting the right herbs. We call hypertension the " silent killer " because most patients are asymptomatic FOR HYPERTENSION. They are not truly asymptomatic however. They always do present a combination of patterns. Nonetheless, the idea that elevated blood pressure is due to ascendant liver yang hyperactivity is simply wrong. Based on that erroneous idea, many patients are given the wrong Chinese meds. I have recently published some case histories of HBP based on such patterns as qi vacuity, etc. which did seemingly get significant results. My point being, forget the modern textbook discussions of HBP and simply treat the patient's presenting patterns. Bob , " Alon Marcus " <alonmarcus wrote: > > Jason > That would have been my next question, what was the BP to start with. I have not treated to many BP pt but i have not seen much reduction in pt with pressures about 150/100 i have seen changes in mild cases. In china i have followed some 100 cases with high BP and i cant say i saw one pt that had such BPs manage them with herbs alone > > > > > > > > > - > > > Saturday, May 05, 2007 7:12 AM > RE: Acupuncture no better than sham in hypertension - SHARP Trial > > > Alon, > > Not sure, quite a few. But I guess we must clarify things, many must continue taking herbs / receive acupuncture. Most are on custom formulas, but I actually have 2 patients that are completely managed with Tian Ma Gou Teng Yin (pre-made granules). One of them needs only 6 capsules a day. (That is 3 grams or 3 scoops) in addition to her custom herb formula (osteoarthritis of the knee †" which is completely managed) (6 caps a day) - it took 1 week for it to start working. Another I am thinking of was interesting because due to my poor intake I had no idea they had HBP and just treated the CC (GI). They reported back a couple months later and said that their BP had gone down dramatically (this was a modified bulk san ren tang). > > I myself had essential hypertension years ago, did raw herbs steady for 6 months and it has now been gone for years. I have a family history, so we will see with time… It seems like in most people, with a little tweaking you can get things under control. If the BP is too high already, you can get a reduction of meds but these people usually have many other problems as well. What are other’s experiences? > > - > > _____ > > On Behalf Of Alon Marcus > Friday, May 04, 2007 10:09 PM > > Re: Acupuncture no better than sham in hypertension - SHARP Trial > > Jason > Out of curiosity how many pt with essential hypertension have you treated successfully? > > > > > > > > > - > > @ <%40> > Friday, May 04, 2007 8:58 PM > RE: Acupuncture no better than sham in hypertension - SHARP Trial > > I agree with Z’ev here 100%. There is no doubt CM has the ability to work (for HBP and many other conditions). Just because a modern cookbook style TCM approach may be found ineffective in some research, does not mean that CM cannot treat that disease. Do you know how many approaches one could find for any given complaint / condition. This is just with herbs. But in regard to acupuncture, just putting a needle in IMO is far from “real†acupuncture, therefore any standardized point (or herbal) prescription is a crap shoot either way (if it will work or not). We love to jump up and down when it does work and laugh (or cry) when it doesn’t. But clearly no one practices this way, or at least the practitioners that I respect and the ones that I see get bomber results. So why perform research in a way that the medicine is not practiced? IMO there is only one way to research CM, the way it is practiced (with placebos and all) †" Put it as a whole, straight up against what ever your testing. > > IMO, “True†CM in practice literally relies on its ability to see the individual and customize treatments. This is not some cliché holistic mumbo jumbo, but clearly demonstrated in the CM literature by anyone who has spent time reading pre-modern or modern case studies. Clearly it is my experience, and doctors that I have followed, that it can effectively treat the very difficult diseases. Not just musculoskeletal. To judge CM with some base sample prescription (with some mods) is just not how the great doctors (that I have observed or read about) practice. It is comparing apples and oranges. > > Over simplification? Just because the current trend in China is to modernize and simplify the medicine with standardize protocols etc does not mean that practicing in an (opposite) individualized fashion doesn’t work, X does not negate Y. Quite frankly it is very hard to practice at the level that really makes use of all information (past and present) and writes individualized formulas, essentially practicing CM the way it is designed to. So why is China doing what they are doing? This is a complicated question and answer. But China is currently teaching to the masses, never before done like this. One school I recently visited (ZheJiang) had over 10,000 students enrolled. (BTW- only around 33% of them end up practicing, most looked like they for 18-20 years old, oh, they were). > > This western modernization has little to do with effectiveness, there are many factors, including economics (as always). Why are McDonalds popping up all over China? Training in China has many problems like we do. > > To put thing in perspective, one has to look where much of the research, that for example Bob has extensively published, comes from. For example, for a PHD thesis many students decide to do some easy research project, taking some base prescription with mods etc and putting it to the test for a given disease. Just like what we commonly read in the journals. When I was talking with the students they said, yes it is easy, you can be done in a few months. This is great for the many who just want there PHD and be out. The alternative is doing some classical literature research (or whatever) which can take years. Granted this (former) type of research can result in the newest and greatest patent for disease X, which does happen, but come on, this is not the in the trenches medicine. Granted there are all levels of doctors, there are those that just give xiao yao san over and over, but again let the results speak for themselves. Judging the medicine on its lowest common denominator makes little sense to me. > > Not to toally bash the Chinese, because they have 1 distinct advantage. The student who does want to break out of the box has almost unlimited resources compared to us. There are old doctors to study with, TCM libraries that I estimate are over 1000x bigger than the average school US TCM library to access material. There are young doctors that are totally rebelling against this modern trend and are very vocal about it! > > Addressing Todd’s 15 year observations: Do you think it is fair to gauge how well the medicine performs by years of watching students in a western school clinic? I have much respect for Todd and his herbal abilities, but in the three school clinics I have been in, I can only laugh at the level of medicine. I am not saying I am any better and I was at one time one of those fumbling students. But putting a 75 year old Chinese doctor to the test makes much more sense then concluding that CM doesn’t work from meager observations, especially with the relatively poor level of practice that goes on in the states (at least herbal medicine). Even supervisors prescriptions in the school clinic are not a fair judge, they rarely spend much time with patients and rely many times of the students observations and perspectives. > > There are many levels and CM has a black hole of knowledge if one desires to access it. It is not easy, but testing simflied approaches (the way that is happening) is just Western medicine testing CM’s tools, not CM’s thinking! > > Finally, because of all of this, I think standardization is a double edged sword, and the many Chinese I have spoke with agree. It is a complex arena and many differing opinions. There are many ideas and articles on the subject. > > - > > _____ > > @ <%40> [@ <%40> ] On Behalf Of > Friday, May 04, 2007 5:31 PM > @ <%40> > Re: Acupuncture no better than sham in hypertension - SHARP Trial > > Ah, that's too bad, I guess I'll have to tell my patients I've helped > with hypertension over the years that it didn't really work. Also, > I'll have to tell all the patients I've treated over twenty-five > years with menstrual disorders, insomnia, digestive problems, and > other conditions that acupuncture only treats musculoskeletal disorders. > > > On May 4, 2007, at 2:28 PM, (AT) comcast (DOT) <%40comcast.net> net wrote: > > > shocking. in 13 years of practice, I never saw any sustained > > decrease in BP from the typical regimen of any form of acupuncture > > plus patent meds that could not be explained by other concurrent > > changes such as diet and exercise. Not just talking about myself, > > but also the patients seen by dozens of others supposedly skilled > > px in school clinics. Even high does herbs are not very effective > > and I was always dismayed to learn how many senior herbalists from > > China took BP meds as they aged as a result. sadly, I predict > > controlled evidence will ultimately show that acupuncture is good > > for some musculoskeletal problems and herbs for a wide range of > > minor complaints. But this medicine is not going to turn out to be > > the salvation of the world. If you really could cure things like > > hepatitis or lupus with TCM, the chinese would be making hay out of > > it instead of racing headlong into their embrace of modern science > > and cutting edge therapies like stem cells. Chinese med is a nice > > safe alternat > > ive to the drugstore for many of the minor things that ail people. > > no miracle cures hiding anywhere. > > > > -------------- Original message ---------------------- > > " " < (AT) tinet (DOT) <%40tinet.ie> ie> > >> Hi All, > >> > >> Bad news: the SHARP trial reported no benefit from AP over sham AP in > >> treating hypertension (BP: systolic 140-179mm Hg; diastolic > >> 90-109mm Hg). > >> > >> I have not been able to access the full text but the abstract is > >> below: > >> > >> Hypertension. 2006;48:838.) � 2006 American Heart Association, Inc. > >> Original Articles Stop Hypertension With the Acupuncture Research > >> Program (SHARP) Results of a Randomized, Controlled Clinical Trial > >> Eric A. > >> Macklin; Peter M. Wayne; Leslie A. Kalish; Peter Valaskatgis; James > >> Thompson; May C.M. Pian-Smith; Qunhao Zhang; Stephanie Stevens; > >> Christine Goertz; Ronald J. Prineas; Beverly Buczynski; Randall M. > >> Zusman > >> From the New England Research Institutes (E.A.M., L.A.K., S.S.), > >> Watertown, Mass; New England School of Acupuncture (P.M.W., P.V.), > >> Watertown, Mass; Children�s Hospital Boston (L.A.K.), Boston, Mass; > >> Massachusetts General Hospital (J.T., M.C.M.P.-S., Q.Z., B.B., > >> R.M.Z.), > >> Harvard Medical School, Boston, Mass; Samueli Institute (C.G.), > >> Alexandria, > >> Va; and the School of Medicine (R.J.P.), Wake Forest University, > >> Winston- > >> Salem, NC. Correspondence to Eric A. Macklin, New England Research > >> Institutes, Inc, 9 Galen St, Watertown, MA 02472. E-mail > >> EMacklin@NERIScienc <EMacklin%40NERIScience.com> e.com Case studies and small trials suggest that > >> acupuncture may effectively treat hypertension, but no large > >> randomized > >> trials have been reported. The Stop Hypertension with the Acupuncture > >> Research Program pilot trial enrolled 192 participants with > >> untreated blood > >> pressure (BP) in the range of 140/90 to 179/109 mm Hg. The design > >> of the > >> trial combined rigorous methodology and adherence to principles of > >> traditional Chinese medicine. Participants were weaned off > >> antihypertensives before enrollment and were then randomly > >> assigned to 3 > >> treatments: individualized traditional Chinese acupuncture, > >> standardized > >> acupuncture at preselected points, or invasive sham acupuncture. > >> Participants received 12 acupuncture treatments over 6 to 8 weeks. > >> During > >> the first 10 weeks after random assignment, BP was monitored every 14 > >> days, and antihypertensives were prescribed if BP exceeded 180/110 mm > >> Hg. The mean BP decrease from baseline to 10 weeks, the primary end > >> point, did not differ significantly between participants randomly > >> assigned to > >> active (individualized and standardized) versus sham acupuncture > >> (systolic > >> BP: -3.56 versus -3.84 mm Hg, respectively; 95% CI for the > >> difference: -4.0 > >> to 4.6 mm Hg; P=0.90; diastolic BP: -4.32 versus -2.81 mm Hg, 95% > >> CI for > >> the difference: -3.6 to 0.6 mm Hg; P=0.16). Categorizing > >> participants by > >> age, race, gender, baseline BP, history of antihypertensive use, > >> obesity, or > >> primary traditional Chinese medicine diagnosis did not reveal any > >> subgroups > >> for which the benefits of active acupuncture differed > >> significantly from sham > >> acupuncture. Active acupuncture provided no greater benefit than > >> invasive > >> sham acupuncture in reducing systolic or diastolic BP. Key Words: > >> acupuncture o blood pressure o hypertension o randomized clinical > >> trial o > >> traditional Chinese medicine > >> > >> Best regards, > >> > >> > >> > >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 5, 2007 Report Share Posted May 5, 2007 Bob I cant agree with you more and add that is true for every single patient. Books are always a source of ideas not treatment guides - Bob Flaws Saturday, May 05, 2007 1:21 PM Re: Acupuncture no better than sham in hypertension - SHARP Trial Alon, Several teachers in China have told me that CM doesn't treat HBP very well. However, that may be in part due to the fact that the contemporary Chinese reframing of hypertension into the traditional Chinese disease categories of headache and dizziness is not correct in the majority of cases, and, therefore, most patients are not getting the right herbs. We call hypertension the " silent killer " because most patients are asymptomatic FOR HYPERTENSION. They are not truly asymptomatic however. They always do present a combination of patterns. Nonetheless, the idea that elevated blood pressure is due to ascendant liver yang hyperactivity is simply wrong. Based on that erroneous idea, many patients are given the wrong Chinese meds. I have recently published some case histories of HBP based on such patterns as qi vacuity, etc. which did seemingly get significant results. My point being, forget the modern textbook discussions of HBP and simply treat the patient's presenting patterns. Bob , " Alon Marcus " <alonmarcus wrote: > > Jason > That would have been my next question, what was the BP to start with. I have not treated to many BP pt but i have not seen much reduction in pt with pressures about 150/100 i have seen changes in mild cases. In china i have followed some 100 cases with high BP and i cant say i saw one pt that had such BPs manage them with herbs alone > > > > > > > > > - > > > Saturday, May 05, 2007 7:12 AM > RE: Acupuncture no better than sham in hypertension - SHARP Trial > > > Alon, > > Not sure, quite a few. But I guess we must clarify things, many must continue taking herbs / receive acupuncture. Most are on custom formulas, but I actually have 2 patients that are completely managed with Tian Ma Gou Teng Yin (pre-made granules). One of them needs only 6 capsules a day. (That is 3 grams or 3 scoops) in addition to her custom herb formula (osteoarthritis of the knee â? " which is completely managed) (6 caps a day) - it took 1 week for it to start working. Another I am thinking of was interesting because due to my poor intake I had no idea they had HBP and just treated the CC (GI). They reported back a couple months later and said that their BP had gone down dramatically (this was a modified bulk san ren tang). > > I myself had essential hypertension years ago, did raw herbs steady for 6 months and it has now been gone for years. I have a family history, so we will see with timeâ?¦ It seems like in most people, with a little tweaking you can get things under control. If the BP is too high already, you can get a reduction of meds but these people usually have many other problems as well. What are otherâ?Ts experiences? > > - > > _____ > > On Behalf Of Alon Marcus > Friday, May 04, 2007 10:09 PM > > Re: Acupuncture no better than sham in hypertension - SHARP Trial > > Jason > Out of curiosity how many pt with essential hypertension have you treated successfully? > > > > > > > > > - > > @ <%40> > Friday, May 04, 2007 8:58 PM > RE: Acupuncture no better than sham in hypertension - SHARP Trial > > I agree with Zâ?Tev here 100%. There is no doubt CM has the ability to work (for HBP and many other conditions). Just because a modern cookbook style TCM approach may be found ineffective in some research, does not mean that CM cannot treat that disease. Do you know how many approaches one could find for any given complaint / condition. This is just with herbs. But in regard to acupuncture, just putting a needle in IMO is far from â?orealâ? acupuncture, therefore any standardized point (or herbal) prescription is a crap shoot either way (if it will work or not). We love to jump up and down when it does work and laugh (or cry) when it doesnâ?Tt. But clearly no one practices this way, or at least the practitioners that I respect and the ones that I see get bomber results. So why perform research in a way that the medicine is not practiced? IMO there is only one way to research CM, the way it is practiced (with placebos and all) â? " Put it as a whole, straight up against what ever your testing. > > IMO, â?oTrueâ? CM in practice literally relies on its ability to see the individual and customize treatments. This is not some cliché holistic mumbo jumbo, but clearly demonstrated in the CM literature by anyone who has spent time reading pre-modern or modern case studies. Clearly it is my experience, and doctors that I have followed, that it can effectively treat the very difficult diseases. Not just musculoskeletal. To judge CM with some base sample prescription (with some mods) is just not how the great doctors (that I have observed or read about) practice. It is comparing apples and oranges. > > Over simplification? Just because the current trend in China is to modernize and simplify the medicine with standardize protocols etc does not mean that practicing in an (opposite) individualized fashion doesnâ?Tt work, X does not negate Y. Quite frankly it is very hard to practice at the level that really makes use of all information (past and present) and writes individualized formulas, essentially practicing CM the way it is designed to. So why is China doing what they are doing? This is a complicated question and answer. But China is currently teaching to the masses, never before done like this. One school I recently visited (ZheJiang) had over 10,000 students enrolled. (BTW- only around 33% of them end up practicing, most looked like they for 18-20 years old, oh, they were). > > This western modernization has little to do with effectiveness, there are many factors, including economics (as always). Why are McDonalds popping up all over China? Training in China has many problems like we do. > > To put thing in perspective, one has to look where much of the research, that for example Bob has extensively published, comes from. For example, for a PHD thesis many students decide to do some easy research project, taking some base prescription with mods etc and putting it to the test for a given disease. Just like what we commonly read in the journals. When I was talking with the students they said, yes it is easy, you can be done in a few months. This is great for the many who just want there PHD and be out. The alternative is doing some classical literature research (or whatever) which can take years. Granted this (former) type of research can result in the newest and greatest patent for disease X, which does happen, but come on, this is not the in the trenches medicine. Granted there are all levels of doctors, there are those that just give xiao yao san over and over, but again let the results speak for themselves. Judging the medicine on its lowest common denominator makes little sense to me. > > Not to toally bash the Chinese, because they have 1 distinct advantage. The student who does want to break out of the box has almost unlimited resources compared to us. There are old doctors to study with, TCM libraries that I estimate are over 1000x bigger than the average school US TCM library to access material. There are young doctors that are totally rebelling against this modern trend and are very vocal about it! > > Addressing Toddâ?Ts 15 year observations: Do you think it is fair to gauge how well the medicine performs by years of watching students in a western school clinic? I have much respect for Todd and his herbal abilities, but in the three school clinics I have been in, I can only laugh at the level of medicine. I am not saying I am any better and I was at one time one of those fumbling students. But putting a 75 year old Chinese doctor to the test makes much more sense then concluding that CM doesnâ?Tt work from meager observations, especially with the relatively poor level of practice that goes on in the states (at least herbal medicine). Even supervisors prescriptions in the school clinic are not a fair judge, they rarely spend much time with patients and rely many times of the students observations and perspectives. > > There are many levels and CM has a black hole of knowledge if one desires to access it. It is not easy, but testing simflied approaches (the way that is happening) is just Western medicine testing CMâ?Ts tools, not CMâ?Ts thinking! > > Finally, because of all of this, I think standardization is a double edged sword, and the many Chinese I have spoke with agree. It is a complex arena and many differing opinions. There are many ideas and articles on the subject. > > - > > _____ > > @ <%40> [@ <%40> ] On Behalf Of > Friday, May 04, 2007 5:31 PM > @ <%40> > Re: Acupuncture no better than sham in hypertension - SHARP Trial > > Ah, that's too bad, I guess I'll have to tell my patients I've helped > with hypertension over the years that it didn't really work. Also, > I'll have to tell all the patients I've treated over twenty-five > years with menstrual disorders, insomnia, digestive problems, and > other conditions that acupuncture only treats musculoskeletal disorders. > > > On May 4, 2007, at 2:28 PM, (AT) comcast (DOT) <%40comcast.net> net wrote: > > > shocking. in 13 years of practice, I never saw any sustained > > decrease in BP from the typical regimen of any form of acupuncture > > plus patent meds that could not be explained by other concurrent > > changes such as diet and exercise. Not just talking about myself, > > but also the patients seen by dozens of others supposedly skilled > > px in school clinics. Even high does herbs are not very effective > > and I was always dismayed to learn how many senior herbalists from > > China took BP meds as they aged as a result. sadly, I predict > > controlled evidence will ultimately show that acupuncture is good > > for some musculoskeletal problems and herbs for a wide range of > > minor complaints. But this medicine is not going to turn out to be > > the salvation of the world. If you really could cure things like > > hepatitis or lupus with TCM, the chinese would be making hay out of > > it instead of racing headlong into their embrace of modern science > > and cutting edge therapies like stem cells. Chinese med is a nice > > safe alternat > > ive to the drugstore for many of the minor things that ail people. > > no miracle cures hiding anywhere. > > > > -------------- Original message ---------------------- > > " " < (AT) tinet (DOT) <%40tinet.ie> ie> > >> Hi All, > >> > >> Bad news: the SHARP trial reported no benefit from AP over sham AP in > >> treating hypertension (BP: systolic 140-179mm Hg; diastolic > >> 90-109mm Hg). > >> > >> I have not been able to access the full text but the abstract is > >> below: > >> > >> Hypertension. 2006;48:838.) � 2006 American Heart Association, Inc. > >> Original Articles Stop Hypertension With the Acupuncture Research > >> Program (SHARP) Results of a Randomized, Controlled Clinical Trial > >> Eric A. > >> Macklin; Peter M. Wayne; Leslie A. Kalish; Peter Valaskatgis; James > >> Thompson; May C.M. Pian-Smith; Qunhao Zhang; Stephanie Stevens; > >> Christine Goertz; Ronald J. Prineas; Beverly Buczynski; Randall M. > >> Zusman > >> From the New England Research Institutes (E.A.M., L.A.K., S.S.), > >> Watertown, Mass; New England School of Acupuncture (P.M.W., P.V.), > >> Watertown, Mass; Children�s Hospital Boston (L.A.K.), Boston, Mass; > >> Massachusetts General Hospital (J.T., M.C.M.P.-S., Q.Z., B.B., > >> R.M.Z.), > >> Harvard Medical School, Boston, Mass; Samueli Institute (C.G.), > >> Alexandria, > >> Va; and the School of Medicine (R.J.P.), Wake Forest University, > >> Winston- > >> Salem, NC. Correspondence to Eric A. Macklin, New England Research > >> Institutes, Inc, 9 Galen St, Watertown, MA 02472. E-mail > >> EMacklin@NERIScienc <EMacklin%40NERIScience.com> e.com Case studies and small trials suggest that > >> acupuncture may effectively treat hypertension, but no large > >> randomized > >> trials have been reported. The Stop Hypertension with the Acupuncture > >> Research Program pilot trial enrolled 192 participants with > >> untreated blood > >> pressure (BP) in the range of 140/90 to 179/109 mm Hg. The design > >> of the > >> trial combined rigorous methodology and adherence to principles of > >> traditional Chinese medicine. Participants were weaned off > >> antihypertensives before enrollment and were then randomly > >> assigned to 3 > >> treatments: individualized traditional Chinese acupuncture, > >> standardized > >> acupuncture at preselected points, or invasive sham acupuncture. > >> Participants received 12 acupuncture treatments over 6 to 8 weeks. > >> During > >> the first 10 weeks after random assignment, BP was monitored every 14 > >> days, and antihypertensives were prescribed if BP exceeded 180/110 mm > >> Hg. The mean BP decrease from baseline to 10 weeks, the primary end > >> point, did not differ significantly between participants randomly > >> assigned to > >> active (individualized and standardized) versus sham acupuncture > >> (systolic > >> BP: -3.56 versus -3.84 mm Hg, respectively; 95% CI for the > >> difference: -4.0 > >> to 4.6 mm Hg; P=0.90; diastolic BP: -4.32 versus -2.81 mm Hg, 95% > >> CI for > >> the difference: -3.6 to 0.6 mm Hg; P=0.16). Categorizing > >> participants by > >> age, race, gender, baseline BP, history of antihypertensive use, > >> obesity, or > >> primary traditional Chinese medicine diagnosis did not reveal any > >> subgroups > >> for which the benefits of active acupuncture differed > >> significantly from sham > >> acupuncture. Active acupuncture provided no greater benefit than > >> invasive > >> sham acupuncture in reducing systolic or diastolic BP. Key Words: > >> acupuncture o blood pressure o hypertension o randomized clinical > >> trial o > >> traditional Chinese medicine > >> > >> Best regards, > >> > >> > >> > >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2007 Report Share Posted May 6, 2007 Dear Alon, Jason, Z'ev, Phil, Todd and all, I feel very strongly that it is foolish and short-sighted to consider that using simply a " tool " such as acupuncture alone is going to resolve a condition such as hypertension. Hypertension as with virtually every other condition is a manifestation of any number of patterns (eg. yin vacuity, liver fire, phlegm fire, liver yang rising, etc) along with so many other factors such as genetic predisposition, dietary indescretions, substance abuse, physical and emotional traumas, etc. To successfully resolve it, we must take a comprehensive approach, and any successful practitioner does just that. That means addressing the patient's imbalances biochemically, biomechanically and bioenergetically, as well as eliminating counterproductive behavior and lifestyle, sources of toxicity,and addressing emotional traumas. High blood pressure does not occur in a vacuum, and it is ridiculous to say that acupuncture is ineffective in treating it, any more than it is ridiculous to say that eating only organic produce will prevent liver disease or digestive disorders. Sincerely, Yehuda Alon Marcus <alonmarcus wrote: Jason That would have been my next question, what was the BP to start with. I have not treated to many BP pt but i have not seen much reduction in pt with pressures about 150/100 i have seen changes in mild cases. In china i have followed some 100 cases with high BP and i cant say i saw one pt that had such BPs manage them with herbs alone - Saturday, May 05, 2007 7:12 AM RE: Acupuncture no better than sham in hypertension - SHARP Trial Alon, Not sure, quite a few. But I guess we must clarify things, many must continue taking herbs / receive acupuncture. Most are on custom formulas, but I actually have 2 patients that are completely managed with Tian Ma Gou Teng Yin (pre-made granules). One of them needs only 6 capsules a day. (That is 3 grams or 3 scoops) in addition to her custom herb formula (osteoarthritis of the knee – which is completely managed) (6 caps a day) - it took 1 week for it to start working. Another I am thinking of was interesting because due to my poor intake I had no idea they had HBP and just treated the CC (GI). They reported back a couple months later and said that their BP had gone down dramatically (this was a modified bulk san ren tang). I myself had essential hypertension years ago, did raw herbs steady for 6 months and it has now been gone for years. I have a family history, so we will see with time… It seems like in most people, with a little tweaking you can get things under control. If the BP is too high already, you can get a reduction of meds but these people usually have many other problems as well. What are other’s experiences? - _____ On Behalf Of Alon Marcus Friday, May 04, 2007 10:09 PM Re: Acupuncture no better than sham in hypertension - SHARP Trial Jason Out of curiosity how many pt with essential hypertension have you treated successfully? - @ <%40> Friday, May 04, 2007 8:58 PM RE: Acupuncture no better than sham in hypertension - SHARP Trial I agree with Z’ev here 100%. There is no doubt CM has the ability to work (for HBP and many other conditions). Just because a modern cookbook style TCM approach may be found ineffective in some research, does not mean that CM cannot treat that disease. Do you know how many approaches one could find for any given complaint / condition. This is just with herbs. But in regard to acupuncture, just putting a needle in IMO is far from “real†acupuncture, therefore any standardized point (or herbal) prescription is a crap shoot either way (if it will work or not). We love to jump up and down when it does work and laugh (or cry) when it doesn’t. But clearly no one practices this way, or at least the practitioners that I respect and the ones that I see get bomber results. So why perform research in a way that the medicine is not practiced? IMO there is only one way to research CM, the way it is practiced (with placebos and all) – Put it as a whole, straight up against what ever your testing. IMO, “True†CM in practice literally relies on its ability to see the individual and customize treatments. This is not some cliché holistic mumbo jumbo, but clearly demonstrated in the CM literature by anyone who has spent time reading pre-modern or modern case studies. Clearly it is my experience, and doctors that I have followed, that it can effectively treat the very difficult diseases. Not just musculoskeletal. To judge CM with some base sample prescription (with some mods) is just not how the great doctors (that I have observed or read about) practice. It is comparing apples and oranges. Over simplification? Just because the current trend in China is to modernize and simplify the medicine with standardize protocols etc does not mean that practicing in an (opposite) individualized fashion doesn’t work, X does not negate Y. Quite frankly it is very hard to practice at the level that really makes use of all information (past and present) and writes individualized formulas, essentially practicing CM the way it is designed to. So why is China doing what they are doing? This is a complicated question and answer. But China is currently teaching to the masses, never before done like this. One school I recently visited (ZheJiang) had over 10,000 students enrolled. (BTW- only around 33% of them end up practicing, most looked like they for 18-20 years old, oh, they were). This western modernization has little to do with effectiveness, there are many factors, including economics (as always). Why are McDonalds popping up all over China? Training in China has many problems like we do. To put thing in perspective, one has to look where much of the research, that for example Bob has extensively published, comes from. For example, for a PHD thesis many students decide to do some easy research project, taking some base prescription with mods etc and putting it to the test for a given disease. Just like what we commonly read in the journals. When I was talking with the students they said, yes it is easy, you can be done in a few months. This is great for the many who just want there PHD and be out. The alternative is doing some classical literature research (or whatever) which can take years. Granted this (former) type of research can result in the newest and greatest patent for disease X, which does happen, but come on, this is not the in the trenches medicine. Granted there are all levels of doctors, there are those that just give xiao yao san over and over, but again let the results speak for themselves. Judging the medicine on its lowest common denominator makes little sense to me. Not to toally bash the Chinese, because they have 1 distinct advantage. The student who does want to break out of the box has almost unlimited resources compared to us. There are old doctors to study with, TCM libraries that I estimate are over 1000x bigger than the average school US TCM library to access material. There are young doctors that are totally rebelling against this modern trend and are very vocal about it! Addressing Todd’s 15 year observations: Do you think it is fair to gauge how well the medicine performs by years of watching students in a western school clinic? I have much respect for Todd and his herbal abilities, but in the three school clinics I have been in, I can only laugh at the level of medicine. I am not saying I am any better and I was at one time one of those fumbling students. But putting a 75 year old Chinese doctor to the test makes much more sense then concluding that CM doesn’t work from meager observations, especially with the relatively poor level of practice that goes on in the states (at least herbal medicine). Even supervisors prescriptions in the school clinic are not a fair judge, they rarely spend much time with patients and rely many times of the students observations and perspectives. There are many levels and CM has a black hole of knowledge if one desires to access it. It is not easy, but testing simflied approaches (the way that is happening) is just Western medicine testing CM’s tools, not CM’s thinking! Finally, because of all of this, I think standardization is a double edged sword, and the many Chinese I have spoke with agree. It is a complex arena and many differing opinions. There are many ideas and articles on the subject. - _____ @ <%40> [@ <%40> ] On Behalf Of Z'ev Rosenberg Friday, May 04, 2007 5:31 PM @ <%40> Re: Acupuncture no better than sham in hypertension - SHARP Trial Ah, that's too bad, I guess I'll have to tell my patients I've helped with hypertension over the years that it didn't really work. Also, I'll have to tell all the patients I've treated over twenty-five years with menstrual disorders, insomnia, digestive problems, and other conditions that acupuncture only treats musculoskeletal disorders. On May 4, 2007, at 2:28 PM, (AT) comcast (DOT) <%40comcast.net> net wrote: > shocking. in 13 years of practice, I never saw any sustained > decrease in BP from the typical regimen of any form of acupuncture > plus patent meds that could not be explained by other concurrent > changes such as diet and exercise. Not just talking about myself, > but also the patients seen by dozens of others supposedly skilled > px in school clinics. Even high does herbs are not very effective > and I was always dismayed to learn how many senior herbalists from > China took BP meds as they aged as a result. sadly, I predict > controlled evidence will ultimately show that acupuncture is good > for some musculoskeletal problems and herbs for a wide range of > minor complaints. But this medicine is not going to turn out to be > the salvation of the world. If you really could cure things like > hepatitis or lupus with TCM, the chinese would be making hay out of > it instead of racing headlong into their embrace of modern science > and cutting edge therapies like stem cells. Chinese med is a nice > safe alternat > ive to the drugstore for many of the minor things that ail people. > no miracle cures hiding anywhere. > > -------------- Original message ---------------------- > " " < (AT) tinet (DOT) <%40tinet.ie> ie> >> Hi All, >> >> Bad news: the SHARP trial reported no benefit from AP over sham AP in >> treating hypertension (BP: systolic 140-179mm Hg; diastolic >> 90-109mm Hg). >> >> I have not been able to access the full text but the abstract is >> below: >> >> Hypertension. 2006;48:838.) � 2006 American Heart Association, Inc. >> Original Articles Stop Hypertension With the Acupuncture Research >> Program (SHARP) Results of a Randomized, Controlled Clinical Trial >> Eric A. >> Macklin; Peter M. Wayne; Leslie A. Kalish; Peter Valaskatgis; James >> Thompson; May C.M. Pian-Smith; Qunhao Zhang; Stephanie Stevens; >> Christine Goertz; Ronald J. Prineas; Beverly Buczynski; Randall M. >> Zusman >> From the New England Research Institutes (E.A.M., L.A.K., S.S.), >> Watertown, Mass; New England School of Acupuncture (P.M.W., P.V.), >> Watertown, Mass; Children�s Hospital Boston (L.A.K.), Boston, Mass; >> Massachusetts General Hospital (J.T., M.C.M.P.-S., Q.Z., B.B., >> R.M.Z.), >> Harvard Medical School, Boston, Mass; Samueli Institute (C.G.), >> Alexandria, >> Va; and the School of Medicine (R.J.P.), Wake Forest University, >> Winston- >> Salem, NC. Correspondence to Eric A. Macklin, New England Research >> Institutes, Inc, 9 Galen St, Watertown, MA 02472. E-mail >> EMacklin@NERIScienc <EMacklin%40NERIScience.com> e.com Case studies and small trials suggest that >> acupuncture may effectively treat hypertension, but no large >> randomized >> trials have been reported. The Stop Hypertension with the Acupuncture >> Research Program pilot trial enrolled 192 participants with >> untreated blood >> pressure (BP) in the range of 140/90 to 179/109 mm Hg. The design >> of the >> trial combined rigorous methodology and adherence to principles of >> traditional Chinese medicine. Participants were weaned off >> antihypertensives before enrollment and were then randomly >> assigned to 3 >> treatments: individualized traditional Chinese acupuncture, >> standardized >> acupuncture at preselected points, or invasive sham acupuncture. >> Participants received 12 acupuncture treatments over 6 to 8 weeks. >> During >> the first 10 weeks after random assignment, BP was monitored every 14 >> days, and antihypertensives were prescribed if BP exceeded 180/110 mm >> Hg. The mean BP decrease from baseline to 10 weeks, the primary end >> point, did not differ significantly between participants randomly >> assigned to >> active (individualized and standardized) versus sham acupuncture >> (systolic >> BP: -3.56 versus -3.84 mm Hg, respectively; 95% CI for the >> difference: -4.0 >> to 4.6 mm Hg; P=0.90; diastolic BP: -4.32 versus -2.81 mm Hg, 95% >> CI for >> the difference: -3.6 to 0.6 mm Hg; P=0.16). Categorizing >> participants by >> age, race, gender, baseline BP, history of antihypertensive use, >> obesity, or >> primary traditional Chinese medicine diagnosis did not reveal any >> subgroups >> for which the benefits of active acupuncture differed >> significantly from sham >> acupuncture. Active acupuncture provided no greater benefit than >> invasive >> sham acupuncture in reducing systolic or diastolic BP. Key Words: >> acupuncture o blood pressure o hypertension o randomized clinical >> trial o >> traditional Chinese medicine >> >> Best regards, >> >> >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2007 Report Share Posted May 6, 2007 Yehuda i was not talking about acupuncture but CM. The pt i followed in china were mainly treated with herbs although some also did acup and qi gong. Emotional trauma was certainty not addressed, at least were i was and at the time i was there 1985. My interest in medicine is interventions that work on the majority of the population. I do not think many are interested or have the time to deal with their emotional traumas to lower their blood pressure, unless they suffer emotional pain. I am a good example, I have genetic metabolic syndrome with hypertension. I am willing to change my diet to some extent which is difficult because i eat out more than i do at home. I train in aikido 3-4 times a week so i do get some physical activity. I am willing to take herbs although i would probably not be willing to cook formulas for extended periods. My attitude is even more cooperative than many of the pt i see. So when talking about any treatment i think it must be realistic. I have been trying to use alternative methods for about 4 months or so. So far my blood pressure is reduced but not enough to be in the recommended levels which are now at 120's/70's. I have been taking combinations of powders and pills (with attention to multiple patterns) as well as some of the more popular nutritional approaches. Obviously this was not done in a " vacuum " although it would be nice to have the time to get regular acup which i do not. Looking at current evidence, keeping blood pressure at the recommended levels makes a big difference in prognosis so what is a person like me to do. I could give it more time but i am probably damaging my heart and kidneys by having a higher blood pressure. Finally, as i said before i do not see many pt for blood pressure in my practice so my US experience is limited to what i saw in school, following some of the most well known practitioners in the US as well as my training in China. From this experience when a pt asks me about treating hypertension at this point i tell them that TCM does not predictably lowers blood pressure and i have seen more failures than successes. I have seen many pt being able to reduce dosage of their medicines. However the question is if they do not have much sideeffects does that make much sense because it takes time and costs money. - yehuda frischman Saturday, May 05, 2007 11:54 PM Re: Acupuncture no better than sham in hypertension - SHARP Trial Dear Alon, Jason, Z'ev, Phil, Todd and all, I feel very strongly that it is foolish and short-sighted to consider that using simply a " tool " such as acupuncture alone is going to resolve a condition such as hypertension. Hypertension as with virtually every other condition is a manifestation of any number of patterns (eg. yin vacuity, liver fire, phlegm fire, liver yang rising, etc) along with so many other factors such as genetic predisposition, dietary indescretions, substance abuse, physical and emotional traumas, etc. To successfully resolve it, we must take a comprehensive approach, and any successful practitioner does just that. That means addressing the patient's imbalances biochemically, biomechanically and bioenergetically, as well as eliminating counterproductive behavior and lifestyle, sources of toxicity,and addressing emotional traumas. High blood pressure does not occur in a vacuum, and it is ridiculous to say that acupuncture is ineffective in treating it, any more than it is ridiculous to say that eating only organic produce will prevent liver disease or digestive disorders. Sincerely, Yehuda Alon Marcus <alonmarcus wrote: Jason That would have been my next question, what was the BP to start with. I have not treated to many BP pt but i have not seen much reduction in pt with pressures about 150/100 i have seen changes in mild cases. In china i have followed some 100 cases with high BP and i cant say i saw one pt that had such BPs manage them with herbs alone - Saturday, May 05, 2007 7:12 AM RE: Acupuncture no better than sham in hypertension - SHARP Trial Alon, Not sure, quite a few. But I guess we must clarify things, many must continue taking herbs / receive acupuncture. Most are on custom formulas, but I actually have 2 patients that are completely managed with Tian Ma Gou Teng Yin (pre-made granules). One of them needs only 6 capsules a day. (That is 3 grams or 3 scoops) in addition to her custom herb formula (osteoarthritis of the knee â? " which is completely managed) (6 caps a day) - it took 1 week for it to start working. Another I am thinking of was interesting because due to my poor intake I had no idea they had HBP and just treated the CC (GI). They reported back a couple months later and said that their BP had gone down dramatically (this was a modified bulk san ren tang). I myself had essential hypertension years ago, did raw herbs steady for 6 months and it has now been gone for years. I have a family history, so we will see with timeâ?¦ It seems like in most people, with a little tweaking you can get things under control. If the BP is too high already, you can get a reduction of meds but these people usually have many other problems as well. What are otherâ?Ts experiences? - _____ On Behalf Of Alon Marcus Friday, May 04, 2007 10:09 PM Re: Acupuncture no better than sham in hypertension - SHARP Trial Jason Out of curiosity how many pt with essential hypertension have you treated successfully? - @ <%40> Friday, May 04, 2007 8:58 PM RE: Acupuncture no better than sham in hypertension - SHARP Trial I agree with Zâ?Tev here 100%. There is no doubt CM has the ability to work (for HBP and many other conditions). Just because a modern cookbook style TCM approach may be found ineffective in some research, does not mean that CM cannot treat that disease. Do you know how many approaches one could find for any given complaint / condition. This is just with herbs. But in regard to acupuncture, just putting a needle in IMO is far from â?orealâ? acupuncture, therefore any standardized point (or herbal) prescription is a crap shoot either way (if it will work or not). We love to jump up and down when it does work and laugh (or cry) when it doesnâ?Tt. But clearly no one practices this way, or at least the practitioners that I respect and the ones that I see get bomber results. So why perform research in a way that the medicine is not practiced? IMO there is only one way to research CM, the way it is practiced (with placebos and all) â? " Put it as a whole, straight up against what ever your testing. IMO, â?oTrueâ? CM in practice literally relies on its ability to see the individual and customize treatments. This is not some cliché holistic mumbo jumbo, but clearly demonstrated in the CM literature by anyone who has spent time reading pre-modern or modern case studies. Clearly it is my experience, and doctors that I have followed, that it can effectively treat the very difficult diseases. Not just musculoskeletal. To judge CM with some base sample prescription (with some mods) is just not how the great doctors (that I have observed or read about) practice. It is comparing apples and oranges. Over simplification? Just because the current trend in China is to modernize and simplify the medicine with standardize protocols etc does not mean that practicing in an (opposite) individualized fashion doesnâ?Tt work, X does not negate Y. Quite frankly it is very hard to practice at the level that really makes use of all information (past and present) and writes individualized formulas, essentially practicing CM the way it is designed to. So why is China doing what they are doing? This is a complicated question and answer. But China is currently teaching to the masses, never before done like this. One school I recently visited (ZheJiang) had over 10,000 students enrolled. (BTW- only around 33% of them end up practicing, most looked like they for 18-20 years old, oh, they were). This western modernization has little to do with effectiveness, there are many factors, including economics (as always). Why are McDonalds popping up all over China? Training in China has many problems like we do. To put thing in perspective, one has to look where much of the research, that for example Bob has extensively published, comes from. For example, for a PHD thesis many students decide to do some easy research project, taking some base prescription with mods etc and putting it to the test for a given disease. Just like what we commonly read in the journals. When I was talking with the students they said, yes it is easy, you can be done in a few months. This is great for the many who just want there PHD and be out. The alternative is doing some classical literature research (or whatever) which can take years. Granted this (former) type of research can result in the newest and greatest patent for disease X, which does happen, but come on, this is not the in the trenches medicine. Granted there are all levels of doctors, there are those that just give xiao yao san over and over, but again let the results speak for themselves. Judging the medicine on its lowest common denominator makes little sense to me. Not to toally bash the Chinese, because they have 1 distinct advantage. The student who does want to break out of the box has almost unlimited resources compared to us. There are old doctors to study with, TCM libraries that I estimate are over 1000x bigger than the average school US TCM library to access material. There are young doctors that are totally rebelling against this modern trend and are very vocal about it! Addressing Toddâ?Ts 15 year observations: Do you think it is fair to gauge how well the medicine performs by years of watching students in a western school clinic? I have much respect for Todd and his herbal abilities, but in the three school clinics I have been in, I can only laugh at the level of medicine. I am not saying I am any better and I was at one time one of those fumbling students. But putting a 75 year old Chinese doctor to the test makes much more sense then concluding that CM doesnâ?Tt work from meager observations, especially with the relatively poor level of practice that goes on in the states (at least herbal medicine). Even supervisors prescriptions in the school clinic are not a fair judge, they rarely spend much time with patients and rely many times of the students observations and perspectives. There are many levels and CM has a black hole of knowledge if one desires to access it. It is not easy, but testing simflied approaches (the way that is happening) is just Western medicine testing CMâ?Ts tools, not CMâ?Ts thinking! Finally, because of all of this, I think standardization is a double edged sword, and the many Chinese I have spoke with agree. It is a complex arena and many differing opinions. There are many ideas and articles on the subject. - _____ @ <%40> [@ <%40> ] On Behalf Of Z'ev Rosenberg Friday, May 04, 2007 5:31 PM @ <%40> Re: Acupuncture no better than sham in hypertension - SHARP Trial Ah, that's too bad, I guess I'll have to tell my patients I've helped with hypertension over the years that it didn't really work. Also, I'll have to tell all the patients I've treated over twenty-five years with menstrual disorders, insomnia, digestive problems, and other conditions that acupuncture only treats musculoskeletal disorders. On May 4, 2007, at 2:28 PM, (AT) comcast (DOT) <%40comcast.net> net wrote: > shocking. in 13 years of practice, I never saw any sustained > decrease in BP from the typical regimen of any form of acupuncture > plus patent meds that could not be explained by other concurrent > changes such as diet and exercise. Not just talking about myself, > but also the patients seen by dozens of others supposedly skilled > px in school clinics. Even high does herbs are not very effective > and I was always dismayed to learn how many senior herbalists from > China took BP meds as they aged as a result. sadly, I predict > controlled evidence will ultimately show that acupuncture is good > for some musculoskeletal problems and herbs for a wide range of > minor complaints. But this medicine is not going to turn out to be > the salvation of the world. If you really could cure things like > hepatitis or lupus with TCM, the chinese would be making hay out of > it instead of racing headlong into their embrace of modern science > and cutting edge therapies like stem cells. Chinese med is a nice > safe alternat > ive to the drugstore for many of the minor things that ail people. > no miracle cures hiding anywhere. > > -------------- Original message ---------------------- > " " < (AT) tinet (DOT) <%40tinet.ie> ie> >> Hi All, >> >> Bad news: the SHARP trial reported no benefit from AP over sham AP in >> treating hypertension (BP: systolic 140-179mm Hg; diastolic >> 90-109mm Hg). >> >> I have not been able to access the full text but the abstract is >> below: >> >> Hypertension. 2006;48:838.) � 2006 American Heart Association, Inc. >> Original Articles Stop Hypertension With the Acupuncture Research >> Program (SHARP) Results of a Randomized, Controlled Clinical Trial >> Eric A. >> Macklin; Peter M. Wayne; Leslie A. Kalish; Peter Valaskatgis; James >> Thompson; May C.M. Pian-Smith; Qunhao Zhang; Stephanie Stevens; >> Christine Goertz; Ronald J. Prineas; Beverly Buczynski; Randall M. >> Zusman >> From the New England Research Institutes (E.A.M., L.A.K., S.S.), >> Watertown, Mass; New England School of Acupuncture (P.M.W., P.V.), >> Watertown, Mass; Children�s Hospital Boston (L.A.K.), Boston, Mass; >> Massachusetts General Hospital (J.T., M.C.M.P.-S., Q.Z., B.B., >> R.M.Z.), >> Harvard Medical School, Boston, Mass; Samueli Institute (C.G.), >> Alexandria, >> Va; and the School of Medicine (R.J.P.), Wake Forest University, >> Winston- >> Salem, NC. Correspondence to Eric A. Macklin, New England Research >> Institutes, Inc, 9 Galen St, Watertown, MA 02472. E-mail >> EMacklin@NERIScienc <EMacklin%40NERIScience.com> e.com Case studies and small trials suggest that >> acupuncture may effectively treat hypertension, but no large >> randomized >> trials have been reported. The Stop Hypertension with the Acupuncture >> Research Program pilot trial enrolled 192 participants with >> untreated blood >> pressure (BP) in the range of 140/90 to 179/109 mm Hg. The design >> of the >> trial combined rigorous methodology and adherence to principles of >> traditional Chinese medicine. Participants were weaned off >> antihypertensives before enrollment and were then randomly >> assigned to 3 >> treatments: individualized traditional Chinese acupuncture, >> standardized >> acupuncture at preselected points, or invasive sham acupuncture. >> Participants received 12 acupuncture treatments over 6 to 8 weeks. >> During >> the first 10 weeks after random assignment, BP was monitored every 14 >> days, and antihypertensives were prescribed if BP exceeded 180/110 mm >> Hg. The mean BP decrease from baseline to 10 weeks, the primary end >> point, did not differ significantly between participants randomly >> assigned to >> active (individualized and standardized) versus sham acupuncture >> (systolic >> BP: -3.56 versus -3.84 mm Hg, respectively; 95% CI for the >> difference: -4.0 >> to 4.6 mm Hg; P=0.90; diastolic BP: -4.32 versus -2.81 mm Hg, 95% >> CI for >> the difference: -3.6 to 0.6 mm Hg; P=0.16). Categorizing >> participants by >> age, race, gender, baseline BP, history of antihypertensive use, >> obesity, or >> primary traditional Chinese medicine diagnosis did not reveal any >> subgroups >> for which the benefits of active acupuncture differed >> significantly from sham >> acupuncture. Active acupuncture provided no greater benefit than >> invasive >> sham acupuncture in reducing systolic or diastolic BP. Key Words: >> acupuncture o blood pressure o hypertension o randomized clinical >> trial o >> traditional Chinese medicine >> >> Best regards, >> >> >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2007 Report Share Posted May 6, 2007 _____ On Behalf Of Alon Marcus Jason That would have been my next question, what was the BP to start with. Alon, Across the board. -Jason Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2007 Report Share Posted May 6, 2007 Jason I do not understand what you mean by across the board - Sunday, May 06, 2007 4:51 PM RE: Acupuncture no better than sham in hypertension - SHARP Trial _____ On Behalf Of Alon Marcus Jason That would have been my next question, what was the BP to start with. Alon, Across the board. -Jason Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2007 Report Share Posted May 6, 2007 A, Some low, some high. Obviously the higher it gets the harder it becomes. -JB _____ On Behalf Of Alon Marcus Sunday, May 06, 2007 5:57 PM Re: Acupuncture no better than sham in hypertension - SHARP Trial Jason I do not understand what you mean by across the board - @ <%40> Sunday, May 06, 2007 4:51 PM RE: Acupuncture no better than sham in hypertension - SHARP Trial _____ @ <%40> [@ <%40> ] On Behalf Of Alon Marcus Jason That would have been my next question, what was the BP to start with. Alon, Across the board. -Jason Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2007 Report Share Posted May 6, 2007 I am sorry about the crosspost, but since the original was crossposted, here are my comments: There is another issue here and where I think the current attacks are being based from biomedicine: the use of " sham acupuncture. " After looking at dozens of papers that compare acupuncture to sham acupuncture, here is the general scenario: let's get a valid acupuncture protocol with TCM practitioner input which invariably includes big, popular points such as LI 4, St 36, Sp 6. Then for a control, we will use sham acupuncture. When you read the methodology these " shams " are usually placed 1-2 cm from the actual acupuncture points. Of course, in these big points a centimeter or two is probably still on the actual point, not taking into account angle of insertion or depth (which are rarely mentioned in the methods despite the excellent STRICTA protocols). So we have a situation where the actual acupuncture points are essentially the same as the sham points. So if the study shows positive impact then the headline reads, as it did 6 months ago, " Migraines helped by acupuncture, sham acupuncture equally helpful. " This gives ammo to critics who simply say it obviously doesn't matter which point is chosen and therefore the " system " doesn't work. Or in the case of this paper, which doesn't have a non-treatment control, even though there was a reduction of blood pressure (which may or may not be statistically valid), the treatment was essentially the same as the control and therefore the treatment is invalid. As acupuncturists we have to be very careful of this new trend for research to use " sham " acupuncture as a control. No matter the results, they are interpreted to be against acupuncture. The best design is probably a comparison of best practices where acupuncture is compared with the standard biomedical practice and may the best intervention win. Of course this is open to often heated debate. ************************************************************************** Dr. Greg Sperber, BMBS, DAOM, MBA, L.Ac. California Licensed Acupuncturist Diplomate in Oriental Medicine (NCCAOM) Greg *************************************************************************** > Hi All, >Bad news: the SHARP trial reported no benefit from AP over sham AP in >treating hypertension (BP: systolic 140-179mm Hg; diastolic 90-109mm Hg). >I have not been able to access the full text but the abstract is below: >Hypertension. 2006;48:838.) C 2006 American Heart Association, Inc. >Original Articles Stop Hypertension With the Acupuncture Research >Program (SHARP) Results of a Randomized, Controlled Clinical Trial Eric A Quote Link to comment Share on other sites More sharing options...
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