ACUPUNCTURE

(Investigator 147, 2012 November)



History

A Chinese philosophical concept, acupuncture dates back some five thousand years. It is mentioned in the Huang-ti Nei-Ching (Yellow Emperor’s Classic of Internal Medicine), a comprehensive documentation of Traditional Chinese Medicine during the time of the Yellow Emperor, Huang-ti, about 2697-2595 B.C.E. Needles made from stone, gold, silver and bronze over 4000 years ago have been found by archaeologists in China.

Although the origin of acupuncture is obscure, some scholars believe that it derived from "scarifying" the skin, and legend has it that a soldier who was injured by an arrow was relieved of his pain when struck by a second arrow.

Introduced into Europe by missionaries in the 17th century, interest waxed and waned until the latter part of that century when it became well established in France and Germany.

Ironically, while gaining popularity in the Western world, the Chinese banned the use of acupuncture several times between 1822 and 1929. Japan too, prohibited the practice in 1876.

When the Communists came to power in 1949, Mao Tse-Tung revived acupuncture together with other forms of traditional Chinese medicine. This was a political solution to overcome the shortage of Western trained doctors and to provide health care for the country’s 600,000,000 people. In 1958, the Chinese began touting acupuncture anaesthesia, attracting the attention of the Western world.

As a direct result of President Nixon's visit to China in 1970, acupuncture was introduced into America with the cultural exchange of medical practitioners between the United States and China. It was also given a boost by The New York Times' noted political analyst James Reston whose appendix was supposedly removed with acupuncture as the anesthetic.

Theory

Originally a humoral concept, in which disease demons were allowed to escape through bloodletting, it was later replaced by the concept of vital energy or life-force. This life-force (Qi or chi), is said to flow in channels beneath the surface of the body constantly interacting between two poles, the Yin negative or feminine element, and the Yang the positive or masculine element. The surface markings of the channels are known as "meridians", along which the acupuncture points or acupoints are precisely located. The original 365 acupoints, corresponding with the number of days in a year, have increased over the millennia and now exceed two thousand.

Each meridian is said to be associated with a particular vital organ, and along the routes of these meridians are tiny energy conductors called tsbos. Their job is to keep energy circulating throughout the body.

Acupuncturists believe that an excess or a deficiency of chi can result in illness, thus by stimulating an acupoint, they can build up chi if there is a deficiency, or drain chi if here is an excess of energy. This balancing of energy is alleged to restore the patient's health.

Acupoints can also be stimulated by the application of heat, cold, electricity, or pressure. Experiments are also being carried out using laser light.


Practice

The term acupuncture is derived from the Latin acus (needle), and punctura (to prick). It involves the insertion of the tips of fine needles into the skin at specific points. Sometimes the needles are rotated or pumped. Weak electrical currents and light are also used by some acupuncturists to stimulate the acupoints. Pulse diagnosis is also used to detect any "imbalances" in the flow of chi.


Assessment

Traditional Chinese medicine encompasses a variety of folk medical practices of which acupuncture is one. While some acupuncturists espouse the traditional view of health and disease, this assessment is concerned only with traditional acupuncture as now practiced.

Dismissed by many science-based medical practitioners as so much "oriental hocus-pocus", the evidence to support both the hypothesis and the efficacy of acupuncture is very thin indeed. Pulse diagnosis is immediately suspect on the grounds that medical science recognises only one pulse corresponding to the heart beat, whereas the advocates of pulse diagnosis allege there are six said to correlate with body organs or functions.

Despite numerous efforts having been made to demonstrate the existence of both meridians and acupoints, all have failed.

One experiment carried out in France in 1984, by De Vernejoul Aldarde and Daras, claimed to have detected meridians with the help of Technetium 99. A check of the experiment by Professor Otto Prokop, together with the Rostock University Radiology Hospital, showed that the radioactive tracer injected into the acupoints diffused to the nearby veins and was then transported by them not by the meridians.

The endorphin hypothesis seized upon by acupuncturists has also been found wanting. Modelled on the Yin-Yang philosophy, it has been claimed that it is effective in the treatment of mental disease, chronic pain and psychiatric symptoms. Studies allegedly in support of acupuncture-induced release of endorphins are either inapplicable or conflicting.

In 1981 the American Medical Association Council on Scientific Affairs noted that pain relief does not occur consistently or reproducibly in most people and does not operate at all in some people.

In 1990, three Dutch epidemiologists analysed 51 controlled studies of acupuncture for chronic pain and concluded that "the quality of even the better studies proved to be mediocre ... The efficacy of acupuncture in the treatment of chronic pain remains doubtful". They also examined reports of acupuncture used to treat various forms of addiction, concluding that acupuncture is not effective as a therapy.

Claims that acupuncture is an effective anaesthesia for use in major surgery has also been found wanting.

Patients who were supposedly operated on using acupuncture as an anaesthetic, were, in fact, selected for their high pain tolerance and heavily indoctrinated beforehand. Petr Skrabanek in the May 26, 1984 issue of the Lancet, reported that local anaesthesia with procaine and pethidine had been administered surreptitiously in intravenous drips. Further, that during the Cultural Revolution, medical records and research papers had been falsified to satisfy the party line.

Positive reports about the efficacy of acupuncture circulating in the West before and after the Nixon visit to China were completely untrue, as were those concerning James Reston. Chemical anesthesia was used during the operation to remove his appendix.

In 1991, in the United States, the National Council Against Health Fraud completed a three year review of the scientific literature and evaluation of acupuncture marketing practices. Among its conclusions were that acupuncture is an unproven modality of treatment: its theory and practice are based on primitive and fanciful concepts of health and disease that bear no relationship to present scientific knowledge, and that the perceived effects of acupuncture are probably due to a combination of expectation, suggestion, counter-irritation, operant conditioning and other psychological mechanisms.

Notwithstanding the prevarications, acupuncture is now recognised as having some analgesic properties, although its potency has been greatly exaggerated.

George A. Ulett. M.D., Ph.D., Clinical Professor of Psychiatry, University of Missouri School of Medicine, believes that the traditional Chinese variety is primarily a placebo treatment, but electrical stimulation of about 80 acupoints has been proven useful for pain control.

A 1989 report on acupuncture published by the Australian National Health and Medical Research Council (NHMRC) looked at the biological basis of acupuncture analgesia. In essence, it concluded that acupuncture does have a mild neurophysiological effect to reduce pain. It uses the same mechanisms as opiates, although somewhat differently. But the main thrust is that it is not meridians, it is nerves. No nerves, no acupuncture.

Some significant risks are associated with acupuncture treatment including faulty diagnosis of a dangerous condition, fainting, hematoma and infections. A survey of 1,135 Norwegian physicians revealed 66 cases of infection, 25 cases of punctured lung, 31 cases of increased pain, and 80 cases with complications. A parallel survey of 197 acupuncturists yielded 132 cases of fainting, 26 cases of increased pain, 8 cases of pneumothorax, and 45 other adverse results.

The dangers can be readily understood when one realises that acupuncture needling is not confined to the skin but can include needles up to 30 cm long used to penetrate deep into the body. Others are thin and poorly made with a tendency to break off in the patient.

Some supporters of acupuncture refer to the studies of acupuncture on animals, suggesting that the placebo effect is excluded. However, animals must be restrained and can develop anaesthesia due to fear and catalepsy. Further, the studies do not differentiate between "real" and "sham" acupuncture and provide no details as to the source of the acupuncture points used. There is no description of acupuncture on animals in the historical Chinese literature.

The following report and analysis appeared on consumer advocate Dr. Stephen Barrett's Quackwatch web page (http://www.quackwatch.com) and is reprinted here with permission.


National Institute of Health (NIH) Debacle.

"In November 1997, a Consensus Development Conference sponsored by the American National Institute of Health and several other agencies concluded that 'there is sufficient evidence ... of acupuncture's value to expand its use into conventional medicine and to encourage further studies of its physiology and clinical value'. The panelists also suggested that the federal government and insurance companies expand coverage of acupuncture so more people could have access to it.

''These conclusions were not based on research done since National Council Against Health Fraud (NCAHF)'s position paper was published. Rather, they reflected the bias of the panelists who were selected by a planning committee dominated by acupuncture proponents.

"Although the report described some serious problems, it failed to place them into proper perspective. ''The panel acknowledged that 'the vast majority of papers studying acupuncture consist of case reports, case series, or intervention studies with designs inadequate to assess efficacy' and that 'relatively few' high-quality controlled trials have been published on acupuncture's effects. But it reported that 'the World Health Organization has listed more than 40 [conditions] for which [acupuncture] may be indicated'. This sentence should have been followed by a statement that the list was not valid.

"Far more serious, although the consensus report touched on Chinese acupuncture theory, it failed to point out the danger and economic waste involved in going to practitioners who can't make appropriate diagnoses. The report noted:

"The general theory of acupuncture is based on the premise that there are patterns of energy flow (Qi) through the body that are essential for health. Disruptions of this flow are believed to be responsible for disease. The acupuncturist can correct imbalances of flow at identifiable points close to the skin. Acupuncture focuses on a holistic, energy-based approach to the patient rather than a disease-oriented diagnostic and treatment model.

"Despite considerable efforts to understand the anatomy and physiology of the 'acupuncture points', the definition and characterization of these points remains controversial. Even more elusive is the scientific basis of some of the key traditional Eastern medical concepts such as the circulation of Qi, the meridian system, and the five phases theory. All of which are difficult to reconcile with contemporary biomedical information but continue to play an important role in the evaluation of patients and the formulation of treatment in acupuncture.

"Simply stated, this means that if you go to a practitioner who practices traditional Chinese medicine, you are unlikely to be properly diagnosed. Claims that acupuncture is an effective anaesthesia for use in major surgery has also been found wanting.

"About a month ago, following his lecture at a local college, an experienced Traditional Chinese Medicine (TCM) practitioner diagnosed me by taking my pulse and looking at my tongue. He stated that my pulse showed signs of 'stress' and that my tongue indicated I was suffering from 'congestion of the blood'. A few minutes later, he examined a woman and told her that her pulse showed premature ventricular contractions (a usually harmless disturbance of the heart's rhythm). He suggested that both of us undergo treatment with acupuncture and herbs ... which would have cost about $90 per visit. I took the woman's pulse and found that it was completely normal. I believe that the majority of nonmedical acupuncturists practice in this manner. The National Institute of Health (NIH) consensus panel should have emphasized the seriousness of this problem."

As an interesting aside, scholars of Chinese history, who can read original ancient works, point out that originally Yin and Yang were not meant to be interpreted literally or as biological entities. The original texts are poetic and allegorical as in "the dark side of the force". It was only subsequently that the concepts were perverted to be something biological.

From: Edwards, H. 1999 Alternative, Complementary, Holistic & Spiritual Healing.


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