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.