Acu-bunk-ture

[Xiao3 Meng4]

having done research myself, I agree that it is very difficult to design a good study, and in some cases it may not be possible to accurately asses certain things w/RCT's (although anecdotal case studies can be a great alternative!)

My vision of the future of Medicine is an integrated approach. A major component of this is inter-disciplinary respect, understanding and communication. I don't want to oppose other models, I want to work with them for the benefit of my patients.

In this vein, it's very tempting to want to "speak the local language"; to have some kind of Western BioMed explanation as to why what I'm doing actually works... and I will admit that I've collected a few choice pieces of research which I feel to be well designed and up to snuff, or at least vetted by a respectable international body. However, I am 100% in agreement that studies from China are NOT reliable, RCTs are often not able to accurately assess certain components of acupuncture due to their propensity towards generalization, and TCM studies often leave huge gaps in their approach. It's to the point where I feel that I'm better off explaining acupuncture to MDs via the standard "Foreign Body Invasion" model ("Look, it's like simultaneously capitalizing on the inflammatory/autoimmune effects of getting a sliver and the effects of triggering a selected nerve fibre response..." Super crude, limited in scope, but understandable at least.)

The anecdotal case studies method is definitely the route I prefer these days. In Canada, many medical tests are government subsidized, so it's very easy to have patients get a bunch of tests done before beginning treatment, and have them track their progression in part through regular testing. Of course, the changes in their symptoms are also an important component, as are the changes in their signs... although often times acupuncture deals with subclinical signs, so it's sometimes difficult to point to these when talking with a Western Doctor. Naturally, it's easier when there's some kind of true clinical sign. In combination, they provide a strong picture of the results of treatment for myself, the patient, and their doctor.

Actually, my father went to see an acupuncturist in Toronto a few years back. He had quite poor liver funtion and high cholesterol. His bloodwork has always been a cause for concern. After his treatments, he went and had new bloodwork done, and his MD called him in to discuss the results. The first thing he asked was, "are you on any medications or treatments that I'm not aware of?" My dad, being a classic "don't p!ss off the MD" personality, said No. His MD continued on to say, "Your bloodwork is the best it's been it 15 years." If only my dad had explained himself!

The rest of your post was a truly enjoyable and informative read. In no way do I feel you to be criticizing acupuncture, and I commend you for your rigorous approach to research analysis.

I cordially invite anyone who believes the statements quoted above to visit me for empirical clarification on this subject...

Haha Doc, way to throw down the gauntlet!

and after 20 min session, I had almost total ROM and after 5 sessions I was MUCH better.

Glad to hear you had a positive experience!

[SimonM]

You going to pay for my bus ticket down to Texas Mr. Strier?

Alternatively you could contact James Randi and try to claim your million bucks.

[Doc Stier]

You going to pay for my bus ticket down to Texas Mr. Stier?

Alternatively you could contact James Randi and try to claim your million bucks.

Sorry, Simon, you're on your own for the bus fare.

And I don't think my work qualifies for James Randi's challenge, as it does not fall into the 'magic' or 'psychic phenomenon' categories, and besides, he has that whole offer set up in a way which guarantees that nobody will ever collect the million dollar prize.

Doc

[SimonM]

No.

Nobody ever has collected the prize because nobody has been able to provide verification under scientific conditions of a supernatural ability.

The ability to regulate the organs of the body by manipulation of an un-measurable, invisible, energy field would certainly qualify as supernatural. And that is what you claim to do right?

[taai gihk yahn]

I'll say this about it, I never believed it.
Then I was getting rehab on my left shoulder for tendonitus and an "impingment".
The therapist suggested Accupunture, I laughed and said I don't believe in that stuff.
He replied I had nothing to lose so I said sure.
Well, he put a needle in my hand, on that web between the thumb and index finger and some on shoulder, put a pad that contracted my muscle ( we had used just the pad before to no real difference) and after 20 min session, I had almost total ROM and after 5 sessions I was MUCH better.
That's all I can say.

well, I have had similar results with people who have had the run-of-the-mill-PT (that is, crap) and I've gotten my hands on them and they've had full shoulder AROM in minutes; reason is that most shoulder "impingement" has nothing to do w/the suprasipnatus tendon getting stuck, it has to do with hyperteonicity of muscles that resist shoulder abduction (lifting it up sideways), such as intercostals, subscapularis and / or latissimuss, which are easily treatable with one or two simple manuevers; alternately, doing a simple HVLA to the thoracic spine can dramatically increase available AROM as well; once in a while, it's more complex, like treating the same side hip / pelvis (quadratus lumborum being a big culprit here), sometimes you have to squeeze their head for a while as well...

anyway, I don't know what points in the shoulder were needled, but the LI4 pt. seems to have some sort of generalized detonification effect on arm flexors / internal rotators (of which subscap and lats could be considered contributory); anyway, I completely believe that it worked, I just don't consider it that amazing in context of how readily that sort of thing responds to other intelligent interventions - the really amazing thing to me is that so many PT's are just thick-skulled and insist on continually cranking on people's arms with no discernible positive effect...

[taai gihk yahn]

I cordially invite anyone who believes the statements quoted above to visit me for empirical clarification on this subject. I will gladly stimulate the appropriate energy point or points in order to cause your body site of choice to become either totally numb and devoid of any feeling or sensation whatsoever, or to become so sensitive that the lightest touch will be quite painful.

that's reasonable - I would propose that the mediating medium is the fascial system...assuming you are not jabbing needles into nerves or ganglia, which I suspect you are not...

Alternately or additionally, I would be happy to dramatically increase or decrease the the internal organ function of your choice by similarly stimulating and manipulating the appropriate acupuncture points. For example, I could cause you to experience multiple, copius bowel movements everyday for next several days, or cause you to have no bowel movement whatsoever for the next week or two.

Your choice, of course, but be careful what you ask for....! These affects can be convicingly demonstrated whether you believe that I can do so or not, and does not depend on mental suggestion or the like to be effective.

again, considering that we auto-regulate our own auntonomic functions constantly (e.g. - mental stress can result in constipation; panic can lead to loose bowels), this in and of itself is not too difficult to encompass: your being able to do so would simply indicate that your level of skill is up to that sort of thing;

of course, the real way to test this is simple: Doc gets a volunteer to agree to a list of say 10 different body functions, one of which Doc will cause to change via his acup. treatment; however, he doesn't tell the volunteer which one exactly he will pick, but writes it down and puts it in a sealed envelope somewhere; if the volunteer has the same augmented / decreased function as the one Doc writes down, then it's purely objective, we know the treatment caused it; in this case, it's guaranteed not placebo, because Doc has 10 things to choose from, it's too many for someone to replicate on their own (or if they did, you'd know it was self-mediated); it's not unethical, because the subject agreed that any of the 10 would be acceptable if it occurred; I would personally volunteer for that study if I had the opportunity - but unfortunately I am not near Texas...
props to Doc for being willing to "step up" to the plate on this though (I have always had the same perspective: if you don't believe what I do works, come see me; if I can't appreciably fix you in 3 sessions, no charge)

Real Classical Oriental Medicine is a precise method of energy healing which easily transcends what people believe to true or false about it, and has done so with such success for such a long time, that it has unwittingly created a major problem. Namely, that more than half of the total human population of our planet is Mongoloid by race and living in Asia, they are too healthy on the whole, they live too long, and there is not enough of almost anything to meet their needs.

I don't know if I buy that - it's a bit of a stretch; that would imply that the degree of good treatment was uniform and consistent across millennia, it ignores things like climate, diet, genetics, public health programs, etc.

The World Health Organization (WHO) has estimated that more human suffering, illness and disease has been successfully treated thus far in human history by Classical Chinese/Oriental Medicine than all other healing and medical modalities combined to date.

where is this available in print?

Not too bad for supposed quackery, eh?

see, I believe that acupuncture is "real": meaning that having been needled, it has produced sensations unlike any other I've felt from any other modality (although, I can't say it has "fixed" anything more effectively for me than getting a good osteopathic treatment has); but by its very nature, it's ripe for misapplication, misappropriation and misunderstanding; never mind that there are different schools of thought that can conflict with each other, but all of which have at some point or another "helped" patients;

bottom line, as I mentioned earlier, it is a modality that is part of a system of healing that to a large degree is predicated on the skill of the operator and his interaction directly with the patient; as such, I think that when you start using a double-blind, RCT format, you have to be very careful about the design and the outcomes, because I think you can draw a lot of false conclusions, both supporting and "debunking" it;

so, while I am personally not casting doubt on Doc's claims nor calling into question his clinical track record (I would have no way of being able to do that), the most I can say is that I can totally see why some people would consider acupuncture as quackery and feel justified in that opinion; which is why TCM (or whatever) peeps have to be very careful when they want to play the EBM game and start claiming clinical efficacy based on studies that are flawed in design (of which there are many); my point with all this is to state the problem clearly: TCM as a profession, if it wants to be considered kosher from an EBM perspective has to learn how to present itself appropriately in that vein; now, it could go the other way, and just say "look, what we do would not be validly / reliably assessed by that methodology" and come up with other ways to delineate itself; but producing flawed studies with dubious claims does nothing, it only serves to provide the naysayers with even more ammo...

[SimonM]

Please keep in mind that even if Acupuncture is nothing more than placebo effect (likely) that doesn't stop other "medical" practices from being total bunk.

[taai gihk yahn]

Please keep in mind that even if Acupuncture is nothing more than placebo effect (likely) that doesn't stop other "medical" practices from being total bunk.

for example:

laparoscopic "cleaning" of the knee has been shown to have absolutely no difference in effect versus sham procedure on patient's reports of symptoms, despite it having been an established form of intervention for decades

MRI's showing lumbar spine bulging discs have been shown to be invalid / unreliable in diagnosing the cause of LBP, because the incidence of "abnormal" disc bulges on MRI are almost as common in asymptomatic people as in symptomatic LBP patients, despite being the final word in diagnosis for years

just 2 examples...

[Xiao3 Meng4]

The ability to regulate the organs of the body by manipulation of an un-measurable, invisible, energy field would certainly qualify as supernatural. And that is what you claim to do right?

There may be some practitioners (and CMAists) that view Qi as a quantitative force, or "energy field." I personally disagree with this definition.

Qi to me is "the dynamic relationship between two complementary polar aspects comprising a singular whole," or to put it succinctly, "the dynamic relationship of YinYang." It's a "relationship," not an "energy," and as such is qualitative more than quantitative.

So when I practice acupuncture, I'm adjusting the "relationships" of the body's many complementary polar aspects - be it the relationship of the left musculature to the right, the limbs to the trunk, the front stabilising muscles to the back ones, the inflammatory response to the anti-inflammatory response, the sympathetic nervous system to the parasympathetic, autonomic to the somatic, the physiology to the psychology, or other observed relationships. Granted, acupuncture doesn't use the labels I've just used, and many relationships are often adjusted at once: none of the relationships in the above-mentioned “polar aspects comprising a singular whole,” however, have any need for a supernatural force in order to be affected or manipulated. Neither does any other acupuncture claim for that matter, and those who say otherwise are, in my books, on the same level as dishonest (or at least misguided) Kung Fu instructors.

that's reasonable - I would propose that the mediating medium is the fascial system...assuming you are not jabbing needles into nerves or ganglia, which I suspect you are not...

The Fascial system is definitely a very useful target for acupuncture. Some have related it directly to the Jing Jin (Contractile aspect) of the body.

Doc: I do not mean to imply that you are dishonest or misguided because you use the word energy, since I do not think that you mean to imply a supernatural cause to your effects.

[taai gihk yahn]

My vision of the future of Medicine is an integrated approach. A major component of this is inter-disciplinary respect, understanding and communication. I don't want to oppose other models, I want to work with them for the benefit of my patients.

then a much greater degree of clarification is going to be needed on both ends...

In this vein, it's very tempting to want to "speak the local language"; to have some kind of Western BioMed explanation as to why what I'm doing actually works... and I will admit that I've collected a few choice pieces of research which I feel to be well designed and up to snuff, or at least vetted by a respectable international body. However, I am 100% in agreement that studies from China are NOT reliable, RCTs are often not able to accurately assess certain components of acupuncture due to their propensity towards generalization, and TCM studies often leave huge gaps in their approach. It's to the point where I feel that I'm better off explaining acupuncture to MDs via the standard "Foreign Body Invasion" model ("Look, it's like simultaneously capitalizing on the inflammatory/autoimmune effects of getting a sliver and the effects of triggering a selected nerve fibre response..." Super crude, limited in scope, but understandable at least.)

not too crude; but no reason why you should stop there - I firmly believe that all TCM-related phenomena can be fully explained utilizing contemporary anatomical / physiological knowledge - and really ought to be as well - the challenge is to be able to synthesize the "western" knowledge in such a way that it describes the complex systems-based way in which TCM (and I would argue, osteopathy) effects the organism; because, if it can, it verifies the validity of the approach; this doesn't mean getting rid of the metaphorical descriptors previously used either, it just proves the strength of the approach - if you can describe something works using a system that is "alien", that, to me, confirms the universality! and there is nothing "crude" about describing TCM anatomically / physiologically - I personally think that the "western" way of describing things is inherently elegant and amazing - organic chemical equations describe a certain aspect of the fundamental processes of life - what's crude about that?
personally, I think that the connective tissue matrix in combination with the autonomic nervous system are important mediators in terms of "why" acupuncture "works"...

The anecdotal case studies method is definitely the route I prefer these days. In Canada, many medical tests are government subsidized, so it's very easy to have patients get a bunch of tests done before beginning treatment, and have them track their progression in part through regular testing. Of course, the changes in their symptoms are also an important component, as are the changes in their signs... although often times acupuncture deals with subclinical signs, so it's sometimes difficult to point to these when talking with a Western Doctor. Naturally, it's easier when there's some kind of true clinical sign. In combination, they provide a strong picture of the results of treatment for myself, the patient, and their doctor.

precisely why you need case studies: to highlight why "sub clinical" signs are of relevance;

Actually, my father went to see an acupuncturist in Toronto a few years back. He had quite poor liver funtion and high cholesterol. His bloodwork has always been a cause for concern. After his treatments, he went and had new bloodwork done, and his MD called him in to discuss the results. The first thing he asked was, "are you on any medications or treatments that I'm not aware of?" My dad, being a classic "don't p!ss off the MD" personality, said No. His MD continued on to say, "Your bloodwork is the best it's been it 15 years." If only my dad had explained himself!

great example of complex systems theory at work in the body!

The rest of your post was a truly enjoyable and informative read. In no way do I feel you to be criticizing acupuncture, and I commend you for your rigorous approach to research analysis.

thanks for the kind words; I know I tend to get under some people's collars when I make statements like "there is little reliable and valid clinical evidence that exists supporting the efficacy of acupuncture"; they think I am labeling it as ineffective / quackery; no; I am just stating what the current climate is like; hey, if you are TCM and you want to be "accepted" by the main, this is the way they accept you; don't like it? too bad; do something about it - either come up with better designed studies (which may or may not "solve" things), or have the balls to push through a paradigm shift, in terms of concertedly "opting out" of the EBM game - that is, either TCM can be appropriately encopassed by the EBM approach, or it can't; but it better take a stand soon, because at present, it's getting it's asz kicked by the production of studies that are being ripped to shreds by Cochrane or UpTo Date (which is what most of the MD profession regularly uses to get its "bottom line" summarized info on all the tons of research out there, and they evaluate studies from a very strict EBM approach); incidentally, PT's had sort of the same problem w/EBM approach - at one point the joke was "PT's just better stop doing research on what they do, because they're going to run out of modalities pretty fast if they keep 'proving' that none of them work"...as a result, the research design got tighter / smarter and more adept at teasing out subtle nuances when assessing things like manual therapy, which is very difficult to study "objectively" for a variety of reasons;

anyway, I very much appreciate your balanced perspective as well - I respect that it takes a very balanced and secure mindset to be on the one hand very personally / professionally invested in a given approach and on the other hand to be able to discuss it objectively, for all its pluses and minuses, without getting defensive and emotional about it (unlike some people on this board...); anyway, onward and upward!

[Xiao3 Meng4]

not too crude; but no reason why you should stop there - I firmly believe that all TCM-related phenomena can be fully explained utilizing contemporary anatomical / physiological knowledge - and really ought to be as well - the challenge is to be able to synthesize the "western" knowledge in such a way that it describes the complex systems-based way in which TCM (and I would argue, osteopathy) effects the organism; because, if it can, it verifies the validity of the approach; this doesn't mean getting rid of the metaphorical descriptors previously used either, it just proves the strength of the approach - if you can describe something works using a system that is "alien", that, to me, confirms the universality! and there is nothing "crude" about describing TCM anatomically / physiologically - I personally think that the "western" way of describing things is inherently elegant and amazing - organic chemical equations describe a certain aspect of the fundamental processes of life - what's crude about that?
personally, I think that the connective tissue matrix in combination with the autonomic nervous system are important mediators in terms of "why" acupuncture "works"...

Bingo!

As far as the functional application of Acupuncture goes, I'm completely satisfied with the theoretical and practical framework. No need to change anything, it works fine. At the same time, I'm very interested in finding ways to describe it through anatomy/physiology. What I have so far is, in my view, in its infancy (hence crude), however I'll start a new thread on the topic with what I have, I'd love to discuss it!

anyway, onward and upward!

[taai gihk yahn]

As far as the functional application of Acupuncture goes, I'm completely satisfied with the theoretical and practical framework. No need to change anything, it works fine.

right - I have never suggested disposing of the "classical" system per se, nor do I feel that it would make any sense to try to "add" to it;

At the same time, I'm very interested in finding ways to describe it through anatomy/physiology. What I have so far is, in my view, in its infancy (hence crude), however I'll start a new thread on the topic with what I have, I'd love to discuss it!

please do so; I would be very interested in your perspective; I have similar ideas about how taiji / so-called "internal" principles can be described in that vein as well, and have talked about that for some time now here (usually to the scornful reply that so-called "western" approach is and always will be woefully inadequate to the task - my response is that maybe those making that statement just haven't studied "western" stuff enough to employ it in a "live" manner...);

[Doc Stier]

No.

Nobody ever has collected the prize because nobody has been able to provide verification under scientific conditions of a supernatural ability.

The ability to regulate the organs of the body by manipulation of an un-measurable, invisible, energy field would certainly qualify as supernatural. And that is what you claim to do right?

No, Simon, that is not what I do.

I think of my work as more of a type of bioelectrical troubleshooting and repair, not as anything supernatural. I simply determine to the best of my trained ability where bioelectrical overloads and short-outs are occuring within someone's body, and match these diagnostic findings with the presenting symptoms in order to effectively correct the underlying pivotal causes. This process is based in great part on more than three decades of successfully treating the same conditions again and again in thousands of patients.

The results are totally measurable in that the same treatment methods, consisting of specific acupuncture point prescriptions, herbal formulae, and other auxilliary treatment modalities, will almost always produce the same results when applied to a specific health condition and it's usual symptoms. This has been repeatedly duplicated in my personal clinic experience probably 95-97% of the time on average. There's nothing magical or supernatural about it at all.

However, every treatment modality, both Eastern and Western, has known limitations which surface over and over again in the inability to effectively treat specific health conditions, illnesses, and diseases. I choose not to work on these particular problems, because I know that the probability of successful resolution is only 50% or less. Fortunately, there are a great variety of health problems that nearly always respond favorably. I will gladly address any of these problems with confident expectations of a successful outcome.

It's just like the professional plumber who came out to my house some years ago to fix a problem with our plumbing. The man came into the house, walked down to the basement, looked at all of the pipes and joints, and then went out to his truck again. He came back inside with a big pipe wrench, went back downstairs to the basement and knocked on a couple of the pipes and one joint with his pipe wrench while I watched him. He then said: "OK, try it now." I did, and everything worked perfectly once again. He charged me $65.

When I questioned the amount of his fee he said: "That's $5 for knocking on the pipes and $60 for knowing where to knock."

Was his success with such a small, simple effort magical or supernatural? Most certainly not. I couldn't really argue with his explanation, because knowing where to apply the acupuncture and which herbal formula to prepare is crucial to my work in a similar way.

Doc

[Lee Chiang Po]

Back in the mid to late 70's a group of young cardiologists went to China to study a very new form of open heart surgery. The thing that captured their attention more than anything else was the fact that they were using accupuncture as an anesthetic rather than gas or strong meds to render the patient pain free and unable to move during the surgery. It was a woman and she was completely awake and speaking with the nurse during the proceedure. The surgeon explained the benefits of accupuncture were that there was no respiratory problems afterwards, and no sickness associated with the meds.
Accupuncture, like most anything else, can not cure all ills. It has to be curable first.

[SimonM]

Back in the mid to late 70's a group of young cardiologists went to China to study a very new form of open heart surgery. .

That was based on an anecdotal story told by one of Nixon's diplomatic aides. What people frequently forget to mention (or out-right deny) was the fact that conventional anastetic was also used.