Acupuncture, legitimate or not

Hi Stanley,

You asked:

PHP:

What is your protocol, and how do you know when it is indicated?

Firstly, I'd like to say that their are many approaches to acupuncture and it's good to see if we are on the same wavelength, so to speak.
Like orthotic therapy discussions and you will find that some are taking plaster casts but with different methods, some are scanning, some are taking impressions etc etc = all sorts of factors that will produce quite different devices.

The first group is the Traditional Chinese Medicine method, which will vary considerably depending on where one was taught but really revolves around "balancing' the energy flow in the meridians often assessed by pulse and tongue diagnosis with consideration to many other factors including very foreign concepts to us, such as zang-fu, the five elements, husband -wife etc

Broadly the second group is often referred to as 'western acupuncture' or 'medical acupuncture' which includes not only 'dry needling' Travell & Simons trigger points but also using some or all of the traditional acupuncture points according to symptoms and modern forms needling ATA's (acupuncture treatment areas - Anthony Campbell). And who knows what else. The western approach is often accused of being too "cookbook", which is nevertheless a way of doing research as demonstrated by the following article. You will see that the points to be used are listed and only minor variation is allowed.

http://www.biomedcentral.com/1472-6882/4/6/

Statistically, you have between 60% and 70% chance of having needles stuck into you if you come in to see me for a podiatric problem. I mainly treat chronic musculoskeletal pain and do not routinely treat nail problems, skin lesions nor perform any surgical procedures any more.

A standard new patient visit will usually include (if indicated), joint mobilisation and fitting of temporary devices with customised wedging. Often a single or small group of trigger points may be dry needled.

I usually book patients in for a small series (3) acupuncture treatments if I decide that this will progress their recovery. These sessions may include dry needling, but always include using acupuncture point needling. With chronic pain, I often find that I am working on different structures on each visit as we progress toward resolution. My approach is very ad hoc.

So from comments of yours I understand that you will be using a system closer to traditional and more about energy balance. From what I have seen I think I could learn a few tricks off you and you never know where this may lead to.

Cheers, for now, as this is enough for me, but happy to carry on more with this discussion.

Shane

 

Hi Shane,
So how do you find your points?
I am familiar with the traditional approach (not that I can do pulse diagnosis), and the 5 element theory. I learned about acupuncture as part of my Applied Kinesiology training. The approach is different than that of Traditional Chinese Medicine, and different from the Western Medical approach. Through the use of muscle testing we can identify the meridians, and then the exact point that will give us the change. Then the underlying joint of bone which is causing the disturbance is corrected, and the same goes for the associated point on the bladder meridian. Originally, the point was found that would strengthen a weak muscle, and that would only work for a short time. Boven found that if you find a meridian that will not sedate, then you find the point that will allow for the sedation and correct it, the underlying pathology, the associated point and the underlying pathology, the correction lasts. Current thinking is to find two muscles that will not sedate, find the appropriate point for each, and then find which point sedates both meridians. (I think it is easier just to do correct one muscle that will not sedate, and if you were wrong, you can then find another muscle that will not sedate and then find the point that will sedate it and then correct it, the underlying pathology, the associated point and its underlying pathology)
When a patient comes to see me, I will usually do the standard tests, cast for orthoses, and then start balancing the patient. My biomechanical exam consists of measuring passive dorsiflexion with the subtalar in neutral and measuring the ASIS to the ground. From this, I can determine what is needed. For example,
1. High ASIS on the side of equinus-usually there is a weak peroneal on this side which I use to find out the cause which is usually a lateral fascial line problem on that side.
2. Low ASIS on the side of equinus-cuneiform subluxation. I will use the muscle testing to find out what is causing the subluxation. This can be anything in the body.
3. Bilaterally equinus-usually a cervical dysfunction, but I will check to make sure using the ankle mortice shearing to make a strong muscle weak and then finding what negates it.
4. No equinus, but the ASIS is low on the one side. In this case I will look for a weak muscle and find out what negates it, which is usually a TMJ problem.
5. No equinus, and ASIS is level. This indicates a foot problem-lateral talus, posterior lateral calcaneus, 3rd met cuneiform joint, or a myriad of other foot muscle, joint, ligament &/or periosteal pathologies.
6. Unilaterally mild equinus and ASIS level or unlevel-This is an acupuncture problem.

Notice that I do not evaluate the PSIS to the ground. I haven't found it to be necessary yet. If a patient is complaining of back pain, then I can easily use AK to find out the muscle that is causing the pelvic imbalance, and then tracking its cause. When I do this, I end up with cranial imbalances that need correction. But I could have ended up here anyways going through the foot.
I don't manipulate, as joint dysfunctions are related to ligaments. &/or muscles, &/or fascia (ie a posterior calcaneus is related to a problem with the posterior talocalcaneal ligament, or a lateral talus is related to a problem with the lateral talocalcaneal ligament.

I find periosteum to be a key tissue. In AK they talk about a holographic interosseous subluxation. Since AK was started by chiropractors, they are always looking for a subluxation to manipulate. Manipulation of the bone itself will correct these problems, but so will frictioning the periosteum. Most of the acupuncture points that I have found that are important for treatment of musculoskeletal pathology are over bone. Correcting the periosteum corrects the acupuncture point at the same time as correcting the underlying bone.

In AK, they are aware of the energy that is in the acupuncture system, but I just work on the damaged areas that cause the alterations of the nervous system.


I'm also very happy to carry on this discussion. I have so musch to learn about the acupuncture system.

Regards,
Stanley

 

Hiya Stanley,

You asked:

My teacher' teacher was Sir Anton Jayasuriya. I use his point selection protocols.
Unfortunately he died a couple of years ago. He was a medical doctor with a rheumatology specialisation (London). His accomplishments are too numerous to mention. He founded the Open International University for Complementary Medicine and the free acupuncture hospital in Sri Lanka
http://www.medicina-alternativa.org/index.html
http://www.antonjayasuriya.info/

So I select points using the following guidelines, virtually quoting from "Clinical Acupuncture" by Anton Jayasuriya. I do not use all of the guidelines as I am treating podiatric conditions and do not take on the treatment of systemic disorders. I will choose which of the points I'll use keeping the following in mind.
Also to always use a minimum of needles (trying to keep it under 5, excluding TrP's)


1. All acupuncture points of a channel treat disorders occurring along the
channel.
2 All acupuncture points treat disorders of the local and adjacent areas.
3 Points distal to the elbow and distal to the knee treat proximal disorders
4 'Ah shi' poimts including periosteal tender points
5 Points according to symptoms
6 Influential points: for muscle or tendon or bone
7 Confluent points
8 Associated trigger points
9 Needling for specific physiological and psychological effect
10 Alarm Points
There are others: Yuan Source Points, Luo-Connecting points, Shu points, Xi Cleft
Note: You only need to needle one side of the body to treat both.

So whilst I may have favoured points for particular conditions such that there is an element of "cook book' about this method, invariably the selection group is unique. This works as I'm sure your method works. I'm very keen to learn a few tricks off you. As yet I do not use AK.

Cheers
Shane

 

I went to the website. Impressive. I see they also teach Homeopathy. Did you learn this also?

I was taught that in China they say the best acupuncturist uses 1 needle and the one that uses 2 needles is only half as good as the one that uses one needle. So I see why you keep it under 5.

I have learned what I think is a small part of the whole system, and since it was developed by chiropractors that can’t do anything invasive, there are no needles, just pressure. I really don’t mind not using needles, as it has afforded me the opportunity to understand at least part of what is going on.
I think we should trade knowledge on one type of point at a time.
This is what I know about alarm points. It is the point that represents the entire meridian. For instance if you have a weak peroneal muscle (a bladder related muscle) and you think there is an acupuncture problem that is causing this weakness, place your hand over the alarm point of the bladder (just above the pubic bone) and retest the muscle. If the muscle becomes strong there is an acupuncture meridian etiology to the weakness. Alarm points are useful in distinguishing which meridian is involved in therapy. Since a pulse point represents 2 meridians, the next step in the evaluation that I was taught was to check the alarm point to find out which of the two meridians is involved.
There are two meridians represented in the foot muscles. This chart summarizes the muscle, meridian, and alarm point.

Muscle.......................................AMC......................Alarm Point

Peroneus Longus/Brevis.............Bladder...................Above Pubic Bone
Peroneus Tertius.......................Bladder..................Above Pubic Bone
Anterior Tibial............................Bladder...................Above Pubic Bone
Posterior Tibial.........................Circulation-Sex.........Between xiphoid and navel
Flexor Hallucis Longus...............Circulation-Sex........Between xiphoid and navel
Flexor Hallucis Brevis................Circulation-Sex........Between xiphoid and navel
Extensor Hallucis Longus...........Circulation-Sex........Between xiphoid and navel
Extensor Hallucis Brevis............Circulation-Sex.........Between xiphoid and navel
Gastrocnemius/Soleus..............Circulation-Sex.........Between xiphoid and navel

Regards,

Stanley

 

Hi guys,

I don't think anyone has mentioned placebo-effect in this thread.

Whilst not denying the effectiveness of acupuncture in some patients, I don't think placebo-effect can be ignored, and it is entirely possible that it alone is responsible for at least some of the reported beneficial results.

In this research project 59 runners with hamstring pain were split into two groups. One group received conventional acupuncture, the other placebo acupuncture (needles stuck in randomly). Both groups reported improvements immediately after treatment (Huguenin et al 2005).

I'm pretty sure this can be found on Google Scholar.
Huguenin L, BrucknerPD, McRory P, Smith P, Wajsweiner H, Bennell K.
Effects of dry needling of gluteal muscles on straight leg raise in a randomized, placebo-controlled double blind trial.
British Journal of Sports Med 39: 84-90 (2005).

Those interested in placebo-effect may also want to chase up a paper called Listening to Prozac, but hearing placebo, by Kirsch I and Saperstein G.

Regards,
David

 

David,

In any therapy, there is a placebo-effect. However, the way that I was trained to do my acupuncture testing, there is no question as to whether these points are the correct ones.
When I find a slight amount of dorsiflexion (which means there is an acupuncture problem from what I have seen), I find a muscle that will not sedate (using muscle testing) when the sedation points are stimulated. I test all 6 pulse points to find out which one will allow the sedation, and it is always one. How can you explain that the placebo effect will affect only one of the six (not 0, nor 2, nor 3, nor 4, nor 5, nor 6, but always one). Then I have to find which of the two meridians that relate to the pulse point. The patient doesn't know how many Alarm points I am going to test, but only one of the two allows for sedation. I retest, just to make sure my testing is accurate. Then if the alarm point for that meridian happens to be on center of the body, (so that there is only one alarm point and not one for the left, and one for the right) then only one associated point is tender. Then I find the one point on the meridian that will allow for sedation. When I first started out, I checked all the points, and found only one. For brevity, I now stop when I find the one point. Then I ask the patient when the injured this area, which they invariable remember. One patient had fibromyalgia along with her plantar fasciitis. I asked her how long she had it, and she replied the number of years (I don't remember how many she answered, whether it was 4 or 5). I asked her what happened in the proceeding 6 months, did she hurt herself? She told me that she had no recollection. She had a weak peroneal muscle that would not strengthen with any cerebellar or cortical stimulation, so I tested the alarm point and the peroneal muscle strengthened. I then tested the posterior tibial to see if it would sedate and it didn't. It turned out that the point that allowed sedation was on her upper arm. I asked her if she hurt this, and she then replied that she had forgotten that she severely injured it about 6 months prior to her developing fibromyalgia. She was playing flag football and she fell. She required several months of physical therapy. Lately, since I figured out that there is a periosteal component to these injuries, I have been able to correlate the direction of injury with the point. Furthermore, the patients have no idea what I am doing. I am sure that we all can tell our drug seekers or work shirkers. I can tell immediately from the muscle test who is telling me the truth. They don't know if they should try or not try, and repeat tests are never the same. These patients are trying to get a certain end result and they can't follow what I am doing to give me the required response.
I don't deny that the placebo effect can help with treatment, but the odds of all these things to fit just right on countless patients seems to demonstrate these points do exist.
I guess it is similar to our orthoses. We make our measurements, make our orthoses, we see a change in gait (at least some of us do), and we assume it is totally because of our orthoses. Interestingly, I find that even though I know much more than I did 30 years ago, my results were more profound back then. Over time, I have learned more things about orthoses and incorporated them, but I was wondering why it seemed I got better results with less knowledge. I realized that I was fresh out of school and I believed every patient was going to get better with my orthoses, and this optimism was imparted to my patients in the form as a placebo effect. It makes you wonder how much placebo effect is involved in the way we present ourselves to our patients. Does a white coat influence the results? Does a positive demeanor influence our results? When I first started with acupuncture testing, I was not sure it would work, and to this day when I check pulse points, I wonder what would I do if all the points were negative? It hasn't happened yet. So all in all, even though there is a placebo effect in all we do, the testing shows that the therapy is correct.

Regards,

Stanley

 

Hi David,

I'd also like to first address your question and assertions about the role of placebo in acupuncture and thank you for your information. You wrote:

I think there are many more studies that show that acupuncture has a stronger effect than placebo and obviously that is my experience as well.
In the study above can you tell me what was the result in the control group that had no needles? Was there a control group?
The use of sham acupuncture points has problems and there are other studies that show an effect almost as good as using conventional points. There is a group of UK medical acupuncturists really started by Felix Mann and more recently championed strongly by Anthony Campbell that use very little of traditional Chinese acupuncture points and do almost "needle anywhere". They treat successfully and would be considered sham by traditionalists. They would say they are using modern medical acupuncture. If traditional and sham are getting similar results but with both well above the accepted placebo ratio then it's to do with needling stirring something up rather than placebo.
There are also studies of acupuncture being used successfully with animals and this puts a dampener on "placebo" as the mode of action. I'm sorry I've not got references on the top of my head. and perhaps others may wish to go into this more academically.

Cheers
Shane

 

HI Stanley, I just spent quite a while writing a response to your response which included alarm points and then lost it all. Happens occasionally and is very, very annoying!

So now a quick one! I didn't learn homeopathy (lucky as it gets scorned in the Arena).
Nevertheless, did get an intro and did do some homeopuncture more than 12 years ago which seemed to enhance the effect.
The alarm points you mention are on what I call the REN (conception) channel but in our system are used for diagnosis, prognosis and monitoring results of treatment on internal organs (depending on the level of tenderness to palpation). They are called Mu-Front points. There are more of these as well as back-shu alarm points on the Urinary Bladder channel on the back. When the points are tender then there is disease present or about to develop in the organ related to that point. The back points are (according to the prof) situated above the specific paravertebral sympathetic ganglion that is connected with its related organ. Hence it is likely that the relationship between these points and the organ is mediated through the autonomic ganglia of the sympathetic chain.
So you use these points in a completely different way and assess them by using the applied kinesiology which also I don't have knowledge of. Tricky.
Also interesting that you say that there are only two meridians represented in the foot muscles. Your nomenclature is different also and I'm unclear as to which channels you refer to.

Cheers
Shane

 

Hi

Felix Mann covers the use of Micro-Acupuncture and Hyper-Micro-Acupuncture (minimal depth where he almost only touches the skin) in his book called "Reinventing Acupuncture a new concept of ancient medicine" Chapter 7. ISBN 0-7506-4857-0

Certainly reading this work raises questions of how to define what some would call "sham" acupuncture or if it possible to have such an approach.

Ian

 

The best thing to do is to write your response in Word, and then cut and paste it.

I use homeopathy, but only if I find mental component is causing the problem. I am fascinated about homeopuncture. What is it and how do you do it? I guess that will have to wait until after we get through with acupuncture.

I am familiar with the conception vessel, but we were taught that it is rarely the problem. We were taught that if none of the 6 pulse points allow the muscle to sedate, then go to the points for the governing vessel and conception vessel just distal to the 3 pulse points on each wrist. As you know not all of the alarm points are located on the governing vessel such as the lung or spleen. So neither of us commonly treat on the conception vessel. What organs relate to which points on the conception vessel?

What you call back-shu alarm points, we would call associated points on the bladder meridian. Each of these are associated with a specific meridian, so if the problem arises at a meridian, the associated point is tender. I was taught to rub these points, but with testing I find they usually should be rubbed away from the spine. Goodheart found that the bone underneath needs treatment for a “holographic interosseous subluxation”, or a standard subluxation otherwise the imbalance recurs. I have found that this holographic subluxation is really a periosteal injury. Do you treat these points also, or do you just use them for diagnosis, prognosis and monitoring results of treatment on internal organs?

It’s not my trick. Using muscle testing helps me find out answers with a lot less knowledge.

Bladder, I think is pretty clear. The Circulation-Sex meridian relates to the adrenals. I just checked to make sure what I wrote was accurate. Ooops, I was off. The alarm point for circulation-sex is 2 tsun above the xiphoid at CV 17 What do you call this meridian?. I use a series of pictographic charts when I work (as I have a hard time remembering all these points:bash. I copied a study aid I was making when I was first learning this material and pasted it in. I’ll have to redo the study aid, and maybe even study it.
There are only two meridians represented as foot muscles, but there are more meridians that go to the foot.

Now that we have almost finished with alarm points, what do you know about beginning points. The ends of the yang meridians that are in the skull?

Regards,

Stanley

 

Comparison of the effectiveness of the traditional acupuncture point, ST. 36 and Omura's ST.36 Point (True ST. 36) needling on the isokinetic knee extension & flexion strength of young soccer players.
Ozerkan KN, Bayraktar B, Sahinkaya T, Goksu OC, Yucesir I, Yildiz S.
Acupunct Electrother Res. 2007;32(1-2):71-9.

 

Here is a link to a podcast produced by an American infectious disease physician with an interest in the critical review of alternative medicine. The physiological theory of acupuncture is outlined in plain language, goes for about 15 minutes - great listening:

http://www.quackcast.com/spodcasts/files/podcast_6.mp3


Same series, a podcast for those who enjoy a healthy dose of evidence-based skepticism ! The evidence for the efficacy of acupuncture is reviewed here (there have also been podcast updates on this topic, let me know if interested):

http://www.quackcast.com/spodcasts/files/podcast_7.mp3

 

Instead of listening to dribble, it would be better to spend some time looking at a scientific articles.

http://www.anesthesia-analgesia.org/cgi/content/full/104/2/308

http://www.sciencedirect.com/scienc...serid=10&md5=81df924e959a7c6b7f71e999c4ecf931

http://ieeexplore.ieee.org/Xplore/login.jsp?url=/iel5/4562568/4570483/04570540.pdf?temp=x

He states the the studies that show acupuncture works is not truthful, because it it is working like a TENS unit. I was waiting for the part where he tells us how we can do foot surgery in our office using only a TENS unit.

Can someone point me to a study that shows how to use a TENS unit properly to allow me to do foot surgery as he implied?

Regards,

Stanley

 

Hi Stanley,

Thanks for your reply, sorry you didn'y much like the podcasts !

I've had only a brief look over the articles you have posted, but have a couple of comments:

1. http://www.anesthesia-analgesia.org/cgi/content/full/104/2/308

Participants were not symptomatic. It's difficult to obtain a treatment effect in an unrepresentative sample.

No placebo treatment. A placebo treatment would be very important with this study. There have been specific collapsing needles especially developed for this purpose.

The biggest confounding factor in this study is that they compared classic points to non-classic points - these were two different locations. Therefore all that can be concluded from the results is that sticking needles in two different locations produces two slightly different effects in brain activity.


2. http://www.sciencedirect.com/science....

Once again, a representative sample was not selected for any clinical condition.

This link is to an abstract only. I tried to obtain full text through my university account but we don't subscribe.

While this abstract describes comparison of 'true' acupuncture to placebo acupuncture, unfortunately the abstract does not detail how this was acheived.

More significantly, the abstract does not report if there was any differences in brain activity between the placebo and true groups. Considering that finding a difference between placebo and treatment is usually the whole point of having the two groups, it seems suspicious that no comparison was reported in the abstract.

3. http://ieeexplore.ieee.org/Xplore/login.jsp?url=/iel5/4562568/4570483/04570540.pdf?temp=x

Unfortunately abstract only.

Moreover, this abstract does not describe a trial / experiment / evidence of any sort. Was this a systematic literature review ? A meta-analysis ?

This abstract can only be weighted as little more than anecdotal - no evidence here.



Unfortunately none of these experimental designs are able to demonstrate the existence of meridians or the efficacy of acupuncture. Even with positive findings it would not be surprising that poking a needle in someone causes increased CNS activity. Are you aware of a randomised, placebo-controlled, double-blind trial investigating the therapeutic effect of acupuncture for the treatment of pain in the foot and ankle ? As a clinician, I feel that this design of trial would be more relevant to evidence-based practice.

Thanks again for your response,

Andrew

 

Andrew,

First of all the podcast that you had us listen to said that acupuncture is quackery and does nothing, and cannot possibly do anything.
This study shows actual brain changes to volunteers under general anesthesia.
Explain to me how patients under general anesthesia can have a placebo effect :wacko:
The only explanation that you can make is that the spirit knew that the acupuncture points were getting stimulated
This study revealed that acupuncture of LI-4 decreased rCBF in the contralateral putamen and in the ipsilateral medial frontal gyrus, whereas "placebo acupuncture" only produced a decrease in the ipsilateral medial frontal gyrus. Therefore, these data suggest that needle penetration of the skin affects the medial frontal gyrus, while acupuncture of LI-4 influences the putamen.

Studies can get torn apart, and if the study was done on patients with a condition, the comments would be:
1. The sample was not large enough
2. The condition would have resolved
3. The placebo effect was a result of something the acupuncturist did.
4. The condition wasn't diagnosed properly
5. It wasn't published in a peer revewed journal

Doing a study on volunteers that were unconscious without eyelash reflexes seems to me to eliminate any questions about the fact that acupuncture does affect the brain.

As far as clinical methods, there are several ways to administer acupuncture. There is a one needle technique, two needle technique, 8 needle technique, and a host of others. The results are very much operator driven, so it is difficult to design a good clinical study.

Regards,

Stanley

 

Hi stanley,

I agree that the podcasts aren't very tactful, I thought they were a convenient way to present some information - no offence intended.

The placebo could have been a non-penetrating needle, this would demonstrate if penetration of the skin is required for the observed results.

I diagree with your conclusion that the differences in CNS activity between the placebo location vs acupuncture location can only be due to the unique effect of acupuncture. It may only demonstrate outcome variations due to the anatomical placement of the needle.

I also think that increased CNS activity as a result of skin penetration would not be a suprising outcome.

Regards,

Andrew

 

I shall not intrude too much on what appears an interesting and informed discussion.

I shall comment on

I looked in vain for the word "blinded" in this study. Without that the results would appear to be of little significance.

Regards
Robert

 

Andrew,

I am lost about the non penetrating needle. Do you mean that the needle just touches the skin, or doesn't touch the skin?

The study clearly showed that when a needle was placed in the non acupuncture point in the skin only one area of the brain was affected. When the needle was placed in an acupuncture point, the same part of the brain was affected (the part that senses needle sticks, I would imagine) and another unrelated area.
So you are correct that needle sticks increase CNS activity, but the study shows clearly that another area of the brain is also stimulated with acupuncture point stimulation.

I am still awaiting your explanation for the need of a placebo for this study.

Robert,

Thank you for your input. From what I see, you found a study on acupuncture that you feel has a procedural problem. I am trying to follow your point about blinding. Are you saying that the soccer players in the study knew the differences between the two points and therefore felt that one would make them stronger? I am from the states, and I never went in for soccer. I am sorry I missed the acupuncture training that comes along with learning that sport.

Also, since everyone seems to feel that double blinded placebo controlled studies are the gold standard for anything in medicine, could someone point me to a double blind placebo controlled study on HAV surgery?

Regards,

Stanley

 

Hi Stanley,

Thanks for your reply.

My primary concern with the studies posted above is that they are not clinical trials, and are therefore unable to demonstrate clinical effectiveness. This is really the only point I wish to make......


However, as stated previously, the study you have quoted compared CNS activity during skin penetration in one anatomical area with CNS activity during skin penetration in a different anatomical area. It is possible that the small difference in results may only be due to the anatomical variation of penetration points, as opposed to any unique effect of acupuncture.

I agree with you that the term placebo is not an appropriate term as this was not a clinical trial, ‘sham’ treatment may be a more appropriate term. Maybe a sharp neurotip applied to the same area as the acupuncture point would produce the same CNS response.

I also agree with you that a RCT is the gold standard of clinical research, but is not always possible (e.g placebo surgery is usually considered unethical). However, RCT’s of acupuncture do not have this limitation as a double-blinded placebo treatment is possible (this is where the collapsing needle has been used in the past, so the patient believes they have received acupuncture). However, any clinical trial of acupuncture for the treatment of foot and ankle pain would be of greater interest than the studies posted above.

Thanks again for the lively discussion, hopefully I have answered the questions you had regarding my previous posts.

Best wishes ,

Andrew

 

Stanley

Firstly, why the combatative attitude? We are merely discussing the relative merits of apaper. No need for it.

Regarding my point on blinding it is a fairly standard research tool. Three points were tested, acupuncture 1 , acupuncture 2 and control. If the patient is told which is which it introduces another element, the effect of the expectations. If they do NOT tell the patient which is which then the study is blinded. If they do not tell the patient and the practitioner is also unaware this is DOUBLE blinded and is the gold standard for research.

The abstract did not mention whether the study was blinded, double blinded or not blinded at all. If it was blinded then well and good but why would the authors neglect to mention this very significant factor?

Thats all.

Robert

 

Just noticed this

How would one go about a double blinding a study for hallux surgery?! Patients tend to know if you've taken a bone saw to their foot! Surgeons tend to know if they've done surgery!

Regards
Robert

 

Andrew,
My responses are related to the “quackcast” that you referenced. The main points were there were no ways that acupuncture can have any effect on the body, and that it is dangerous. My point is that we first have to get beyond the concept that acupuncture has no effect if we are going to have an intelligent discussion. The study with the CNS activity under general anesthesia shows this.

Andrew, placebo acupuncture only produced a decrease of cerebral blood flow in the ipsilateral medial frontal gyrus. This section of the brain is associated with decision making. (This would make sense. If you get stuck with a needle you are going to have to make some decisions, for instance, what do I do about this needle, is there more danger, and how do I respond if there is). The acupuncture point caused a change in this area AND the putamen. The putamen is associated with sensorimotor integration and motor control. It is important in posture. We are not talking about a simple difference in location of the skin causing a difference in the corresponding portion of the brain, but rather a difference in function. If you look at my previous posts, that is exactly what I see happen. I get postural changes.

Andrew, I get my postural changes by just rubbing the acupuncture points in the right direction. The point is that there are many ways to stimulate an acupuncture point, so trying to show a difference in the stimulation is not a good sham treatment. That is what is nice about this study, there are no conscious effects. If you remember when you took physiology lab, and you had the decerebrate frog, You put epinephrine on the heart to see how it changed the heart rate. I bet you don’t remember the instructor telling you that you had to use a sham treatment because of the placebo effect.

Robert, I was not being combative, only sarcastic.

You referenced a summary. Summaries take out what they consider unnecessary information. My interpretation is that the practitioners did not mention the names of the points. Another point is even if they did, for the athletes to be affected, they would have to know something about the points.
A practitioner can be blinded in a drug study, where he doesn’t know the ingredients of the drug. He is not required, as the drug can be placed in the room without the practitioner being present and the patient being told to take the drug when they enter the room. The practitioner must be present and know what he is doing to perform acupuncture, so it is impossible to double blind this.

Robert, again you miss the sarcasm. The point of this is why would we be able to double blind an acupuncture study, but not a surgery study? We are dealing with a physical act on the body in both cases. We could easily do a sham surgery with an osteotomy in a wrong place or direction.

Regards,

Stanley

 

Hi Stanley,

Perhaps it would be helpful to have agreement in this thread on a definition of ‘acupuncture’, starting with the proposed theory of ‘qi’ and ‘meridians’. I have pasted below an excerpt from the website of the Australian Acupuncture and Chinese Medicine Association which briefly describes these components:

http://www.acupuncture.org.au/acupuncture.cfm

"When healthy, an abundant supply of qi (pronounced chee) or "life energy" flows through the body's meridians (a network of invisible channels through the body). If the flow of qi in the meridians becomes blocked or there is an inadequate supply of qi, then the body fails to maintain harmony, balance and order, and disease or illness follows."

The existence of ‘qi’ and ‘meridians’ seems to be essential to the definition of ‘acupuncture’. If the use of the term ‘acupuncture’ does not refer to the existence of ‘meridians’ and ‘qi’, then I think the term ‘acupuncture’ should not be used. Based on biology, I have doubts that either ‘qi’ or ‘meridians’ exist. The absence of these central components leads me to the conclusion that the theory of ‘acupuncture’ is somewhat flawed. As without ‘qi’ or ‘meridians’ it is not ‘acupuncture’ and should probably not be termed as such. If the existence of 'qi' or 'meridians' is denied, perhaps it would be misleading to a patient to call the treatment 'acupuncture', as the patient will no doubt believe that their podiatrist has confirmed the existence of these para-normal components.

I suppose the objective of the study which we are discussing was not to measure the effect of ‘qi’ stimulation via ‘meridians’ on CNS activity. I can therefore only guess that the study was investigating the effect of skin penetration in two different anatomical areas on CNS activity, and was therefore not testing the effect of ‘acupuncture’.

I understand the following transmission of pain sensation to the CNS: Noxious stimuli : bradykinins and other mediators : nociceptors and free nerve endings : action potential / axon : dorsal horn. I guess the study was just trying to find out if penetration of the skin at an acupuncture point is associated with different CNS activity to penetration of the skin at a non-acupuncture point.

Even if this was the case, as the study only tested 1 acupuncture point to 1 non-acupuncture point, it cannot demonstrate that penetration of the skin at all acupuncture points is consistently associated with different CNS activity to penetration of the skin at all non-acupuncture points. Thankfully, the study itself doesn’t seem to make this claim. The claim it does make seems however somewhat misleading:

‘These data suggest that needle penetration of the skin affects the medial frontal gyrus, whereas acupuncture of LI-4 influences the putamen.’

It would be more accurate to state:

‘These data suggest that needle penetration of the skin between the 3rd and 4th metacarpal affects the medial frontal gyrus, whereas needle penetration of the acupuncture point LI-4 influences the putamen.’

However, there is an absence of p values. The paper therefore fails to report the extent to which any difference between groups was due to chance. The paper states (this is pasted from the full-text):

“A comparison of respiratory/vascular variables and BIS scores between the baseline state and baseline + acupuncture were performed using Wilcoxon's matched pairs test. Results are represented as means ± sd.”

This is a non-parametric test, so the data may not have been normally distributed. It seems suspicious to me that there are no p values, as the sample sizes for each group were very small (n=6, n=7).



Apologies for another long message !

Best wishes,


Andrew

BTW, my understanding is that double blinding is achieved when the person who gives the sham or placebo treatment is not the same person who asks the participant questions at follow-up. The person who asks the questions at follow-up and the participant are both unaware of which treatment group the participant is in.

 

A brief addition to my last post.

If 'qi' and 'meridians' are essential components of 'acupuncture', surely any trial / study claiming to investigate the effect of 'acupuncture' will need to control for nerve conduction.

This could be achieved in podiatry by only using participants who are completely paralysed from the waste down. Any effect on CNS activity in these participants from skin penetration below the waste could truly be attributed to a 'life-force' flowing through 'invisible channels'.

Sorry to keep blabbing on about this topic - I'll stop now !

 

Perhaps your posts would be clearer without the sarcasm?

For example i'm struggling with your statement above. Are you now being serious or still being sarcastic?

Are you actually saying that one could carry out a study involving unnecessary joint surgery as a placebo?! Whilst putting an acupuncture needle in a random spot and performing needless surgery are both, as you say, physical acts i think there is a rather large difference. I can't see people queueing around the block for a 50% chance of an osteotomy "in the wrong direction".

As to the researcher not mentioning whether the study was blinded or not, i suggest that it is one of the fundamental aspects of a piece of research. To omit it from the abstract is extraordinary if the tester has gone to the trouble of making it blinded!

Hi amcmillan

With respect, I rather think you may be mistaken here. A double blinding is acheived when the experimentor (the person giving the treatments does not know which is the real and which the control treatment. This removes the possibility of subconcious indications to the patient via body language or intonation that one treatment may work better.

This makes the idea of a double blind study on HAV surgery more than a bit tricky to acheive BTW! :wacko:

A quick google search will confirm.

Kind regards
RObert

 

Andrew,

Acupuncture is 5,000 years old, and the explanation is related to the understanding that was available at the time. Similarly, 10,000 years ago, it was thought that the planets and sun revolved around the earth. Even though this was inaccurate, they were able to calculate the eclipses.

Instead of using the concept of Qi, I think a neurophysiologic approach would be more accurate. Below is an article that gives some insight to this concept.

http://www.anatomytrains.com/uploads/rich_media/c04c7252238ff6f72d81f52c89a20f85.pdf

 

Robert,
What I am saying is that you could do a double blind study on surgery if you had to. That is not to say it is something you should do.
As far as the skill required, one non surgeon could be taught incorrect surgery, and the other could be taught correct surgery. Again, this is not a desired thing to do, so practically it is possible, even though it is possible theoretically.
Due to the accuracy of the placement of the needles, it is doubtful that the acupuncture points could be taught easily to a layman. So to me, there is similarity in trying to do studies of surgery and acupuncture.

Robert, I thought it was pretty obvious that the subject had no knowledge of the points, as it is not something that someone would know about or be able to understand; and the examiner was not blinded, as he has to know where to place the needles.

Regards,

Stanley

 

Hi Stanley,

Thanks for confirming your stance on the existence of ‘qi’ and ‘meridians’. I would appreciate your feedback on one more comment if possible:

Personally, I feel the use of precise terminology to describe this / any intervention is very important. The term ‘acupuncture’ would be interpreted by the vast majority of patients (and practitioners) as referring to unblocking the flow of ‘qi’ from ‘meridians’, or at least unblocking the flow of ‘energy’ from pathways other than neural pathways. This is also the description of ‘acupuncture’ a person without prior knowledge would obtain by a brief Google search (where many patients seem to obtain medical information).

Without the existence of ‘qi’ or ‘meridians’, maybe persisting with the 5,000 year old ‘traditional acupuncture points’ is also inaccurate. If the intervention is acting by neural stimulation, perhaps it would be more scientific to penetrate the skin according to the well-established dermatome and myotome sensory nerve distributions.

If the intervention was referred to as “fine needle nerve stimulation according to dermatome and myotome sensory distribution”, the intervention would then be based on a scientifically plausible mechanism of action (and would definitiely not be called ‘acupuncture’).

If well-controlled clinical trials followed with favourable findings for foot and ankle pain, the intervention would then also be considered ‘evidence-based practice’ in podiatry.

Thanks again,

Andrew

 

Andrew,

I am not sure I know these answers. What I think is that there is another communication system that travels along the fascia. The exact pathway from the fascia to the brain is where I am stuck.
Let me give you some of the parts that I know. We are bipeds with flexible bones (to absorb shock). We need muscluar reflexes to prevent eccentric loading of bone. The sensors will be on the periosteum, and the most logical place to put them would be on the place on the bone that would deform the most.
I am not sure that the speed of response would be fast enough if carried by the nervous system. If the signal was to be carried mechanically, then it would be travelling at the speed of sound, and this would make sense.
I am not sure this is what is going on, but this makes sense to me.

There is obviously a lot more. We have acupuncture points that correspond to points on the fascial trains, and these are the traditional points.
There are also points that affect the limbic lobe, and hence emotions. This is the area, I hope to do some work in.

Regards,

Stanley

 

Thanks for your reply Stanley, good luck with your future work in this area.

Regards,

Andrew

 

Andrew,
I've missed looking at this thread since you posted:

I regarded it as completely offensive and had no interest whatsoever in even attempting a discussion into the comments. There was no spirit of discussion and it it seemed more like throwing excrement.

I now see that a discussion has ensued with a little bit of 'combativeness' , which is not surprising considering as I mentioned, the offensive nature of the links and the comments that introduced them. It really was attacking anyone who had anything to do with acupuncture even though you may have thought it was only about some non personal thing called acupuncture.

My friend Stanley whom I look forward to meeting one day, took on the difficult task of trying to defend against a lampoon a modality that he uses successfully as a clinician without being in an academic. I'd like to help but am also primarily a clinician.

The discussion is not new and plecebos and blinding will always be a problem and pretend needling and sham needling are falling out of favour. A bit like your "sham" orthoses for which there may be now only one evidenced base use for that modality. If orthoses are being used for anything other than symptomatic pediatric flat feet then the clinician is clinically treating according to his experience and judgement rather than evidence of the gold standard type. Many are also treating 'pronation' which is now considered untrue. I'm saying this for some perspective about keeping some standards equal.

Personally, I do not believe that channels exist ie meridians as physical structures nor do I believe in Qi as explained in TCM. Acupuncture was in use well before modern understandings of anatomy, physiology and pathology and they had a way of explaining it that fitted with their perception at the time, not surprising. It continues to be generally taught in that way and nevertheless Medical Acupuncture Societies are striving to bring science into acupuncture and are well aware of the issues. There are a vast number of medical doctors, physiotherapists and podiatrists world wide who use acupuncture and it is being taught at post grad level in Physiotherapy in one Australian state at least and will most likely be included as a post grad component in podiatry in another state.
I work in a sports and pain clinic, mostly long term problems that have already had significant failed treatments. Even just the component of acupuncture called 'dry needling' in the west (which was always a part of acupuncture) is incredibly widespread in all elite sports medical protocols.

So, just a little respect and we can have a discussion and not just a point scoring argument. Thankfully, it seems that the tone is changing.

With an open mind I think that acupuncture works primarily through the nervous system. There may also be a local histological effect and maybe even a bioelectric effect along the fascial planes. I only use it because it works brilliantly and I include it as a major modality alongside mechanical interventions and manual therapies.
The best I can do is write up the information that I have tomorrow as I'm off to a party now.

Best wishes
Shane

 

I not so sure about that now. This was recently published:

Visualized regional hypodermic migration channels of interstitial fluid in human beings: are these ancient meridians?
Li HY, Yang JF, Chen M, Xu L, Wang WC, Wang F, Tong JB, Wang CY.
J Altern Complement Med. 2008 Jul;14(6):621-8.

 

Thanks Craig,

I'll keep more open about the possibility of meridians!
There is good research on the interactions in the nervous system and I'll go through some of that when I get home.
There are two sides to research: the clinical studies are one thing, but there are studies also into the mechanisms which are showing a lot of specific activity.
Just as with orthotic therapy which is being driven really by the studies into function and biomechanics. This is not done on a placebo basis.

Cheers
Shane

 

Hi Shane,

Thankyou for your comments – my intention was not to cause offence, but to post material relevant to the title of this thread : “Acupuncture, legitimate or not”. My understanding is that this thread is not restricted to proponents and practitioners of acupuncture. Whether liked or disliked, the opinions put forward in the podcasts exist, and the presentation represents a valid perspective which many (including myself) find agreeable.

A few comments in response to your post above (it came across as a bit of a reprimand) :

I am currently an undergraduate student, and therefore do not have the responsibility of providing evidence-based treatments to fee-paying patients. I do however, aim to provide evidence-based interventions to the patients I treat as a student, and my awareness of the value of evidence will increase from next year as I charge for my consults. I realsie there are many treatments in podiatry (and medicine in general) that are not supported by gold standard research, but I would prefer to acknowledge this as a limitation and aim to make amends.

In my view, it is a vital skill for a clinician to be able to critically analyse the methodological quality and clinical implications of research. Furthermore, this is not the role of the academic at all – it is the clinician who has the responsibility to interpret the evidence (or lack of) in the interests of patient care and best practice. I also don’t buy into the absolute distinction between ‘academia’ and ‘clinical practice’, I think a good clinician must also be a good academic, and vice versa (There is an interesting post on the 'teaching and learning' forum called “Do those who can’t do it, teach it?).

As stated previously, I think it is very important to use accurate terminology when discussing any intervention. It seems to me that ‘acupuncture’, ‘qi’ and ‘meridians’ are like arrows shot into a bare wall, with the bullseye of the targets painted around them afterwards. I agree with the quote from the podcasts, that “ ideas must be distinct before reason can act upon them”. I am also of the understanding that a hypothesis must be falsifiable to be considered scientific.

I have no problem with the mechanism of action of ‘dry needling’ (not that I know any more than it is likely to stimulate a local immune response), but ‘dry needling’ is not in my view ‘acupuncture’, as the 'qi' isn't being 'unblocked'.

There seems no doubting the current popular culture surrounding alternative therapies, with the obvious demand for this style of practice demonstrated by the marketing of private health insurers. (In Australia we have a tv ad where an ambulance rushes to the aid of a man lying on the ground, the back door is flung open to reveal a plethora of ‘feel good’ therapies). It seems to me a public injustice that 30% of alternative therapies provided by private health insurance is subsidised by government, while public dentistry is almost completely absent in this country. If given an informed choice, would the public choose rotten teath and gingivitis in order to have a subsidised massage, with calming music in the background to increase their ‘wellness’ ?

There is an obvious popular demand for alternative therapies, and I would imagine that advertising ‘acupuncture’ would successfully appeal to a wide popular market. This is the only reason I can think of to persist with the term ‘acupuncture’ in the absence of ‘qi’ and ‘meridians’, which are clearly interpreted by the mainstream of practitioners as being essential components (the definition of the Australian Acupuncture and Chinese Medicine association is re-posted here: http://www.acupuncture.org.au/acupuncture.cfm).


I have looked for a clinical trial (RCT or otherwise) in this thread demonstrating the efficacy (or otherwise) of ‘acupuncture’ in the treatment of foot and ankle pain, but have found none so far. The silence here is deafening – given the ‘combativeness’ of recent posts, I would have expected that if one was out there, it would have been posted here already ….. but I haven’t looked myself, so am unsure. I've read Craig P write elsewhere that 'the level of emotion associated with a theory is inversely proportional to the level of evidence in support of that theory' or something like that ....

I agree with most of your comments on foot orthoses, however my understanding is that they have been shown to be effective (in clinical trials) in more conditions than those you have cited (this would be better discussed on a different thread). I also strongly agree that the same level of skepticism should be applied to all interventions.

Personally, I am especially skeptical of customised FO’s, given the complete lack of evidence for increased efficacy when compared with prefabs (unless I'm missing something), in my view the disproportionate cost to the patient borders on the unethical. I realise that in the presence of significant deformity, a customised device is indicated and very appropriate. However, I think the role of this intervention tends to be overemphasised generally. I’m sure this comment will further deepen the hole I seem to be digging for myself in this thread (and probably elsewhere), but thankfully treatment of musculoskeletal pain by podiatrists in Victoria is soon to be expanded beyond physical therapy.

I have truly posted too much on this thread already ….. my apologies !

Regards,

Andrew

 

Hi Andrew

"I have looked for a clinical trial (RCT or otherwise) in this thread demonstrating the efficacy (or otherwise) of ‘acupuncture’ in the treatment of foot and ankle pain, but have found none so far. The silence here is deafening – given the ‘combativeness’ of recent posts, I would have expected that if one was out there, it would have been posted here already ….. but I haven’t looked myself, so am unsure. "

Sadly I cannot give a ref as the paper was was not published but a colleague of mine, for her research project, compared the effectiveness of OTC orthoses as a stand alone treatment for PF with OTC orthoses combined with acupuncture for treating PF. She used two ( or three?) traditional acupuncture points. Although a relatively small number of people involved, the results demonstrated a significant difference in recovery time between the two approaches.

Hope this adds to the discussion.

Although I use Western medical Acupuncture for pain relief in the foot and ankle I have used the beginnings and ends of meridians (without needles), for several years, in treating people with psychological distresses. The effectiveness of this is remarkable, in a psychological setting. Does it argue for meridians. Of itself I don't know but I tend to think there is, or maybe, communication aspects to the human being we so far have failed to really grasp. I'm not uncomfortable with the concept of an energy system of communication but I think that even in Comp Med we have failed to really grasp a helpful way of defining this

"I've read Craig P write elsewhere that 'the level of emotion associated with a theory is inversely proportional to the level of evidence in support of that theory' or something like that ...."

Whilst I value this comment of Craigs, wish I'd written it, I'd have to say that passion does not necessarily negate the relevance or application or validity of the argument a person brings. Passion without objectivity might, but there is a thread in itself perhaps!

Cheers
Ian

 

Nothing new under the sun. Its called the gunslinger fallacy. If you enjoy this sort of thing PM me and i'll email you an article i wrote on heuristics, biases and suchlike (not online unfortunatly).

A mild digression, if we get too far into this we'll crack off a new thread. However i think you might be missing the point with this.

The studies i have seen all compare customised insoles as in a root neutral prescription with posting based on the always controversial heel bisection. As you say these have not been shown to be significantly different to pre fabs.

What i have not yet seen is a study comparing insoles customised with any / all of the other types / modifications against pre fabs.

I wonder how pre fabs would fare against the clinicians choice of heel skives, heel cushions, varied orthotic materials from Poron 92 through to carbo fiber and from fully to non shank dependant patternes, planter fascial grooves, rearfoot / forefoot wedges, varus / valgus extensions, cluffy wedges, neuro modifications, removable pads, soft supports, laminated supports, stiker mods, Tissue stress prescriptions Sach mods, high / low / medium medial wraps / heel cups etc etc etc.

For me, if they were comparing a single type of insole (polyprop root prescription) they were not comparing a true custom insole.

But we digress.

Interesting research on acupuncture. For me, there is enough evidence to show that there is SOMETHING going on SOMETIMES. My problem is that if we do not properly understand the mechanisms we cannot work out exactly HOW it works. There are numerous studies which show acupuncture to perform no better than placebo acupuncture which must be considered alongside the studys which do show a significant effect. If we have no direct inductive evidence for the use of acupuncture in feet and no mechanism to derive deductive evidence how can we know that even if there IS some kind of mechanism we are not doing it wrong and just getting the placebo?

Its like a caveman fiddling with a computer. From time to time he might hit the right button and switch it on, however if he does not understand how he did that how can he claim to be able to do it again? We have evidence that the caveman can sometimes switch it on but also studies which showed the cave man failing to switch it on...

Regards
Robert

 

Hi Ian and Robert,

Thanks for your replys - much to think about !

Good points about emotive arguments not always being without substance, and that the variety custom FO mods not being represented in current clinical trials. Too bad about the FO/acupuncture trial not being published, it would have made interesting reading - thanks for mentioning it though ...

Maybe when the computer does switch on, it's attributed to the power of Zeus (when in fact it was the lithium battery)

I think a problem with acupuncture is that it has a lot of baggage - it already has a mechanism of action..................the term 'dry needling' might be a good example of how a scientific treatment can be established from acupuncture, without needing all the baggage ....

 

Firstly, I'd like to go back to Andrew's previous posting and maybe eventually get onto a discussion.

It's good Andrew that you have a fire in your belly and nevertheless the posting and promotion of Dr Quackbuster is offensive to me personally. I'm not saying you can't do it or have different opinions to mine but that I am not willing to start a discussion from his point of ridicule. Obviously others are and that's fine. I don’t have a problem about having a discussion and preferably with someone who has an open mind. You seem to have taken a strong position which you will defend to the end and so what’s the point in having a discussion with you? I’m sorry but I’m only being honest just as I am with all of my patients. I also get the inference from you that there is something unethical about using acupuncture. I have been ridiculed by Podiatrists in this arena for using chairside mechanical interventions on a trial basis and only go on to customized devices when I have established that they are required, will be effective and actually have determined what prescription will be used.
Mostly I am treating musculoskeletal pain of long duration in folk who are “slipping through the cracks.” They have already had a lot of unsuccessful treatment some of which has even exacerbated their symptoms. We “trial” acupuncture, which is a very conservative treatment and not expensive. Obviously that modality ceases if it is not producing results.
My quest began more than 20 years ago to produce long term pain relief most efficiently for conditions commonly presented to Podiatrists. It was obvious that orthotic therapy was useful but could not possibly achieve fully comprehensive results and also that the therapy itself when done poorly was a cause of some cases of chronic pain. Evidence based practice will not produce the results that I get. More than anything else we are there to produce results for our clients as quickly and cheaply as possible. Even this is off the topic but you have ‘chunked’ a lot of stuff together.

My point about clinicians was simply that we tend not to have all the information neatly filed and catalogued. So, bringing up articles is easier said than done not that we don’t read, for goodness’ sake. I expect that I do far more reading than most podiatrists and not just on clinical research but also in reviewing anatomy etc. Personally, I also have studied clinical research methods and am aware of the distinctions. Most pods without post grad studies will not be. That doesn’t mean that they will not be effective and provide best practice. Also appreciate the gap that exists between the cutting edge and standard practice can be quite a few years. New ideas and improvements sometimes come from practice ‘outside of the square’.

Acupuncture has been practiced through out Asia, not just China for possibly more than 2000 years, and through many parts of Europe for over 100 years. The Japanese style and the Sri Lankan styles are divergent from TCM and the Japanese have never ceased to treat ‘trigger points’. The same is true apparently for the French acupuncturists. “Trigger points” were first mentioned in western literature in Germany before being ‘discovered’ in USA and treated by injection. Dry needling was eventually found to be also effective. Dry needling is an acupuncture technique. With what evidence do you say that it works by stimulating a local immune response? By what mechanism? It was a part of acupuncture before the term 'dry needling' was coined. It only became less used in TCM during the Cultural Revolution when acupuncture education came to classrooms for large numbers to be taught by a rote learning methodology. As with our academic systems, practical training had to take a back seat in the economics of mass education. There are many who approach acupuncture with techniques quite at odds with TCM. Generally we practice what has been termed Western or Medical Acupuncture and it is not dependent on TCM definitions. There is serious debate about whether acupuncture even started in China. There are approaches which do not use meridians or even specific TCM points. Meridians may or may not exist and you do not have to believe in them to do acupuncture.

The fact that some alternative therapies are subsidized by the health funds is due to the fact that the public has been using them in such increasing numbers that the demand was perceived by the health funds for them to gain more “customers” and make more bucks.
It was simple economics. It did not happen as a directive from the government and only through some generally perceived dissatisfaction by the public in a medical system that often wasn’t delivering the results.

How about we lump together all areas of the musculoskeletal body and ‘assume’ that if acupuncture produced beneficial results for elbows or shoulders or backs whatever, then it may also be helpful for feet and ankles (where research is always a bit slower). I think you will get some hits. Also do Cochrane on foot orthoses and you will not find “many conditions” at all, you may find one that is not seriously qualified?

Finally, as mentioned on an earlier post, I think there has been significant research into the possible mechanisms of acupuncture and far less randomised double blind placebo controlled trails on clinical results. There are many in the pipeline.

So Andrew, I have responded and no matter what will next post on “mechanisms” next and will continue a discussion with you if we can have mutual respect.
I also promise to never write such a long response ever.

Cheers
Shane

 

Thanks for your reply Shane,

Good to read your perspectives and to learn of your success with this intervention in chronic / complex pain management, this must be a very challenging clinical specialty.

I do have a perspective that is different to yours, however, this does not equate to a closed mind - science is not indoctrination.

My main interest is that the term ‘acupuncture’ seems to have such a large variety of meanings that neither the treatment itself, nor the mechanism by which it acts is falsifiable. The same may be said for foot orthoses, however, foot orthoses are not associated with a paranormal mechanism of action. Both historical and contemporary explanations for the mechanism of action of foot orthoses have biophysical hypotheses in either kinematics, kinetics, EMG etc.

Whether believed by all or not, acupuncture is associated with, and in many cases defined by, a paranormal mechanism of action. This is the reason I remain skeptical.

If your use of the term acupuncture does not refer to 'qi' and 'meridians', then perhaps the only contention between us is whether the term acupuncture should be used or not (and I have no new material here !)

Looking forward to reading more as you post it.

Regards,

Andrew

PS - For the record, I have inserted 2 quotes into my previous post to you (as I now know how to do it), thereby clarifying that my comments on academia and orthoses were in response to your earlier comments.