Qi Spot

I would like to point out a slight error in your statements as quoted here: http://www.gmanews.tv/story/213171/chinese-embassy-court-sustains-death-sentence-on-3-pinoys

“(A Chinese ambassador told me that) they are very, very strict when it comes to drug laws because it’s a major concern of theirs. Iyung sa shabu, iyung ephedrine is a natural, comes from a plant that grows primarily in China. Mas malaki ang problema nila doon, they have a bigger populace, and they have syempre the history of opium from before,”

Why the heck is ephedrine mentioned in the same breath as methamphetamines and opium?  Again this is due to Ephedra’s bad rep as it is banned in the United States.  I shan’t repeat myself, but I would like to refer our President to my articles about Ephedra:

“News Bias Continues: Ephedra’s True Story” http://qi-spot.com/2010/02/01/news-bias-continues-ephedras-true-story/

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A quote:

Herba Ephedrae or Ma Huang is usually the first herb one would see in a typical textbook of Chinese herbal medicine.  It is usually used to clear early symptoms of flu, and not ALL kinds of flu.  ANY look at the texts will give SPECIFIC indications for it’s use.  However, western herb enthusiasts had, according to the article, “converted from an herbal treatment for diseases to an energy stimulant and a weight-loss product.”

What are it’s classic textbook uses?

Actions: induces diaphoresis, resolves surface, ventilates the lungs to relieve asthma, regulates water metabolism.

Applications: febrile diseases due to exterior-excess, fever, chillphobia [aversion to cold], anhidrosis [lack of perspiration], ostealgia [bone pain], arthralgia, cough with dyspnea, edema, edema due to wind.

From this, it becomes obvious that Herba ephedrae is meant to be used in actual illness, not in a healthy person just trying to get a kick or lose weight.  The weight loss aspect is gleaned from it’s strong diaphoretic effect.  However, a basic look at any  Chinese herbal textbook will show that administration of ma huang should stop WHEN PERSPIRATION BEGINS, whether or not the flu has dispersed.

Again, if the patient has external symptoms (chills, slight fever, arthralgia, muscle pain) with no sweating, ma huang may be given AS PART OF A FORMULA to mediate effects (see ma huang tang, among others) and should be STOPPED when sweating begins.

Also, it should not be used as a tonic.  Many of the early ma huang/ephedra “supplements” were mixtures of ephedra and other tonics (including caffeine!)  Disaster waiting to happen.

How does that compare with western enthusiasts taking the herb individually for what we MDs would term as “off label use” contrary to all warnings?

OF COURSE they’ll get sick.  A professor of mine in China warned against yin collapse (shock due to blood or fluid loss) after using too much sweat-inducing herbs.

“The Art of Chinese Medicine” http://qi-spot.com/2010/11/15/the-art-of-chinese-medicine/

My point, Mr. President, is that Ma Huang or ephedra, the source of ephedrine, is a very valuable medicinal material in China and is banned in the US only because SOME IDIOTS misused it for off-label purposes.  It does not deserve to be compared to real dangerous drugs

It is but natural for many people to consider their personal philosophies and worldviews as the standard against which others must measure their versions.  I recall an incident from my first year in college.  For me, it was my first time to have classmates who did not know any Chinese, and for them, it was their first exposure to someone (there were two of us, actually), who used a language using a non latin alphabet.  (Filipino, while a malay language, currently uses a latin alphabet).

I wrote some characters on a blackboard.  My newfound friend asked, “so is there like, one character per english letter?” (the answer was no)

I hope you get the idea – for someone exposed ONLY to latin alphabets, it is assumed that the latin alphabet is the standard from which others are based.  Another example:

The Zentraedi Alphabet by Kazutaka Miyatake

The Zentraedi are a fictional alien race in Japanese cartoons, particularly the Macross series by Tatsunoko Productions.  So, an alien race who who have no concept of culture, much less a culture like ours, have an “alphabet” that corresponds one-to-one with English.  Who would have thunk it.

Let’s get this straight, the east is the east and the west is the west.  There is no “gold standard”.

So, this is the mindset people have to overcome.  When inquiring about Qi, therefore, the western mind is looking for a cultural and linguistic equivalent based on the western paradigm.  It’s like an Englishman looking for a Japanese letter representing the sound made by the letters “L” and “R”.  There isn’t any.  There’s a combination of both into one sound but that’s it.

Failing to find a single one-to-one correspondence for the meaning of the word “Qi”, the westerner ends up disappointed and skeptical.

The failure lies in those who are unaware of how to explain Qi, particularly to MDs.

Here is something I wrote in an email about this topic:

“I would start off by saying that most MD’s do not want to hear anything that sounds vaguely “supernatural”.  Of course, to folks like us, Qi isn’t supernatural, it is in fact the basis of everything – hence nature – but that’s not what it SOUNDS like to them.

So I always start by asking members of the audience to explain what they think Qi is, while gently correcting.  I then also show that Qi has a wide variety of meanings depending the context.  I use “sheng qi” (get angry), to explain that in this sense, qi is physiology as the blood rises to the head when one gets angry as sheng qi literally means bring forth qi.  ”Tian Qi” or weather, to imply that Qi has a “communication” and “status” aspect (status as in state of being) as tian means heaven and so tian qi can mean the state of the heavens or the nature of the heavens at a given time.  Qi has a breath or air aspect as when we say hot air balloon or qi qiu (qi ball).

Once that fundamental is established, I then narrow it down to medical terms.  Qi therefore has something to do with physiology, a state of being, a breathing or dynamic aspect.  Hence, when we say “qi flows” it means natural function is present.  If qi is blocked, then function is impaired.”

“(Instead of sounding New Agey by going through the philosophy of Qi is, we can simplify it by just saying)… that “Qi” has many meanings in english, just like the greeks had about seven or so different words for one english word love.  One meaning of Qi with most relevance to the body is physiology.  Acupuncture has been proven to release NO (nitrous or nitric oxide, I forget) which is a vasodilator, making blood vessels larger and facilitating better blood flow – that’s why acupoints with needles turn slight red.  Hence, when we say Qi is unblocked, in biomedicine we can say the physiology is facilitated or made more efficient.  Nothing supernatural, nothing gimmicky, just proper translation of terms.”

Again, this is not a comprehensive explanation of exactly what Qi is, but it is my personal method of explaining it to MDs in such a way as to make the concept more relevant to them.

Enough with answering back at mudslingers.  I get more than enough of that in the local media, with the Philippine elections just around the corner.  Let’s move on to being proactive instead of being defensive.

A common “debunking” technique of anti-acupuncture bigots is to come up with “evidence” that acupuncture is clinical similar to placebo and then “conclude” that acupuncture is therefore useless or irrelevant.  This plays the assumption that placebo = no effect, when in actuality placebo  = the doc does nothing but the patient feels an effect. (http://qi-spot.com/2010/04/28/the-smear-campaign-continues-acupuncture-does-not-relieve-childbirth-pain/)

Of course, even if both acupuncture and sham acupuncture have clinical effects that seem similar (and studies have shown that the real thing beats the fake stuff, even if not by much), the argument the skeptics pose is that if acupuncture is no different than placebo, then what’s the point of doing real acupuncture at all?

Well, a while back, I posted about a study I was looking forward to. (http://qi-spot.com/2010/04/04/a-study-to-look-forward-to-acupuncture-more-than-just-placebo/).  Thanks to Chris, I now have the whole article.   I would like to start by quoting thus:

As long as acupuncture and sham acupuncture treatments produce similar clinical improvements, the results of respective trials can only be taken as evidence against the efficacy of acupuncture. (I don’t think so… – Philip) Only when it can be shown that acupuncture and sham acupuncture effects are mediated differently, this can be taken as evidence that acupuncture effects are different from placebo effects, although both may still be equally effective.

I still can’t help but detect a bit of bias.  When something can be interpreted negatively, it “can only be taken as evidence against…” meaning there is no other way to interpret it, supposedly.

Similar clinical effect, different mechanism of action

Still the point is valid.  If we can show that the real deal triggers physiologic reactions distinct from sham, then that should construe evidence that acupuncture is not only valid, but should be encouraged.

According to the article “Acupuncture, Psyche and the Placebo Response” (the article mentioned above) they HAVE found such physiologic differences.  Why does this matter?  It matters because a) skeptics can’t say it’s like placebo anymore and b) we now have an increased knowledge of acupuncture mechanism of action, which is more than what we can say for such western drugs as lithium.

Take two of these and call me in the morning, even if we don't know how they work

So how does the real thing differ from the fake stuff?  Let’s count the ways as enumerated by Enck et al:

a) “Acupuncture but not sham acupuncture was found to induce both cerebellar as well as limbic cortex activation indicating both motor as well as affective component modulation of the pain matrix.  Acupuncture resp. electroacupuncture at non-acupuncture points and tactile stimulation alone served as controls in early fMRI studies (Wu et al., 2002; Yoo et al.m 2004)

b) Verum (true) acupuncture in contrast to non-penetrating placebo nedles activated cortical centers involved in affective pain modulation (Chae et al., 2009)

c) Greater activation of sensorimotor areas by sham procedure (superficial manipulation at acupuncture points) than by true acupuncture (Napadow et al 2009) – (note that stimulation of true acupuncture points by non-needling methods was considered sham by the authors, whereas in chinese medicine it is a valid method of stimulation)

d) Variances of time of central activation between verum and sham acupuncture, attributed to stronger peripheral actions of true acupuncture

e) PET scans on fibromyalgia patients show that needling at true points elicited significant activation of mu opoid receptor binding capacity in the cingulate, caudate, thalamus and amygdala both after one session and after four weeks, while with sham (insertion into non acupuncture points), small DEactivations were noted, an effect that is seen with placebo analgesia. (Zubieta et al., 2005)

There are more, but these should suffice to prove the point.

All in all I believe this evidence validates my personal belief that real acupuncture has longer lasting effects than sham acupuncture.  This is shown by the fact that real acupuncture has more central (meaning up in the brain, as opposed to just local pain mediation) effects.

Another thing worth noting is that different people have different definitions of sham.  For some, it’s using real points but not inserting.  For others, it’s inserting into non-acupoints.  Logic dictates that both have different effects.  Controls used in acupuncture studies should be standardized!

The crazy thing is that all this has been known by Stux, Berman and others since I was in grammar school in the early 80s!  Jeez!

_________________________

Enck, P., et al., Acupuncture, psyche and the placebo response.  Auton. Neurosci. (2010), http://www.ncbi.nlm.nih.gov/pubmed/20359961

Harris, Zubieta et al. ” Traditional Chinese Acupuncture and placebo (sham) acupuncture are differentiated by their effects on Mu-Opioid Receptors (MORS)” Neuroimage.  2009 Sep; 47(3):1077-85. Epub 2009 Jun 6. http://www.ncbi.nlm.nih.gov/pubmed/19501658

Firstly, I’d like to apologize for not posting for two weeks. I’ve been travelling a lot through Hong Kong and China. I will blog more on some observations I’ve made while in Hong Kong as soon as I get some of my photographs uploaded to my laptop.

Speaking of Hong Kong, I am beginning to wonder if there is some grand plot to discredit acupuncture in Hong Kong. First comes the “letter to the editor” concerning acupuncture spreading disease (http://qi-spot.com/2010/03/20/new-bashing-technique-acupuncture-causes-disease/) and now this.

“Acupuncture does not relieve childbirth pain” (http://www.guardian.co.uk/society/2010/apr/28/acupuncture-childbirth-pain-study)

I am the first person in the world to admit where acupuncture is one big FAIL (such as in colour blindness). But I would like to call the attention of the reader to the weasel wording evident in this smear campaign of a headline.

Look at the title. “Acupuncture does not relieve childbirth pain.” What does this imply to the reader? It implies that acupuncture has no effect at all on the pain felt by mummy.

Yet the sub-title below the headline betrays a hint of the truth:

“Research suggests results from complementary therapy during labour may be placebo effect”

Now, we have no idea, based on this sub-headline if this is a single study or a meta-analysis.  As we have said before, a meta-analysis is a fancy way of saying, “let’s put different studies together just to get the numbers up.  We can always find a way to put the studies together that the sum total numbers can be made to say whatever we want.”

Secondly, it “suggests” (whatever that means) that the results may be placebo effect.  Wait.  Results?  RESULTS?  I thought that acupuncture “does not relieve” childbirth pain?  So if it is useless, why are there “results”?  That means there WAS relief of pain.

So why come up with a headline saying otherwise?  Because the results “may” be placebo effect.

Actually, I wouldn't use those points in pregnancy... but what the heck. Then again, he just might be some really fat guy...

The finding, which has already prompted a vigorous debate about the value of acupuncture, came from British and Korean researchers who examined previous studies of its use in labour.

“The results show that there is little convincing evidence that women who had acupuncture experienced less labour pain than those who received no pain relief, a conventional analgesia, a placebo or sham acupuncture,” researchers told BJOG: An International Journal of Obstetrics and Gynaecology. The journal is owned by the Royal College of Obstetricians and Gynaecologists, which represents most of the UK’s doctors specialising in childbirth and maternity care.

The finding, which has already prompted a vigorous debate about the value of acupuncture, came from British and Korean researchers who examined previous studies of its use in labour.
“The results show that there is little convincing evidence that women who had acupuncture experienced less labour pain than those who received no pain relief, a conventional analgesia, a placebo or sham acupuncture,” researchers told BJOG: An International Journal of Obstetrics and Gynaecology. The journal is owned by the Royal College of Obstetricians and Gynaecologists, which represents most of the UK’s doctors specialising in childbirth and maternity care.

So it IS a meta-analysis.  Strike one.  I wonder what points were used? Hmmm…

Prof Edzard Ernst, of the Peninsula medical school at Exeter and Plymouth Universities and co-author of the report, said: “The effects of acupuncture perceived by women are largely due to placebo. Acupuncture has many qualities that maximise placebo effects: it involves touch and is invasive and, psychologically, is attached to the mysticism of the east.”

Ernst is a known skeptic of acupuncture and makes a living (i.e. buy his book!) by bashing it.  Then again, I make my living healing patients with it, so I guess we cancel each other out.  Still, he admits that acupuncture DOES have an effect, it’s just that he either cannot or will not recognize the evidence that acupuncture DONE PROPERLY is more than placebo. (http://qi-spot.com/2010/04/04/a-study-to-look-forward-to-acupuncture-more-than-just-placebo/)

I would like to point out that even in western medicine, there exist drugs for which the mechanism of action is unknown.  Lithium is used for bipolar disorder and it is not known how it works.  Yet it is given, despite toxicity, because it has been observed to work.  I leave it to the reader to witness where the double standard lies.

Also, I find it disturbing that people will look down (albeit unintentionally) on patients’ experience just to pooh-pooh acupuncture.

Prof Philip Steer, BJOG’s editor-in-chief, said labour pain can be so intense that a women would do anything to minimise it.

Please, by that logic we can get a shaman in pyjamas to conduct ritual chants and that would work.  Yet it doesn’t, and acupuncture does.

“Acupuncture is a drug-free approach and that may explain why some women prefer its use during labour. This review shows that in a very small number of cases acupuncture may be of help, usually for short periods of time after treatment, and this may be down to psychological rather than a physiological effect. Generally the consensus is that the evidence does not support its use.”

The only benefits were 11% less pain in the first 30 minutes after receiving acupuncture and a need for less pharmacological pain relief, the authors say.

Wait wait wait.   The “only” benefits? So “they” begrudgingly admit that there are benefits!  Back to my first question: why the irresponsible headline, then?  The last part of the sentence betrays the answer:

“…a need for less pharmacological pain relief” – in english: LESS DRUGS.

Less drugs, less profit for big pharma.

I will skip to the last part:

Mike O’Farrell, chief executive of the British Acupuncture Council, said: “We’re surprised by these findings as previous trials, along with the evidence that our members see in their practices every day, suggest that acupuncture can be effective in providing pain relief in many different circumstances.”

Again, as I have said before, people not biased by big pharma can see where acupuncture works and it doesn’t.  I am happy to report, both first hand and through correspondence with other OB-Gynecologists even in the US, that acupuncture can work in reducing childbirth pain IF DONE PROPERLY.

My final thoughts: this article should have been entitled “Acupuncture apparently no better than placebo” instead of “Acupuncture doesn’t work”.  News bias, bah humbug.

Campbell, Denis.  ”Acupuncture does not relieve childbirth pain” The Guardian.  28 April 2010.  <http://www.guardian.co.uk/society/2010/apr/28/acupuncture-childbirth-pain-study> Accessed 28 April 2010

Shi Xue Min is a legend in acupuncturist circles.  He is the head of the single largest acupuncture department in the world in Tianjin, China.  In his hospital, a new 22 storey acupuncture building is being constructed just to deal with patient load.  I bring him up now because I want to show through his example why acupuncture is a procedure and not a pill, and why not all acupuncturists are created equally.

From Blue Poppy I quote:

At any rate, Shi Xue-Min is the chief editor of many important acupuncture texts in China, including the “gold standard” yellow hardbound Acupuncture Treatment (Zhen Jiu Zhi Liao) textbook that is found in any good Chinese TCM library. One thing that stands out when reading Chinese acupuncture textbooks (in comparison with English ones) is the emphasis on needling sensation and stimulation methods. Many English textbooks say “needle point x” while Chinese texts say “needle point x with even supplementing and draining technique for 30 seconds of continuous stimulation, until the qi sensation propagates to the lower abdomen.” Similarly, Shi Xue-Min’s lecture placed a tremendous emphasis on HOW the points should be needled, which techniques were appropriate, how long the stimulation should be, etc. (emphasis mine)

In virtually every western style study I have seen, I have seen the use of electroacupuncture.  There is practically no mention of needling technique.  Is it any wonder, then, that results may be inconsistent?

It's how you use it that counts!

Let’s go back to what I’ve been saying.  Acupuncture is being studied in the west as a PILL and not as a PROCEDURE.  Jesus Christ if I had a nickel for every time I’ve tried to hammer that into skeptics’ brains I’d be rich.  Let’s explain further. You can prick and get a moderate effect, or you can needle properly, get the achieved qi sensation and increase your success rate.  Can this qi sensation be obtained with massage alone? Yes.  But it’s much harder.

It was once said (I forgot where I read it – I think it was from a Maciocia book) that “the meridians are like strings, the body the instrument, and the acupuncturist the player”.  If the musician is lousy, does that mean that the musical instrument is inherently bad?   Just because your next door neighbor can’t play the piano to save his life does that mean we should discount pianos altogether?

I'm tempted to do the same to lousy pseudo-acupuncturists who give the real thing a bad name.

The Yellow Emperor’s Medical Classic, or Huangdi Neijing, is clear on this.  When needles are inserted proper needling sensation must be obtained.  The problem these days is that “acupuncturists” just follow the book (bypassing proper diagnosis) on point selection, then stick needles without performing proper technique (how would you know what technique to use if you didn’t diagnose right?) and then ignore proper technique and just hook the patient up to some machine that tries to do your work for you?

Show me an acupuncturist who knows how to modulate the qi sensation using proper manipulation and I’ll show you someone with a long line of satisfied patients.

And for the Nth time – study acupuncture as a PROCEDURE, not a PILL.

Now where’s my nickel?