Qi Spot

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

Now before we wonder how fetuses in mommies get depression, let me clarify that what is mentioned here is depression of the mother-to-be.

Two New Studies Show Acupuncture Can Relieve Pain and Depression

The first study we have already mentioned (Scientists Find How Acupuncture Deactivates Pain (well, one of the ways) ) so let’s go to the second one:

Meanwhile, a study that was included in the 30th annual meeting of the Society for Maternal-Fetal Medicine in Chicago revealed that depression among pregnant women can be effectively treated with acupuncture.

Depression during pregnancy poses a tough dilemma for would-be mothers because anti-depression drugs can disrupt normal development of the fetus.

Experts at the acupuncture New York center suggest that the risk of miscarriage may increase upon intake of anti-depressants, especially Selective Serotonin Reuptake Inhibitors (SSRIs).

Mothers who take anti-depression medication during pregnancy are also prone to give birth prematurely to underweight and sickly infants.

“The results of our study show that the acupuncture protocol we tested could be a viable treatment option for depression during pregnancy,” Dr. Rosa Schyner, one of the authors of the study, said.

Previous studies providing scientific evidence validating the efficacy of acupuncture are plentiful.

Dr. Mike Cummings, Medical Director of the British Medical Acupuncture Society, pointed that decades of brain imaging data have already shown results like those of Dr. Asghar and Schyner’s studies.

He said that activity of primitive brain parts linked with pain and suffering decrease with acupuncture.

Dr. Cummings also said that acupuncture “appears to be particularly effective at treating pain and the suffering related to pain, but it may also have some effects on mood disorders, such as depression, through its general effects on the brain.”

Given that the qi sensations associated with REAL acupuncture are easily explained by stimulation of certain sensory fibers, and that all sensory stimuli pass through the hypothalamus, and that the hypothalamus is a collection of nuclei that affect everything from circadian rhythm to effecting the pituitary, I’m not surprised.

I still wish I could FIND the actual article and not just rely on the press release.  Google time.

… but are a bit lacking in their conclusion.  Let me explain.

Their headline is “Acupuncture ‘lessens pain in brain not body’, scientists discover”.

Acupuncture works by making the brain, rather than the body, no longer experience pain, according to new research.

by Andrew Hough (http://www.telegraph.co.uk/health/healthnews/7167362/Acupuncture-lessens-pain-in-brain-not-body-scientists-discover.html)

Scientists who scanned the brains of volunteers as they were given the Chinese therapy found it deactivated pathways that govern pain.

Complementary medicine expert Dr Hugh MacPherson, of the University of York, said: “These results provide objective scientific evidence that acupuncture has specific effects within the brain which hopefully will lead to a better understanding of how acupuncture works.”

The findings, published in Brain Research, suggest acupuncture has a significant effect on specific nerve structures.

Dr MacPherson and colleagues explained when a patient receives acupuncture treatment a sensation called deqi can be obtained. Scientific analysis showed this switches off areas within the brain that are associated with the processing of pain.

After reading this, I came to the realization that one reason that people do not understand that it is quite difficult to conduct double blind studies with acupuncture is the fact that they fail to see that acupuncture is more than just sticking needles into points.  The manipulation of the aforementioned needles is important, as they lead to the deqi sensation.  The feeling of deqi (“acquiring qi”) or “needling sensation” can be present upon inserting the needles alone (if done right), or through a bit of manipulation.  These manipulations are very dependent on the manual skill of the practitioner.  Hence, acupuncture should be treated as a PROCEDURE and not a pill.

Electroacupuncture is a supplement to enhance the "de qi"

You can insert the needles on the same points and not have the same effect if one acupuncturist just pricks the skin and the other manipulates them properly according to the specific needs of the patient.  For example I know that some patients are sensitive at LI 4 and only insertion is needed.  At the same time others may need a bit of stroking at the handle of the needle to obtain the deqi.  This knowledge comes from experience both with the points themselves in general and from knowing patients personally.

It's not enough to stick it in. The needles may have to be manipulated to obtain the qi sensation or "de qi"

The title says it all.

Once again, real acupuncture wins.

From Reuters:

Electroacupuncture shows promise for knee arthritis

NEW YORK (Reuters Health) – A modern twist on traditional acupuncture may bring some pain relief to people with knee arthritis, at least in the short term, a small study suggests.

The study, published in the journal Pain, looked at the effects of electro-acupuncture among 40 adults with knee osteoarthritis — the common “wear-and-tear” form of arthritis in which the cartilage cushioning the joints breaks down.

Electro-acupuncture is similar to traditional acupuncture, where fine needles are inserted into specific points in the skin. What’s different is that the practitioner fits the needles with clips that are attached to a small device that delivers a continuous electrical impulse to stimulate the acupuncture point.

Among the patients in the current study, those who had a daily electro-acupuncture session for 10 consecutive days reported greater improvement in their pain compared with patients who received a “sham” version of the therapy.

In my own practice, you don’t even need the electric current: you just have to manipulate the needles properly.

Patients in that latter group received acupuncture, but the needles were inserted at random points on the skin rather than traditional acupuncture sites. And while the needles were attached to the electrical device, it was not actually turned on.

The findings suggest that true electro-acupuncture may offer at least short-term pain relief to knee arthritis sufferers, according to the researchers, led by Dr. Sadia Ahsin of the Army Medical College Rawalpindi in Pakistan.

Acupuncture has been used for more than 2,000 years in Chinese medicine to treat a wide variety of ailments. According to traditional medicine, specific acupuncture points on the skin are connected to internal pathways that conduct energy, or qi (“chee”), and stimulating these points with a fine needle promotes the healthy flow of qi.

Modern research has suggested that acupuncture may help ease pain by altering signals among nerve cells or affecting the release of various chemicals of the central nervous system, such as pain-killing endorphins.

(and not by “breaking electrical circuits)

In their study, Ahsin and colleagues found that electro-acupuncture appeared to raise patients’ blood levels of endorphins and lower their levels of the hormone cortisol, which tends to rise during physical or mental stress. So it’s possible that these changes explain the greater pain relief, according to the researchers.

Oh come on.  Any review of literature will tell us we know this since at least the 80s.

Larger, longer-term studies are still needed to see whether electro-acupuncture can have lasting benefits — and to find out how often patients would need treatment to gain those benefits.

For now, Ahsin’s team writes, the current findings suggest that, for people who are interested in trying it, electro-acupuncture can be added to conventional treatment for knee arthritis.

Acupuncture and electro-acupuncture are generally regarded as low-risk therapies. Among patients in this study, there were no major side effects apart from bruising at the needle site in three patients, the researchers note.

SOURCE: Pain, online December 15, 2009.

The thing is that if there is structural damage to the knee cartilage, acupuncture will only relieve the pain temporarily.  Think of it this way: acupuncture restores the “flow”, but because the knee is anatomically damaged, the flow WILL get mucked up again.  Hence, acupuncture becomes a glorified pill – giving temporary pain relief.  Where will it come in? It will come in in patients who, for some reason or another, cannot take too many drugs for a long time.  Kidney disease, esophageal varices… any reason to avoid more pills.

Seriously, again we find “news” expounding on something that we practitioners have known for millenia.  Tai Chi helps arthritis.  Here’s the article: “Tai Chi has major benefits for arthritic knees“  Note two things: the title says “MAJOR BENEFITS”, not just fringe “I feel better” benefits.  Second, this study is to be published in the Nov. 15 issue of Arthritis and Rheumatism, a major trade mag.

In a study, researchers found that practicing the Chinese mind-body exercise led to improvements in pain, function and even mental health for people with osteoarthritis of the knee. Some of these benefits persisted for a full year after the study began—months after people had stopped doing the exercises.

If this is placebo effect, I want my share!

“The Tai Chi group seems to have developed a general sense of well being, suggesting that there may be synergy between the physical and mental components of this discipline,” note Dr. Chenchen Wang of Tufts University School of Medicine in Boston and colleagues in the journal Arthritis & Rheumatism. “These findings are promising because there are few efficacious long-lasting treatments for knee osteoarthritis.”

Tufts… last I heard that was a WESTERN medical school.  Nice to know they’re looking into this for real!  Let’s see how they did it:

To investigate further, they randomly assigned 40 people with knee osteoarthritis to an hour of Tai Chi or an hour of wellness education and stretching exercises twice a week for 12 weeks. Study participants’ average age was 65, and three-quarters were women. Most were overweight.

No patients dropped out of the study and those in the Tai Chi group attended 85 percent of the sessions, while the control participants went to 89 percent of the sessions.

At 12 weeks, pain scores had improved by 75 percent, on average, for the Tai Chi group, while function had improved by 72 percent—57 percent and 46 percent greater than for the control-group patients, respectively.

The Tai Chi group also showed significant improvements in quality of life, “self-efficacy,” and depression and anxiety compared to the control group, and the improvements in self-efficacy and depression persisted at week 24 and week 48. Self-efficacy refers to a person’s belief that he or she can accomplish a goal.

Pain scores and others may be subjective, but I’m hoping “function” was measured using objective scales.  Will be looking forward to this when published!  But wow, gotta say it: more than double the effectiveness!

Now one might wonder how can what appears to be standing around and waving the arms while dancing can actually improve joint pain and degeneration.  Here’s my take on it: firstly, tai chi isn’t just about meditation, it’s about making Qi flow more efficient.  If Qi flow is more efficient, then there is better Blood flow.  (Note that I capitalized Blood here – indicating TCM Blood as opposed to western blood.)

In Chinese medicine, Blood has three functions: to nourish, to house the mind, and to moisten.  If Qi flows better, more Blood flows to the joints, and thus the joints are more moistened and have less friction and dryness, at least according to the theory.

Western medicine wise, circulation is improved, leading to more nourished cartilage, I presume.

Either way, the stuff works.