You are currently browsing comments. If you would like to return to the full story, you can read the full entry here: “Chinese Medicine Demystified (Part V): A Closer Look At How Acupuncture Relieves Pain”.
- Chinese Medicine Demystified (Part IV): How Acupuncture Works Modern research demonstrates that acupuncture can relieve pain, reduce inflammation and restore homeostasis. In this...
- Chinese Medicine Demystified (Part VI): 5 ways acupuncture can help you where drugs and surgery can’t Five reasons acupuncture beats western medicine as a primary healthcare modality....
- Chinese Medicine Demystified (Part II): Origins of the “Energy Meridian” Myth The idea that Chinese medicine is a psychic, metaphysical medicine is based on gross mistranslations...
- Chinese Medicine Demystified (Part I): A Case of Mistaken Identity Most of what we've been told in the west about how Chinese medicine works isn't...
- Chinese Medicine Demystified (Part III): The “Energy Meridian” Model Debunked Historical evidence and modern research indicate that the Chinese medicine has nothing to do with...
Tags: acupuncture, chinese, mechanisms, medicine, pain, relief, research
I thought acupuncture was supposed to be mostly painless. How does it stimulate the release of painkillers?
Hello, I am skeptical of acupuncture (and homeopathy, and chiropractic, and most other alternative medicine), but would like to ask a few questions so I can at least understand it better – even if I still may not accept its validity! I do recognize its benefit in short-term pain relief through gate control, but suspect longer-term pain relief is due to placebo instead of physiological changes.
First, do you have a reference for the role of proprioceptors in pain perception? My understanding is that proprioceptors act to inform us of our body position, not pain perception. Pain position is reported by the same nerves as report the pain itself.
Don’t mast cells also release histamines, which trigger an inflammatory response? According to your description of action (and according to Wikipedia http://en.wikipedia.org/wiki/Inflammation) leukotrienes are also an inflammatory agent, not an anti-inflammatory.
You say that the body has a long-term response to injury of reducing blood flow to the area. It was my understanding that the vasoconstriction in response to injury was very short-term, around ten minutes, followed by vasodilation.Is there another mechanism for longer-term vasoconstriction to a wound? The texts I have available don’t mention one, but they are rather introductory.
I apologize if your references address any of these – I’m a broke college student, so don’t want to spend money on more books!
Ok, so it’s the type of damage which elicits a certain pain response that induces painkiller release, rather than the amount of the certain type of pain or something? I get it.
It’s not exactly damage… it’s more of a controlled stimulation. Pomeranz’s studies show that it is the A-delta fibers which are stimulated and give off the “qi” sensation. Naloxone blocks this effect and blocks the pain control.
Okay. So, if stimulating the immune system with a needle leads to healing throughout the body, something like vaccines should be even better for that, right? Or any kind of injection, to some extent.
Oh, it would be silly to use vaccines to stimulate the nervous system. I was just wondering whether vaccines might incidentally have the same effect as the acupuncture needles, if they both stimulate the immune system.
Acupuncture creates an inflammatory response – so the immune cells at work would be macrophages. Vaccines work by forcing T-cells to go to work. (If I recall my second year pathology right)
Oh, ok. I’ve learned some about the immune system, but it has mostly been in relation to its interaction with pathogens. It seems like my limited knowledge is getting in the way of my understanding more than ignorance would
In life there are several ways to enter into belief. One is through personal experience. One is through gathering evidence and trying to fit the pieces together, like what we’re trying to do now. Another is faith. It’s too bad that there’s no level playing field when it comes to faith in medicine. Because “western” medicine apparently predominates, “they” say something and people are more than likely to readily believe. With Chinese medicine, from the point of view of an outsider, we usually demand a bit more, like what we’re doing now. There’s a double standard though – people are more likely to accept western medicine “pronouncements” on faith alone (faith in medical authority).
On one level I agree, Philip. Doctors can be wrong: their information can be outdated, and their understanding can be a misinterpretation. It is often good to get more than one opinion on an issue of diagnosis/treatment and try to find a consensus.
On another level, I think “western” medicine is based on science, at least in theory (perhaps not in practice, with every doctor), and I believe the scientific method is a great way to avoid human error. It is not without problems of its own, of course, so here too there is value in seeking a consensus of people who have made a career of looking at the evidence. A few may be fooled by false conclusions, but it seems like the truth should be found by the majority. So it doesn’t surprise me much that people who cannot investigate matters well on their own should put their trust in the mainstream. Does that make sense?
Most of us have been taught that western medicine is based on science, and science represents the unbiased, objective way to search for truth. However, subjective judgments lie behind all the facets of “scientific” research. (Not to mention that nowadays, most clinical research are funded by pharmaceutical companies)
All data are theory-, method-, and measurement-dependent. That is, “facts” are determined by the theories and methods that generate their collection; indeed, theories and methods create the facts.
This means that how the problem will be defined, which model(s) of inquiry will be considered to be relevant to the problem as defined, which model(s) of inquiry will be considered to be relevant to the problem as defined, where one shall look (and, by implication where on shall not look) for evidence–and even what one shall consider to be constitutive of evidence–are all determined by the paradigmatic “map” or world view to which the scientist is committed.
–John Ratcliffe, Notions of validity in qualitative research methodology
What are you suggesting, Donna? Can you give an example or two, so I can understand better?
Jesse: Thank you for your open-mindedness. I agree with almost everything you said. Here are the exceptions:
Yes, western medicine in theory (thank you for pointing that out) is based on science. However, I would like to point out that so is Chinese medicine. It is based on evidence – collective experience by practitioners accumulated over millenia – which I’m sure was subjected to the basic rigors of the so-called “scientific method”. Namely – identify the problem, search for past attempts to solve the problem in the literature, formulate a hypothesis, experiment to prove or disprove the hypothesis, and draw conclusions. Time has proven that some formulas or point combinations have faded away to obscurity because they don’t work as well as others.
Secondly, science is only now validating what was known before. I could fill this comment box with citation after citation concerning the effects of individual chinese herbs – both beneficial and otherwise. It is difficult to analyze individual components of formulas, but formulas have been studied. I just gave a lecture last week on scientific studies involving Liu Wei DiHuang Wan (Six Flavor Rehmannia Decoction) where it’s anti diabetic and immune modulating activity is proven through published studies.
Thank you also for acknowledging that ALL science and ALL medicine have problems. True, even chinese medicine is the victim of commercialization and money-making chicanery. I’ve seen patients get kidney failure from overdosing on korean red ginseng, for example. This was promoted by unscrupulous traders as a panacea… and being “natural” it supposedly had no side effects – forgetting the fact that a very “hot” herb like red ginseng should be used sparingly in a hot humid climate like in my Philippines.
Donna is correct in that many people trust “scientists” implicitly because we are taught that science is an objective search for truth. The truth is that modern science is an objective search for funding.
Chris – I think one of the main problems with reconciling TCM and mainstream western medicine is the seeming inability to reconcile terminology. It is my adamant belief that TCM will be easier to understand if the TCM philosophy and terminology is explained using the western paradigms – you got the ball rolling with your posts on the meridians. Are you planning any more? For example, we know fire = inflammation, what about damp? or cold? =)
Jesse, one of my teachers have said, ‘When we examine any system of human medicine, we must first ask the question: “According to this medicine, what is a human being?” and, therefore, “What is a healthy human being?”‘ (Liu Ming)
As Chris said very well in the Part VI article, western medicine mainly geared towards suppressing symptoms. This is the basis of how most researches are designed. For example, there are many clinical trials that follow the same logic: i.e. In a clinical trial, ___% of patients with (_____symptom) who undergo (______treatment, can be a drug, or surgery etc.) show improvement of symptom compare to ___% who took placebo, compare to the control group…. The basic premise of most clinical trials of this kind is to see statistically how certain symptom is managed with a drug. However, are we just a statistical number? These research methodologies also play down the human factor to try to be “objective” about the results. However, we have to ask, between the drug and the symptom, where is the human being in it?
What does that say about the philosophy of western medicine?
Chris, I agree with you that chinese medicine has to be subject to scrutiny. But, as you know, Chinese medicine address the whole person, it considers the full range of human experiences (e.g. emotions, lifestyle, diet, climate and other environment factors) that leads to a systemic malfunction/imbalance to that leads to the symptoms. This paradigm is different from western medicine and so chinese medicine should be scrutinized under a different set of research methodology.
well said. as they say, “The difference between a medicinal and a poison is dosing.”
I would like to thank everyone for your willingness to discuss things with me. I have encountered many ideas in this series for the first time, and am sorta working out what I think of everything as I go. So thanks for your patience.
I’m glad to hear that Chinese medicine is based on science too. In that case it should eventually be accepted into the mainstream, I believe.
It’s true there is some corruption in science, but I think most of it is eventually worked out through peer review and replication. After all, scientists aren’t paid to question the work of their colleagues, but they do it anyway
I agree that reconciling terminology should help. Defining concepts precisely in ways everyone understands leads to clearer discussions.
Defining what a healthy human being is seems like a good idea. How does one go about doing that?
You also say chinese medicine should be scrutinized a different way. What sort of research methodology might work for the purpose?
I am aware that the WHO has separate guidelines for acupuncture research – I cannot bring up the info off the top of my head but I now have fodder for future blog posts.
Suffice it to say that I have previously written on one misconception about acupuncture that makes it difficult to formulate studies on it . In summary it can be stated that “Acupuncture is a procedure, not a pill.” It is practitioner dependent. There is no one set of “points” for every named western condition. A practitioner has to determine the root cause behind the given symptoms.
For example both “heat” and “cold” can cause similar respiratory symptoms. It takes skill both in history taking and physical exam to distinguish between them. This, plus taking into account the patient’s constitution, occupation, living conditions and diet, may lead a practitioner to prescribe seemingly totally different treatments for what appears to be the same condition. On the other hand, the same “root” may manifest differently in different people. Sudden fits of anger may manifest as vertigo in one patient, liver attacking the spleen/stomach and leading to indigestion in another. In that way, different conditions may appear to be getting similar treatments.
I hope this gives an idea on how difficult it is to do double blind studies.
“I don’t entirely agree that it’s not possible to do good research on the effectiveness of acupuncture” I never meant to say that. I just said that I don’t think that double blind studies are the best way to do it.
“What probably has a greater effect on outcomes than the practitioner’s skill or point selection is the meaning that the patient attributes to the treatment. ”
-respectfully slightly disagree. I’ve had long time patients where, I admit, sometimes my diagnosis was wrong, my point selection didn’t work. But when I realized my error and corrected my manipulation and/or points used and that achieved the desired effect. These are patients that I have seen several times over the years and return for new problems. Hence, they already have confidence in me and in the medicine. Yet if you do the wrong thing it doesn’t work… Hardly ascribable to placebo effect.
This is the benefit of open discussion and open minds: we exchange ideas, clarify misconceptions, etc etc. =)
Yes I am aware of those studies involving sham and active acu. I’ve blogged about some myself. I could always use more references though, and maybe you have some I’ve missed. I’d appreciate an email heh heh.
And lastly, yes that’s the important thing for us. If only it were the important thing for all.
There are many issues to discuss here, not just one. I probably can’t get into discussing some of it without opening some other cans of worms.
Chris, I am not saying outcome or symptom reduction don’t matter, or that current research methods have absolutely no value in evaluating acupuncture. Current research methods have some value if you can see it for what it is–the context of it, the paradigm in which it is based on, notice what it omits, and the underlying limitations, instead of believing that is the objective whole truth.
Right now, most studies in medicine are quantitative research. Because of the holistic nature of Chinese medicine, I would like to see more qualitative research being done. I don’t have an idea how it should be done, as designing studies has not been my area of focus. I would leave it to people who are more inclined to do so.
On the problem of current acupuncture studies: some “sham” acupuncture in researches use non-penetrating needle to stimulate a acupuncture point. However, many Japanese blind acupuncturists use non-penetrating “contact needles” in acu treatments. Dr. Bear, whom I studied with, uses such method, and I have witnessed its effectiveness. Sometimes, when I am deciding on which points to select, I would test them by placing my finger lightly on one point at a time. Patients can usually tell me which point has better effect on their pain, breathing etc.
So yes, even just placing my finger on an acu point can elicit a immediate response from the body. How can that be explained?
There are many ways to understanding the body that goes beyond the biochemistry model of western medicine, and actually more based on the 20-21st century modern physics findings, some look into the bioelectricity and electromagnetic field generated by the body (e.g. <i>Root of Chinese Qigong</i> by Dr. Yang Jwing Ming), some focuses on the signal system functions derived the way our body is organized and developed since it’s embryonic stage, (<i>Chasing the Dragon’s Tail </i> by Yoshio Manaka, MD, which I just started reading, fascinating work so far) some look at how universe is entirely holographic in nature, including our body (<i>Holographic Universe</i> by Michael Talbot), etc. etc.
Philip, I agree on the value of being open-minded and exchanging idea. There is a fable of the 3 blind people who never encountered an elephant before. One day, there is an elephant in town, they all touched a very different part of the elephant and drew a different conclusion of what an elephant is like, and started arguing with one another and insisting the others are wrong, and their own idea of the elephant is the only truth.
They would have learned from each other if they can just be open-minded and discuss more openly.
Jesse, I hope this is not too overwhelming. It has taken me many years of thinking/ learning about the subject of healing, what I found is a web that everything is connected with everything else, and that’s why it is hard to just talk about one thing without mentioning all other things.
“Defining what a healthy human being is seems like a good idea. How does one go about doing that?” This is entirely subjective. We can go on and go about what makes us healthy or not, but in the end, it is your direct experience that counts most.
Chris, thanks for mentioning the importance of meaning response, and that one of the important advantage of acupuncture is that it is low-risk with little side effects. I completely agree with that.
My theory about why touch already has an effect is this: acupuncture can be considered a form of really really really deep tissue massage (think about it) and in some patients, just a light touch can already stimulate the same receptors that acupuncture needles stimulate.
TCM wise, the theory of meridians and collaterals infers that Qi and Blood ultimately cover the whole body – so hypothetically inserting a needle or applying pressure anywhere can have an effect.
addendum: hypothetically they can have an effect, but the points are areas which clinical experience has proven to have stronger more specific effects. Just my two cents.
“Because we practice in an environment dominated by evidence-based medicine.” True, and again, context is everything.
Chris, we may not agree on all points and that’s fine with me. I am glad to hear that your article is bringing more people to try acupuncture. That’s a really good thing. This discussion has prompted me to start reading the Dao of Chinese Medicine. When I can overlook Kendall’s occasional opiniated and dogmatic tone, I can see that there is a lot to learn from his interpretation. I think it is possible to discuss chinese medicine in terms of physiology without being dogmatic about it. It is also interesting to read Manaka’s Chasing the Dragon’s Tail, (which I highly recommend even if you don’t practice his method,) for a different viewpoint. I think it would be interesting to have this conversation again in 20, 30 years’ time to see what new breakthrough in the western medicine can shed more light on the subject. The fascinating thing about chinese medicine is that many new principles and findings in biophysics/physics/biochemistry was actually already mentioned in the ancient texts!
I appreciate your effort in writing this articles and the discussions. See you in school!
Now that you so brilliantly demystified acupuncture, what do you think of reflexology? Can you demystify that as well? Is that a part of chinese medicine as well or is that a western invention?
What do you think of this study? It seems like a good one: large size, decently done, published in a respectable journal. But it shows that fake acupuncture using toothpicks is no more effective than any kind of needling.
What I meant was, fake acupuncture using toothpicks is just as effective as any kind of needling, or any kind of needling is no more effective than fake acupuncture.
According to classical meridian theory the meridians are like major vessels and the collaterals link them together. The whole body system is covered by them. It is similar to how you have major arteries and veins, then smaller ones, down to capillaries, yet every nook and cranny of the body is reached by it.
Hence, according to Sun Simiao (if memory serves me right), if there is pain, there is an acupuncture point. These are called locus dolendi or “ah shi” points. What can be deduced from this is that sticking a needle anywhere can have an effect. The points are just places where effects are more profound imho.
Now, there are many ways to influence these points and meridians. Acupuncture is one. Others include moxibustion and tui na massage. Think about it, in tui na you use touch to stimulate these points, and they also work. Moxibustion may not even have actual physical contact with the patient, but there is a physiologic reaction to the heat and volatile oils released. My point is traditional chinese medicine recognizes that acupuncture is not the only way to stimulate points and elicit reactions. Even simple touch can do. Given this, then even “fake” acupuncture can be as effective (at times) or only slightly less effective (sometimes even more) because it’s not how the stimulation occurs, it’s the fact that stimulation does occur.
So why use needles? If I want to hit eight points at once with only two hands, you can see how using needles makes treatment more efficient and less tiring than my hands and fingers! It also enables me to treat more than one patient at a time. From experience, using needles is sometimes less painful for the patient from using finger pressure to reach points, LI 4 and LIV 3 come to mind…
Chris and Philip,
At this point, I’m not suggesting that acupuncture, whether with needles or toothpicks, has no effect.
However, I thought the point of this article was to suggest a possible mechanism for the effects of acupuncture: that needles damage the skin, inducing release of painkillers, and that they stimulate the immune system, which helps healing and stuff.
It seems like these effects are dependent on the puncture of the needle, which toothpicks would not provide. So if toothpicks still work as well as needles, doesn’t this suggest that your mechanism is wrong?
That’s my concern at the moment. I think it would be good to discuss placebo at some point too, but I understand you’re planning some future posts on the subject, so I guess I’ll wait until then.
So toothpicks induce A-Delta fiber firing without penetrating the skin? If I read the original post correctly, that was one of the two mechanisms you proposed for how acupuncture works: Needling causes micro-traumas that induce the brain to release painkillers and allow the old injury to heal. Do toothpicks cause micro-traumas?
Jesse, actually just touching your skin against something causes capillaries to burst. It’s just that our bodies are quite efficient in immediately repairing the damage. If not, we’d have bruises all over.
Okay, that’s what I thought you were saying. Thanks for answering my questions. At this point it sounds like I would prefer toothpick treatment if I were ever to get acupuncture, as it sounds more pleasant, though I’m sure your experience suggests that it wouldn’t work as well, hehe.
What do you think about the theory of meridians being connective tissue planes?
I wouldn’t be surprised.
Again, Chris and I would differ in opinion on this one. I’d have to get my copy of Huangdi Neijing and Zhenjiu Jiayijing to be sure though..
What I’d like to say though, is that there should be many ways of looking at the same thing, in order to achieve a better understanding. (just not the “energy meridian”… )
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