Talk:Acupuncture/Medical acupuncture

Moved from "Modern (Western) acupuncture" discussion page

Medical acupuncture

The provenance of medical acupuncture, it states that Dr Felix Mannn (et al) attended an acupuncture course in 1973 and that was the 'beginning' of Western medical acupuncture. This can not be so, Felix Mann's first published book on acupuncture was in 1962. I think that this needs to be cleaned up, there probably was not a single pint in time when a distinct form of Western medical acupuncture arose, it evolved surely..... —Preceding unsigned comment added by Babbybulldog (talk • contribs) 00:51, 24 October 2009 (UTC)

Isn't this the same as medical acupuncture? It makes no mention of it. The opening paragraph should be a one-sentence definition, which is lacking here as well. Please clarify. heidimo 22:40, 1 May 2004 (UTC)

There is also an apparent contradiction in this somewhat partisan (or at least condescending) article. If the "apparatus" of traditional points is "ignored or radically reinterpreted," then why is there a mention of "trigger points" as being important later? I've done some NPOV editing, but more needs to be done. Fire Star 06:42, 2 May 2004 (UTC)

Agreed! heidimo 15:11, 2 May 2004 (UTC)

I have found something else about this. Out of suspicion that this is a joke article, I did a quick Google search on Wilhelm Ten Rijn and found this:

http://encyclopedia.thefreedictionary.com/Modern%20(Western)%20acupuncture

This may or may not violate copyright regulations. Fire Star 13:03, 3 May 2004 (UTC)

Does look suspicious to have the same exact entry in 2 encyclopedias, but I guess if they're both "free" content it may be ok. Perhaps we should rewrite this to be about medical acupuncture. I have never heard of the term used in the title of this page. To add to the suspicious nature, the person who posted this article does not have a user page, so we can't ask about it. Every other editor apparently has tried to improve the article without necessarily addressing the content until recently. If nobody defends it soon, let's retitle and do a major rewrite. Any objections from any one? heidimo 15:29, 3 May 2004 (UTC)

Cheers, H. It definitely should be renamed. Chinese acupuncture is just as "modern," it just has a (much) longer history. The article also gave the impression to the casual reader (until I reworded things a bit) that "Modern" Western acupuncture had been around for centuries. This page also seems to have wanted to give the impression that there is no need to actually learn any theory or technique from the quaint, if backward, Chinese - if a Westerner just wants to start sticking needles anywhere it will work just as well. I exagerrate for effect, but only slightly. While we should certainly leave in all of the information presented, the editorial slant is partisan and insulting and has to go. My vote is that this puppy is a candidate for a complete rewrite. I'll do what I can, but as I'm not an acupuncturist please check in if you can to keep me in line! Fire Star 20:33, 3 May 2004 (UTC)

Sure, Fire Star, between the 2 of us I'm sure we can whip it into shape, assuming at this point earlier contributors aren't showing any interest. Thanks for your efforts, as always. heidimo 22:59, 3 May 2004 (UTC)

Comments from the author of the original article

1. The material in the encyclopedia cited above has been taken from my web page, without acknowledgement. The copyright is mine.

2. Modern "western" acupuncture has indeed been around for a long time, at least since the early nineteenth century, when John Churchill wrote his monograph on the subject in 1821 (further book in 1828). It attracted a lot of favourable notice but fizzled out later, except at UCH in London and the Leeds General Infirmary, where it was still being used in the 1870s. This acupuncture was carried out without much reference to its oriental roots. User:Acampbell70, 10 May 2004.

Thanks for the clarification. heidimo 15:30, 10 May 2004 (UTC)

New discussion after move begins here

Rewrite

I gave it a re-write. Whatcha think? Can you improve on it? heidimo 23:58, 3 May 2004 (UTC)

It has been much improved. I added half a sentence after the "heresy" comment, as the idea of just sticking needles anywhere does indeed seem irresponsible to a classicly trained practitioner.Fire Star 14:05, 5 May 2004 (UTC)

Glad you find it improved. Agreed, to your addition. I expanded and reworded that bit to make the language work, and to emphasize the danger of this approach. Sorta like "it doesn't matter where you stick the scalpel into the brain" approach to brain surgery? heidimo 15:32, 5 May 2004 (UTC)

which can be difficult for the Western mind to grasp

Unless someone has evidence suggesting there is a defference between the western mind and the eastern mind I'm taking out this comment.Feel free to replace it with person y or group x say/saidGeni 08:27, 6 May 2004 (UTC)

Geni, it is poor wikiquette to make frivolous accusations of racism, and will not win you friends among other Wikipedians. I realize you are a newbie, so you might want to brush up on that. Such accusations can be revised, as you have, but cannot be undone.

If you are unfamiliar with the field of Anthropology, it is rife with a tremendous amount of documentation of cultural misunderstandings which painfully demonstrate the difficulty of the Western mind in grasping non-Western thought. Perhaps a review of the missionary tradition and its impact on world religious traditions, notably Taoism, would help you come to grips with these cultural differences in thought and mind. To state that Taoist mysticism is difficult for Westerners to grasp is an understatement, but to state that it can be difficult is not POV.

You did not say westeners you said the western mind. I think the problem is that we interprit that phrase differently. To me it means that by an acident of goegraphy people are incaperble of thinking in certian ways. To you it means that taoism and other relgions belonging to the chinoindo subcontinat do not tie in well with the dominat materist and somewhat reductionist philophy that is prevatlent in the west. Am I correct in thinking this? At the moment you have shown that some elements of western culture do not combien well with certian elements of traditional chinese/indian (and the various other copuntries around that area) but you went much further than that in your stament. Do you see now why I have problem with it?

I get the impression you are following me around mining for POV. It may just be a coincidence. If you are searching for a way to be helpful, perhaps you would like to write the article on acupuncture point or put in some time at Wikipedia:Pages needing attention or cleanup. heidimo 20:59, 6 May 2004 (UTC)

I'm keeping an eye on the CAM project because that is an area that interests me. Asside from that I'm trying to put together articles on all of the canals of England. I do my best to keep track of what is going on elsewhere but a lot of these are in areas I have little knowlage of.

Most adverse events caused by medical acupuncturists

What is the evidence for this statement? A recent paper by White et al., Adverse events following acupuncture: prospective survey of 32000 consultations with doctors and physiotherapists. BMJ 2001;323:485-6., showed a low incidence of adverse effects, none serious. I think statements of this kind should be excluded unless adequately referenced. User:Acampbell70

Well, I'll admit I was a bit surprised to see a reference to pneumothorax resulting from an acupuncture treatment! That would not be an easy thing to do... Fire Star 20:42, 10 May 2004 (UTC)

I removed the statement and will only replace it if I find the documentation. Fire Star, please see the main acupuncture article for a discussion of hazards. These were emphasized repeatedly while I was in TCM acupuncture school. Rare, yes; unheard-of, no. A couple of years ago an MD practicing medical acupuncture put a patient in the hospital by puncturing their kidney, here in the town where I live. Embarassing for us all. heidimo 23:54, 10 May 2004 (UTC)

Remarkable. I don't doubt what you say, but I wasn't expecting pneunothorax as a possible complication of acupuncture! I worked in the OR of a major urban trauma center in the middle of a drug war for 17 years, so I know a little bit about sucking chest wounds, and I guess I just didn't think that acupuncture needles had enough diameter. My thought was; bullets, yes, needles, no. But, every possibility has to be considered. That shows you how much I know about acupuncture! It is good that you guys are prepared for all of that. Cheers, Fire Star 03:53, 11 May 2004 (UTC)

I have been prepared to never, ever do that and if I somehow do, I'm prepared to call 911! Send them to that OR. I bet very few OR's have ever seen an acupuncture injury, unless it was a do-it-yourself job. (Kids, do not try this at home. Seek professional help!)  ;) heidimo 04:11, 11 May 2004 (UTC)

Almost every organ in the body has probably been damaged by acupuncture at some time and pneumothorax is the commonest serious injury. Needling anywhere round the chest wall, including the commonly used GB21, can do this. An acupuncture needle is certainly capable of inducing pneumothorax and this may not be apparent clinically or on x ray for up to 24 hours.

Another important and potentially lethal site is over the sternum (CV17). About 5-8 per cent of the population have a defect at this site (foramen sternale) which can allow a needle to penetrate the heart. This results in blood leaking into the pericardial sac and causing cardiac tamponade due to the pressure becoming equal inside and outside the heart in diastole. Some 8 to 10 cases of this have been reported in the last few years and at least 2 were fatal.

Another potentially dangerous site that is commonly used is LI4 in the hand. In the last few years 2 patients in Germany suffered damage to the radial artery at this point which resulted in amputation of the hand.

To put all this in perspective, the risks of acupuncture, if performed by someone with adequate anatomical knowledge, are probably less than those of giving the commonly used non-steroidal antiinflammatory drugs (some of which are available over the counter). Acupuncture is generally pretty safe if done properly. Nevertheless it has to be realized that the insertion of needles into the body can never be risk-free and in some cases it can even be fatal. Acampbell70

The current issue of Acupuncture Today just arrived in my mailbox. It has an article on "Preventing Pneumothorax." heidimo 16:05, 13 May 2004 (UTC)

Section entitled "Mechanism"

I removed the following non-encyclopedic comments form this section: "Add in about 'Living Matrix', bioelectromagnetism, reductionist paradigm not the whole story, etc, here." Edwardian 22:53, 22 September 2005 (UTC)

I removed the following lines: "Quantum science is beginning to reveal many of the complex mechanisms of the human body that have been beyond the understanding of previous Newtonian western scientific theories, and seem to point towards a future merging of western and traditional oriental medical understanding." No matter, who said that, as a physicist I can say, that quantum theory by itself has nothing to say about the macroscopic functions of the human body. People usually use this fancy word to give the impression they are talking about something, that other people cannot understand. The only thing quantum theory can tell us about acupuncture might be that you should think more in a holistic than in a reductionist way about the human body. But to express that, fancy words like "quantum theory" are unnecessary. coffeefellow 15:43, 8 December 2006 (GMT+1)

Good catch. The use of the words "quantum bla, bla" in alt med subjects is often a red flag preceding some sort of pseudscientific speculation presented as fact. -- Fyslee 15:13, 8 December 2006 (UTC)

Bias?

This entire article seems rather biased and not really NPOV. However, since I'm not familiar with the subject I'm not confident about fixing it. --Chrysoula 16:41, 31 August 2006 (UTC)

Agreed. The field itself is a sort of POV fork.  :-) -Jim Butler^(talk) 07:47, 2 September 2006 (UTC)

• There's a neutrality disputed tag but the related discussion is not clearly indicated. This section seems to be the appropriate section but the discussion here is too lacking in specifics to support the tag. I will remove the tag unless some specifics are forthcoming. Colonel Warden (talk) 18:42, 27 April 2008 (UTC)

• A review of acupuncture laws (Acupuncture.com) in the U.S. indicates that MDs can perform acupuncture without any training. Therefore, I am concerned that the opening description is not accurate. —Preceding unsigned comment added by CoulterTM (talk • contribs) 21:15, 25 January 2009 (UTC)

NCCAM classification; not a manipulative method

I just removed this from the infobox: NCCAM: Manipulative Methods. NCCAM does not place so-called "medical acupuncture" in any category, though it does include acupuncture per se under Energy Medicine (kind of missing the point that its actual mechanisms don't depend on the ancient Chinese world-view, but c'est la vie), and it includes TCM (and thus acupuncture) Whole Medical Systems.

I also removed Template:Manipulative_and_body-based_methods because acupuncture doesn't fit the definition and I can't find any reliable source saying it does. Acupressure and shiatsu, sure, but not needle insertion. thx, Jim Butler^(talk) 02:58, 14 December 2007 (UTC)

You have stated a series of your own conclusions. Where are the facts? I pointed out your conclusion errors on my talk page, which you have conveniently ignored. Medical acupuncture is intended to be a scientific form of acupuncture that is devoid of the energy mumbo jumbo of TCM. How well it has succeeded is entirely besides the point. -- John Gohde (talk) 16:50, 14 December 2007 (UTC)

Save your flames; all you're doing is violating WP:CIVIL (and WP:ES), which won't do you any good on WP. You request facts, which I've cited above, along with some logic as well. Now your turn to do the same. If acupuncture (of any type, "medical" or otherwise) is seen as a manipulative therapy, then per WP:V, please show a source to that effect. Later. Jim Butler^(talk) 06:18, 15 December 2007 (UTC)

Kindly STOP making personal attacks when you know full well that I wasted lots of time explaining it on my talk page. -- 17:59, 15 December 2007 (UTC)

For the very last time, Medical acupuncture is not accupunture. -- John Gohde (talk) 19:11, 15 December 2007 (UTC)

Pointing out factual errors does NOT constitute a flame. -- John Gohde (talk) 19:17, 15 December 2007 (UTC)

Nobody attacked you, John. Quite the contrary. You were the one who deleted the discussion from your talk page and called my words "nonsense".

I'm just asking that you provide a source saying acupuncture is a manipulative therapy (aka manual therapy). Per WP:V, you must provide such a source if you want the material to stay. Until you provide such a source, I have every right to revert your unsupported edit.

And thanks for reposting the discussion from your talk page below, which again shows that your logic is flawed: chiro's and DO's use manual therapy, but not everything they use is manual therapy, so the fact that they use acu doesn't make acu a manual therapy. That's pretty straightforward. Jim Butler^(talk) 04:26, 16 December 2007 (UTC)

Manipulative Methods discussion from my talk page

Hi John -- I saw you recently put the infobox Template:Manipulative_and_body-based_methods on acupressure and medical acupuncture. Agree re former, but I don't think that insertion of needles meets the defination of manual therapy. I'd suggest limiting the infobox to acupressure (and Japanese non-insertive needle techniques like Toyohari, if/when an article on the latter is created). Your thoughts? (I'll check this page for your reply; no need to respond on my user talk page). regards, Jim Butler^(talk) 20:12, 10 December 2007 (UTC)

Looks like NCCAM classifies acupuncture under TCM, which itself is classified under "Whole Medical Systems", not "Manipulative and Body-Based Practices". Not sure where that leaves so-called "medical acupuncture". But I'd tend to follow NCCAM on Wikipedia. regards, Jim Butler^(talk) 20:18, 10 December 2007 (UTC)

The orange infobox in Medical acupuncture has been in the article since at least 2004. The new template affirms this classification.

A very large number of CAM therapies have been grossly misclassified in Wikipedia, especially in categories. Regarding, Medical acupuncture I can quote the article itself as follows: "Medical acupuncture was created for Western practitioners such as medical doctors, physiotherapists, chiropractors and osteopaths who wish to use acupuncture based practices without the lengthy study of traditional Chinese Medicine theory which is usually required for acupuncturists."

Contrary to the Wikipedia classifications, NCCAM classifies chiropractors and osteopaths as a Manipulative_and_body-based_methods. -- John Gohde (talk) 03:41, 11 December 2007 (UTC)

Hi John, thanks for the reply. WP in fact has chiropractic under Category:Manipulative_therapy, in accordance with NCCAM. As for acupuncture, the fact that DC's and DO's use it doesn't make it a manipulative therapy, any more than the use of nutritional counseling by those professionals would make it a manipulative therapy. We can and should change these things if they're miscategorized. I'll go ahead and do so when I have a chance, and anay specific issues we can discuss on the relevant talk pages. thanks, Jim Butler^(talk) 21:52, 13 December 2007 (UTC)

Jim is an expert acupuncturist and knows these issues well. He's right about the classification. John's classification is not supported by NCCAM (they classify acupuncture as energy medicine), and they don't make a special case for medical acupuncture. This is John Gohde's original insertion of "medical acupuncture," which I have removed from that category. NCCAM lists acupuncuture under energy medicine. I don't recall that it places medical acupuncture in another category., so John's classification is pure OR.

I do understand the point about a difference between ordinary and medical acupuncture, but lacking a source we can't engage in OR. A similar case can be made for chiropractic. Chiropractic adjustments without vertebral subluxation is like acupuncture without meridians. That's true, but unless we have good sources, we can't use it, and certainly not by using a category and using a reference to NCCAM that doesn't support it in the least. -- Fyslee / talk 19:27, 16 December 2007 (UTC)

The two articles are completely different because one has not been re-directed into the other. The insertion of a needle is an obvious manipulation of soft tissue, which has nothing to do with energy fields in Medical Acupuncture. NCCAM's failure to specifically classify each branch of CAM has nothing to do with anything. No reference is needed at all. Just the commonsense application of logic. IF the two topics were the same, the articles would have been merged years ago. Medical acupuncture is not acupuncture! And just as obviously, what somebody thinks that the NCCAM has said about acupuncture , does not automatically apply to medical acupuncture.

A source is not required because NCCAM is not in the business of classifying every branch of CAM.-- John Gohde (talk) 20:25, 16 December 2007 (UTC)

We're not in the business of classifying every branch either, certainly not unless we have reliable sources, per WP:V. That's the main issue here.

Sidebars: John, the "medical acupuncture" folks do in fact embrace classical Chinese concepts along with the biomedical paradigm. See, e.g., this article by Joseph Helms, the author of the main textbook used in that field:

Medical acupuncture respects our contemporary understanding of neuromuscular anatomy and pain physiology while embracing the classical Chinese perception of a subtle circulation network of a vivifying force called qi.

So, it seems to me that if anything, we could follow NCCAM and put it under "Energy Medicine". There are all kinds of ways it could be categorized. I've also seen acupuncture referred to as a "quasi-surgical technique". But who cares? It doesn't have to be categorized as long as the article is decent. (And personally I would favor merging the article with the main article on acupuncture, but I don't feel that strongly about it. However, based on the Helms quote above and other material, the article does need to be revised to include the field's emphasis on TCM concepts.) regards, Jim Butler^(talk) 23:25, 16 December 2007 (UTC)

Just because there are Quacks out there trying to force their view of classical acupuncture onto scientific medical acupuncture, that is absolutely no reason to ignore the differences between the two treatments in a world class encyclopedia,like Wikipedia. -- John Gohde (talk) 12:07, 17 December 2007 (UTC)

The guy I quoted is the founding president of the American Academy of Medical Acupuncture! Do your homework, please, and quit disrupting the article with your OR. Jim Butler^(talk) 21:24, 18 December 2007 (UTC)

P.S. If you still insist on reverting then I'll start an article RfC, in which case I hope you will respect consensus. I also ask, once again, that you respect WP:V and not edit war, especially when your edits go against policy. --Jim Butler^(talk) 22:19, 18 December 2007 (UTC)

Sources for manipulative and body-based methods classification claim

What is true for acupuncture does not automatically apply to scientific medical acupuncture which is devoid of references to the flow of chi as a rationale for possible mechanicisms of action that result in the reduction of pain, for example.

1. Section 6.1 "Manipulative and body based methods[1]
   • Acupuncture
   • Reflexology
   • Massage
   • Aromatherapy
   • Chiropractic
   • Osteopathy
2. "Commonly, physiotherapists implement western acupuncture using neuro-anatomical principles to select acupuncture points. Points are chosen that are situated in close proximity to the injured body part, with the intention of inducing a strong segmental pain inhibitory effect. In many cases, particularly for acute nociceptive pain, this approach is extremely successful. However, when it fails to produce positive results alternative methods for change or rogression of treatment are limited. Adding more needles, leaving the needles in situ for longer or applying greater intensity of stimulation are some methods sed. ... Many acupuncture points are on or close to major peripheral nerve trunks. By needling these points, acupuncture may influence all tissues supplied by the nerve. As around 70% of acupuncture points lie in muscle tissue (Melzack, Stillwell, & Fox, 1977), the myotomal innervation of muscles should be learned and applied in practice."[2]
3. "The main difference between Eastern and Western acupuncture is the reason for inserting the needles. A traditional Chinese practitioner would place the needle at the Ho-Ku point in order to influence a meridian and the flow of chi. Practitioners of modern Western acupuncture would place the same needle in the same location, but would say that they were doing it to stimulate peripheral branches of the radial nerve in order to motivate the production of endorphins, the natural morphine-like substances produced in the brain that cause humans to feel less pain."[3]
4. "Traditional Chinese acupuncture is based on the idea of 'qi' (vital energy), which is said to travel around the body along specific channels or 'meridians'. Fine needles are used to puncture the skin at certain defined points to restore the balance of ‘qi’. Western Acupuncture uses the same needling technique but is based on affecting nerve impulses and the central nervous system.[4]

Being that the manipulation of engergy fields that do not physically exist is not an option for scientific medical acupuncture the next best choice is clearly manipulative and body-based methods because the insertion of needles into soft-tissue is an obvious manipulation of the human body. -- John Gohde (talk) 04:57, 21 December 2007 (UTC)

The founding president of the American Academy of Medical Acupuncture disagrees with you, and I think his opinion trumps the matter. -- Fyslee / talk 07:01, 21 December 2007 (UTC)

Expert opinion, especially when it is obviously wrong on the face of it, doesn't count in Wikipedia. It is regrettable that far too many acupuncturists are more than willing to call their chi quackery scientific medical acupuncture. A world class encyclopedia like Wikipedia has higher standards.

Energy fields which do not physically exist are not a part of science. Ergo: Calling Medical acupuncture an Engery Therapy is an oxymoron because the entire concept of energy therapy is not remotely compatible with science. -- John Gohde (talk) 18:40, 21 December 2007 (UTC)

Sounds like WP:OR. --Ronz (talk) 19:38, 21 December 2007 (UTC)

(de-indent) Replying to John point by point, as it were:

(1) That looks like a good source ([5]) for categorizing medical acu (and acu in general) as manipulative therapy. Well-done. Unless there is some flaw in the source that I'm overlooking, and if other editors agree, I have no objection to restoring Category:Manipulative therapy on this and related pages. However, please refrain from saying NCCAM calls it manipulative therapy unless you can source that claim. Since NCCAM does in fact call acu an "energy therapy", that is what the article should say. And there is no reason in the world why we can't say both.

(2) That source is fine also. It doesn't moot AAMA. Again, it's simply an additional POV that we include.

(3) Not a reliable source (free-essays.us?).

(4) Good source, and citable, but not grounds to remove AAMA/Helms.

Overall, various viewpoints on this topic documentably exist. Writing the article accordingly is simply NPOV. thanks, Jim Butler^(talk) 03:00, 22 December 2007 (UTC)

OK, I went back to read John's sources 1-4 again, and there is one small problem with them: none of them mention the term "medical acupuncture"! Sure, they are about the use of acupuncture in the West, but to say that "medical acupuncture" = "use of acupuncture in the West" is WP:SYN unless we can source it. Again, as far as I can tell, the main use of the term "medical acupuncture" is by Helms et. al. at the AAMA.

What I would suggest is the following: (1) use Category:Manipulative therapy and Category:Alternative Medicine on all acu-related articles. (2) Think really strongly about how to deal with this article: merge with acupuncture? Rename to a more appropriate, generic name, being careful not to POV fork? (3) Stick close to NCCAM when using infoboxes. John, why on earth did you restore "NCCAM: Manipulative Methods" (diff) yet again, in blatant violation of WP:V? Where is the source for this? Please stop editing contrary to WP policy. Jim Butler^(talk) 02:21, 23 December 2007 (UTC)

This is supposed to be a science article

The quackery about there being no difference between medical acupuncture and TCM acupuncture should be removed from this science article.

I am concerned that a practitioner of traditional acupuncture is trying to duplicate the acupuncture article. The view point expressed in this article needs to be broaden to that of a scientific discipline. -- John Gohde (talk) 18:58, 21 December 2007 (UTC)

John, what is apparent from sources is that so-called "medical acupuncture" (or acupuncture practiced by Western healthcare providers who are not specifically trained in TCM) has many facets, and the AAMA (founded by Helms) represents a significant one, and the AAMA does utilize the traditional Chinese concept of qi. Call it quackery if you want, but the Helms quote above (and which Fyslee considerately added to the article[6]) is about as good as a source gets on WP. And so far it's the only source in the article. Why not just do it the NPOV way, and let the various facets of medical acupuncture be described? I think that's a better approach then the tendentious OR you keep advocating. There is obviously (per excellent sources) more to the field than you have acknowledged. regards, Jim Butler^(talk) 02:44, 22 December 2007 (UTC)

P.S. From the AAMA's web page, you can read their journal articles. It's a mix of East and West. Have a look at the TOC from their most recent issue (PDF file). Jim Butler^(talk) 02:44, 22 December 2007 (UTC)

P.P.S. Agree re Fyslee's removal of the expert-attention tag. He knows what he's talking about in both CAM and scientific terms, and so do I, as you can see from my user page. regards, Jim Butler^(talk) 03:07, 22 December 2007 (UTC)

The article needs the opinion of a genuine practicing physician. You two are the reason that I have requested that a real physician needs to step in. -- John Gohde (talk) 18:57, 22 December 2007 (UTC)

Ok I am going to argue that medical acupuncture and TCM acupuncture are essentially the same thing as there is minimal evidence supporting the efficacy of acupuncture. From the acupuncture article: "A review published by the Scientific Review of Alternative Medicine, however, argued that at the time of writing (2005) the data "are insufficiently reliable to confirm such an effect", that's basically the trend throughout the acupuncture research; insufficient evidence and difficulty making a sufficient placebo which is a large problem as placebo effects for pain have been reliably demonstrated (which most acupuncture studies involve). Medical acupuncture suggests evidence based medicine so I ask you what evidence are they basing their practice on? If there is no evidence there is no medical acupuncture. This is the problem with the article and the reason that the debates are going through the same cycles. I don't see what people think the opinion of a physician will resolve either. How is a physician going to state the conventional medicine principles that medical acupuncture is based on when there aren't any.

Lets examine the two theories for how acupuncture works. 1. Gate theory of pain - proposed 30 years ago and like most theories proposed 30 years ago it was probably a little over simpliifed and I brief search does not reveal many recent studies using the keywords "Gate theory of pain". "Gates" may be an incorrect term but I believe there is evidence for spinal mediated pain inhibition mechanisms. 2. Endogenous opiates - I know a lot more about this theory. The notion that endogenous opiates mediate the experience of pain is strongly supported. fMRI and PET scans have shown that levels of activity increase in certian areas of the brain (thalamus, insula and anterior cortex) that is associated with a decrease in the subjective experience of pain. This response was inhibited by naltroxone (an opiate antagonist) which shows that these are in fact opiates. Problematically for acupuncture, many studies produced this response by administering a placebo.

What do both these theories have in common? They have nothing to do with acupuncture directly. They simply detail the body's pain dampening circuits. The second system, at least, is stimulated by the expectation of reduced pain regardless of whether any actual treatment is administered at not so it would be erroneous to state that acupuncture causes endogenous opiates to be released just because they are released during acupuncture. Similarly I think some studies have demonstrated placebo effects that cannot be accounted for by endogenous opiates and have thus been explained by spinal mediated mechanisms. I think this research concerns more chronic pain and the results are generally less robust but the point remains: both of these circuits could be stimulated by placebos and there is no solid explanation of how acupuncture would stimulate these circutis. It's not really surprising that the mechanism for acupucnture has not been explained when no one is certain acupuncture works at all.

So I think the inclusion of the AAMA statement, "The choice of needle patterns can be based on traditional principles such as encouraging the flow of qi (pronounced chee), a subtle vivifying energy, through classically described acupuncture channels, modern concepts such as recruiting neuroanatomical activities in segmental distributions, or a combination of these two principles." which includes the concept of Qi in this article is valid. In reality, since there is no scientific basis for practicing acupuncture (even if it works it probably does not work better than standard pain or nausea medications) anyone practicing the techniques is likely to go back to the TCM practices or stick needles in randomly. Assuming the gate theory of pain is correct, the most logical place to stick the needle would be the spinal segment associated with the area that is in pain. Of course if the endogenous opiates thoery is correct and the gate theory is not you can stick needles anywhere you like as it makes no difference.

So to close, I reiterate; there is no such thing as a "genuine practicing physician" of medical acupuncture because there is insufficient evidence to support its use. A proper medical doctor should base all their therapies on the scientific evidence. So what is medical acupuncture but a psuedoscientific version of TCM acunpuncture? The scientific validity of a technique is no measured by how medical sounding the explanation for the technique is but how much evidence there is for its use. The statement, "acupuncture works by activating pain gating mechanisms and the statement "acupuncture works by mediating energy flows" are on equal par until evidence can be found for one statement or another (provided energy flows are testable). Right now I see zero scientific references in this article. Find some evidence or expect the article to be littered with references to qi.JamesStewart7 (talk) 01:46, 23 December 2007 (UTC)

Thank for your comments, James. AFAIK, one will find better scientific evidence for the efficacy of acupuncture than for its mechanisms. See the sources discussed at Acupuncture#Scientific_research_into_efficacy, e.g. the Cochrane and Ernst stuff. Evidently those EBM reviewers would disagree with your assertion that "there is insufficient evidence to support its use". Additionally, different doctors may make different judgement calls on whether evidence is sufficient to justify using an intervention. Individualized care is not incompatible with EBM [7]. There is a reasonable ethical argument for using things that can't hurt and may well help.

Additionally, when you discuss and dismiss gate theory and endogenous opioids, and conclude that "there is no such thing as a "genuine practicing physician" of medical acupuncture because there is insufficient evidence to support its use", it seems to me that you are confusing mechanism with efficacy. True, we know little about acupuncture's mechanisms, and to what extent and under what treatment conditions those mechanisms exceed placebo, but that does not moot the EBM findings with regard to efficacy. Just because we don't know a modality's mechanism doesn't mean we can't use it if there is evidence for its safety and efficacy. For example, psychiatrists have been using lithium to treat manic-depressive illness for some time now, but we still don't have a clear idea how it works.

You note parenthetically that "even if it works it probably does not work better than standard pain or nausea medications". That does not support your preceding statement that "there is no scientific basis for practicing acupuncture". There may be situations, e.g. drug allergies or interactions, where a non-drug intervention is desirable.

Overall, though, I do tend to agree that there seems little reason to have a separate articles on "medical acupuncture" and "acupuncture", and am leaning increasingly in favor of merging, or at least reworking, this article. regards, Jim Butler^(talk) 02:51, 23 December 2007 (UTC)

Interesting enough the NIH statement diverges from the AMA statemenn with respect to acupuncture. This is the cochrane collection statement which I believe is relatively reliable "There is insufficient evidence to make any recommendations about acupuncture or dry-needling for acute low-back pain. For chronic low-back pain, results show that acupuncture is more effective for pain relief than no treatment or sham treatment, in measurements taken up to three months" for nausea "Electroacupuncture is effective for first day vomiting after chemotherapy, but trials considering modern antivomiting drugs are needed" for headaches "o)verall, the existing evidence supports the value of acupuncture for the treatment of idiopathic headaches. However, the quality and amount of evidence are not fully convincing".

In summary, according to cochrane, the evidence is not convincing except for chronic low-back pain and maybe nausea. In my opinion though the evidence is not convincing anywhere. Accupuncture is a technique that involves sticking needles into someone's back, which makes it very hard to make appropriate sham treatments and the areas in which reliable effects have been demonstrated are also those where placebo effects are likely to be the strongest eg subjective measurements such as those used for nausea and pain have been shown to be influenced by placebo conditions. "A German study published in the September 2007 issue of the Archives of Internal Medicine found that nearly half of patients treated with acupuncture or a sham treatment felt relief from chronic low back pain over a period of months compared to just nearly a quarter of those receiving a variety of more conventional treatments (drugs, heat, massage, etc.)[53][54] The greater benefit of the real and sham treatments were not significantly different." This study is a great part of the reason I don't think accupuncture is effective. It was also done well after many of these policy statements. The fact that the sham treatment produced a large and very similar effect suggests that if you don't get the blinding right your results are useless. How many trials report success of blinding? To the best of my knowledge few trials in any area report blinding success.

The question is though, where does this lead this article? I covered gate theory and endogenous opiates not because I was confusing mechnanism with efficacy, but because that is what is currently sitting in the article and what needs to be in the article for the article to be more than a blank page but as I pointed out the mechanisms are rather speculative and not directly relevant to accupuncture. Furthermore the differing policy statements and conclusions from different scientists and organisations suggest that the efficacy of accupuncture is still very much up for debate. Since the efficacy of accupuncture is still under debate, I find it highly doubtful that a consensus on how accupuncture should be administered in a conventional medical setting has been reached. In fact I think it is likely that most people administering accupuncture is following the TCM view of the subject because that is what has been tested in the trials. Essentially there is no difference between medical and TCM accupuncture apart from why the administrator thinks it works. Can you really have two seperate articles when both practicioners are doing the same thing but just think differently, even when the medical view of why people think accupuncture works has not been validated?

I guess you could argue that given the various policy statements you can practice EBM and perscribe accupuncture but consider this. There is very strong support for the efficacy of various nausea and pain medications. There is much debate over whether accupuncture works at all. Doctors should really perscribe a well supported treatment over a weakly supported one when there are choices available. I could see why someone would use accupuncture when all the effective drugs cannot be given due to allergies or interactions but does anyone really believe that is the case in the majority of cases where accupuncture is given? Also, lets not forget accupuncture is not risk free either. One final note: all of this is covered on the acupuncture page already so what is this page intended to discuss that is not already written in that article. JamesStewart7 (talk) 07:22, 23 December 2007 (UTC)

Hi James -- agree very much with your statement: "Since the efficacy of accupuncture is still under debate, I find it highly doubtful that a consensus on how accupuncture should be administered in a conventional medical setting has been reached. In fact I think it is likely that most people administering accupuncture is following the TCM view of the subject because that is what has been tested in the trials. Essentially there is no difference between medical and TCM accupuncture apart from why the administrator thinks it works."

I also agree there is no point in getting sidetracked into a debate on efficacy except to the extent that it influences the article. In my view, that issue has been hashed out already at acupuncture, and there is not much to be done here other than prune unverified material. Indeed, all we should do in any article is stick close to V RS's, not make WP:SYN-ish judgement calls about definitions, e.g. how efficacy impacts whether or not to designate the topic as "medical acupuncture". (I'm not saying your thoughts above are uninteresting, only that they are not very relevant to the topic at hand, because the term "medical acupuncture", like "alternative medicine", already exists, whether or not one feels it is oxymoronic or otherwise objectionable.)

Instead, we should go by what sources say about the topic. From what I can tell, the term "medical acupuncture" is specifically coined and popularized by the AAMA. I think the article should confine itself to that and (if they exist) other verified usages of the term, unless we can find a source saying that the term can also refer to the generalized, non-TCM (or at least putatively not-only-TCM, like AAMA) usage of acupuncture in the West. The latter can be covered in a paragraph at acupuncture, imo. thanks, Jim Butler^(talk) 17:08, 23 December 2007 (UTC)

Agreed with all your points. We don't want this article to contain huge amounts of overlap with the accupuncture article or the scientific theories regarding accupuncture, nor do we want unverifiable information. Lets look at the reliable sources then and see how they practice accupuncture

Lets take the British Medical accupuncture society and look at what they offer (their website is probably the most clear). They use accupuncture to treat:

Functional bowel or bladder problems such as IBS or irritable bladder, and even mild forms of urinary incontinence Allergies such as hayfever, perennial allergic rhinitis, and some types of allergic rashes such as urticaria or prickly heat Some other skin problems such as discrete rashes and ulcers, pruritus (itching), and some forms of dermatitis Sinus problems and chronic catarrh Dry mouth and eyes Stopping smoking Menstrual and menopausal symptoms

There is no evidence for the efficacy of accupuncture in many of these areas so you would be hard pressed to say "medical accupuncture" is all evidence based. Note also the terminology they used. "They don't state accupuncture is efficacious in treating..." They state "Some other situations in which acupuncture might be used..."

From what I can see, the practice of accupuncture is virtually identically to the TCM in terms of what conditions are treated with accupuncture and how accupuncture is performed. What does differ, however, is the philosophy, "However, our modern medical knowledge makes it very hard for Western doctors to accept the principles of TCM - which to many Western doctors do not fit with their understanding of how the body works."

They also give a nice desripition of what is meant by medical accpuncture, "Some members of the BMAS are not only trained as orthodox health professionals, but are also trained in TCM. Most members of the BMAS, however, use Western medical acupuncture within their usual professional practice. They often use the descriptive title "medical acupuncturist". It seems from this statement, that medical accupunture is just TCM accupuncture that is practiced by people who happen to also be trained in conventional medicine. Given this, this article should not attempt to discuss differences in the practice of medical and TCM accupuncture (which is all unreferenced anyway) but the differences in philosophy between the practitioners. The article should also clearly state that "medical accupuncture" does not necessarily imply a purely EBM practice (which is evident by the treated condition list) but practitioners may explain the apparent effects of accupuncture through scientific principles (whether correct or not).

The article should probably refer any discussion of whether accupuncture actually works to the main accupuncture page and state things in terms such as "Practitioners of medical accupuncture explain their perceived healing effect of acupuncture through what they believe to be empirically supported scientific principles such as neurohormonal changes. A discussion of the hypotheses to how accupuncture may work, if it is effective, may be found at scientific theories regarding acupuncture." There is a reliable source for this claim (BMAS) and this statement is about as NPOV as I can think of.JamesStewart7 (talk) 03:44, 24 December 2007 (UTC)

Sounds good; to your proposed statement I'd append something like: "Reviews of controlled studies of acupuncture (i.e., research into efficacy as opposed to mechanisms) can be found at Acupuncture#Scientific_research_into_efficacy." Great work; more comments later on this stuff. Merry Christmas! Jim Butler^(talk) 04:46, 25 December 2007 (UTC)